Search Results (7,206)

Background/Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD) are a common reason for emergency department (ED) attendance and hospital admission. Acute respiratory worsening is non-specific, and previous spirometric confirmation may be unavailable at presentation. We aimed to translate current recommendations into an ED-specific clinical pathway that standardizes safety-critical steps without replacing individualized clinical judgment. Methods: We performed a targeted synthesis of international and Spanish guidance and key studies relevant to ED diagnosis, severity assessment, pharmacological treatment, respiratory support, antimicrobial stewardship, and disposition. The evidence base was updated in June 2026, and the pathway was reviewed by a multidisciplinary clinical group. Results: The revised pathway comprises four stages: (1) verify previous COPD confirmation, identify an acute exacerbation-like syndrome, and assess alternative or concomitant diagnoses; (2) grade acute severity using point-of-care variables and separately assess patient vulnerability; (3) provide severity-adjusted treatment with early reassessment; and (4) determine disposition and follow-up. It incorporates controlled oxygen, individualized bronchodilator delivery, explicit criteria for systemic corticosteroids and antibiotics, assessment of risk for Pseudomonas aeruginosa, non-invasive ventilation (NIV), and a defined adjunctive role for high-flow nasal cannula (HFNC). Patients without previous post-bronchodilator spirometry are classified as having suspected COPD and require confirmation after recovery. Conclusions: This evidence-informed pathway is a preliminary clinical framework, not a diagnostic rule or validated decision instrument. It is intended to support, rather than replace, professional judgment. Feasibility, acceptability, diagnostic safety, and clinical impact require prospective evaluation, beginning with a pilot implementation study. Full article

Antimicrobial resistance (AMR), largely driven by the inappropriate and excessive use of antibiotics, requires rapid and reliable bacterial detection and antibiotic susceptibility testing (AST), as conventional culture-based methods remain time-intensive. Here, we report a real-time, label-free interdigitated wave electrode array (IWEA) that combines dielectrophoretic (DEP) enrichment with impedance spectroscopy for rapid bacterial detection and AST. The proposed IWEA was designed and optimized via COMSOL Multiphysics to enhance DEP-relevant electric-field strength, thereby improving DEP-assisted bacterial enrichment compared to conventional planar interdigitated electrodes. The platform enabled sensitive detection of both Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) in 0.1× PBS across 10–10⁵ CFU/mL within 30 min using DEP-assisted preconcentration (100 kHz, 10 V_pp), outperforming passive (non-DEP) operation (10²–10⁵ CFU/mL). For AST, bacterial responses to vancomycin, gentamicin, and ampicillin were monitored through impedance variations following DEP-based enrichment. Susceptible bacteria produced concentration-dependent reductions in ΔZ/Z₀, whereas resistant bacteria showed similar responses to untreated controls. Quantitative assessment yielded CC₅₀ values of 2.86 ± 0.22 µg/mL and 3.06 ± 0.20 µg/mL for vancomycin and gentamicin against S. aureus, and 4.59 ± 0.30 µg/mL for gentamicin against E. coli. Resistance profiles of S. aureus to ampicillin and E. coli to vancomycin and ampicillin were clearly distinguished. SEM imaging and disk diffusion assays independently validated the impedance-derived susceptibility results. Collectively, this IWEA platform offers a rapid, label-free, and quantitative approach for bacterial detection and AST, with strong potential for antimicrobial screening and point-of-care diagnostics. Full article

Dengue virus (DENV) remains a major global public health challenge, driven by the expanding distribution of Aedes vectors, rapid urbanization, and increasing climate variability. This review aimed to synthesize current evidence on dengue transmission dynamics, immunopathogenesis, molecular epidemiology, diagnostic and therapeutic advances, vaccine development, and the influence of climatic factors on disease patterns. A comprehensive search of major electronic databases was conducted to identify relevant literature, followed by a qualitative synthesis of the evidence. The evidence highlights complex transmission cycles involving Aedes aegypti and Aedes albopictus, with transmission strongly influenced by temperature, humidity, rainfall, and extreme climate events. Advances in immunopathogenesis research have improved understanding of mechanisms associated with severe disease, including antibody-dependent enhancement and dysregulated inflammatory responses. Diagnostic innovations, such as reverse transcription polymerase chain reaction (RT-PCR), NS1 antigen detection, and point-of-care technologies, have enhanced case identification, while prevention strategies increasingly incorporate integrated vector management, digital surveillance systems, and emerging vaccines. Integrating epidemiological, molecular, and climatic information may strengthen early warning systems, improve outbreak prediction, and support more effective dengue prevention and control strategies. Full article

