Advancements in supervised deep learning for metal artifact reduction in computed tomography: A systematic review.

BACKGROUND: Metallic artefacts caused by metal implants, are a common problem in computed tomography (CT) imaging, degrading image quality and diagnostic accuracy. With advancements in artificial intelligence, novel deep learning (DL)-based metal artefact reduction (MAR) algorithms are entering clinical practice. OBJECTIVE: This systematic review provides an overview of the performance of the current supervised DL-based MAR algorithms for CT, focusing on three different domains: sinogram, image, and dual domain. METHODS: A literature search was conducted in PubMed, EMBASE, Web of Science, and Scopus. Outcomes were assessed using peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) or any other objective measure comparing MAR performance to uncorrected images. RESULTS: After screening, fourteen studies were selected that compared DL-based MAR-algorithms with uncorrected images. MAR-algorithms were categorised into the three domains. Thirteen MAR-algorithms showed a higher PSNR and SSIM value compared to the uncorrected images and to non-DL MAR-algorithms. One study showed statistically significant better MAR performance on clinical data compared to the uncorrected images and non-DL MAR-algorithms based on Hounsfield unit calculations. CONCLUSION: DL MAR-algorithms show promising results in reducing metal artefacts, but standardised methodologies are needed to evaluate DL-based MAR-algorithms on clinical data to improve comparability between algorithms. CLINICAL RELEVANCE STATEMENT: Recent studies highlight the effectiveness of supervised Deep Learning-based MAR-algorithms in improving CT image quality by reducing metal artefacts in the sinogram, image and dual domain. A systematic review is needed to provide an overview of newly developed algorithms.

Effectiveness of intra-articular analgesia in reducing postoperative pain after minimally invasive sacroiliac joint fusion: a double-blind randomized controlled trial.

During the first postoperative days following minimally invasive sacroiliac joint fusion (MISJF), patients often report serious pain, which contributes to high utilization of painkillers and prevention of early mobilization. This prospective, double-blind randomized controlled trial investigates the effectiveness of intraoperative SIJ infiltration with bupivacaine 0.50% versus placebo (NaCl 0.9%) in 42 patients in reducing postoperative pain after MISJF. The primary outcome was difference in pain between bupivacaine and placebo groups, assessed as fixed factor in a linear mixed model. Secondary outcomes were opioid consumption, patient satisfaction, adverse events, and length of hospital stay. We found that SIJ infiltration with bupivacaine did not affect postoperative pain scores in comparison with placebo, neither as group-effect (p = 0.68), nor dependent on time (group*time: p = 0.87). None of the secondary outcome parameters were affected in the postoperative period in comparison with placebo, including opioid consumption (p = 0.81). To conclude, intra-articular infiltration of the SIJ with bupivacaine at the end of MISJF surgery is not effective in reducing postoperative pain. Hence, we do not recommend routine use of intraoperative SIJ infiltration with analgesia in MISJF.

Memory representations during slow change blindness.

Classic change blindness is the phenomenon where seemingly obvious changes that coincide with visual disruptions (such as blinks or brief blanks) go unnoticed by an attentive observer. Some early work into the causes of classic change blindness suggested that any pre-change stimulus representation is overwritten by a representation of the altered post-change stimulus, preventing change detection. However, recent work revealed that, even when observers do maintain memory representations of both the pre- and post-change stimulus states, they can still miss the change, suggesting that change blindness can also arise from a failure to compare the stored representations. Here, we studied slow change blindness, a related phenomenon that occurs even in the absence of visual disruptions when the change occurs sufficiently slowly, to determine whether it could be explained by conclusions from classic change blindness. Across three different slow change blindness experiments we found that observers who consistently failed to notice the change had access to at least two memory representations of the changing display. One representation was precise but short lived: a detailed representation of the more recent stimulus states, but fragile. The other representation lasted longer but was fairly general: stable but too coarse to differentiate the various stages of the change. These findings suggest that, although multiple representations are formed, the failure to compare hypotheses might not explain slow change blindness; even if a comparison were made, the representations would be too sparse (longer term stores) or too fragile (short-lived stores) for such comparison to inform about the change.

