Tag: pubmed

Equine Vet J. 2025 Oct 4. doi: 10.1111/evj.70108. Online ahead of print.

ABSTRACT

BACKGROUND: The healthcare sector contributes significantly to global greenhouse gas (GHG) emissions, with anaesthetic gases being a notable contributor. Implementing sustainable practices in equine anaesthesia, such as low-flow anaesthesia, offers potential benefits.

OBJECTIVES: To audit oxygen and isoflurane usage in five equine hospitals, their associated GHG emissions, and the impact of anaesthesia training on mitigating these emissions.

STUDY DESIGN: Multi-centre clinical audit.

METHODS: This audit covered two periods: study period one (1 June-30 September 2022) and study period two (1 June-30 September 2023). After period one, an anaesthesia training programme introduced low-flow techniques. Data collected retrospectively included patient signalment, anaesthetic protocol, and 5-min recordings of fresh gas flow (FGF) and vapouriser settings. GHG emissions (in carbon dioxide equivalents) and costs (in £) were calculated. Statistical analysis used a linear mixed-effects model with a significance level of p-value <0.05.

RESULTS: A total of 414 general anaesthetics were audited. Between study period one and two, isoflurane and oxygen usage decreased by 9.6% and 17.9%, respectively, resulting in a 9.6% reduction in GHG emissions (from 14.6 to 13.2 tCO₂e). A linear mixed-effects model identified five significant predictors of GHG emissions per case: study period, oxygen usage, anaesthesia duration, average isoflurane vapouriser setting, and the interaction between oxygen usage and study period. Cases in study period two were associated with lower GHG emissions, producing on average 10.4 kgCO₂e less per case (p = 0.01), while each additional litre of oxygen consumed increased emissions by 0.12 kgCO₂e (p < 0.001).

MAIN LIMITATIONS: Missing data from FGF and/or vapouriser settings and the minimal variability between hospitals could be perceived as limitations.

CONCLUSIONS: This audit demonstrates that practising low-flow anaesthesia can effectively reduce the environmental impact of inhalant anaesthetic agents during equine anaesthesia. Wider adoption could improve sustainability, although further research and broader professional engagement are needed.

PMID:41045252 | DOI:10.1111/evj.70108

ESC Heart Fail. 2025 Oct 4. doi: 10.1002/ehf2.15417. Online ahead of print.

ABSTRACT

AIMS: Despite the potential of alginate hydrogel intramyocardial injections in the treatment of heart failure (HF), minimally invasive implantation techniques remain scarce. This study evaluated the safety and feasibility of percutaneous transcatheter endocardial alginate hydrogel injection (TEAi), facilitated by novel implants and a dedicated catheter-based device, in patients with HF with reduced ejection fraction (HFrEF).

METHODS AND RESULTS: This first-in-human study enrolled HFrEF patients [New York Heart Association (NYHA) Class III-IV and left ventricular ejection fraction (LVEF) ≤35%]. The primary endpoint was the incidence of procedure- or device-related serious adverse events (SADEs) at 30 days. Secondary endpoints included the device success rate, HF hospitalization at 6 months, and change from baseline to 6 months post-procedure in the following parameters: LVEF as assessed by MRI; NYHA functional class; 6 min walk test distance (6MWT); the quality of life assessed by the Kansas City Cardiomyopathy Heart Failure Questionnaire (KCCQ); and serum N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) level. Pre- and post-procedural biomechanical analysis was also evaluated. Ten patients successfully underwent TEAi with no SADEs at 30 days. There was one death and two HF hospitalizations at 6 months. At 6 months, LVEF improved from 17.7% ± 3.8% to 24.9% ± 11.2% (P = 0.021), end-systolic volume decreased from 297.5 ± 67.9 mL to 264.8 ± 101.4 mL (P = 0.029), and KCCQ scores increased from 49.7 ± 3.9 to 79.0 ± 8.07 (P = 0.008). No statistically significant changes were observed in end-diastolic volume, NT-proBNP and 6MWT at six months compared with the baseline. Biomechanical analysis revealed a reduction in peak left ventricular end-diastolic wall stress (6.5 ± 1.1 kPa vs. 5.9 ± 1.3 kPa, P = 0.043).

CONCLUSIONS: TEAi is feasible and safe for the treatment of HFrEF, warranting further randomized, efficacy clinical trials.

PMID:41045241 | DOI:10.1002/ehf2.15417

Waste Manag Res. 2025 Oct 4:734242X251374491. doi: 10.1177/0734242X251374491. Online ahead of print.