Background/Objectives: Whether the prognostic contribution of low skeletal muscle mass varies with age in ventilated patients is untested. We assessed whether the association between low computed tomography (CT)-derived thoracic muscle area and ventilator-liberation outcomes differs by age. Methods: This single-center retrospective cohort included 607 adults with pneumonia requiring invasive ventilation in the intensive care unit (ICU) between 2016 and 2021. Thoracic muscle area was quantified by deep-learning segmentation of the whole thoracic musculature (first to twelfth thoracic vertebra) on the chest CT obtained closest to ICU admission and normalized to the length of the thoracic spine (median offset 0 days; 86% within ±7 days, before or after); low thoracic muscle area was the sex-specific lowest quartile. The primary outcome was composite weaning failure (extubation failure, tracheostomy, or ventilation >21 days). Multivariable logistic regression stratified at 75 years tested a muscle-area-by-age interaction. Results: Composite weaning failure occurred in 290 patients (47.8%). In fully adjusted complete-case models (n = 539), low thoracic muscle area was associated with composite weaning failure in younger patients (adjusted odds ratio 3.63; 95% CI 1.67–7.87) but not significantly in older patients (1.68; 0.91–3.13); the age interaction was not significant (p = 0.061) and was removed by height-normalization and by correction for multiple comparisons. A graded association across muscle-area quartiles was present in both strata (lowest vs. highest quartile: younger 4.79, older 2.53). Low thoracic muscle area was not associated with ICU mortality in either stratum, although an exploratory landmark analysis showed higher 7-day mortality in younger patients with low muscle area (20.6% vs. 10.8%). Conclusions: Low CT-derived thoracic muscle area was associated with composite weaning failure in both age strata, with a larger point estimate in patients younger than 75 years, although the age interaction was not significant in the fully adjusted model and was removed by height-normalization and by correction for multiple comparisons. The graded association in both age strata is hypothesis-generating and requires prospective validation. Full article

Acinetobacter baumannii is a critical WHO priority pathogen due to its multidrug resistance and high mortality in carbapenem-resistant infections. Resistance is predominantly mediated by class D carbapenemase genes bla_OXA-23 and bla_OXA-40, which spread rapidly via horizontal gene transfer in healthcare settings. To address the lack of a rapid assay capable of detecting both blaOXA-23 and blaOXA-40 in a single analytical workflow, we developed a multiplex two-step RPA–CRISPR/Cas12a assay. Since infections caused by strains harboring either gene require identical therapeutic management, their co-detection in a single reaction is clinically justified. Although simultaneous use of two crRNAs within a single CRISPR/Cas12a reaction is often considered technically challenging due to potential inter-crRNA competition, here it advantageously enables dual-target coverage without compromising sensitivity. The assay demonstrated high specificity with no cross-reactivity against a panel of clinically relevant bacterial species, including closely related Acinetobacter spp. Evaluation using genomic DNA extracted from 63 cultured clinical A. baumannii isolates revealed bla_OXA-23 in 19 isolates (30.2%), bla_OXA-40 in 28 (44.4%), and co-carriage of both genes in 9 (14.3%), with at least one resistance gene detected in 60.3% of isolates. The complete workflow was accomplished within 45 min without specialized equipment, offering a rapid, sensitive, and cost-effective solution for point-of-care molecular surveillance of carbapenem-resistant A. baumannii in clinical and resource-limited settings. Full article