Effect of statins on mitochondrial function and contractile force in human skeletal and cardiac muscle.

OBJECTIVES AND BACKGROUND: The success of statin therapy in reducing cardiovascular morbidity and mortality is contrasted by the skeletal muscle complaints, which often leads to nonadherence. Previous studies have shown that inhibition of mitochondrial function plays a key role in statin intolerance. Recently, it was found that statins may also influence energy metabolism in cardiomyocytes. This study assessed the effects of statin use on cardiac muscle ex vivo from patients using atorvastatin, rosuvastatin, simvastatin or pravastatin and controls. METHODS: Cardiac tissue and skeletal muscle tissue were harvested during open heart surgery after patients provided written informed consent. Patients included were undergoing cardiac surgery and either taking statins (atorvastatin, rosuvastatin, simvastatin or pravastatin) or without statin therapy (controls). Contractile behaviour of cardiac auricles was tested in an ex vivo set-up and cellular respiration of both cardiac and skeletal muscle tissue samples was measured using an Oxygraph-2k. Finally, statin acid and lactone concentrations were quantified in cardiac and skeletal homogenates by LC-MS/MS. RESULTS: Fatty acid oxidation and mitochondrial complex I and II activity were reduced in cardiac muscle, while contractile function remained unaffected. Inhibition of mitochondrial complex III by statins, as previously described, was confirmed in skeletal muscle when compared to control samples, but not observed in cardiac tissue. Statin concentrations determined in skeletal muscle tissue and cardiac muscle tissue were comparable. CONCLUSIONS: Statins reduce skeletal and cardiac muscle cell respiration without significantly affecting cardiac contractility.

Prognostic value of pretreatment radiological MRI variables and dynamic contrast-enhanced MRI on radiotherapy treatment outcome in laryngeal and hypopharyngeal tumors.

Background: This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy. Methods: 320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60median and AUC60p95) were determined in the tumor volume. Results: Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60p95 (<31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.In multivariable analysis, a Cox proportional hazard model showed that a AUC60p95 ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, P<.001). Tumor volume was prognostic for DC (HR=3.42, P<.001) and OS (HR=3.27, P<.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders. Conclusion: Low pretreatment AUC60p95 is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.

Automated Identification of Postoperative Infections to Allow Prediction and Surveillance Based on Electronic Health Record Data: Scoping Review.

BACKGROUND: Postoperative infections remain a crucial challenge in health care, resulting in high morbidity, mortality, and costs. Accurate identification and labeling of patients with postoperative bacterial infections is crucial for developing prediction models, validating biomarkers, and implementing surveillance systems in clinical practice. OBJECTIVE: This scoping review aimed to explore methods for identifying patients with postoperative infections using electronic health record (EHR) data to go beyond the reference standard of manual chart review. METHODS: We performed a systematic search strategy across PubMed, Embase, Web of Science (Core Collection), the Cochrane Library, and Emcare (Ovid), targeting studies addressing the prediction and fully automated surveillance (ie, without manual check) of diverse bacterial infections in the postoperative setting. For prediction modeling studies, we assessed the labeling methods used, categorizing them as either manual or automated. We evaluated the different types of EHR data needed for the surveillance and labeling of postoperative infections, as well as the performance of fully automated surveillance systems compared with manual chart review. RESULTS: We identified 75 different methods and definitions used to identify patients with postoperative infections in studies published between 2003 and 2023. Manual labeling was the predominant method in prediction modeling research, 65% (49/75) of the identified methods use structured data, and 45% (34/75) use free text and clinical notes as one of their data sources. Fully automated surveillance systems should be used with caution because the reported positive predictive values are between 0.31 and 0.76. CONCLUSIONS: There is currently no evidence to support fully automated labeling and identification of patients with infections based solely on structured EHR data. Future research should focus on defining uniform definitions, as well as prioritizing the development of more scalable, automated methods for infection detection using structured EHR data.

Indication of long-range correlations governing city size.

