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Carbon dioxide (CO2) laser therapy is widely used in the endoscopic treatment of benign tracheal stenosis (BTS). However, the comparative effectiveness of its 2 principal techniques-CO2 laser wedge resection and radial incision with dilation-remains uncertain. This study aims to compare the recurrence rates of BTS following CO2 laser wedge resection versus radial incision with dilation. We conducted a systematic review using MEDLINE (Ovid), Embase, Web of Science, and Cochrane Central through March 28, 2025. Three independent reviewers (C.Z., N.K., and A.H.) performed study screening, risk of bias assessment, and data extraction. A random-effect model was applied for meta-analysis. The primary outcome was to compare recurrence rates between wedge resection and radial incision. Twelve trials, including 685 patients met inclusion criteria. CO2 laser wedge resection was associated with a lower recurrence rate (43.2%) compared with those treated with radial incision with dilation (66.1%), approaching statistical significance (χ²=3.75, P=0.053). At follow-up beyond 3 years, this difference became significant (55.8% vs. 81.0%, χ²=9.46, P=0.002). Wedge resection also showed longer time to first recurrence. Reported complication rates were low across both techniques. CO2 laser wedge resection may be superior to radial incision with dilation in reducing recurrence of BTS, particularly over long-term follow-up. Personalized treatment strategies considering procedural variables and patient-specific factors are warranted to optimize outcomes.

Early and accurate identification of clinical warning signs in young infants may help avert sepsis morbidity and mortality in resource-limited settings. To systematically review evidence on the association and accuracy of clinical signs to diagnose sepsis or predict mortality in young infants aged 0 to 59 days to inform management in settings with limited laboratory diagnostics. MEDLINE, Embase, CINAHL, Global Index Medicus, and Cochrane CENTRAL Register were searched from inception through May 2023, with updated searches on September 5, 2024. An umbrella search of systematic reviews was conducted in January 2024. Included studies reported data on 24 infant clinical signs informed by current World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and hospital-based algorithms for the care of sick young infants reporting odds ratios (OR), risk ratios, or sensitivity and specificity. Data were extracted independently by 2 reviewers. Quality assessment used the Newcastle-Ottawa, Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), and Quality Assessment of Prognostic Accuracy Studies (QUAPAS) scales. OR data were pooled using random-effects models. Data analysis was performed from July to September 2025. OR of all-cause mortality, culture-confirmed sepsis, or clinical sepsis (with access to laboratory investigations). Of 7641 studies, 52 studies with 140 885 participants were included. A total of 16 clinical signs were significantly associated with mortality, 11 with culture-confirmed sepsis, and 13 with clinical sepsis. For mortality, the 5 strongest associations were weak, abnormal, or absent cry (OR, 20.48; 95% CI, 6.59-63.67); not able to feed at all (OR, 18.32; 95% CI, 6.00-55.97); not feeding well (OR, 13.39; 95% CI, 6.97-25.72); drowsiness or unconsciousness (OR, 12.46; 95% CI, 6.06-25.62); and prolonged capillary refill (OR, 12.06; 95% CI, 2.77-52.53). The top 5 signs associated with culture-confirmed sepsis were not feeding well (OR, 4.52; 95% CI, 1.10-18.59); prolonged capillary refill (OR, 3.59; 95% CI, 2.05-6.28); lethargy (OR, 3.44; 95% CI, 1.89-6.26); drowsiness or unconsciousness (OR, 3.07; 95% CI, 2.01-4.68); and feeding intolerance (OR, 2.95; 95% CI, 1.67-5.21). All current WHO IMCI clinical signs were significantly associated with mortality or culture-confirmed sepsis. Several signs not in IMCI were identified that may improve identification of life-threatening illness in young infants in resource-limited settings where clinical sign algorithms are the primary diagnostic tool.

The increasing frequency and severity of natural disasters, exacerbated by climate change, have significant implications for medicine, particularly in the realm of plastic and reconstructive surgery. Current research indicates that limb injuries, soft tissue trauma, and burns are among the most common injuries sustained during natural disasters. The immediate need for surgical interventions, such as wound closures, skin grafts, amputations, and limb salvage techniques, underscores the vital role of plastic and reconstructive surgery in disaster response. We conducted a comprehensive literature search across PubMed, Embase, Global Health, and Web of Science Core Collection on March 4, 2025. All English-language original research studies that described climate-related natural disasters, extreme weather, or pollution requiring plastic and reconstructive surgery intervention were screened and included in this review. A total of 35 studies met our criteria for final analysis. A larger number of studies were published in recent years, with the majority of studies from high-income countries (n=26, 74.3%). Hand and lower extremity surgeries were the most common after a weather event (n=22, 62.9%), followed by general (n=11, 31.4%), burn (n=8, 22.9%), craniofacial (n=4, 11.4%), and breast reconstruction (n=3, 8.6%). This scoping review highlights the growing relevance of climate-related events to the field, underscoring the need for improved emergency preparedness among plastic surgeons. As weather events continue to worsen, further research is essential to quantify their impact and guide future clinical response.

