HOPE Clinic

The detection rate of contralateral hilar involvement in NSCLC during EBUS-TBNA staging is not well established. We conducted a retrospective observational single-center study of all EBUS-TBNA staging examinations performed from 2016 through 2020 to determine the incidence of PET and CT negative N3 hilar metastasis by EBUS-TBNA in patients with radiographic T1-T4, N0-N3, M0 NSCLC. A total of 516 patients underwent EBUS-TBNA sampling of contralateral hilar lymph nodes. Metastatic non-small cell lung cancer was detected in one or more contralateral hilar lymph node stations in 5 patients (0.97%). Four of these patients had radiographic N2 or N3 disease on PET imaging. Patients with mediastinal N2/N3 disease by PET scan were at higher risk of having occult contralateral hilar disease as compared with mediastinal N0/N1 by PET (P=0.017). In individuals radiographically staged as mediastinal N3 by CT scan, 14 (95% CI: 3-78) patients would need to undergo EBUS-TBNA sampling of a CT negative contralateral hilar lymph node to identify malignant involvement of the latter. In cases radiographically staged as mediastinal N3 by PET scan, 25 (95% CI: 6-141) patients would need to undergo EBUS-TBNA sampling of a PET-negative contralateral hilar lymph node to identify malignancy involvement in this location. In patients with NSCLC undergoing EBUS staging for radiographic N0/N1 disease by PET, it is reasonable to not sample the contralateral hilar lymph node stations. In radiographic N2/N3 disease by PET or CT, sampling the contralateral hilar lymph node stations appears to be justified.

The fast growth of quick commerce apps has revolutionized the urban retail system of India. This paper will investigate the impact of perceived affordability on the demand of quick commerce services among the generation Z and Millennials in Gujarat. Primary data were collected using a descriptive quantitative research design and a structured questionnaire was used to collect data in 200 respondents in six cities; Gandhinagar, Ahmedabad, Surat, Vadodara, Rajkot and Dahod. Probability sampling was not accepted and analysis of data was done using SPSS. The results indicate that perceived affordability is a significant issue impacting on the purchase frequency and platform choice. Although speed and convenience are motivational to users, more importantly in demand formation are cost-efficiency, delivery fee and promotional offers. Affordability to young consumers is beyond the low prices to the general transaction convenience and to digital experience. Though the adoption is better in large urban centres, Tier 2 cities also have significant growth potential as long as the issue of pricing is well tackled. The research is based on the Consumer Value Theory [10] in placing affordability within a multidimensional construct multidimensional construct of functional, emotional, and conditional value. These conclusions have strategic implications to the operators of the platform who may want to gain competitive advantage based on pricing, special promotions and digitally enhanced customer interaction.

BackgroundSelf-management is essential for coping with depressive symptoms, yet little is known about its associations with depressive symptoms and personal recovery.MethodsWe conducted a cross-sectional questionnaire survey of 183 outpatients with major depressive disorder in Japan between October 2024 and June 2025. Participants reported the use and perceived usefulness of 63 self-management strategies. Associations between the number of strategies and symptom severity and recovery were examined using Spearman’s rank correlation coefficients with the Japanese versions of the Quick Inventory of Depressive Symptomatology (QIDS-J) and the Questionnaire about the Process of Recovery (QPR-J).ResultsOf the 183 respondents (mean age 43.6 ± 12.4 years; 54.1% female), the mean QIDS-J score was 9.55 ± 5.25 and 60.7% were in remission. Fourteen of the 63 strategies were used by at least half of the participants. The most frequently used strategies were “ensure enough rest to avoid exhaustion through overexertion” (88.0%), “engage in leisure activities (e.g. reading, watching TV, cooking, traveling, and driving)” (78.9%), and “eat a healthy diet” (65.0%). The strategies rated most useful included “discuss information about depression with a therapist” (86.7%), “meet with friends with whom I can be myself” (83.5%), and “avoid or minimize contact with people who tend to make me stressed or depressed” (83.3%). Participants reported using an average of 20.8 ± 13.5 strategies, of which 13.1 ± 9.16 were rated as useful. The number of strategies rated as useful was weakly negatively correlated with the QIDS-J scores (Spearman’s ρ = −0.207, p = 0.006) and moderately positively correlated with the QPR-J scores (Spearman’s ρ = 0.472, p < 0.001).ConclusionThe number of self-management strategies rated as useful showed a stronger correlation with personal recovery than with depressive symptom severity. The use of a greater number of self-management strategies may be associated with higher levels of personal recovery.