City systems are characterized by the functional organization of cities on a regional or country scale. While there is a relatively good empirical and theoretical understanding of city size distributions, insights about their spatial organization remain on a conceptual level. Here, we analyze empirically the correlations between the sizes of cities (in terms of area) across long distances. Therefore, we (i) define city clusters, (ii) obtain the neighborhood network from Voronoi cells, and (iii) apply a fluctuation analysis along all shortest paths. We find that most European countries exhibit long-range correlations but in several cases these are anti-correlations. In an analogous way, we study a model inspired by Central Places Theory and find that it leads to positive long-range correlations, unless there is strong additional spatial disorder-contrary to intuition. We conclude that the interactions between cities extend over large distances reaching the country scale. Our findings have policy relevance as urban development or decline can affect cities at a considerable distance.

Association between cognitive functioning and health-related quality of life and its mediation by depressive symptoms in older patients with kidney failure.

BACKGROUND: Impaired cognition, poor health-related quality of life (HRQoL) and depressive symptoms are common in older patients with kidney failure. Understanding what influences HRQoL is important, as older patients regard HRQoL as a health priority. This study examines whether cognitive functioning is associated with HRQoL and whether depressive symptoms mediate this effect in older patients with kidney failure. METHODS: Outpatients aged ≥ 65 years from 35 Dutch and Belgian hospitals with eGFR 20-10 mL/min/1.73 m2 were included from the ongoing DIALOGICA study. Cognitive functioning was assessed using the Montreal Cognitive Assessment. Depressive symptoms were screened with 2 Whooley Questions and thereafter assessed with the 15-item Geriatric Depression Scale. HRQoL was assessed using the 12-item Short-Form Health Survey. To assess whether cognitive functioning is associated with HRQoL, cross-sectional multivariable linear regression analyses were performed. Subsequent mediation analyses were performed with PROCESS using the product method. RESULTS: In total, 403 patients were included, with a mean age of 76.5 years (SD 5.8) and estimated glomerular filtration rate (eGFR) of 14.5 mL/min/1.73 m2 (SD 3.0). Cognitive functioning was associated with mental HRQoL (adjusted ß 0.30, 95% CI 0.05;0.55) but not physical HRQoL (adjusted ß 0.18, 95% CI -0.09;0.44). This effect is mediated by depressive symptoms (adjusted ß 0.14, 95% CI 0.04;0.25). CONCLUSION: Lower cognitive functioning was negatively associated with mental HRQoL, which was mediated by depressive symptoms in older patients with kidney failure. Future research should explore whether cognitive interventions and treatment of depression improve HRQoL in this vulnerable patient population.

Renal sinus adipose tissue: exploratory study of metabolic features and transcriptome compared with omental and subcutaneous adipose tissue.

OBJECTIVE: The objective was to study metabolic characteristics and transcriptome of renal sinus adipose tissue (RSAT) located around renal arteries and veins. METHODS: Adipose tissue biopsies from RSAT, omental (OAT), and subcutaneous (SAT) depots were obtained from healthy kidney donors (20 female, 20 male). Adipocyte glucose uptake rate and cell size were measured, and gene expression analyses using transcriptomics were performed. RESULTS: RSAT adipocytes were significantly smaller, with a higher basal glucose uptake rate, than adipocytes from SAT and OAT. Transcriptomic analyses revealed 29 differentially expressed genes between RSAT and OAT (RSAT: 23 lower, 6 higher) and 1214 differentially expressed genes between RSAT and SAT (RSAT: 859 lower, 355 higher). RSAT demonstrated molecular resemblance to OAT, both exhibiting lower metabolic gene expression and higher expression of immune-related pathways, including IL-17, TNFα, and NF-κB signaling than SAT. Weighted gene coexpression network analysis associated RSAT with immune response and nucleic acid transport processes. Despite its location near the renal hilum, RSAT closely resembled OAT and there was a lack of expression in the classical brown adipose tissue genes. Gene enrichment analyses suggest an inflammatory environment in RSAT compared with SAT and, to some extent, OAT. CONCLUSIONS: The findings suggest specific RSAT functions that could impact renal function and, possibly, the development of renal and cardiometabolic disorders.

Allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer: An observational cohort study.

INTRODUCTION: The Value-Based Health Care (VBHC) model of care provides insights into patient characteristics, outcomes, and costs of care delivery that help clinicians counsel patients. This study compares the allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer in a dedicated VBHC pathway. MATERIALS AND METHODS: Data was collected from patients with primary esophageal cancer without distant metastases, aged 70 years or older, and treated at a Dutch tertiary care hospital between 2015 and 2019. Geriatric assessment (GA) was performed. Outcomes included treatment discontinuation, mortality, quality of life (QoL), and physical functioning over a one-year period. Direct hospital costs were estimated using activity-based costing. RESULTS: In this study, 89 patients were included with mean age 75 years. Of 56 patients completing GA, 19 were classified as frail and 37 as fit. For frail patients, the treatment plan was chemoradiotherapy and surgery (CRT&S) in 68% (13/19) and definitive chemoradiotherapy (dCRT) in 32% (6/19); for fit patients, CRT&S in 84% (31/37) and dCRT in 16% (6/37). Frail patients discontinued chemotherapy more often than fit patients (26% (5/19) vs 11% (4/37), p = 0.03) and reported lower QoL after six months (mean 0.58 [standard deviation (SD) 0.35] vs 0.88 [0.25], p < 0.05). After one year, 11% of frail and 30% of fit patients reported no decline in physical functioning and QoL and survived. Frail and fit patients had comparable mean direct hospital costs (€24 K [SD €13 K] vs €23 K [SD €8 K], p = 0.82). DISCUSSION: The value of curative oncological treatment was lower for frail than for fit patients because of slightly worse outcomes and comparable costs. The utility of the VBHC model of care depends on the availability of sufficient data. Real-world evidence in VBHC can be used to inform treatment decisions and optimization in future patients by sharing results and monitoring performance over time. TRIAL REGISTRATION: The study was retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 (date of registration: 22-10-2019).

Metabolomic Profiling of Adipose Tissue in Type 2 Diabetes: Associations with Obesity and Insulin Resistance.

The global prevalence of Type 2 Diabetes (T2D) poses significant public health challenges due to its associated severe complications. Insulin resistance is central to T2D pathophysiology, particularly affecting adipose tissue function. This cross-sectional observational study investigates metabolic alterations in subcutaneous adipose tissue (SAT) associated with T2D to identify potential therapeutic targets. We conducted a comprehensive metabolomic analysis of SAT from 40 participants (20 T2D, 20 ND-T2D), matched for sex, age, and BMI (Body Mass Index). Metabolite quantification was performed using GC/MS and LC/MS/MS platforms. Correlation analyses were conducted to explore associations between metabolites and clinical parameters. We identified 378 metabolites, including significant elevations in TCA cycle (tricarboxylic acid cycle) intermediates, branched-chain amino acids (BCAAs), and carbohydrates, and a significant reduction in the nucleotide-related metabolites in T2D subjects compared to those without T2D. Obesity exacerbated these alterations, particularly in amino acid metabolism. Adipocyte size negatively correlated with BCAAs, while adipocyte glucose uptake positively correlated with unsaturated fatty acids and glycerophospholipids. Our findings reveal distinct metabolic dysregulation in adipose tissue in T2D, particularly in energy metabolism, suggesting potential therapeutic targets for improving insulin sensitivity and metabolic health. Future studies should validate these findings in larger cohorts and explore underlying mechanisms to develop targeted interventions.

Potential Nutrient Contribution of Community-Based Insects in Children's Food in Northern Ghana.

