Search Results (608)

Context: As quantum technologies advance with innovations in cardiovascular medicine, it can be challenging to distinguish genuine clinical progress from mere ideas. There will also be difficult transitions involved in moving technology from proof of concept demonstrated in the lab. This transition is complicated by the excitement and hype that comes with any new technology. Aim: This work aims to assess what quantum technologies are available in cardiovascular medicine for real-world use, to identify which applications are closer to clinically relevant translation, and to differentiate realistic advances from advanced-not-yet realities. Methods: A narrative review was conducted using PubMed, EMBASE, Scopus, Web of Science, IEEE Xplore, and arXiv. While real-world use of technologies was prioritized, we included all theoretical literature, regardless of date of publication. Search terms were a combination of the vocabulary of quantum technologies and the vocabulary of cardiovascular medicine. Peer-reviewed publications included primary research, reviews, theoretical works, and conference proceedings. Two reviewers independently screened all citations, and any disagreements were resolved through consensus discussion. Results: We identified three core application areas: (1) quantum sensing, such as cardiac magnetometry, where there is potential for SQUID magnetocardiography to be used for detecting cardiomyopathy; (2) quantum computing for cardiovascular risk prediction, and (3) next-generation quantum sensors for mobile cardiac imaging. Conclusions: Quantum technology in cardiovascular medicine represents modest promise in select applications, most notably, magnetocardiography. To go from “hype to hope”, clinical trials will be required to identify application domains where quantum technologies outweigh the challenges of implementation in clinical practice. Full article

This article focuses on participation in youth-led climate-oriented groups and the role of this form of civic engagement for young people. Thirty interviews were conducted with 13- to 18-year-olds belonging to four groups: Extinction Rebellion Youth, Sustainabiliteens, Sunrise Movement, or school-affiliated clubs. The participants had been part of their group for an average of 1.5 years, coming from either the United States (n = 26) or Canada (n = 4). They were predominantly female (n = 22), with a few male (n = 5) and a small number identifying as non-binary (n = 3). Significant in the thematic analysis was the critical role of increased meaning-making, which involved relationship-building, processing emotions, and taking action. The peer-led group settings served to create community, work through the range of emotions the climate crisis evoked, and generate actions that felt purposeful at both the individual and collective levels. In these spaces, young people seek meaning together, and they propose and demand action from governmental bodies and corporations on climate change. Through everyday activism, young people express an ecocitizenship that is constructive, hopeful, and generative. In a world characterized by the climate crisis, joining and contributing to youth-led climate groups is becoming part of young people’s identity development, a way of enacting citizenship and expressing political agency. Full article

Background: Pediatric tracheostomy decisions are challenging for clinicians and parents, especially when a child’s survival/neurodevelopmental outcome is uncertain. Better understanding of parents’ values over the decision period is crucial for clinical decision-making. Objective: To describe parents’ values during tracheostomy decision-making for their critically ill child and to identify opportunities to improve parent–clinician shared decision-making (SDM). Methods: We thematically analyzed 12 semi-structured interviews with parents who recently faced a tracheostomy decision for their critically ill child. Three study team members with qualitative expertise reviewed the transcripts, identifying key topics independently. A codebook was developed, and data were coded. Key research questions guided analysis, with findings iteratively reviewed by the study team. Results: We identified parents’ values at the three time points: when the decision was introduced, during their deliberations of it, and when the ultimate decision was made. Initially, parents resisted tracheostomy because it threatens normalcy. They valued proof of a need for tracheostomy and information with certainty. As certainty for tracheostomy increased over time, parents’ hope focused on reversibility of tracheostomy and improvement in normalcy compared to current status. They concurrently worried about practical issues such as emergencies, home care, and finances. Key considerations driving the final decision included best interest of the child, perceived benefits of tracheostomy compared to its downsides or other options, and potential for better quality of life and longer life. Conclusions: Parents’ dynamic values shifting with clinical uncertainty suggests opportunities to improve SDM by attending to parents’ individualized needs and managing expectations. Full article

