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Glucocorticoid prescribing trends in congenital adrenal hyperplasia, 2017 to 2023
Full text linkObjective
This study investigates the utilization of modern glucocorticoid medications (Acecort®, Alkindi®, Efmody®, Plenadren®) for congenital adrenal hyperplasia due to 21-hydroxylase deficiency, examining prescribing patterns, barriers to adoption, and geographical and temporal trends.
Methods
A two-part study was conducted: a retrospective analysis of treatment regimens from the International Congenital Adrenal Hyperplasia Registry across 46 centres in 20 countries (2017-2023), and a qualitative survey of 39 centres regarding barriers to prescribing modern medications. Patients included both paediatric and adult populations. Data analysed included regional prescription trends, timing of modern glucocorticoid adoption, and identified barriers.
Results
From 2017-2023, 44 of 790 (5%) patients transitioned from traditional to modern glucocorticoid therapy, with the highest adoption in high-income Western European countries. Alkindi® was exclusively prescribed to patients under 8 years, while 97% of Efmody® users were 7 years or older. By 2023, modern glucocorticoid availability varied among centres: Alkindi® (54%), Efmody® (46%), Plenadren® (33%), and Acecort® (15%).
Conclusion
Adoption of modern glucocorticoid medications for congenital adrenal hyperplasia remains limited, with only approximately 5% of patients transitioning from traditional therapies. Significant barriers include legislative approval, supply chain challenges, and elevated costs
From footprints to forecast: Baropodometry for fall risk identification and mobility classification among pilgrims
Full text linkBackground/Objectives: Hajj is a major annual mass gathering. It requires prolonged walking under conditions of fatigue, heat stress, and crowd density, which increases mobility difficulties and fall risk, particularly among older adults and individuals with chronic diseases. Therefore, rapid operational mobility screening is required to identify risk and plan mobility. To support an operational mobility-classification workflow in a pre-Hajj setting, this study evaluated whether Timed Up and Go (TUG)-based stratification, combined with spatiotemporal gait and plantar pressure measurements, differentiates fall-risk categories. Methods: We conducted a cross-sectional study at a seasonal medical center near Al-Haram in Madinah Al-Munawwarah (21 May–3 June 2025) within the “I Lean On It” screening initiative. Participants completed the TUG and dynamic baropodometric gait assessments. We stratified the risk of falling as low (≤10 s), moderate (10.1–13.5 s), and high (>13.5 s) according to the TUG performance. We performed between-group comparisons using the Kruskal–Wallis test and evaluated the associations using Spearman’s correlation analysis. Results: Participants were classified as having low (n = 103), moderate (n = 24), or high (n = 29) fall risk. TUG performance significantly increased across the fall-risk groups. Significant between-group differences were observed in cadence, half-step length, walking speed, test duration, and functional mobility, whereas plantar pressure magnitude and gait symmetry did not differ significantly. Spearman correlation analysis showed significant negative correlations between TUG time and sex (rs = −0.357), half-step length (rs = −0.617), walking speed (rs = −0.577), and cadence (rs = −0.420). Significant positive correlations were observed with weight-bearing time (right: rs = 0.584; left: rs = 0.461), test duration (rs = 0.376), and number of steps acquired (rs = 0.356) (all p ≤ 0.003). Overall, TUG performance was primarily associated with dynamic gait and functional mobility. Conclusions: Integrated functional mobility and spatiotemporal gait screening significantly differentiate fall risk and provide clinically actionable mobility-support guidance in a mass-gathering pre-Hajj clinical workflow
Hybrid Pickering emulsifiers (HYPIEs) via synergistic water/oil interfacial interactions: enhanced properties and applications
Full text linkEmulsions stabilized by surface-active solid particles, known as Pickering emulsions, offer advantages over conventional emulsions, including enhanced stability, biocompatibility, and the potential recyclability of particles. These attributes underpin their growing use in cosmetics, food, catalysis, enhanced oil recovery, and pharmaceuticals. However, single-particle emulsifiers often lack the versatility required to precisely control emulsion formation, stability, and morphology. To address these limitations, hybrid Pickering emulsifiers (HYPIEs), which combine solid particles with secondary emulsifiers, have emerged as a powerful alternative. By improving interfacial wettability and adsorption, HYPIEs exhibit superior performance compared with their individual components and enable the co-adsorption of species with antagonistic properties, facilitating the design of smart emulsifying systems. This review categorizes HYPIEs based on synergistic combinations, including particle-particle (i.e. ‘hard’-‘hard’, ‘hard’-‘soft’, ‘soft’-‘soft’), particle-(bio)surfactant and particle-(bio)polymer systems. We elucidate the mechanisms underlying their enhanced interfacial behavior and highlight the diverse interfacial architectures that can be achieved. Finally, we discuss emerging applications of HYPIEs in shaping oil–water interfaces for catalysis, biomedicine, cosmetics, personal care, and food products, and outline current challenges and future perspectives, including strategies for tailoring synergistic functionalities and computational approaches for in silico HYPIE design