Background: Micronutrient deficiencies are a major problem among children in northern Ghana. Available local foods and existing plant-based dietary patterns among children are insufficient to meet children's nutrients requirements. Aside enhancing diets with animal source foods, most of which are expensive for rural households, entomophagy, which is culturally accepted, appears to be a great alternative. Objectives: This study aimed to 1) document the types of insects commonly consumed and the reasons for or against entomophagy in the study area, 2) document the reasons for adding or not adding insects to household meals, and 3) determine the nutrient contribution of community-based insects in children's food. Methods: Both qualitative and quantitative research methods were concurrently applied in this exploratory study (N = 392 individuals; 6 focus group discussions) in northern Ghana. Results: Termites, crickets, grasshoppers, and caterpillars were recognized as the most prevalent edible insects in communities. These insects were largely consumed by children but presently only included in household meals by a few households. Individual, sociocultural, sensory characteristics of insects, climate, and economic aspects were cited as grounds for and against entomophagy. Existing community-based children's diets were unable to meet the acceptable recommended nutrient intake (RNI; within a given age and gender group, the RNI is the amount of a nutrient ingested daily that would meet the needs of almost all healthy individuals in that group) level of all nutrients under consideration, especially for zinc, vitamin B-12, folate, and fat. Inclusion of community-based edible insects increased the RNI levels for all 11 micronutrients considered and met children's zinc, vitamin B-12, folate, and fat requirements. Conclusions: Community-based insects demonstrate a great potential for meeting micronutrients needs of children in the research setting. Future research is required to improve households' adoption of community-based insects as part of household meals and to make insects accessible to households.

Dealing with an uncertain future: a survey study on what patients with chronic kidney disease actually want to know.

Background: Prognostic uncertainty is a recurring theme among patients with chronic kidney disease (CKD). We developed a survey to explore whether CKD patients want to know more about their future, and if so, which topics they prioritize. In addition, we explored differences between several subgroups. Methods: A survey was constructed and tested in collaboration with the Dutch Kidney Patients Association. The survey consisted of three parts: (i) demographics, (ii) considerations about the future, and (iii) prognostic information. The survey was distributed among CKD patients (all stages) through patient associations and via healthcare professionals in two Dutch hospitals. Descriptive statistics were used to summarize the results. All results were stratified by population, sex, and age. Results: A total of 163 patients (45 CKD, 26 dialysis, and 92 kidney transplantation) participated in the survey. The mean age was 63.9 (SD 12.0) and 48.5% was male. Most patients think about their future with CKD occasionally (56.4%) or often (35.0%). Nearly half of the patients (49.7%) discuss the future with their nephrologist, some (19.6%) do not but would like to, and 20 (15.3%) prefer not to. Most patients (73.6%) want more prognostic information, regardless of it being positive or negative. Key topics to receive prognostic information about were laboratory values, symptoms, and physical well-being. Dialysis patients prioritized mental over physical well-being. CKD patients without kidney replacement therapy (KRT) indicated thinking about, and discussing their future more regularly than KRT patients. Conclusions: Patients with CKD contemplate their future regularly and express interest in receiving prognostic information on a variety of topics. One in five patients currently do not discuss their future with CKD with their nephrologist, despite wanting to do so. These findings underline the need to tailor prognostic information provision to patients' preferences, advocating more attention to this subject both in research and clinical practice.

Biomarker guided antibiotic stewardship in community acquired pneumonia: A randomized controlled trial.

BACKGROUND: In community-acquired pneumonia (CAP), the role of biomarkers to shorten duration of antibiotic treatment has not been firmly established. We assessed the effectiveness of active feedback of treatment algorithms based on procalcitonin (PCT) and C-reactive protein (CRP), compared to standard care, on the duration of antibiotic treatment in patients hospitalized with community-acquired pneumonia (CAP) in non-ICU wards. METHODS AND FINDINGS: We performed a randomised, open label, parallel group, multi-centre trial in 3 Dutch teaching hospitals. Treatment was guided by a PCT algorithm, CRP algorithm or standard care. Participants were recruited by a member of the study team and randomised at day 2-3 of admission in a 1:1:1 ratio. Treatment was discontinued upon predefined thresholds of biomarkers that were assessed on admission, day 4 and days 5-7 if indicated. The primary outcome was total days on antibiotic treatment until day 30. In total 468 participants were included in this study. The median days on antibiotics (IQR) was 7 (IQR 7-10) in the control group, 4 (IQR 3-7) in the CRP group (rate ratio (RR) of 0.70, 95% CI 0.61-0.82 compared to standard care; p <0.001), and 5.5 (IQR 3-9) in the PCT group (RR of 0.78, 95% CI 0.68-0.89 compared to standard care; p <0.001). New antibiotics within the first 30 days were prescribed to 24, 23 and 35 patients in standard care, CRP and PCT groups, respectively. The hazard ratio for a new prescription in patients in the PCT group compared to standard care 1.63 (CI 0.97-2.75; p = 0.06). No difference in time to clinical stability or length of stay was found. CONCLUSIONS: A strategy of feedback of CRP-guided and PCT-guided treatment algorithms reduced the number of days on antibiotic in the first 30 days after hospital admission in non-ICU wards for CAP. The study was not powered to determine safety of shortening duration of antibiotic treatment. (NCT01964495).