Nephrotic syndrome (NS) is a complex kidney disorder characterized by profound proteinuria, hypoalbuminemia, hyperlipidemia, and edema, significantly impacting patients’ quality of life. While corticosteroids and calcineurin inhibitors (CNIs) have traditionally been the primary treatments, B cell-targeted therapies, especially the anti-CD20 monoclonal antibody rituximab, have transformed the management of steroid-dependent and multidrug-resistant NS (MRNS). Rituximab has demonstrated efficacy in reducing relapse rates and steroid dependence by depleting CD20+ B cells, which play a pivotal role in autoantibody production and immune dysregulation. However, limitations such as incomplete B cell depletion, immunogenicity leading to anti-rituximab antibodies, and variable efficacy in refractory cases have led to the development of next-generation therapies. This review critically examines recent advances in B cell-targeted therapies for NS, with a particular focus on overcoming the limitations of conventional rituximab treatment. This review systematically analyzes next-generation anti-CD20 monoclonal antibodies, CD38-targeted therapies, and emerging CAR-T cell approaches, evaluating their distinct mechanisms of action and clinical trial outcomes. The analysis extends to innovative combination strategies and biomarker-guided treatment algorithms for refractory cases. By synthesizing preclinical data with clinical evidence, this work provides a framework for optimizing therapeutic decision-making in NS, while identifying key knowledge gaps that warrant future investigation. Collaborative research and translational studies are essential for advancing precision medicine in NS, ensuring that new therapies provide lasting clinical benefits for patients. The evolving field of anti-B cell therapies marks a new era in managing refractory NS, offering hope for better long-term prognoses. Full article

This paper is aimed at landscape managers and designers. It looks at 123 real-world coastal landscape projects and organizes them into clear design categories, i.e., wetland restoration, hybrid infrastructure, or urban green spaces. We looked at how these projects were framed (whether they focused on climate adaptation, flood protection, or other goals) and how they tracked performance. We are hoping to bring some clarity to a very scattered field, helping us to see patterns in what is actually being carried out in terms of landscape interventions and increasing sea levels. We are hoping to provide a practical reference for making better, more climate-responsive design decisions. Coastal cities face escalating climate-driven threats from increasing sea levels and storm surges to urban heat islands. These threats are driving increased interest in nature-based solutions (NbSs) as green adaptive alternatives to traditional gray infrastructure. Despite an abundance of individual case studies, there have been few systematic syntheses aimed at landscape designers and managers linking design typologies, project framing, and performance outcomes. This study addresses this gap through a meta-synthesis of 123 implemented coastal landscape interventions aimed directly at landscape-oriented research and professions. Flood risk reduction was the dominant framing strategy (30.9%), followed by climate resilience (24.4%). Critical evidence gaps emerged—only 1.6% employed integrated monitoring approaches, 30.1% provided ambiguous performance documentation, and mean monitoring quality scored 0.89 out of 5.0. While 95.9% of the projects acknowledged SLR as a driver, only 4.1% explicitly integrated climate projections into design parameters. Community monitoring approaches demonstrated significantly higher ecosystem service integration, particularly cultural services (36.4% vs. 6.9%, $p<0.001$), and enhanced monitoring quality (mean score 1.64 vs. 0.76, $p<0.001$). Implementation barriers spanned technical constraints, institutional fragmentation, and data limitations, each affecting 20.3% of projects. Geographic analysis revealed evidence generation inequities, with systematic underrepresentation of high-risk regions (Africa: 4.1%; Latin America: 2.4%) versus concentration in well-resourced areas (North America: 27.6%; Europe: 17.1%). Full article

This paper attempts to clarify some of the aspects and dynamics that appear particularly significant when embarking on a path that can lay the foundation for a broader reflection on the “sociology of hope”. This path will be outlined starting from the development of the concept of hope in the social sciences through an analysis of the existing literature within a specific field of study. It will continue with a systematic synthesis of those sociological studies that have led to a “dialogue” with the concept of hope and that, most often directly or indirectly, have considered hope as a force that mobilizes individuals and social groups to action. The final stage of this path will be reserved for presenting the debate that has opened in recent years around the sociology of hope, both critically and constructively, to provide recommendations for future research that, in line with this perspective, aims to study how to improve the world. Full article

