European Journal of Heart Failure consensus statement. Heart failure pharmacotherapy for patients with heart failure with reduced ejection fraction and concomitant atrial fibrillation: review of evidence and call to action

Heart failure (HF) and atrial fibrillation (AF) are major global health challenges with rising prevalence and significant morbidity, mortality, and healthcare burden. Despite advances in HF management, AF remains a critical comorbidity that worsens outcomes and requires ad hoc treatment strategies, increasing the risk of non‐adherence and side effects. While rhythm control strategies in AF have gained attention for their prognostic benefits in HF, the pharmacological treatment of HF in patients with AF, including the benefit of rhythm versus rate control, remains underexplored. The relationship between HF and AF lacks sufficient evidence and targeted research to assess the optimal treatment strategies. This narrative review critically examines current HF pharmacotherapy in the context of AF, focusing on the four cornerstone treatments and modifiers of prognosis for HF with reduced ejection fraction: beta‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers/sacubitril‐valsartan, aldosterone antagonists, and sodium–glucose co‐transporter 2 inhibitors. Although these therapies are well‐established in HF patients, their efficacy in patients with concomitant AF requires further prospective investigation. The unique challenges posed by AF, including arrhythmia‐induced remodelling and cardiomyopathy, necessitate a more individually tailored treatment. We also highlight critical knowledge gaps and the need for dedicated clinical trials specifically assessing HF therapies in AF subgroups, such as paroxysmal, long‐standing persistent and permanent AF, and the benefit of heart rate and rhythm control strategies. The future of precision medicine in HF‐AF management lies in bridging these evidence gaps through targeted research and interdisciplinary collaboration

Master statistical analysis plan: attractive targeted sugar bait phase III trials in Kenya, Mali, and Zambia

This manuscript is a master statistical analysis plan for each of three-cluster randomized controlled trials to evaluate the efficacy of attractive targeted sugar baits (ATSB) described in an already published protocol. The master SAP contains an overarching plan for all three trials, which can be adapted to trial-specific circumstances. The primary objective of the trials is to evaluate the efficacy of ATSB in the presence of universal vector control coverage with insecticide-treated nets (ITN) or indoor residual spraying (IRS) after two transmission seasons on clinical malaria incidence as compared with universal vector control coverage with ITN or IRS alone. The primary outcome measure is the incidence rate of clinical malaria, assessed in cohorts aged 12 months to less than 15 years (≥ 5 years to 15 years in Mali) during monthly follow-up visits. The primary unadjusted analysis will be conducted on the intention-to-treat analysis population without adjustment for any anticipated confounding variables. The primary outcome will be analyzed using a multi-level model constructed on a generalized linear model framework with a Poisson likelihood and a log link function. Random intercepts will be included for each study cluster and a fixed effect for study-arm. The analyst will be blinded to study arm assignment. Several secondary outcomes will be analyzed, as well as a pooled analysis (individual patient data meta-analysis) across the three trial sites. Additionally, a standard meta-analysis is expected to be conducted using combined data from all sites

Contemporary challenges, needs and opportunities for emerging behavioral nutrition and physical activity researchers: a mixed-methods study

Background: Emerging researchers commonly navigate challenging and insecure working environments. Yet the impact on emerging behavioral nutrition and physical activity researchers is unknown. Hence, we sought to identify the contemporary challenges, needs, and opportunities for emerging behavioral nutrition and physical activity researchers. Methods: We employed a convergent mixed methods design, using an online survey. Participants completed socio-demographic questions, and rated the impact of personal and professional challenges, development needs with descriptive elaborations, and existing and desired professional development opportunities. Data analysis included thematic analysis of open-ended responses and descriptive statistics and multiple linear regressions of quantitative data. Integration of quantitative and qualitative data was through narrative and weaving. Results: Emerging researchers (n = 111, 57% graduate students) from over 20 countries participated. Synthesised results related to all four domains of the Researcher Development Framework. Specifically, we identified 8 themes relating to conducting research (domain 1); physical and mental health, and networking (domain 2); grant funding, and employment opportunities (domain 3); and leadership, supportive work networks, and communication with non-academic audiences (domain 4). Financial comfort was a predictor of both professional and personal development needs. Conclusions: Our study highlights the multiple challenges emerging researchers face, with increasing demands of collective efforts to support sustainable career development. Our findings serve as a foundation for promoting an inclusive and equitable research environment for emerging researchers. Though individual-level solutions may help, greater impact is likely from systemic changes to increase job security, career progression pathways and availability of ECR-specific funding

A full-length 16S survey using Nanopore sequencing to uncover the bacterial microbiome in Ixodes ricinus ticks from a single UK woodland, collected across three springs (2019-2021)

