Impact of Chronic Kidney Disease on Outcomes With Drug‐Coated Balloons Versus Drug‐Eluting Stents: Insights From the REC‐CAGEFREE I Trial

Background Data regarding the efficacy and safety of drug‐coated balloons (DCBs) versus drug‐eluting stents (DES) in patients with chronic kidney disease (CKD) remains limited. Aims To assess the prognosis of DCB versus DES in patients with and without CKD. Methods REC‐CAGEFREE I was an investigator‐initiated, non‐inferiority trial conducted at 43 sites in China, which randomized 2272 patients to paclitaxel‐coated balloons with the option of rescue stenting (DCB group) or second‐generation sirolimus‐eluting stents (DES group) for treating de novo lesions, regardless of vessel diameter. In this pre‐specified subgroup analysis, patients were stratified based on the presence of CKD (kidney damage or estimated glomerular filtration rate < 60 mL/min per 1.73 m²) at baseline. The primary outcome was the device‐oriented composite endpoint (DoCE; including cardiovascular death, target vessel myocardial infarction, and clinically and physiologically‐indicated target lesion revascularization) at 2 years. Results Of 2272 patients enrolled, 203 (8.9%) had CKD, with 95 and 108 treated with DCB and DES, respectively. At 2 years, the risk of DoCE was significantly higher in CKD versus non‐CKD patients (22/203 [10.9%] vs . 88/2069 [4.3%], HR IPTW : 2.14, 95% CI: 1.13−4.07, p = 0.022). There was no significant interaction between CKD and treatment allocation ( p interaction = 0.352). Among CKD patients, DoCE occurred in 12/95 (12.7%) and 10/108 (9.3%) patients in the DCB and DES groups (HR IPTW : 1.57, 95% CI: 0.66−3.71, p = 0.317), respectively. Among non‐CKD patients, DoCE occurred in 60/1038 (5.8%) versus 28/1031 (2.7%) patients in the DCB and DES groups (HR IPTW : 2.27, 95% CI: 1.38−3.72, p = 0.002), respectively. Conclusion Patients with CKD had worse outcomes compared to those without. DCBs were associated with a higher risk of DoCE than DES, irrespective of CKD status. Trial Registration Unique Identifier: NCT04561739; URL: https://www.clinicaltrials.gov

Network meta-analyses in IBD: pitfalls and promise for clinicians

Network meta-analysis (NMA) has seen an exponential rise in use over the past two decades, with publications in gastroenterology increasingly using this approach to inform guidelines, such as for colorectal cancer surveillance and inflammatory bowel disease management. However, alongside this growth comes a parallel risk: that methodological complexity and statistical misinterpretation may lead to misuse of the findings. As this paper outlines, NMAs can unintentionally mislead when clinical certainty is obscured by statistical hierarchy. To address these limitations, we present the promise of NMAs and a novel way of presenting NMA results, the GORDON Plot (Grade Of Results Diagram Of Network meta-analysis)

Blended Intelligence: A Framework for How Professionally Diverse Multi-disciplinary Teams Solve Problems in Elite Sport