Introduction: The organization of mental health care is undergoing a transformation from an institutionalized model to a community-centered model. Due to the critical specialist workforce shortage, insufficient funding, and the large number of children in crisis, its implementation presents a challenge. The aim of this study is to analyze the current situation regarding access to system-based care under contracts with the National Health Fund in various provinces in Poland. Materials and Methods: Based on an analysis of data, resources available to patients were assessed—specifically, information was obtained from the National Health Fund website entitled “NFZ Treatment Waiting Times.” From this, the waiting times for appointments in child and adolescent mental health care facilities, the availability of mental health care facilities under contracts with the National Health Fund in Poland, legal acts, and data from the Central Statistical Office were extracted. Then, an analysis of the current accessibility to child and adolescent mental health services was conducted. The inclusion criteria for data sources were as follows: accessibility—the data had to be openly available to researchers without restrictions; credibility—the data had to be verified by individual health care facilities; usefulness—the data had to accurately reflect the actual availability of services and the needs within the child and adolescent psychiatric care system. Results: There are significant differences and deviations from the average number of facilities and waiting times when comparing the 16 provinces. Notably, some of the analyzed facilities are already operating within the framework of Child and Adolescent Mental Health Centers, where the mean waiting period for inpatient care is 105 days, the mean waiting period for day-care units is 61 days, and the mean waiting period for outpatient clinics is 257 days. The number of facilities is increasing under the reform, with new level I reference centers being opened, which ensures prevention and early support is provided by a pedagogue, psychologist, and non-medical staff, providing enhanced accessibility to care without the need for a visit to a child and adolescent psychiatrist, of whom there are only 579 for the entire child population in Poland. This metric primarily refers to first-time appointments in public institutions, with notable disparities between urban and rural areas. Conclusions: The development of the reform offers hope for quicker access to mental health support for children and adolescents. With the consistent implementation of the reform and further support from non-governmental organizations, there is a high chance of building an effective community-based model with a short waiting time for help and reducing ineffective hospitalizations, among other things, in terms of costs. Full article

The main purpose of this paper is to present a comprehensive and systematically organized overview of the current state of vibration monitoring and measurement techniques used in railway stock. It aims to raise awareness of significant technological developments in recent years and their practical applications. The scope of the analysis is strongly informed by established European norms, fundamental research efforts across the continent, and the practical needs of the railway sector. Last but not least, we hope this paper serves as a valuable reference point for engineers, researchers, and decision-makers working within the complex context of railway system design, maintenance, and evolving regulations. For effective monitoring of railway vehicle vibrations, a combination of specialized measurement methods and system architectures is recommended. These approaches are carefully developed to capture the dynamic responses of critical components of the railway vehicle, thereby providing invaluable data. This information is essential for thorough condition monitoring, improved ride comfort, and a deeper structural understanding of vehicle quality throughout its lifecycle. Full article

Background: Small-cell lung cancer (SCLC) is a highly aggressive neuroendocrine malignancy characterized by rapid growth, early metastatic dissemination, and a dismal prognosis. For decades, treatment paradigms remained largely stagnant, particularly for extensive-stage disease (ES-SCLC). However, the last five years have witnessed a significant evolution in the therapeutic landscape. Methods: The information for this article was gathered by synthesizing data from several key sources. This article synthesizes the evidence supporting current standards of care for both limited-stage (LS-SCLC) and ES-SCLC, incorporating data from pivotal clinical trials, a network meta-analysis of first-line chemoimmunotherapy regimens, and a critical appraisal of international treatment guidelines, and a critical analysis of international treatment guidelines from prominent organizations like the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO). This comprehensive approach allows for a robust and well-supported summary of the current therapeutic landscape. Results: For limited-stage SCLC (LS-SCLC), concurrent chemoradiotherapy (cCRT) remains the curative-intent standard, but its efficacy is now being augmented by consolidative immunotherapy, as demonstrated by the landmark ADRIATIC trial. The role of prophylactic cranial irradiation (PCI) in LS-SCLC is being re-evaluated in the era of high-sensitivity brain imaging and concerns over neurotoxicity. For ES-SCLC, the treatment paradigm has been fundamentally transformed by the integration of immune checkpoint inhibitors (ICIs) with platinum–etoposide chemotherapy, establishing a new standard of care that offers a modest but consistent survival benefit. Conclusions: The treatment of SCLC has been significantly advanced by the integration of immunotherapy, particularly for extensive-stage disease, which has established a new standard of care and improved patient outcomes. Looking to the future, the quest for predictive biomarkers and the development of novel therapeutic classes, such as Bi-specific T-cell Engagers (BiTEs) and antibody–drug conjugates, promise to build upon recent progress and offer new hope for improving the dismal prognosis associated with this disease. Full article