ABSTRACT

Of the carbon emissions that the National Health Service (NHS) directly produces, waste and water currently make up about 21%, only second to building energy. This study evaluated current knowledge, perception, attitude and behaviour on sustainable healthcare waste management (SHCWM) practices within selected NHS Trusts in Northwest England post-COVID-19 as part of wider research to develop a resilient assessment tool for SHCWM implementation within NHS Trusts in the United Kingdom. The study utilised a questionnaire survey of hospital staff across three NHS Trusts. A total of 58 respondents from clinical and non-clinical roles were analysed. The results showed lack of periodic training, reflected in generally low levels of knowledge on health/environmental risks of healthcare waste management (HCWM), SHCWM practices and legislation on HCWM in the United Kingdom and deficiencies in segregation practice. Statistical tests showed significant differences in attitude among age groups and roles. Those under the age of 35 demonstrated more positive attitude towards SHCWM, whereas clinical support staff demonstrated more positive attitude towards SHCWM compared to doctors and nurses. While the findings demonstrate a lack of periodic training on SHCWM, there appears to be a generally positive perception and attitude towards SHCWM practices. Where SHCWM initiatives are introduced, the findings suggest that staff would be willing to engage and participate. This paper gives those leading sustainability efforts at NHS Trusts a snapshot of current sentiment towards SHCWM and elevates the need to develop minimum mandatory periodic training to improve staff knowledge and practice on SHCWM as part of efforts towards a net zero future.

PMID:41045201 | DOI:10.1177/0734242X251374491

Angew Chem Int Ed Engl. 2025 Oct 4:e202513744. doi: 10.1002/anie.202513744. Online ahead of print.

ABSTRACT

Tailoring supported bimetals to alloyed or phase-separated structures is of vital importance while this process is blocked by the support interferences during universal impregnation processes. Conventional trial-and-error approaches rooted in chemical intuition often lack efficiency and generality. Here, we present a design strategy guided by the statistical sampling of comparative ease of alloy formation through the metadynamics-based gas-solid nanoreactor approach, which enables the rational and systematic development of bimetallic nanocatalysts (NCs). Using metal oxide-supported PdAu coupling with model CO₂ reduction as a proof-of-concept system, the integrated theoretical and experimental results not only validated the reliability of simulation results but also successfully predicted and realized the alloy formation or phase separation of supported PdAu NCs. The generated PdAu alloys over CeO₂ weaken the metallicity of supported Pd species and thus the catalytic hydrogenation property, but increase moderate basicity, contributing to activated CO₂ hydrogenation to CO via a formate intermediate. However, the phase separation of Pd and Au over TiO₂ support promotes formic acid production efficiency attributed to increasing weak basicity to accelerate CO₂ activation during a bicarbonate pathway. These findings highlight statistical sampling as a general broadly applicable framework for the rational design of advanced bimetallic NCs.

PMID:41045186 | DOI:10.1002/anie.202513744

Bioelectromagnetics. 2025 Oct;46(7):e70025. doi: 10.1002/bem.70025.

ABSTRACT

Compliance testing of wireless devices with absorbed power density (APD) limits requires body models that conservatively reproduce the absorption characteristics of human skin. Previous studies indicate that impedance-matching effects are caused by the stratum corneum (SC) layer. The objective of this study is to develop a single macroscopic dielectric model reproducing absorption of electromagnetic fields by the skin up to 110 GHz. The reflection coefficient of the skin of human volunteers was measured at frequencies of 15 to 43 GHz with open waveguide probes, complementing previous data from 45 to 110 GHz. The measurements were made at various regions of the body. The statistical analysis of the results shows that the reflection coefficient in dB follows normal distribution in regions with thin SC, which permits the development of a conservative skin model. In regions with thick SC, for example, the palms, the reflection coefficient is not normally distributed because the thickness of the SC depends on the mechanical stress the hands are exposed to. The measured data allow the derivation of dispersive two-layer models representing absorption and reflection at the skin surface with known uncertainty. The models can be used to conservatively demonstrate compliance with the APD limits of wireless devices in any of the 5G and 6G bands.

PMID:41045064 | DOI:10.1002/bem.70025

J Child Adolesc Psychiatr Nurs. 2025 Nov;38(4):e70038. doi: 10.1111/jcap.70038.

ABSTRACT

BACKGROUND: Family planning significantly reduces maternal mortality and contributes to achieving the Sustainable Development Goals. However, the unmet need for family planning in Ghana is still relatively high. This study assessed the factors influencing the use of family planning in a resource-limited setting.