Defining moderate disease and progression in hidradenitis suppurativa: an expert framework to unlock the window of opportunity for prompt treatment
Full text linkThe concept of a therapeutic window of opportunity, defined as the period from symptom onset during which treatment initiation yields the most favorable patient outcomes, is applied in routine clinical practice across a range of inflammatory conditions. It has become an increasingly important area of interest in hidradenitis suppurativa (HS), a disease in which recurrent inflammation and accumulating damage can lead to irreversible destruction of skin architecture. Biologic therapies, aiming to suppress the inflammatory burden and prevent disease progression, are currently only permitted in moderate to severe HS. However, as there is no consensus definition of moderate disease, physicians may face uncertainty about when to consider or switch biologic therapy. To identify the boundaries of the window of opportunity within HS, global HS experts have developed frameworks for defining moderate HS and disease progression. It is proposed that prompt medical treatment should be administered to patients with moderate HS, defined as patients with inadequate control of HS symptoms on conventional therapies, or one inflamed skin tunnel (draining/non-draining), or four or more inflammatory lesions (including inflammatory nodules and abscesses) involving two or more anatomic areas. Furthermore, the proposed definition for disease progression is the development of one or more new tunnel(s) and/or the extension of existing tunnels, or development of one or more persistent HS lesions in an anatomical region not previously affected, or any increase in the number of persistent HS lesions in an affected anatomical region. The proposed frameworks aim to provide practical advice to physicians and support targeting the window of opportunity during routine clinical practice
Characteristics of women, intrapartum interventions, and maternal and neonatal outcomes among users of intrapartum water immersion: The UK POOL Cohort Study
Full text linkBackground: The POOL study explored intrapartum water immersion and associated maternal and neonatal outcomes at 26 UK sites 2015–2022. Methods: Retrospective and prospective data captured in electronic maternity and neonatal UK National Health Service (NHS) information systems. Analysis—(a) proportions of women using and factors associated with water immersion during labour or birth; (b) outcomes among “low‐risk” women who used water immersion during labour or birth; (c) management and outcomes of the third stage of labour following waterbirth. Results: Among 869,744 included births, 10% (n = 87,040) used water immersion during labour or birth and 4.6% (n = 39,627) gave birth in water, with rates falling over time. Being of white or multi‐ethnicity, fluent in English, non‐smokers or ex‐smokers, from more affluent areas, and nulliparous were associated with higher rates of water use. Overall, 39.6% of nulliparous and 9.9% of parous women at low risk at labour onset, and who used water immersion during labour, received obstetric or anesthetic care during the intrapartum period. Physiological third stage management was used following 27.1% (n = 10,737) of waterbirths and following 8.6% (n = 2260) of waterbirths the placenta was delivered into water. The rate of recorded blood loss ≥ 1000 mL was not significantly different when the placenta was delivered in water compared to placental delivery out of water. Conclusion: This large UK study of water immersion during labour and birth provides important information for policymakers, maternity health professionals, and for women and families considering the option of intrapartum water immersion. Care providers need to ensure equal access to intrapartum water immersion across demographic groups and provide women with evidence‐based rates of obstetric interventions that take into account their risk status and birth choices. Trial Registration: ISRCTN1331558
Individual and conjunctive operation of tidal lagoons along the west coast of the UK