Breast cancer is one of the most common cancers globally. Unfortunately, many patients with breast cancer develop resistance to chemotherapy and tumor recurrence, which is primarily driven by breast cancer stem cells (BCSCs). BCSCs behave like stem cells and can self-renew and differentiate into mature tumor cells, enabling the cancer to regrow and metastasize. Key markers like CD44 and aldehyde dehydrogenase-1 (ALDH1), along with pathways like Wingless-related integration site (Wnt), Notch, and Hedgehog, are critical to regulating this stem-like behavior of BCSCs and, thus, are being investigated as targets for various new therapies. This review summarizes marker-dependent strategies for targeting BCSCs and expands on the challenges for the development of anti-BCSC drugs. We explore cutting-edge approaches like artificial intelligence (AI)-driven drug discovery and urge readers to seriously consider biological clocks and chronotherapy as experimental variables in drug discovery. Collectively, the task of cancer researchers is to overcome the many hurdles targeting BCSCs if we hope to tangibly improve breast cancer treatment outcomes and reduce mortality. Full article

Since the turn of the 21st century, urban studies and planning research has examined the strategic role of artists, arts organizations, and cultural activity as local and regional economic development catalysts. This article shifts the spotlight from the “creative class” and “creative industries” as drivers of a “creative city” to study the role of art, culture, and creative practices in community-led, place-based efforts to stabilize neighborhoods and advance more hopeful, healthy, and equitable urban futures. It explores Boston’s Chinatown, where community-based art activism has a long history of addressing critical issues such as reclaiming land taken by interstate highway and urban renewal projects, as well as combating gentrification and displacement through site activation. The case study focuses on Residence Lab, a community-based arts residency program initiated by the Pao Arts Center and the Asian Community Development Corporation that brought together multimedia artists with residents to collectively preserve Boston’s Chinatown through creative and artistic activation of underutilized sites in the neighborhood from 2019 to 2022. We examine a selection of ResLab projects, which give form and meaning to the struggles and aspirations of being at home in Chinatown and embody the art activism of partner organizations and program participants, along with the ResLab’s impacts on participating residents and artists. The concluding discussion considers ResLab’s contributions and implications for the shifting ways in which urban, political, and artistic cultures have intersected and impacted one another in Chinatown along with the relationship between collective action and the preservation and transformation of culture in the urban frame. Full article

Chimeric antigen receptor (CAR)-T-cell therapy has revolutionised haematological cancer treatment. However, its application in solid tumours remains significantly limited by the immunosuppressive tumour microenvironment (TME), poor antigen specificity, and physical barriers to infiltration. This review explores a compelling question: can CAR-T cells be adapted to overcome immunosuppression in solid tumours effectively? We provide an in-depth analysis of the immunological, metabolic, and structural challenges posed by the TME and critically evaluate emerging engineering strategies designed to enhance CAR-T cells’ persistence, targeting, and function. These include metabolic reprogramming, hypoxia-responsive constructs, checkpoint-resistant designs, and innovative delivery techniques such as locoregional administration and nanotechnology-assisted targeting. We highlight promising preclinical and early clinical studies demonstrating that armoured CAR-T cells secreting cytokines like interleukin (IL)-12 and IL-18 can reprogram the TME, restoring antitumour immunity. Moreover, we examine synergistic combination therapies that integrate CAR-T cells with immune checkpoint inhibitors, radiotherapy, oncolytic viruses, and epigenetic modulators. Special attention is given to personalised strategies, such as bispecific targeting and precision delivery to tumour-associated vasculature or stromal elements, which are showing encouraging results in overcoming resistance mechanisms. This review aims not only to synthesise current advancements but also to ignite optimism in the potential of CAR-T-cell therapy to breach the immunological fortress of solid tumours. As we enter a new era of synthetic immunology, this evolving landscape offers hope for durable remissions and novel treatment paradigms. For clinicians, researchers, and biotech innovators, this paper provides a roadmap toward transforming a therapeutic dream into clinical reality. Full article

