This study aims to compare the dosimetric accuracy between the enhanced leaf model (ELM) in Eclipse V18.0 and the traditional multileaf collimators (MLCs) modelling in Eclipse V16.1 for volumetric modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT) treatments. The objective is to evaluate whether the ELM improves dose calculation accuracy and agreement with measurements in clinical practice.

A retrospective analysis of 30 patients was conducted, categorized into Head-and-Neck (H&N), pelvic and lung SBRT groups. Treatment plans were created using the Acuros XB algorithm in both Eclipse versions. Gamma index pass rates for 1%/1 mm, 2%/2 mm and 3%/3 mm criteria were calculated using portal dosimetry for patient-specific quality assurance. Validation of MLC modelling was performed using closed leaf fields, sweeping gap fields, and the Picket Fence (PF) test across 6MV, 10MV, 6FFF and 10FFF photon energies.

Eclipse V18.0 demonstrated statistically significant improvements (p < 0·05) in dosimetric accuracy and gamma index pass rates across all photon energies and test conditions. In fully blocked fields, dose discrepancies reduced from 1.1% in V16.1 to 0.49% in V18 for 6MV. For the 6 mm sweeping gap test, discrepancies reduced from 1.19% to 0.31% for 6MV. The 1%/1mm gamma pass rates improved from 70% to 91.8% for H&N cases and from 82.4% to 87.3% for SBRT cases.

The ELM in Eclipse V18.0 significantly improves dose calculation accuracy and treatment deliverability, supporting its adoption in clinical practice for VMAT and SBRT to achieve better treatment accuracy and outcome.

Exposure to workplace bullying is associated with an increased risk of mental health conditions, yet it is debated whether the association is causal. This study aims to address this by examining whether onset of workplace bullying is associated with initiating treatment with psychotropic medication, here used as a proxy measure for onset of common mental disorders.

We used two longitudinal datasets from Sweden and Denmark (mean age: 47.4, women: 52.8%), combined with national registry data on psychotropic medication purchases. Using a target trial approach, the study population (N = 25 309) consisted of employees free of workplace bullying and psychotropic medication use at baseline. We used Cox proportional hazards regression (adjusted for sociodemographic variables, depressive symptoms and psychosocial work characteristics) to assess the association between onset of exposure to workplace bullying and incident treatment with psychotropic medication during 2 years.

In total, 1490 individuals (5.9%) experienced onset of workplace bullying. Bullying onset was associated with incident treatment with any psychotropic medication (HR: 1.42, 95% CI 1.15–1.77, model adjusted for sociodemographic variables). This association was attenuated in the fully adjusted model (HR: 1.24, 95% CI 0.99–1.53). In analyses focusing on antidepressant treatment, the estimates were stronger (HR: 1.55, 95% CI: 1.15–2.09, fully adjusted model). The results further demonstrated an exposure–response relationship, such that higher frequency of bullying exposure was associated with an increased risk of initiating any psychotropic treatment and antidepressants.

Individuals experiencing onset of workplace bullying were at higher risk of starting antidepressant treatment within 2 years. This is the first study showing that onset of workplace bullying can contribute to the development of mental health conditions requiring medical treatment. These results underline the importance of preventive interventions that reduce workplace bullying.

The specialties of ENT and anaesthesia have always had a unique relationship because of their longstanding history of co-operation over the shared airway.

This historical review narrates how the modern practice of ENT surgery has developed following advances in anaesthetic techniques, as well as inspiring them.

From the earliest use of anaesthetic gases by Long, Wells and Morton, to their rapid adoption for use in tonsil and cleft palate surgical procedures, ENT surgeons were early beneficiaries of this new technology. The demands of surgery for facial injuries in World War II was a driver for anaesthetic advances, and Ivan Magill reinvented the specialty in response.

Further developments in managing the shared airway, including jet ventilation, total intravenous anaesthesia and awake fibre-optic intubation, have shaped the modern ENT operating theatre, and highlight the vital collaboration between ENT and anaesthesia over the past 150 years.

This study aims to explore the perspectives on disinvestment of low-value care and interventions in Malaysia’s healthcare system, with a focus on establishing the criteria for assessing disinvestment candidates, identifying potential barriers, and proposing strategies to improve the acceptance and effective implementation of disinvestment.

Between March and May 2023, we conducted online, semistructured interviews with seventeen Malaysian healthcare stakeholders with different professional roles at various levels of governance and decision making. Participants were recruited through a mix of purposive and snowballing sampling. Interviews were transcribed verbatim and analyzed using inductive thematic approach in Atlas.ti.