Spatial correlation between in vivo imaging and immunohistochemical biomarkers: A methodological study.

In this study, we present a method that enables voxel-by-voxel comparison of in vivo imaging to immunohistochemistry (IHC) biomarkers. As a proof of concept, we investigated the spatial correlation between dynamic contrast enhanced (DCE-)CT parameters and IHC biomarkers Ki-67 (proliferation), HIF-1α (hypoxia), and CD45 (immune cells). 54 whole-mount tumor slices of 15 laryngeal and hypopharyngeal carcinomas were immunohistochemically stained and digitized. Heatmaps of biomarker positivity were created and registered to DCE-CT parameter maps. The adiabatic approximation to the tissue homogeneity model was used to fit the following DCE parameters: Ktrans (transfer constant), Ve (extravascular and extracellular space), and Vi (intravascular space). Both IHC and DCE maps were downsampled to 4 × 4 × 3 mm[3] voxels. The mean values per tumor were used to calculate the between-subject correlations between parameters. For the within-subject (spatial) correlation, values of all voxels within a tumor were compared using the repeated measures correlation (rrm). No between-subject correlations were found between IHC biomarkers and DCE parameters, whereas we found multiple significant within-subject correlations: Ve and Ki-67 (rrm = -0.17, P < .001), Ve and HIF-1α (rrm = -0.12, P < .001), Ktrans and CD45 (rrm = 0.13, P < .001), Vi and CD45 (rrm = 0.16, P < .001), and Vi and Ki-67 (rrm = 0.08, P = .003). The strongest correlation was found between IHC biomarkers Ki-67 and HIF-1α (rrm = 0.35, P < .001). This study shows the technical feasibility of determining the 3 dimensional spatial correlation between histopathological biomarker heatmaps and in vivo imaging. It also shows that between-subject correlations do not reflect within-subject correlations of parameters.

Generation of human induced pluripotent stem cell (hiPSC) lines derived from three patients carrying the pathogenic CRYAB (A527G) mutation and one non-carrier family member.

A newly identified pathogenic variant (A527G) in alpha B-crystallin (αB-crystallin) has been linked to congenital cataract and young-onset dilated cardiomyopathy (DCM) within a Dutch family, although the disease mechanism remains unclear. Four human induced pluripotent stem cell (hiPSC) clones were generated from three symptomatic patients carrying the A527G variant, and one healthy proband. Peripheral blood mononuclear cells (PBMCs) were reprogrammed using integration-free Sendai viral pluripotency vectors. The established hiPSCs clones exhibited regular ESC-like morphology, expression of pluripotency markers, and normal karyotyping. These hiPSC lines can facilitate future studies to understand the chaperone function and its role in DCM disease progression.

The Development and Characteristics of Planetary Health in Medical Education: A Scoping Review.