Cardiovascular diseases (CVDs) pose a significant threat to human life and mortality worldwide, encompassing a variety of conditions that affect the heart and blood vessels. These diseases are influenced by both genetic and environmental factors, which play a critical role in their development. Recent research has highlighted the importance of gut microbes—the diverse community of bacteria in the gastrointestinal tract—that function as a “super organ” within the human body. These microbes have a remarkable impact on metabolic pathways and are increasingly recognized for their role in serious conditions like CVDs. They contribute to metabolic regulation, provide essential nutrients and vitamins, and help protect against diseases. Various internal and external factors influence the dynamic relationship between the human host and gut microbiota, thereby regulating overall metabolism. This review explores the complex connection between gut microbiota and microbial metabolites—such as short-chain fatty acids (SCFAs), bile acids (BAs), and trimethylamine N-oxide (TMAO)—and their potential influence on the development and progression of CVDs. We also examine the interaction between dietary interventions and gut microbes in the context of conditions including atherosclerosis, obesity, type 2 diabetes, heart failure, hypertension, atrial fibrillation, and myocardial infarction. Gaining a deeper understanding of the gut microbiota’s role in maintaining physiological balance creates exciting possibilities for identifying novel diagnostic biomarkers and therapeutic targets for treating CVDs. This knowledge offers hope for early disease prediction, improved clinical management, and innovative treatments. Full article

Schizophrenia (SZ) is a complex neuropsychiatric disorder characterized by heterogeneous symptoms, relatively poor clinical outcome, and widespread disruptions in neural connectivity and oscillatory dynamics. This article attempts to review current evidence linking genomic and proteomic alterations with aberrant neural oscillations observed in SZ, including aberrations in all oscillatory frequency bands obtained via human EEG. The numerous genes discussed are mainly involved in modulating synaptic transmission, synaptic function, interneuron excitability, and excitation/inhibition balance, thereby influencing the generation and synchronization of neural oscillations at specific frequency bands (e.g., gamma frequency band) critical for different cognitive, emotional, and perceptual processes in humans. The review highlights how polygenic influences and gene–circuit interactions underlie the neural oscillatory and connectivity abnormalities central to SZ pathophysiology, providing a framework for future research on common genetic-neural function interactions and on potential therapeutic interventions targeting local and global network-level neural dysfunction in SZ patients. As will be discussed, many of these genes affecting neural oscillations in SZ also affect other neurological disorders, ranging from autism to epilepsy. In time, it is hoped that future research will show why the same genetic anomaly leads to one illness in one person and to another illness in a different person. Full article

Precision neurosurgery is rapidly evolving as a medical specialty by merging genomic medicine, multi-omics technologies, and artificial intelligence (AI) technology, while at the same time, society is shifting away from the traditional, anatomic model of care to consider a more precise, molecular model of care. The general purpose of this review is to contemporaneously reflect on how these advances will impact neurosurgical care by providing us with more precise diagnostic and treatment pathways. We hope to provide a relevant review of the recent advances in genomics and multi-omics in the context of clinical practice and highlight their transformational opportunities in the existing models of care, where improved molecular insights can support improvements in clinical care. More specifically, we will highlight how genomic profiling, CRISPR-Cas9, and multi-omics platforms (genomics, transcriptomics, proteomics, and metabolomics) are increasing our understanding of central nervous system (CNS) disorders. Achievements obtained with transformational technologies such as single-cell RNA sequencing and intraoperative mass spectrometry are exemplary of the molecular diagnostic possibilities in real-time molecular diagnostics to enable a more directed approach in surgical options. We will also explore how identifying specific biomarkers (e.g., IDH mutations and MGMT promoter methylation) became a tipping point in the care of glioblastoma and allowed for the establishment of a new taxonomy of tumors that became applicable for surgeons, where a change in practice enjoined a different surgical resection approach and subsequently stratified the adjuvant therapies undertaken after surgery. Furthermore, we reflect on how the novel genomic characterization of mutations like DEPDC5 and SCN1A transformed the pre-surgery selection of surgical candidates for refractory epilepsy when conventional imaging did not define an epileptogenic zone, thus reducing resective surgery occurring in clinical practice. While we are atop the crest of an exciting wave of advances, we recognize that we also must be diligent about the challenges we must navigate to implement genomic medicine in neurosurgery—including ethical and technical challenges that could arise when genomic mutation-based therapies require the concurrent application of multi-omics data collection to be realized in practice for the benefit of patients, as well as the constraints from the blood–brain barrier. The primary challenges also relate to the possible gene privacy implications around genomic medicine and equitable access to technology-based alternative practice disrupting interventions. We hope the contribution from this review will not just be situational consolidation and integration of knowledge but also a stimulus for new lines of research and clinical practice. We also hope to stimulate mindful discussions about future possibilities for conscientious and sustainable progress in our evolution toward a genomic model of precision neurosurgery. In the spirit of providing a critical perspective, we hope that we are also adding to the larger opportunity to embed molecular precision into neuroscience care, striving to promote better practice and better outcomes for patients in a global sense. Full article