IntroductionMost patients receive behavioural healthcare (BH) in a primary care setting, yet much of the BH research was not developed to account for eventual implementation. Areas of research and intervention that are considered priorities to patients may be absent from our existing knowledge base. Engaging the community in the research process can facilitate translation and uptake. A key strategy for community engagement is to employ a Community Advisory Board (CAB). CABs can assist in a number of research processes, including guiding research questions to fit the priorities of the community and creating research materials that are tailored to the patient population and healthcare setting. There is variability in practices and reporting standards for CABs. The field would benefit from a summary of the state of the current literature on CAB utilisation for BH research in primary care. To fill this gap, we will conduct a scoping review to answer the question, ‘What is known about the use of CABs in behavioural health studies in primary care?’.Methods and analysisWe will use the guidelines for scoping reviews outlined by Arksey and O’Malley: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data and (5) collating, summarising and reporting the results. Our reporting of the results will be guided by the Arnos and colleagues Toolkit for Project-Based Community Advisory Boards, a set of practical guidelines for employing a CAB. To this end, we will report on how well CABs currently employed in BH primary care research match existing guidelines and what gaps need to be filled by future research.Ethics and disseminationThis review does not require ethics board approval, as no patient data will be collected. We will disseminate findings primarily through journal publications and conference presentations.Trial registration numberThis scoping review protocol was registered on the Open Science Framework (https://osf.io/pa3rz/?view_only=31c558eb395a4a9482ee9c5b57ca1c4c)

Goal concordance underpins high-quality care for patients with serious illness and older adults with multimorbidity and geriatric syndromes; however, a criterion standard for measurement is lacking. To identify and describe patient- and caregiver-reported measures of goal concordance for patients with serious illness, geriatric syndromes, and multimorbidity to create a conceptual model of goal-concordance measurement. This scoping review included an electronic search across MEDLINE, Embase, Web of Science Core Collection, the CINAHL, and PsycINFO through September 2024. Search terms included goals, priorities, preferences, value, expectations, concordance, discordance, match, attain, achieve, align, congruence, dissonance, respect, and terms related to multimorbidity, geriatric syndromes, and serious illness. The review included randomized clinical trials and quasiexperimental, observational, cohort, cross-sectional, mixed methods, quality-improvement, and qualitative studies, plus secondary analyses that either included a patient- and/or caregiver-reported measure of goal concordance as an outcome or as part of a measure development or validation study. Two reviewers extracted data and resolved disagreements via discussion. Study and measure characteristics were summarized and cross-tabulated to identify measurement framework patterns and to propose a conceptual model of measurement. Of 4801 articles screened, 664 full-text articles were assessed for eligibility. A total of 63 studies met inclusion criteria, yielding 67 measures; 44 measures were unique. Most studies were secondary data analyses (17 studies [27.0%]) and included patients with serious illness (44 studies [69.8%]). Measures used 7 of 10 available goal concordance frameworks, with most adopting framework 7 (40 measures [59.7%]), which matched patient preference for an outcome with degree of desired outcome achievement. Four framework components were identified and used to create a conceptual model for goal-concordance measurement: (1) patient preference for an outcome or treatment, (2) treatment undergone or treatment intention, (3) degree of treatment alignment with preference, and (4) degree of desired outcome achievement. This scoping review of patient- and caregiver-reported measures of goal concordance for patients with serious illness, geriatric syndromes, and multimorbidity describes existing measurement frameworks and proposes a conceptual model of measurement that can be used to guide future goal-concordance measure development in geriatrics and palliative care.

While some interactions between climate change and health have been well documented, the complex relationship between climate change, its proximate causes, and cancer is less clear. This scoping review was conducted to survey specific elements within existing peer-reviewed and grey literature addressing the impacts of climate change-related exposures on 1) cancer risks, 2) outcomes, and 3) care delivery. Following PRISMA guidelines, peer-reviewed and selected grey literature on these topics were identified using pre-specified eligibility criteria. Structured searches by independent reviewers and data extraction from multiple electronic databases were performed, from which syntheses were generated and research gaps identified. Of 542 studies identified by title/abstract for full-text review, 182 studies were eligible for data extraction. Of these, 127 examined fossil fuel-related pollutant levels and excess cancer risks, 29 investigated the impact of climate change on cancer outcomes, and 31 examined the impact of climate change-related events on cancer care delivery. Overall, the effects of climate change-related exposures, or climate change's proximate causes, lead to increases in cancer risk. Climate change effects such as extreme weather events disrupt care and impact survival outcomes. Across these subject areas, climate change-related events' exacerbation of existing healthcare disparities was an emergent theme. Climate change has impacts across the cancer care continuum. Research gaps include limited data on the direct effect of climate change on cancer outcomes and care delivery, population health research, and mitigation efficacy. More work is needed in education, adaptation, and climate preparedness for cancer patients and healthcare systems.