Multi-Disciplinary Teams (MDT’s) have become an important requirement of high-performance sport. Practitioners from diverse professional backgrounds work in silo and concert to deliver performance support services in the pursuit of enhanced individual athlete health, well-being and optimised performance outcomes. Whilst the MDT approach and performance support is well established there is a relatively limited body of research advocating for how these teams operate in practice and what they attend to. Anecdotally, practitioners and MDTs are expected to collaboratively solve performance problems and yet, to date, despite the terms common use and widespread reference across the literature, what this looks like in practice, why (and if) it is required and how teams go about this, is underdeveloped from a research perspective. This thesis sets out to critically examine and better articulate the role of MDTs in high-performance sport focusing on their problem-solving and decision-making processes. The research aim is to explore how individual practitioners, MDTs, and high-performance leaders conceptualise and execute problem-solving within high-performance environments. The output of this thesis is a contemporary problem-solving framework that can be adopted or deployed by practitioners, teams, leaders and organisations to rationalise approaches to problem-solving, creating conditions to better access and leverage the expertise of the MDT and direct it appropriately to the requirements within the context. This consequently answers how high-performance MDT’s solve problems in high-performance sport. A pragmatic research design (Giacobbi et al., 2005) including both Likert scale surveys visualised through dual axis heat maps and a constructivist, qualitative methodology was employed using reflexive thematic analysis (Braun & Clarke, 2019). The research adopted an inductive, data-driven approach, emphasising the active role of the researcher in knowledge production. Data were collected through surveys, focus groups and semi-structured interviews with high-performance sport practitioners and leaders. Heat maps were created to show patterns in practitioner responses whilst thematic analysis was used to identify patterns and emergent themes related to MDT collaboration and problem-solving. Findings suggest that a continuum of problem-solving approaches was identified, ranging from routine, intuitive decision-making to deliberate, innovative problem-solving. Despite the increasing emphasis on cognitive flexibility, many practitioners default to discipline-specific, pre-established solutions rather than interdisciplinary collaboration and novel problem-solving. While MDTs are expected to collaborate, they often function as loosely connected groups of specialists. Key barriers that were identified to collaboration included ambiguity in roles and expertise, professional territoriality, and the absence of structured approaches to problem-solving and decision-making. Leaders in high-performance sport face systemic, structural, and interpersonal complexities that create ‘wicked problems.’ While cognitive diversity is crucial for effective problem-solving, leaders lack clear frameworks to harness this diversity. The research highlights the necessity for structured problem-solving methodologies, such as design thinking, to enhance MDT effectiveness and proposes a problem-solving framework for individuals, teams and leaders. The body of work advances theoretical understanding by contributing to the literature on multi and interdisciplinary team dynamics, problem-solving frameworks, and applied cognition in high-performance sport. From an applied perspective, it highlights the importance of ‘T-Skills’ (meta-cognitive, interpersonal, and critical thinking skills) in MDT training and professional development. The findings suggest reframing MDTs as active problem-solving entities rather than passive collections of expertise, emphasising structured collaboration, leadership clarity, and integrated decision-making or problem-solving frameworks. The research underscores the need for high-performance sport organisations to implement structured problem-solving methodologies to maximise MDT effectiveness. Implications for Practice: 1. Developing structured collaboration frameworks to optimise MDT integration. 2. Enhancing cognitive flexibility training for practitioners to bridge the gap between formal education and applied problem-solving. 3. Implementing leadership strategies that emphasise cognitive diversity and structured problem-solving. This thesis provides a foundation for future research on the operationalisation of problem-solving within MDTs in high-performance sport, with implications for training, leadership, and organisational effectiveness

Customized batch fabrication of highly sensitive thin capacitive soft sensors based on high dielectric constant composite polymers

Soft capacitive sensors are essential for emerging technologies in soft robotics, wearable electronics, and human-machine interfaces. However, scalable, customizable, and cost-effective fabrication methods remain a challenge. In this work, we present a novel batch fabrication approach for producing thin, highly sensitive soft capacitive sensors using high-dielectric-constant composite elastomers. Our method enables the rapid production of large-area sensor sheets that can be precisely patterned into arbitrary geometries using laser cutting, eliminating the need for complex microstructuring or lithography. These sensors are composed entirely of soft layers, including carbon nanofiber-based electrodes and dielectric layers enhanced with barium titanate (BTO) or titanium dioxide (TiO2). We demonstrate a gauge factor of 2.83 and a sensitivity of 0.55 kPa⁻¹, with low hysteresis and broad pressure range. Furthermore, we present the integration of these sensors into a tactile array for wearable pressure sensing, highlighting their potential in soft robotics and health monitoring systems. This work offers a scalable and versatile platform for next-generation soft sensing technologies

Naringenin-encapsulated nano-cochleate hydrogel for topical delivery: cellular anti-inflammatory activity and dermatokinetic profiling

Naringenin (NR) is a plant-based flavonoid with poor aqueous solubility, which is indicated for the treatment of psoriasis due to its strong antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the non-steroidal NR-loaded nanocochleate hydrogel (NR-NC-G) for its skin permeation, safety, and efficacy in the treatment of psoriasis. First, nanoliposomes (NR-LIPO) were prepared and further chelated using calcium chloride to transform them into nanocochleates (NR-NCs). NR-NCs exhibited rolled sheet-like nanosized particles with a hydrodynamic diameter of approximately 160–170 nm, an encapsulation efficiency of 81–82%, and good colloidal stability, as indicated by a ζ-potential of −27 mV. To achieve a local reservoir-like action, nanocochleates were loaded into a hydrogel comprising of combination of Carbopol 934P and sodium alginate. NR-NC-G was characterised for its physical and rheological characteristics, and it exhibited uniform drug loading, long-term stability, and the ability to scavenge reactive oxygen species (ROS), as validated by various antioxidant assays. Furthermore, NR-NC-G reduced cellular ROS levels, nitrate accumulation, and mitochondrial healing ability in a lipopolysaccharide-stimulated RAW264.7 inflammation model, thereby proving its enhanced antioxidant and anti-inflammatory effects. The ex vivo skin permeation and dermatokinetic studies showed that NR-NC-G exhibited high permeation across the excised skin of BALB/C mice. The dermatokinetic studies showed that topical application of NR-NC-G provided 3.43 and 3.34-fold greater Cmax and AUC0−t in the epidermal layer, respectively, compared to the bulk NR solution. Overall, this novel nanoformulation enhances ROS scavenging capacity, improves cellular uptake, enhances skin permeation and retention, and suggests potential applications for treating psoriasis