Background/Objectives: Lactate is a key biomarker of tissue hypoperfusion in severe trauma. While admission lactate is widely used, the prognostic value of delayed lactate clearance remains a subject of ongoing investigation, notably due to the inherent risk of survivorship bias. This study assessed the association between lactate kinetics and in-hospital mortality in a cohort of severely injured patients admitted to the intensive care unit. Methods: We conducted a single-center retrospective cohort study including adult patients (≥18 years) admitted to the ICU for severe trauma between January 2018 and December 2022. Arterial lactate was measured at H0, H4 (±1 h), and H12 (±1 h). Lactate clearance (LC) was calculated using the formula: LC (%/h) = [(Lactate_t1 − Lactate_t2)/Lactate_t1] × (1/Δt) × 100, where positive values indicate decreasing lactate (clearance) and negative values indicate worsening lactatemia. LC was calculated over H0–H4, H0–H12, and H4–H12. Among the 38 patients who died before 12 h and were excluded from the LC H0–H12 analysis, non-survivors were significantly older, had higher severity scores, and presented more frequently with hemorrhagic shock. Predictive performance was evaluated using ROC curves and multivariate logistic regression. The composite prognostic score was assessed using bootstrap internal validation (1000 resamples) to provide an optimism-adjusted AUC estimate. Results: Among 318 patients (median age 36 years; 86.5% male), hyperlactatemia (>2.2 mmol/L) was present in 70.1% at admission and persisted in 39.9% at 12 h. Non-survivors exhibited higher lactate levels and lower LC at all time points. LC H0–H12 demonstrated the best predictive performance for in-hospital mortality (AUC = 0.75; 95% CI [0.69–0.81]; p < 0.001). For early mortality (≤48 h), LC H0–H12 achieved an AUC of 0.80 (95% CI [0.71–0.89]; p < 0.001). A composite prognostic score incorporating age >60 years, GCS ≤ 7, prothrombin time ≤ 55%, pH ≤ 7.29, and LC H0–H12 > −2.93 %/h demonstrated good discrimination (AUC = 0.84; optimism-adjusted AUC = 0.82). Conclusions: Lactate levels and 12 h lactate clearance are valuable prognostic markers in severe trauma. Given the inherent survivorship bias affecting the LC H0–H12 analysis, its prognostic performance should be interpreted with appropriate caution and within a multimodal clinical assessment. The proposed composite score is promising but requires prospective external validation before clinical implementation. Full article

Background/Objective: Perioperative nursing care encompasses a diverse patient population with varying needs, anatomical and physiological characteristics, and differing levels of vulnerability, demanding specialized knowledge and skills. This study aims to identify key research priorities in perioperative nursing across the lifespan. Methods: A two-round e-Delphi study was conducted across three Portuguese hospitals, involving expert perioperative nurses (87 in the first round and 69 in the second). Participants rated the importance of various research topics on a 5-point Likert scale about six dimensions: (1) professional development and non-technical skills, (2) person-centered care, (3) organizational aspects and work environment, (4) patient and team safety, (5) digital innovation, and (6) patient outcomes and quality of care. Data were analyzed using mean scores, Content Validity Ratio (CVR) for initial validation, and the Coefficient of Variation (CV) to determine the level of consensus. The reporting of this study followed the DELPHISTAR (Guideline for Reporting Delphi Studies) recommendations. Results: A high degree of consensus was achieved (all CV < 0.20). The experts established a consensus on 48 components. The highest-rated priority was nurse burnout and professional satisfaction (Mean = 4.74). This was closely followed by patient safety (Mean = 4.68), team safety (Mean = 4.65), disaster response (Mean = 4.62), and emergency management (Mean = 4.58). Acute pain control and interdisciplinary communication also emerged as critical areas. Topics such as digital innovation and artificial intelligence, while valued, received lower priority scores. Conclusions: The identified priorities should direct funding toward research, education, quality improvement, and health policies. Future studies should focus on developing interventions to promote a favorable perioperative environment and optimize clinical responses to individuals’ conditions, catastrophes, and life-threatening situations across the lifespan. Full article