PURPOSE: Climate change, biodiversity loss, and other ecological crises threaten human health globally. The interrelation between human health and ecosystems is addressed in the emerging field of planetary health. Ecological crises have created an urgency to integrate planetary health, including sustainable health care, into medical education. To facilitate integration and guide future research, this review aims to provide an overview of the existing literature about planetary health in medical education. METHOD: The authors conducted a scoping review using the conventional methodological framework for scoping studies. They performed a comprehensive search in 7 databases without language restrictions in March 2022. Two researchers independently extracted data. The team analyzed the data using data-driven thematic analysis, content analysis, and qualitative summarizing. Data were structured according to the Curriculum Development for Medical Education: A Six-Step Approach. RESULTS: The authors identified 3,703 unique publications, of which 127 were included. Articles predominantly (71%, n = 90) covered the call to integrate planetary health in medical education (step 1: general needs assessment). Many publications (24%, n = 31) proposed learning objectives (step 3); these mainly concerned raising awareness while few concerned action perspectives. Publications limitedly reported on the final steps of curriculum development. Only 2 covered a full cycle of curriculum development. Most were published recently, with first authors mainly from Europe and North America. CONCLUSIONS: Planetary health in medical education is an urgent and hot topic. Literature focused predominantly on why planetary health should be integrated in medical education and what should be covered. The authors recommend future research and education development to shift to how to do so, especially in evaluation and feedback. Research and education development needs to be conducted and reported on systematically and underpinned by educational principles. Lastly, it would benefit from perspectives beyond 'Western-based' ones.

Mind-body practices for people living with dementia and their family carers: a systematic review.

INTRODUCTION: People with dementia and their family carers may benefit from non-pharmacological interventions, including mind-body (MB-) practices, which can improve physical and mental health by inducing relaxation. This systematic review provides an overview of availability and effects of MB-practices. CONTENT: The authors performed a systematic search in PubMed, Embase, Emcare, Web of Science, Cochrane Library, PsycINFO, China National Knowledge Infrastructure and Academic Search Premier on February 1, 2024. Research papers on MB-practices for people with dementia and/or their family carers in English, Chinese, Japanese, German, French and Dutch were included if a full text was available. Selection of included articles, data extraction and methodological quality assessments were conducted by two researchers. SUMMARY: Of the 130 included studies, 100 (77 %) were of high quality. Traditional Chinese Medicine (TCM) and touch interventions for people with dementia, and meditations for family carers resulted in improvements in respectively cognition and neuropsychiatric symptoms, and mental health. Lack of evidence for other MB-practices is related to small numbers of studies, fragmented use of outcome measures and mixed findings. OUTLOOK: MB-practices showed promising results. We recommend implementation and further research of TCM- and touch interventions for people with dementia as well as meditations for family carers. We suggest a cross-over of the promising results of one group to be studied in the other group.

Inconsistent definitions of prolonged labor in international literature: a scoping review.

Objective: Prolonged labor is the commonest indication for intrapartum cesarean section, but definitions are inconsistent and some common definitions were recently found to overestimate the speed of physiological labor. The objective of this review is to establish an overview of synonyms and definitions used in the literature for prolonged labor, separated into first and second stages, and establish types of definitions used. Data sources: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier. Study eligibility criteria: All articles in English that (1) attempted to define prolonged labor, (2) included a definition of prolonged labor, or (3) included any synonym for prolonged labor, were included. Methods: Data on study design, year of publication, country or region of origin, synonyms used, definition of prolonged first and/or second stage, and origin of provided definition (if not primarily established by the study) were collected into a database. Results: In total, 3402 abstracts and 536 full-text papers were screened, and 232 papers were included. Our search established 53 synonyms for prolonged labor. Forty-three studies defined prolonged labor and 189 studies adopted a definition of prolonged labor. Definitions for prolonged first stage of labor were categorized into: time-based (n=14), progress-based (n=12), clinician-based (n=5), or outcome-based (n=4). For the 33 studies defining prolonged second stage, the majority of definitions (n=25) were time-based, either based on total duration or duration of no descent of the presenting part. Conclusions: Despite efforts to arrive at uniform labor curves, there is still little uniformity in definitions of prolonged labor. Consensus on which definition to use is called for, in order to safely and respectfully allow physiological labor progress, ensure timely management, and assess and compare incidence of prolonged labor between settings.