Abstract Objective/BackgroundTransmission-dynamic models are commonly used to study infectious disease epidemiology. Calibration involves identifying model parameter values that align model outputs with observed data or other evidence. Inaccurate calibration and inconsistent reporting produce inference errors and limit reproducibility, compromising confidence in modeled results. No standardized framework exists for reporting on calibration of infectious disease models, and an understanding of current calibration approaches is lacking.MethodsWe developed a 15-item framework for reporting calibration practices and applied it in a scoping review to assess calibration approaches and evaluate reporting comprehensiveness in transmission-dynamic models of tuberculosis, HIV and malaria published between January 1, 2018, and January 16, 2024. We searched relevant databases and websites to identify eligible publications, including peer-reviewed studies where these models were calibrated to empirical data or published estimates.ResultsWe identified 411 eligible studies encompassing 419 models, with 74% (n=309) being compartmental models and 20% (n=82) individual-based models (IBMs). The predominant analytical purpose was to evaluate interventions (71% of models, n=298). Parameters were calibrated mainly because they were unknown or ambiguous (40%, n=168), or because determining their value was relevant to the scientific question beyond being necessary to run the model (20%, n=85). The choice of calibration method was significantly associated with model structure (p-value<0.001) and stochasticity (p-value=0.006), with approximate Bayesian computation more frequently used with IBMs and Markov-Chain Monte Carlo with compartmental models. Regarding reporting comprehensiveness, all 15 framework items in the framework were reported in 4% (n=18) of models; 11-14 items in 66% (n=277), and 10 or fewer items in 28% (n= 124). Implementation code was the least reported, available in only 20% (n=82) of models.ConclusionsReporting on calibration is heterogeneous in recent infectious disease modeling literature. Our proposed framework for reporting of calibration approaches could support improved reproducibility and credibility of modeled analyses.Author SummaryCalibration, the identification of parameter values so that model outcomes are consistent with observed data or other evidence, is often employed in the process of obtaining model results to inform health decision making. Despite its importance, there has not been a standardized framework for reporting how calibration is conducted in infectious disease modeling studies. This has led to inconsistent reporting practices and challenges in reproducing model results, potentially compromising confidence in their validity. We developed a calibration reporting framework, based on best practices found in the literature and informed by our expertise in conducting calibration. To assess calibration practices and their reporting, we applied our framework in a scoping review of 419 infectious disease transmission models of HIV, TB and malaria published between 2018 and 2024. Most models reviewed were compartmental (74%) or individual-based (20%), and the choice of calibration methods was associated with model structure and stochasticity. Calibration was conducted predominantly in the context of models aimed at evaluating the impact of disease control interventions, highlighting the role of calibration in decision making. Parameters were calibrated mainly because they were unknown or ambiguous, or because reporting their value was relevant to the scientific question beyond just being necessary to run the model. The comprehensiveness of calibration reporting varied across models, with most models omitting 1 to 5 items in the framework. Accessible implementation code was the most underreported, with only 20% of models including it. Our proposed framework could serve as a tool to standardize calibration reporting, thereby enhancing the transparency and reproducibility of calibration processes in transmission-dynamic models.

Background: Orthostatic hypertension (OHTN) is common among adults with hypertension (HTN) and associated with cardiovascular disease (CVD). It is unclear whether HTN treatment reduces CVD outcomes similarly in adults with OHTN as adults without OHTN. Methods: We performed an individual-level meta-analysis, updating a previous systematic review of MEDLINE, EMBASE, and CENTRAL databases through November 13, 2023, which included randomized trials of blood pressure (BP) pharmacologic treatment (more intensive BP goal or active agent) on CVD or death. CVD events were adjudicated and included fatal and nonfatal coronary heart disease, stroke, and congestive heart failure. OHTN was defined as a rise in systolic BP ≥20 mmHg and/or diastolic BP ≥10 mmHg after changing positions from sitting to standing. Effects were examined overall and by trial type (BP goal or active agent), using Cox proportional hazard models adjusted for age and sex. Results: Of the 9 trials included, there were 29,235 participants followed for median of 4 years (mean age 69.5±10.9 years; 48.3% female; 21.0% with OHTN at baseline). Baseline OHTN was not associated with a higher risk of CVD or death (HR 1.03; 95% CI: 0.95, 1.13). More intensive BP treatment or active therapy lowered risk of CVD or death among those with OHTN at baseline (HR 0.80; 95% CI: 0.69, 0.93) and without OHTN at baseline (HR 0.81; 95% CI: 0.75, 0.87) with no difference between strata ( P -interaction 0.95) ( Figure ). Conclusion: While baseline OHTN was common among adults with HTN, it was not associated with CVD or death and did not alter the protective effect of more intensive treatment. More intensive treatment is an effective approach to prevent CVD events among adults with OHTN.

El eterno vaivén e incertidumbre… 'The never-ending swaying/oscillation and uncertainty' can be used to describe Puerto Rico's political and historical landscapes and positions within the Américas and the world. This sense of uncertainty and belonging not only impacts Puerto Rican cultural works but is also reflected in the narratives portrayed in those works, including youth literature. Given the current geopolitical and imperialistic relationships