Ixodes ricinus is a key vector of several bacterial pathogens, including Borrelia and Rickettsia species. To assess bacterial prevalence and diversity, we characterised the microbiome of ticks collected from a single UK woodland, comparing different woodland types, life stages (adult male, female, and nymph), and sampling years (spring 2019–2021). Unlike previous studies that target short regions of the 16S rRNA gene, we used Nanopore sequencing to generate full-length 16S reads, allowing for higher taxonomic resolution. Our results showed significant microbiome differences across life stages, but not by woodland type or year. Rickettsia was the most abundant taxon, with prevalence varying by life stage and year. Borrelia was present in all life stages but absent in 2021 samples. Anaplasma abundance varied significantly by year and life stage, peaking in nymphs from Pine woodland. Bartonella was found across all woodland types, with the highest abundance in nymphs from Oak-dominated areas

First reported case of <i>Capnocytophaga canimorsus</i> pituitary abscess

Background: Capnocytophaga canimorsus is a rare human pathogen, typically associated with exposure to dog saliva. It is a slow-growing, Gram-negative anaerobe, with clinical manifestations being sepsis, meningitis, or endocarditis. Pituitary abscesses are themselves uncommon, accounting for &lt;1% of all pituitary lesions, and are often misdiagnosed preoperatively due to their nonspecific presentation and frequent culture negativity. We present the first documented case of a pituitary abscess caused by C. canimorsus, highlighting the diagnostic value of 16S ribosomal RNA (rRNA) polymerase chain reaction (PCR) when conventional microbiological methods are inconclusive. Case Description: A 69-year-old woman presented following a collapse with symptoms including hypernatremia, new-onset atrial fibrillation, and thyrotoxicosis. Initial sepsis workup–including cerebrospinal fluid analysis–suggested possible encephalitis. Brain magnetic resonance imaging revealed a cystic, contrast-enhancing pituitary lesion with central diffusion restriction. The patient underwent endoscopic transsphenoidal surgery, with intraoperative findings consistent with abscess formation. Despite direct culture yielding no growth, 16S rRNA PCR of the aspirated fluid identified C. canimorsus. Histology revealed xanthogranulomatous inflammation. The patient was treated with a 6-week course of intravenous ceftriaxone, with subsequent clinical and radiological recovery. Importantly, she had no known exposure to animal bites or saliva and no underlying immunosuppressive condition. Conclusion: This case is the first to implicate C. canimorsus in the formation of a pituitary abscess, expanding the spectrum of its potential clinical presentations. It underscores the diagnostic limitations of conventional microbiological techniques in deep-seated intracranial infections and supports the role of 16S rRNA PCR as a critical adjunct when routine cultures are negative. Clinicians should maintain a high index of suspicion for atypical pathogens in sellar lesions and consider molecular diagnostics early, particularly when histopathology reveals inflammatory features suggestive of infection without an identifiable organism

An automation framework for clinical codelist development validated with UK data from patients with multiple long-term conditions

Background: Codelists play a crucial role in ensuring accurate and standardized communication within healthcare. However, preparation of high-quality codelists is a rigorous and time-consuming process. The literature focuses on transparency of clinical codelists and overlooks the utility of automation. Methods: (Automated Framework Design and Use‑case: DynAIRx) Here we present a Codelist Generation Framework that can automate generation of codelists with minimal input from clinical experts. We demonstrate the process using a specific project, DynAIRx, producing appropriate codelists and a framework allowing future projects to take advantage of automated codelist generation. Both the framework and codelist are publicly available. DynAIRx is an NIHR-funded project aiming to develop AIs to help optimise prescribing of medicines in patients with multiple long-term conditions. DynAIRx requires complex codelists to describe the trajectory of each patient, and the interaction between their conditions. We promptly generated ≈214 codelists for DynAIRx using the proposed framework and validated them with a panel of experts, significantly reducing the amount of time required by making effective use of automation. Results: The framework reduced the clinician time required to validate codes, automatically shrunk codelists using trusted sources and added new codes for review against existing codelists. In the DynAIRx case study, a codelist of ≈14000 codes required only 7-9 hours of clinician’s time in the end (while existing methods takes months), and application of the automation framework reduced the workload by &gt;80%. Conclusion: This work examines current methodologies for codelist development and the challenges associated with ensuring transparency and reproducibility. A key benefit of this approach is its emphasis on automation and reliance on trusted sources, which significantly lowers the workload, minimizes human error, and saves substantial time, particularly the time needed from clinical expert

Myelin mapping in patients with rheumatoid arthritis-related fatigue: a TBSS-MTR study of integrity