Full text linkThe conjunctive operation of multiple Tidal Range Schemes (TRSs) along a coastline, particularly where tidal phasing is appreciable, may partially offset the power output intermittency when TRSs are considered in isolation. This study investigates the individual and conjunctive operations of three prospective tidal range schemes: North Wales Tidal Lagoon (NWTL), West Somerset Lagoon (WSL) and Swansea Bay Lagoon (SBL). Each lagoon was assessed individually and then conjunctively to explore their potential interaction on the hydrodynamic impact and power output. Under individual operation, the tidal velocity magnitude across the NWTL impoundment typically increased by 0.1–0.5 m/s, in contrast to the decreased maximum current velocity observed within the WSL and SBL basins. The analysis of open boundary placement in lagoon modelling underscores the importance of employing a sufficiently large model domain for accurate simulation of TRSs. In the conjunctive operation of WSL and NWTL, as well as WSL and SBL, interactions between the lagoons were found to be minor. However, the duration with no power generation for lagoons running independently was reduced from 2.5 to 3.75 h to less than 1.5 h, demonstrating the feasibility of delivering near-continuous tidal power through the conjunctive operation of WSL and NWTL. This study is the first to explore the hydrodynamic interactions of conjunctive tidal lagoon operations in the UK, demonstrating their mutual impacts and the potential of coordinated operation to reduce intermittency
The Conservative Party and the closed shop: inherent contradictions, non-compliance and the failure of the Industrial Relations Act 1971
Full text linkThe 1970–74 Conservative Government was strongly committed to enacting industrial relations legislation which would simultaneously grant workers the right to belong or not to belong to a trade union, provide for legally enforceable collective agreements and facilitate more stable industrial relations by enhancing the authority of trade unions over their members. The associated 1971 Industrial Relations Act was therefore intended both to enhance the liberty of individual workers by weakening compulsory trade union membership and imbue Britain’s system of industrial relations with greater order and predictability by reducing unofficial or wild-cat strikes by local-level shop stewards. Drawing on the archival record, we argue that ministerial haste resulted in inherent contradictions at the heart of this strategy being overlooked or underestimated: if the closed shop was outlawed, and fewer workers belonged to a trade union, then the authority of union leaders would be correspondingly diminished. Pragmatic and effective policy was sacrificed to Conservative Party ideological predilections as inherent contradictions and legislative inconsistencies ultimately resulted in a major failure
Exploring the potential of ammonia as a fuel: Advances in combustion understanding and large-scale furnace applications
Full text linkFrom an environmental standpoint, carbon-free energy carriers such as ammonia and hydrogen are essential for future energy systems. However, their high-temperature chemical behavior remains insufficiently understood, posing challenges for the development and optimization of advanced combustion technologies. Ammonia, in particular, is globally available and cost-effective, especially for energy-intensive industries. The addition of ammonia or hydrogen to methane significantly reduces the accuracy of existing predictive models. Therefore, validated and detailed data are urgently needed to enable reliable design and performance predictions. This review highlights the compatibility of ammonia with existing combustion infrastructure, facilitating a smoother transition to more sustainable heating methods without the need for entirely new systems. Applications in high-temperature heating processes, such as metal processing, ceramics and glass production, and power generation, are of particular interest
MRI and implant safety at low-field and ultralow-field strengths
No full textDespite its unequivocal value in radiological diagnosis, access to conventional high-field MRI systems remains extremely uneven across the world. Access is particularly limited in underfunded and remote settings, due to the high cost and infrastructure requirements of MRI systems. Low-field MRI offers a range of benefits including affordability, portability, suitability for use in intensive care units and for point-of-care imaging. Different low-field configurations enhance flexibility in various clinical scenarios, including imaging claustrophobic or obese subjects, accommodating different body postures, extremity-focused investigations, and neonatal imaging. Moreover, lower field strengths offer important safety benefits. However, the overarching assumption that lower fields are safe without exception may foster a false sense of security, potentially leading to hazardous situations. On behalf of the International Society for Magnetic Resonance in Medicine, this paper provides a comprehensive review of important safety considerations for low-field MRI, aiming to inform users and stakeholders of both its benefits and limitations, and to empower them toward its safe use. These recommendations are likely to evolve as new evidence becomes available