METHODS: The study used 384 adults (17-56 years) in the Navrongo central sub-municipality, selected using the multi-stage sampling method. Data was cleaned in Microsoft Excel 365 before being transferred to SPSS version 27 and R for analysis. Composite scores were determined and transformed into percentages. The percentage scores of more than 75% were coded as utilisation or good knowledge of modern family planning, depending on the specific section. The Pearson Chi-square test was performed to examine the relationship between the independent variables on overall utilisation and overall knowledge of family planning. Logistic regression and complementary log-log models were used to model the predictors of the utilisation and knowledge of modern family planning. All p-values ≤ 0.05 were deemed statistically significant.

RESULTS: The overall utilisation of modern family planning was not very high (43.2%). Overall, the respondents showed good knowledge (81.3%) of modern family planning. Married young adults (RR = 2.1, 95% CI: 1.39-3.27, p-value = 0.001) were more likely to utilise modern contraceptives. Male young adults are less likely to utilise family planning (RR = 0.21, 95% CI: 0.12-0.34, p < 0.001) than females. Those aged at least 37 years (RR = 1.72, 95% CI: 1.11-2.71, p-value = 0.017) were more likely to have good knowledge of modern family planning than those aged 17 to 26 years. Compared with those with tertiary education, those below SHS (RR = 2.53, 95% CI: 1.54-4.31, p-value < 0.001) and those with SHS education (RR = 1.79, 95% CI: 1.27-2.55, p-value = 0.001) were more likely to have good knowledge of modern family planning. Those with household income between 500 and 1000 (RR = 5.39, 95% CI: 2.18-17.99, p-value = 0.002) and household income more than 1000 cedis (RR = 5.12, 95% CI: 2.04-17.25, p-value = 0.003) were more likely to have good knowledge of family planning than those with household income below 500 cedis per month.

CONCLUSION: This study revealed a high level of knowledge and relatively low utilization of modern family planning. Family planning interventions must incorporate behaviour change theoretical models to translate high knowledge to effective and sustained uptake of family planning among young adults in resource-limited settings.

PMID:41045063 | DOI:10.1111/jcap.70038

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70130. Online ahead of print.

ABSTRACT

BACKGROUND: The electrocardiogram (ECG) used for gating in cardiac MRI may be compromised by multiple confounders inside the scanner bore.

PURPOSE: To quantify the influence of magnetic field strengths (1.5 T/3 T/7 T), standardized electrode positions, and imaging sequences on ECG signals used for gating.

STUDY TYPE: Prospective.

POPULATION: Sixteen healthy volunteers (eight male; mean age 26.25 ± 7.67 years).

FIELD STRENGTH/SEQUENCE: Balanced steady-state free precession cine (1.5 T/3 T), fast low-angle shot cine (7 T), and 4D flow (1.5 T/3 T/7 T) sequences.

ASSESSMENT: ECG-signals were recorded during breath-hold and non-breath-hold short axis cine (sax-bh and sax-nbh, respectively) and 4D flow scans at 1.5 T/3 T/7 T. All scans were repeated with 4 standardized electrode positionings (pos1-4) at each field strength. Pos1/2 were vendor-recommended positionings for 1.5 T/3 T/7 T scans, respectively, whereas pos3/4 were alternative positionings recommended in previous studies. Similarity between confounded ECG-signals and unconfounded baseline ECG-signals was assessed by QRS-feature correlation. Cine image quality (IQ) was assessed by 3 readers (with 6, 10, and 22 years experience) on a four-point Likert scale.

STATISTICAL TESTS: Linear mixed models with type III tests of fixed effects (overall) and t tests with adjusted degrees of freedom (pairwise subgroup-comparisons) at significance level p < 0.05.

RESULTS: Increasing field strength resulted in significantly decreasing similarity to baseline measurements, with r values (provided with 95% confidence interval) of 1.5 T: 97% (92.6-101.3); 3 T: 91.4% (87.1-95.8); 7 T: 50.4% (46-54.9) and lower IQ: 1.5 T: 2.33 (2.12-2.55); 3 T: 1.96 (1.75-2.17); 7 T: 0.91 (0.7-1.12). Vendor-specified electrode positions pos1: 91.8% (87.2-96.5), pos2: 88.3% (83.7-92.9) showed significantly higher correlation with baseline measurements than alternative positions pos3: 67.5% (62.9-72.1) and pos4: 70.8% (66.2-75.4). The evaluated standardized sequences showed similar amounts of electrocardiogram distortion, with r values of: sax-bh: 77.3% (73-81.7); 4D: 79.3% (75-83.7), p = 0.54; sax-nbh: 82.1% (77.8-86.5), p = 0.31, but the difference between sax-bh and sax-nbh: 4.8% (2.88-6.72) was significant.