Rheumatoid arthritis (RA) patients frequently report fatigue, which notably diminishes their quality of life. Emerging research points to a correlation between inflammation-induced fatigue and brain structural alterations. This study evaluates the variance in myelin integrity among patients with RA-related fatigue, investigating the potential of magnetization transfer ratio (MTR) as a biomarker, in comparison with healthy controls. A prospective cohort analysis was conducted comprised 60 RA patients with fatigue, categorized into active (  = 30) and non-active (  = 30) disease states, alongside 20 healthy controls (HC). A 3 Tesla MRI system was utilized to perform diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) sequences. MTR maps were generated using in-house MATLAB code and co-registered with DTI data using SPM8. These were then analyzed through tract-based spatial statistics (TBSS) with threshold-free cluster enhancement (TFCE) and corrected for multiple comparisons. MTR values were assessed using Randomize from the FSL toolkit, applying a general linear model (GLM) for voxel-wise analysis and TFCE for p-value generation, with family-wise error (FWE) control (  &lt; .05) for multiple comparisons. The RF group exhibited significantly lower myelin integrity (TFCE, &lt; .05) compared to HCs, particularly in the middle cerebellar peduncle and splenium of the corpus callosum, with no marked difference between active and non-active RA disease statuses. There is a discernible disparity in myelin integrity between RA patients with fatigue and healthy individuals, suggesting microstructural white matter alterations that are congruent with DTI findings. This study reveals that rheumatoid arthritis (RA) patients with fatigue exhibit significantly lower myelin integrity, particularly in the middle cerebellar peduncle and splenium of the corpus callosum, compared to healthy controls. Notably, this finding was consistent regardless of the active or non-active status of the RA disease, highlighting persistent white matter alterations in this patents cohort. The research demonstrates that magnetization transfer ratio (MTR) imaging can effectively map microstructural changes in RA patients with fatigue, suggesting its potential as a biomarker for assessing white matter integrity in this condition. While it does not establish a direct causal relationship, it provides valuable insights into the role of MTR mapping in understanding brain alterations in patients with fatigue-related RA

Transforming Primary Care in Scotland. New Models of Care in General Practice: learning from Scotland, Denmark and England

Report on a meeting held in September 2025 at the Dovecot Studios in Edinburgh. A meeting was held on the 1st September 2025 at the Dovecot Studios in Edinburgh to discuss primary care transformation in Scotland and new models of care in general practice. Speakers from Scotland presented recent evaluations of the 2018 Scottish GMS contract, and speakers from Denmark and England presented recent developments in their countries. This was then followed by break-out groups to discuss key learning and next steps

Autonomous helicopter shipboard recovery flight control design based on tau theory

This paper develops an autonomous flight control system to alleviate the heavy workload involved in managing multiple emergencies during manned helicopter shipboard recovery operations. It can operate either partially or fully autonomously preserving the pilot's familiar guidance strategies while allowing pilot intervention when necessary. First, a simulation model of helicopter recovery flight is developed integrating the impacts of ship airwake turbulence and ship motions. A comprehensive flight control system is subsequently established to facilitate multi-mode and multi-response-type capabilities for manned helicopters. Then, the tasks of ‘Precision Hover’ and ‘Vertical Maneuver’ are employed as examples to demonstrate the methodologies for deceleration-to-hover and end-to-end trajectory planning utilizing bio-inspired tau theory. Furthermore, precision trajectory tracking control laws are formulated. Finally, numerical simulations of helicopter recovery flight are conducted to assess the efficacy of the flight control system. The results indicate that the tau theory-based planning results in efficient and smooth helicopter maneuvers, particularly in acceleration, deceleration, and transitions, which mirrors real pilot strategies. The trajectory tracking control laws effectively follow the prescribed trajectory and compensate for ship movements, with robust turbulence rejection capabilities

FRC Quality Inspections and Materiality Judgment

This study examines the impact of Financial Reporting Council (FRC) inspections on audit materiality decisions. Using data from listed UK companies between 2017 and 2022— following the adoption of ISA 700—we investigate whether FRC inspections influence materiality thresholds in both inspected and non-inspected audit engagements. Our results indicate that auditors reduce materiality following an inspection. However, this adjustment is not accompanied by improvements in audit quality, suggesting symbolic compliance. We also find spillover effects: non-inspected engagements within inspected offices similarly reduce materiality level, indicating that the informational impact of FRC inspections extends beyond the engagements directly subject to review. Our findings contribute to the literature on regulatory oversight, audit quality, and materiality, highlighting the dual role of inspections as both a signaling and disciplinary mechanism. Policy implications suggest that while auditors respond to regulatory scrutiny through materiality adjustments, these changes may not result in substantive quality enhancements