Introduction People affected by skin-neglected tropical diseases (NTDs) may experience stigma and discrimination due to visible physical impairments, negatively affecting their mental health, wellbeing, and quality of life. To address these challenges, our partnership used a community-based participatory research (CBPR) approach to co-develop, test, and evaluate a community-led intervention that included self-help groups. In this article, we critically evaluate the intervention implementation process, to provide clear implementation considerations when operationalising self-help groups for NTDs, a missing component of the evidence base. Method Photovoice activities with self-help group members and leaders explored the experience of peer-support amongst people affected by skin NTDs. Additional data included reports from self-help group meetings and reflective sessions, in-depth interviews with group members, and key-informant interviews with stakeholders. Data were analysed using framework analysis using NVivo 12. Results Five interrelated elements were identified as central to people-centred community-led self-help groups for people affected by skin NTDs in Kasai, DRC: 1) relevant and actionable needs-based activities; 2) a shared purpose amongst group members; 3) inclusivity and equity in roles, responsibilities, and benefits; 4) committed leadership; and 5) continuous capacity strengthening and support from research and implementing partners. Conclusion This is one of the first studies presenting insights from people affected by skin NTDs on how community-led self-help groups can be operationalised in a people-centred way. The findings highlight key implementation considerations that may inform the design and delivery of self-help group interventions in low-resource settings, potentially supporting sustainability and user-led engagement.

In 2018, Illinois implemented House Bill 40 (HB40) which required Medicaid (means-tested public insurance) coverage of abortion care for Illinois residents. Medicaid coverage of abortion increases financial accessibility, which oftentimes leads to earlier access to care for covered patients. The ability of residents to use Medicaid may have increased the availability of financial assistance for non-residents. However, whether Medicaid coverage is associated with any changes in abortion access among out-of-state patients - who cannot use Medicaid for abortion coverage - is unknown. To explore if Medicaid coverage of abortion is associated with changes in abortion access for out-of-state patients, we analyzed de-identified records of abortion visits among non-Illinois residents presenting for abortion care across 12 Illinois health centers. We used logistic regression to assess if presenting early for an abortion (≤11 weeks gestation) was associated with implementation of HB40 (2017 vs 2018-2019). Although out-of-state residents were more likely to present early if they received abortion care in the post-HB40 period than pre-HB40 (81% at ≤11 weeks in 2018-2019 vs 78% in 2017), multivariable regression shows that HB40 was not associated with early abortion access when controlling for other patient characteristics. Out-of-state patients had higher odds of presenting ≤11 weeks of gestation during the study period if they were a resident of a state bordering Illinois (OR 1.89, 95% CI 1.55-2.30, p < 0.001) or were over the age of 24 (OR 1.50, 95% CI 1.35-1.66; p < 0.001). Given the significant rise in out-of-state patients after the Dobbs decision, future research should explore how large increases in patient volume over time have impacted abortion care in Illinois and other states, and assess how federal and state-level legal or policy changes influence abortion access for out-of-state patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory pathogen that emerged in December 2019 and caused a global pandemic by March 2020, with >7 million deaths due to coronavirus disease 2019 (COVID-19) globally as of September 2025. The clinical syndrome of COVID-19 ranges from asymptomatic infection to severe disease with pneumonia and death. SARS-CoV-2 variant type, inoculum, previous exposure and host factors influence the clinical trajectory. Identification of key structural proteins of SARS-CoV-2 and insights into the pathophysiology of the immune response to infection led to the development of effective preventive (vaccines and monoclonal antibodies) and therapeutic (antivirals and immunomodulatory agents)agents. Antiviral agents, such as remdesivir and nirmatrelvir-ritonavir, inhibit viral replication and immunomodulatory agents, such as tocilizumab and baricitinib, act to reduce a dysregulated immune response to SARS-CoV-2. The pandemic had economic and socio-cultural consequences that affected the quality of life and overall life expectancy of individuals. As the emergency phase of the pandemic concludes, robust monitoring and surveillance systems must be sustained and research to improve vaccines and therapeutics must continue to maintain control of SARS-CoV-2 in the population and be prepared for emerging pathogens with pandemic potential.

We present an evaluation of a strength-based, cognitive-behavioral therapy program provided to individuals with a serious mental illness who had committed a sexual offense. Utilizing an intent-to-treat design, individuals who participated in treatment were compared with a group of untreated men on treatment-relevant measures and recidivism. Individuals who completed treatment demonstrated greater change in perceptions of working alliance and dynamically assessed risk to re-offend compared to noncompleters. During the 18-month fixed follow-up period, 3.7% re-offended sexually, 20.4% re-offended violently, and 39.8% re-offended generally. After controlling for baseline risk, participation in treatment was significantly associated with an approximate two-thirds decrease in the hazard of future violent (including sexual) recidivism. High-risk, untreated men in our sample showed significantly higher rates of violent recidivism than the treated groups. Results support the utility of a strength-based approach among men residing in an institutional setting and presenting with a serious mental illness.