Background: A substantial proportion of patients with chronic migraine (CM) with previous failures among oral standard-of-care migraine medications do not respond to monoclonal antibodies targeting the calcitonine gene related peptide pathway (CGRP-mAbs), leaving limited evidence-based options for subsequent preventive strategies. The present multicentre real-world study evaluated the effectiveness of onabotulinumtoxin-A (BoNT-A) in CM patients with previous CGRP-mAb failure and multiple prior oral preventive failures. Methods: This prospective, observational, non-randomized multicentre study enrolled patients with CM who had failed ≥3 classes of oral preventive treatments and ≥1 CGRP-mAb due to lack of efficacy or intolerance. Participants received BoNT-A according to the PREEMPT “follow-the-pain” paradigm every three months and were followed for 6 months. Co-primary outcomes were change in monthly headache days (MHD) after three and six months and ≥50% MHD responder rates at both time points. Results: Fifty-three patients were analysed (85% female, aged 48.5 ± 15.2 years, range 20–73). Compared to the baseline, at the third month and sixth month, MHD decreased from 22.83 (SD 6.74) to 15.38 (SD 7.91; p < 0.001) and 14.55 (SD 9.35; p < 0.001), respectively. The percentages of participants achieving the response status in MMD at the third month and sixth month were 30% and 45%, respectively. In the third and sixth months, 22 patients (41.5%) and 27 patients (50.9%), respectively, converted from chronic to episodic migraine, while the prevalence of medication-overuse headache decreased from 81.1% of patients at baseline to 45.3% and 43.4%, respectively. Migraine-related impact and disability scores improved over follow-up, alongside improvements in anxiety and depressive symptoms and in migraine-specific quality of life. Conclusions: The present findings support the use of BoNT-A in difficult-to-treat patients with CM following CGRP-mAb failure and provide further evidence that its therapeutic effects may rely on mechanisms that are at least partially distinct from, and potentially complementary to, those of CGRP-targeted therapies. Full article

Virus-specific antibody responses, including binding antibodies and neutralizing antibodies (nAbs), are important indicators of antiviral immune status after infection or immunization. They provide complementary information on antiviral humoral immunity after infection or vaccination. Antigen-binding antibodies indicate previous exposure and the magnitude of the immune response, whereas receptor-blocking and functional neutralization assays assess whether antibodies interfere with viral entry or infection. Conventional neutralization assays, such as plaque reduction neutralization tests and pseudovirus neutralization tests, provide functional information but are labor-intensive, time-consuming, biosafety-restricted, and difficult to deploy for large-scale or decentralized monitoring. Paper-based biosensors, including lateral flow assays (LFAs), microfluidic paper-based analytical devices (μPADs), and paper-based ELISA, have emerged as promising point-of-care tools owing to their low cost, portability, simple operation, and compatibility with visual or digital readouts. This review critically evaluates these platforms according to whether they measure antigen-binding antibodies, receptor-blocking activity, surrogate neutralization, or functional neutralization and summarizes the applications of these three platforms for monitoring antibody responses against SARS-CoV-2, influenza, dengue, Zika, and monkeypox viruses. Unlike previous reviews that mainly focus on general paper-based biosensor design or conventional nAb assays, this review emphasizes the distinction between antigen-binding, receptor-blocking, and surrogate neutralization readouts, and critically discusses how paper-based signals should be interpreted in relation to functional immunity. We further analyze key translational challenges, including quantitative accuracy, antigen cross-reactivity, standardization, clinical validation, regulatory positioning, and real-world implementation. Future development should combine multiplex detection, standardized calibration, digital and AI-assisted interpretation, and clinically validated assay formats. Paper-based biosensors have considerable potential for decentralized antibody monitoring and public health surveillance, but their clinical utility depends on clear assay positioning and validation against appropriate functional or reference methods. Full article