New Methodological Directions for Involving Children in Past Life Memories Research

Past life memories in children have been studied extensively through standard qualitative and quantitative methodologies. Research to date has produced valuable data to support how we understand children’s past life memories. Children are the primary source for data collection in past life research, as the producers/facilitators of memories. Despite this, children tend to be researched on rather than with, through adult-centric approaches. In this article, we include a case study example of spontaneous past life and in-utero memories of a 6-year old child. The case study example is taken from a parent study, ‘Investigating Extra Sensory Experiences of Children from Various Cultural Backgrounds’. Through the article, we demonstrate how using creative research methods and sensory ethnography can generate important knowledge from children about their own past life memories. We include results from the parent study that show past life memory data from children, parents and professionals. We propose involving children as active agents in past life memory research and argue for new directions in the field of PLM through creative and child-friendly research

Impact of COVID-19 pandemic on characteristics, extent, and trends in child maltreatment in 34 Euro-CAN COST Action Countries: a scoping review of the literature

Background The COVID-19 pandemic intensified known risk factors for child maltreatment (CM). Yet, globally inconsistent trends were reported. Little is known about CM trends across Europe, given varying surveillance systems. Objective This scoping review systematically examined evidence on CM trends during the pandemic in 34 European countries in the COST Action Euro-CAN network. Participants and Setting. CM (physical, sexual, psychological abuse, neglect, and online harms) across various settings (population, healthcare, social care including NGOs, child protection services, judicial/police). Methods We searched PubMed, EMBASE, PsycINFO, Scopus, Web of Science, OPENGREY, and Google Scholar (January 2020–November 2024). Eligible studies included primary research and systematic or narrative reviews. Two reviewers independently screened and extracted data. Findings were synthesized narratively by CM type, sector, country, and study design, and reported following the PRISMA-ScR. Results Of 4658 records screened, 87 records were included (72 primary research, 15 reviews). Most studies used quantitative methods (n = 64, 89 %) and reported healthcare and population-based data. Physical abuse was the most frequently reported type (n = 42, 58 %). Results were mixed, showing increase, decrease, or no change in CM. The most consistent signal was an increase in physical abuse identified in French hospital datasets. Qualitative studies highlighted concerns about children's safety during school closures and changes in referral patterns. Conclusion This is the first comprehensive review of CM trends in Europe during the pandemic, covering the longest timeframe. Fragmented evidence reflects heterogeneous definitions, reliance on institutional data and underrepresentation of vulnerable groups. Findings stress for harmonised definitions and resilient surveillance systems

Development and Impact of Virtual Reality-Based Training for the Radial Forearm Free Flap: A Multicentre Prospective Feasibility Study

Introduction Surgical education faces growing challenges due to reduced theatre access, variable supervision and limited procedural exposure, particularly for complex reconstructive operations such as the radial forearm free flap (RFFF). Virtual reality (VR) offers an opportunity to deliver immersive, standardised surgical training unconstrained by geography or theatre availability. This study evaluates the effectiveness of a VR-based teaching intervention in improving procedural confidence and anatomical understanding of the RFFF. Methods A prospective multicentre feasibility study was conducted across 10 UK medical schools and one NHS trust. Participants completed a 60-minute workshop including a 360° VR simulation of the RFFF procedure and a VR anatomical exploration session. Pre- and post-workshop surveys assessed procedural confidence, anatomical understanding and user experience using validated Likert-scale tools. Results 141 participants completed both pre- and post-workshop assessments. The majority were undergraduate medical students (90.8%), of whom 93.8% had never previously observed an RFFF. Procedural confidence improved significantly from a median of 2 (IQR 2) to 4 (IQR 1) post-workshop (p < 0.001), with greater improvements in those without prior exposure. Anatomical confidence also increased from 3 (IQR 1) to 4 (IQR 2) (p < 0.001), particularly among pre-clinical medical students. Participants rated the module highly for educational value, immersion and clarity of anatomical and procedural content. Conclusion The VRiMS RFFF teaching module significantly improves learner confidence and anatomical understanding, particularly among early-stage trainees. These findings support the use of VR-based platforms as effective and scalable adjuncts to existing surgical education