DATA CONCLUSION: Increasing field strength leads to significant ECG signal distortions. Vendor-specified positions 1/2 resulted in less distorted ECG signals than alternative positions 3/4 recommended in previous publications.

TECHNICAL EFFICACY: Stage 5.

PMID:41045052 | DOI:10.1002/jmri.70130

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70143. Online ahead of print.

ABSTRACT

BACKGROUND: Disruption of the blood-brain barrier (BBB) is an important mechanism in the pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE), potentially influencing disease progression and cognitive function.

PURPOSE: To investigate voxel-wise BBB permeability differences among NPSLE, non-NPSLE, and healthy controls (HC) using dynamic contrast-enhanced MRI (DCE-MRI), and explore associations with disease activity and cognitive function.

STUDY TYPE: Multicenter, cross-sectional study.

SUBJECTS: 22 NPSLE patients, 24 non-NPSLE patients, and 27 age- and sex-matched HC.

FIELD STRENGTH/SEQUENCE: 3.0 Tesla, GE: 3D T1-FSPGR, DCE-LAVA-Flex sequences; Philips: 3D T1-FFE, eTHRIVE sequences.

ASSESSMENT: Post-processing of DCE-MRI images was conducted to calculate the volume transfer constant (K^trans) and plasma volume fraction (V_p) maps, which were transformed to Montreal Neurological Institute space. Brain regions were defined using the Anatomical Automatic Labeling (AAL) atlas. Group differences among NPSLE, non-NPSLE, and HC were assessed. Mean K^trans/V_p values from suprathreshold clusters were evaluated for associations with the Disease Activity Index (SLEDAI) and Montreal Cognitive Assessment (MoCA) scores. Mean K^trans/V_p from corresponding AAL regions was extracted for further validation of the observed correlations.

STATISTICAL TESTS: Voxel-wise ANOVA with Tukey’s HSD test; Spearman correlation and linear regression. Threshold: Voxel-wise p < 0.001, cluster size > 20; group comparisons p < 0.05.

RESULTS: A significantly elevated K^trans was observed in the right caudate of NPSLE patients compared to non-NPSLE patients, and hippocampal K^trans was significantly higher in NPSLE than both non-NPSLE and HC. Both NPSLE and non-NPSLE patients exhibited widespread significant increases in V_p compared to HC. In the entire SLE cohort, right caudate K^trans was positively associated with SLEDAI (ρ = 0.43, R² = 0.18) and negatively associated with MoCA scores (ρ = -0.35, R² = 0.12) after adjusting for confounding factors.

DATA CONCLUSION: This study provided voxel-level evidence linking regional BBB leakage to both disease activity and cognitive impairment in SLE.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:41045050 | DOI:10.1002/jmri.70143

Early Interv Psychiatry. 2025 Oct;19(10):e70087. doi: 10.1111/eip.70087.

ABSTRACT

AIM: In 2016, the Access and Waiting Time Standard (AWTS) was introduced in England, UK, outlining that people with first-episode psychosis should receive treatment from an early intervention for psychosis (EIP) service within 2 weeks. We examined sociodemographic, pathways to care (PtC), and clinical factors associated with EIP service wait time.

METHOD: We collected de-identified data from a large mental health provider in South London, UK. We included patients referred and accepted to EIP services as inpatient or community contacts between 1 May 2016 and 30 April 2019, providing 3 years of data from the introduction of AWTS. Descriptive statistics and multivariable linear regression were performed.

RESULTS: A total of 1806 patients were identified with a mean age of 30 (SD: 10.7) years, of whom 86.3% (n = 1559) accessed community EIP and 13.7% (n = 247) accessed inpatient EIP; of these, 26.7% were not seen within 2 weeks. Community EIP patients waited longer adj.β = 2.21 days (95% CI: 2.05-2.37) compared with inpatient EIP patients, and being older was associated with longer wait time. Conversely, a shorter wait time was associated with A&E [adj.β = -0.22 days (95% CI: -0.36, -0.10)] and ‘other’ [adj.β = -0.21 days (95% CI: -0.36, -0.03)] PtC characteristics. White non-British and South Asian patients had shorter wait times compared with White British patients; however, this difference diminished after adjusting for PtC and clinical factors.

CONCLUSIONS: Our findings indicate that individual factors, PtC, and mode of contact influence wait time for EIP services. More than a quarter of patients were not seen within 2 weeks, indicating that targeted support in community EIP services is needed to meet clinical guidelines.

PMID:41045048 | DOI:10.1111/eip.70087

Psychiatry Clin Neurosci. 2025 Oct 4. doi: 10.1111/pcn.13906. Online ahead of print.

NO ABSTRACT

PMID:41045043 | DOI:10.1111/pcn.13906