Background and Objective: Glucagon-like peptide-1 (GLP-1) receptor agonist therapy has intensified the policy debate over whether obesity pharmacotherapy increases short-term healthcare expenditures or reduces downstream medical costs (i.e., non-drug, acute-care expenditures). This study estimated same-year associations between GLP-1 use and medical spending among adults with observed obesity. Methods: Analyses used Medical Expenditure Panel Survey (MEPS) person-year files compiled from 2018 to 2022, with body mass index (BMI)-defined analyses restricted to 2019 and 2021. The primary analytic sample included 7144 person-years, of which 275 represented sustained GLP-1 users. Overlap-weighted Poisson pseudo-maximum likelihood models, utilization regressions, two-part decompositions, and a layered diagnostic framework were applied to assess spending patterns and same-year cost implications. Robustness was evaluated through sensitivity analyses across all-obesity, severe-obesity, and diabetes-excluded subsamples, as well as exploratory molecule-specific specifications. Results: Findings showed no evidence of same-year cost savings, but rather a distinct shift in spending composition. In fully adjusted primary models, GLP-1 use was associated with reduced non-drug medical spending (beta = −0.2494; marginal effect = −$2586 per person-year) and lower acute-care spending (beta = −0.5856; marginal effect = −$2019), while total medical spending was higher (beta = 0.3182; marginal effect = +$6483). Point E values of 1.89 (non-drug) and 2.99 (acute-care) indicated moderate-to-strong resilience to unmeasured confounding. Negative control models using dental spending and visits showed significant positive associations. Since this residual confounding operates in the direction opposite to the negative acute-care association, the headline compositional pattern is unlikely to be an artifact of upward health-seeking bias. Utilization models indicated fewer inpatient discharges (IRR = 0.686) and inpatient nights (IRR = 0.524). Two-part models further suggested that the reduction in acute-care spending was concentrated on the intensive margin among individuals with positive expenditures. Conclusions: The use of GLP-1 is not associated with overall short-term cost savings. This usage is related to a shift in the composition of observed medical spending during the same year. This change is leading to a decline in hospital admissions and acute care costs, in parallel with the rise in pharmaceutical spending. Non-drug and acute-care costs were lower among regular users. However, total spending was at a higher level, consistent with a trend in the budget records from that period in which drug costs were the dominant factor. These associations are consistent with a potential reallocation of healthcare resources from inpatient acute care toward pharmacy and ambulatory services, with corresponding planning implications for payers and possible workforce reallocation of nursing capacity from acute to outpatient settings, contingent on replication in post-2022 data. Full article

The widespread use of tetracycline (TC) has resulted in its frequent occurrence in aquatic environments because of incomplete metabolism and continuous release, raising increasing concerns regarding water quality and environmental safety. Reliable determination of trace TC in real water samples remains challenging owing to its low concentration and the complex sample matrix. In this work, an aptamer-functionalized extended-gate ion-sensitive field-effect transistor (EG-ISFET) was developed for sensitive TC detection. The sensing interface was constructed by immobilizing a TC-specific aptamer on a Ta₂O₅ extended gate. Upon target recognition, aptamer folding redistributes the interfacial charge, thereby modulating the surface potential of the extended gate and producing a measurable field-effect response. The proposed sensor exhibits a broad linear detection range from 1 pM to 1 μM with a detection limit of 0.33 pM. To facilitate practical applications, a compact plug-and-play point-of-care testing (POCT) platform integrating the EG-ISFET sensor was further developed for rapid on-site analysis. The portable system demonstrated satisfactory accuracy and reliability for the determination of TC in river water samples, highlighting its potential for environmental monitoring and point-of-use water quality assessment. Full article

Background: Chronic subdural haematoma (cSDH) is one of the most common neurocranial conditions in older adults and is increasing in incidence. Conservatively managed patients are typically older, frailer, and more comorbid than surgical candidates, yet specialist geriatrician input into their management is rarely formalised. Potential for geographic inequity in hub-and-spoke neurosurgical networks within the UK compounds this challenge. We describe a service evaluation of a novel regional geriatric trauma advice service providing specialist trauma geriatrician input into cSDH management alongside the neurosurgical team, across a single UK Neurosurgical Network. To the authors’ knowledge, this is the first of its kind in the UK. Prior to this service ‘normal’ care within our region was no routine specialist medical input. Methods: A service evaluation of all referrals received by the North Bristol National Health Service (NHS) Trust geriatric trauma team between July 2024 and March 2026 was performed by the authors. Referrals were discussed within a multidisciplinary team including geriatric trauma, interventional neuroradiology and neurosurgery. Individuals’ demographic data, advice types, management enhancement, intervention outcomes and mortality were recorded and analysed descriptively. Management enhancement was defined as a definitive management decision that resulted in either an action or an active decision not to act. Results: Ninety referrals were included. Median age was 83 years (IQR 77–88) and median Clinical Frailty Scale (CFS) score was 4, with 50% classified as frail (CFS 4–8). Referrals were received from five satellite NHS trusts and the community. Three-quarters (75.6%) required multiple concurrent advice types; Middle Meningeal Artery Embolisation (MMAE) suitability (93.3%) and antithrombotic management (51.1%) were the most frequent. Specialist geriatrician input enhanced management in 97.8% of cases. Forty percent of conservatively managed patients were converted to active intervention, most commonly standalone MMAE (50%). Of district general hospital patient referrals, 40.3% were conveyed to the neurosurgical centre following geriatric trauma review. Mortality was comparatively lower at multiple time points when compared to existing UK data for conservatively managed patients. Conclusions: A regional virtual geriatric trauma advice service for older adults with cSDH is feasible and is associated with enhanced management of this cohort, potentially improving access to treatment. Combining neurosurgical, neurointerventional and geriatrician expertise through a structured multi-disciplinary team (MDT) approach addresses the clinical complexity of this patient group and the potential geographic inequity of hub-and-spoke networks. Further research is needed to investigate the impact of routine geriatrician input into cSDH care. Full article