We identified four major themes: disinvestment as a catalyst for efficient resource allocation; disinvestment as a justifiable way of cutting budgets; challenges and barriers in implementation; and strategies for value-based assessment and effective implementation. Stakeholders viewed disinvestment both optimistically and skeptically in terms of its implementation but were unanimous in including equity as a key component in decision making. Practical challenges and uncertainty among healthcare professionals emerged as significant barriers to implementing disinvestment initiatives in Malaysia.

Malaysian stakeholders viewed disinvestment as both an opportunity to improve resource allocation and a source of concern due to potential negative consequences and system readiness. This study identified strategies to support value-based assessment and implementation, underscoring the need for accountability and collaboration. Although current disinvestment efforts in Malaysia remain limited and undocumented, the thematic framework developed offers transferable insights and a structured lens for assessing readiness. These stakeholder-derived themes can guide other countries in designing transparent, equitable, and context-sensitive disinvestment processes.

A standardized framework for evaluating Emergency Medical Teams (EMT) deployments is currently lacking. This study aimed to identify evaluation practices and elucidate stakeholder perspectives on evaluating EMT deployments.

Qualitative interviews were conducted with seventeen participants from all World Health Organization regions, including EMT members, researchers, funders, EMT deploying organizations, and host governments. Thematic analysis using Braun and Clarke’s 6-step process was applied to generate data-driven codes and themes.

Participants generally agreed on the importance of evaluating EMT deployments and sharing lessons learned to establish best practices. Participants recommended that evaluations be carried out externally for objectivity, incorporating both qualitative and quantitative data. They highlighted that voices of local stakeholders are essential but often overlooked. Participants identified evaluation areas which could be used to develop a comprehensive evaluation framework, which included leadership, partner coordination, information management and planning, health operations and technical expertise, operations support and logistics, and finance and administration.

Stakeholders generally recognized the value of establishing a standardized evaluation framework for EMT deployments to enable sharing of best practices and learning for improvement. Further research should prioritize identifying evaluation priorities, with next steps being piloting in both training and deployment settings.

Although often associated with ageing, disability is becoming increasingly prevalent among young adults. While disability can pose a substantial psychological burden for young adults on critical pathways to establish the foundations for their future, the mental health risks faced by this population remain underexplored.

This study aimed to (1) assess the association between disability – including its presence, severity and type – and the risk of depressive and anxiety disorders, and (2) examine whether this association varies across sociodemographic factors, health behaviours and comorbidities in a young adult population.

We conducted a population-based cohort study using linked data from the National Disability Registry and the National Health Insurance Database of South Korea. A total of 6,058,290 individuals aged 20–39 years who underwent health check-ups between 2009 and 2012 were followed through 2022. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for depressive and anxiety disorders.

Individuals with disabilities had significantly higher risks of depressive (aHR: 1.58, 95% CI: 1.55–1.60) and anxiety disorders (aHR: 1.50, 95% CI: 1.42–1.59). Increased risks were consistently observed across various disability types with the highest risk observed for mental health-related disabilities in depression (aHR: 4.98, 95% CI 4.62–5.37) and epilepsy-related disabilities in anxiety disorders (aHR: 12.05, 95% CI 8.73–16.63). Subgroup analyses revealed stronger associations among individuals in their 20s, low-income groups, non-smokers and those abstaining from alcohol, compared to their respective counterparts.

Young adults with disabilities, a population that has been relatively overlooked in policy discussions, warrant greater policy attention in relation to their mental health.

Growing studies have reported an elevated risk of violence in patients with depression, yet the neurobiological underpinnings remain poorly understood. The present study explored the resting-state electroencephalogram (EEG) features in major depressive disorder (MDD) patients with violent offenses to identify potential neurological markers for violence prediction and intervention.

Twenty-nine MDD patients who committed violent offenses (violent depression [VD] group), 27 MDD patients without violent behaviors (nonviolent depression [NVD] group), and 25 healthy controls (HCs) were included. Resting-state EEGs were recorded for at least 5 min. EEG microstates, functional connectivity (FC), and graph theory metrics were analyzed and compared between groups.

First, the VD group had increased microstate A, more microstates A-B transition, but lower microstates B-D and C-D transition. Second, the VD group exhibited two enhanced functional brain networks compared to NVD and HCs, and three weakened functional brain networks compared to HCs, which were primarily distributed in the frontal and frontoparietal networks. Third, the VD group specifically exhibited reduced nodal efficiency (aNe) in the superior parietal lobe and increased aNe in the middle occipital gyrus.