Background/Objectives: This study aimed to develop and internally validate the RIN-IM model, which integrates routinely measured biomarkers reflecting renal dysfunction, systemic immune-inflammatory activation, albumin-related alterations during acute illness, and metabolic stress, for prediction of 28-day mortality in critically ill adults. Methods: This retrospective cohort study included 1000 adults admitted to the intensive care unit (ICU) between January 2020 and June 2025. The first available demographic, clinical, and laboratory measurements obtained within 24 h of ICU admission were analyzed. The five prespecified RIN-IM predictors—serum creatinine, serum albumin, SII, PIV, and the TyG index—were initially evaluated as continuous variables; SII and PIV were natural-log-transformed, and potential nonlinear associations were examined using restricted cubic splines. Ridge-penalized logistic regression was used to address coefficient instability arising from correlation between SII and PIV. After evaluation of the primary continuous model, a simplified point-based score was derived by assigning 0–2 points to clinically ordered categories for each component, producing a total score of 0–10. Scores were categorized as low- (0–3), intermediate- (4–6), or high-risk (7–10). The primary outcome was 28-day all-cause mortality. Model performance was assessed using discrimination, calibration, Brier score, formal paired AUC comparisons, incremental-value testing, and decision-curve analysis. The complete development procedure was internally validated using 1000 bootstrap resamples. Results: Overall, 300 of 1000 patients (30.0%) died within 28 days. Mortality increased across the RIN-IM risk categories, from 7.6% (32/420) in the low-risk group to 27.2% (98/360) in the intermediate-risk group and 77.3% (170/220) in the high-risk group (p < 0.001). After adjustment for the clinical reference variables, each one-point increase in the simplified RIN-IM Score was associated with higher odds of 28-day mortality (adjusted OR, 1.68; 95% CI, 1.54–1.84; p < 0.001). The primary continuous model had an apparent AUC of 0.907 (95% CI, 0.885–0.929) and an optimism-corrected AUC of 0.898. The corresponding values for the simplified score were 0.890 (95% CI, 0.861–0.919) and 0.878, respectively. The apparent difference between the continuous and simplified models was 0.017 (95% CI, 0.007–0.028; p = 0.001). The simplified RIN-IM Score had higher discrimination than APACHE II (ΔAUC, 0.070; 95% CI, 0.038–0.102; p < 0.001) and SOFA (ΔAUC, 0.090; 95% CI, 0.057–0.123; p < 0.001). Adding RIN-IM to the clinical reference model increased the apparent AUC from 0.821 to 0.923 (ΔAUC, 0.102; 95% CI, 0.078–0.126; p < 0.001) and improved the Brier score from 0.160 to 0.112. Conclusions: In this single-center cohort, the RIN-IM model showed good discrimination and calibration for predicting 28-day mortality. The simplified score retained most of the predictive information of the continuous model and may complement established clinical severity scores using routinely available early laboratory measurements. External validation and clinical-impact studies are required before routine implementation. Full article

Purpose: To evaluate the visual, functional, educational, and mobility outcomes of a comprehensive pediatric low vision rehabilitation (LVR) program and determine whether electronic low vision aids (LVAs) provide additional benefit. Methods: A multicenter prospective observational cohort study was conducted across three tertiary low vision rehabilitation centers in Jordan. Two hundred children aged 6–16 years with moderate-to-severe visual impairment were enrolled. The intervention group (n = 150) received comprehensive multidisciplinary rehabilitation, including optical LVAs, rehabilitation training, educational support, and electronic LVAs when indicated, while the comparison group (n = 50) received routine low vision care without participation in the structured multidisciplinary rehabilitation program. Primary outcomes were LogMAR distance visual acuity (VA) and LV Prasad Functional Vision Questionnaire (FVQ) scores. Secondary outcomes included near VA, reading speed, mathematics performance, and mobility independence. Results: At 12 months, the intervention group demonstrated significant improvement in distance VA from 0.87 ± 0.13 to 0.65 ± 0.11 LogMAR (mean change −0.22; 95% confidence interval [CI], −0.25 to −0.19; p < 0.001), whereas the comparison group showed only minimal improvement. FVQ scores increased significantly from 42.3 ± 8.7 to 76.5 ± 9.1 (+34.2 points; p < 0.001). Within the intervention group, reading speed improved by 25.3 words/minute, mathematics scores by 15.7%, and mobility independence by 32% (all p < 0.001), whereas only minimal changes were observed in the comparison group. Multivariate regression analysis identified electronic LVA use as the strongest independent predictor of functional improvement (β = 0.41, p < 0.001). Conclusions: Comprehensive pediatric low vision rehabilitation improved visual, educational, and mobility outcomes. In an exploratory subgroup analysis, children using electronic low vision aids demonstrated greater functional improvement than those using non-electronic low vision aids. Full article

Background: Bedside prognostication after acute ischemic stroke remains challenging despite the availability of several composite scores, which often demand variables not routinely obtained at admission. Whether the combination of baseline neurological severity and early non-contrast computed tomography findings can support parsimonious, contemporaneous prediction of 3-month functional outcome is an open question, particularly given the well-documented overlap between clinical and imaging measures of stroke extent. Methods: We retrospectively analyzed 432 consecutive adults admitted with confirmed anterior-circulation acute ischemic stroke to a Turkish tertiary care university hospital between January 2022 and December 2025. The primary outcome was a poor functional outcome, defined as modified Rankin Scale (mRS) score 3–6 at 3 months. A prespecified multivariable logistic regression model incorporated three admission variables: baseline National Institutes of Health Stroke Scale (NIHSS) per five-point increment, Alberta Stroke Program Early CT Score (ASPECTS) per one-point increment, and age dichotomized at 65 years. Model performance was assessed with the area under the receiver operating characteristic curve (AUC), five-fold stratified cross-validation, and calibration testing. We additionally performed DeLong tests, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analyses to evaluate the incremental contribution of ASPECTS, and compared the parsimonious model against a comprehensive multivariable model containing ten predictors. Results: At 3 months, 252 patients (58.3%) had poor functional outcome, with 177 deaths (41.0%). Baseline NIHSS emerged as the dominant predictor (adjusted odds ratio [aOR] 4.16 per five-point increase, 95% confidence interval [CI] 2.79–6.22, p < 0.001), whereas ASPECTS retained no independent prognostic value after adjustment (aOR 0.99 per point, 95% CI 0.73–1.34, p = 0.952). Age ≥ 65 years was likewise non-significant (aOR 0.79, 95% CI 0.46–1.37, p = 0.405). The parsimonious model achieved excellent discrimination (AUC 0.904, 95% CI 0.876–0.932; cross-validated AUC 0.899, 95% CI 0.873–0.926) and good overall calibration on internal validation (calibration slope 0.958; calibration-in-the-large 0.009), although the Hosmer–Lemeshow test was significant (p = 0.001), reflecting localized miscalibration in the intermediate-risk range. Adding ASPECTS to a reduced model containing only NIHSS and age produced no meaningful discrimination gain (ΔAUC + 0.0003, DeLong p = 0.50; IDI ≈ 0), consistent with substantial variance sharing between NIHSS and ASPECTS (Spearman ρ = −0.89). A comprehensive model including infarct volume, Glasgow Coma Scale, reperfusion therapy, and comorbidities did not improve discrimination (AUC 0.905) and yielded a worse Akaike information criterion, supporting the sufficiency of the parsimonious model. Conclusions: In this Turkish tertiary center cohort, baseline NIHSS captured most of the prognostic information available at admission, and early ASPECTS added minimal independent value once neurological severity was accounted for. Findings should be interpreted in the context of the high case-mix severity of this referral population; external validation in independent, multicenter cohorts is required before clinical implementation is considered. Full article