MDD patients with violent offenses exhibited alterations in EEG microstates, FCs in the frontal lobe and frontoparietal network, and disrupted aNe in specific parietal and occipital lobes. These alternations are closely associated with deficits in emotional regulation, executive function, and inhibitory control, which may subserve as potential neurobiomarkers for violence risk assessment in patients with depression.

Our objective was to identify key patterns and discuss the lessons learned from the use of real-world data (RWD) in the cost-effectiveness analyses (CEAs) of innovative health products (IHPs) as assessed by the French National Authority for Health from January 2016 to May 2023.

A retrospective analysis was conducted on the use of RWD in the CEAs of IHPs. Our material included HAS assessments of CEAs and manufacturers’ technical reports. The RWD studies were classified into eight categories, and a specific template was constructed to report and discuss their use in terms of predefined methodological aspects.

In all, 88 percent (129/147) of the CEAs integrated RWD studies. Retrospective cohorts were the most frequently used kind of study in the CEAs, while prospective cohorts were mainly used to identify the analyzed population and to externally validate models. We identified opposing temporal trends in the use of cohort studies versus registries. Approximately 8 percent (10/129) of the CEAs could be adjudged as invalidated due to major limitations regarding RWD use (e.g., lack of relative effectiveness).

We learned several lessons from the use of RWD in the HAS assessments of the CEAs of IHPs. Retrospective cohort studies were the most commonly used RWD source to populate CEA parameters of the CEAs regardless of the type of IHP, and their use has increased over time. The implementation of good practices for the use of RWD studies should improve the role of RWD in economic modeling and address uncertainties surrounding CEAs.

Borderline personality disorder (BPD) is characterised by instability in interpersonal relationships, self-image, and affect. Dysregulated negative emotional processing involving prefrontal and limbic circuits is considered a neural basis of BPD. However, it remains unclear how prefrontal modulation of social decision-making in BPD differs from non-psychiatric controls.

To investigate social decision-making in response to unfairness, we conducted an functional magnetic resonance imaging study involving adults with a diagnosis of BPD (n = 77) and healthy controls (HCs; n = 60). Using an inequality aversion model, we derived parameters of social norm adaptation and inequality sensitivity from behavioural data during a modified ultimatum game designed to measure responses to offer norm shifts. Valence and salience signal-processing models isolated prefrontal activations related specifically to social norm prediction error.

Cumulative rejection rates indicated that individuals diagnosed with BPD exhibited consistent differences in overall offer rejection rates but similar adaptation to HC when responding to norm shifts. Preservation of normative social decision-making in BPD (no significant difference vs. HC) was evident in regression analyses of rejection rates and in reinforcement learning models, with no group differences observed in Rescorla–Wagner parameters. Furthermore, we detected no significant neural activation differences between groups, although ventral regions of the medial prefrontal cortex were preferentially involved in valence-related rather than salience-related polynomial modulation.

Contrary to our hypotheses, neither behavioural nor neural responses to economic norm violations differed significantly between BPD and HC groups across one-shot games involving unknown partners. Future research could explore whether more personally relevant or higher-stress social contexts elicit differences not observed here.

Bystander cardiopulmonary resuscitation (CPR) has been shown to be associated with increased rates of survival from non-traumatic out-of-hospital cardiac arrest (OHCA). GoodSAM is a platform integrated into the computer-assisted dispatch system. The software allows the telecommunicator to send a link to the caller’s smart phone. Once activated, the telecommunicator can see and hear the patient, and obtain breathing and heart rates using the camera and microphone on the caller’s phone. The telecommunicator can use the platform to identify cardiac arrest and provide real-time compression feedback. It was hypothesized that telecommunicator use of video telecommunication would be associated with increased rates of pre-arrival CPR.

This was a retrospective review of all cardiac arrest resuscitations performed from July 2021 through February 2022 in the San Antonio Fire Department (SAFD) Emergency Medical Services (EMS) system – the seventh largest city in the United States. Data source was the Office of the EMS Medical Director (OMD) Cardiac Arrest Registry. Inclusion criteria included cardiac arrests for which resuscitation was attempted. Exclusion criteria were cardiac arrest was witnessed by EMS personnel, or missing data. Dataset included: location of arrest, presumed etiology of the arrest, if dispatch CPR instructions were given; caller compliance; type of CPR performed; who witnessed the arrest; and who performed the CPR prior to EMS. Patients were dichotomized as to whether video telecommunication was used by the paramedic telecommunicator. A case was recorded as having received pre-arrival CPR if the initial CPR was performed by anyone other than the responding unit.

A total of 779 cases were included in the study. Primary outcome, in the cases where video telecommunication was utilized, 46/74 (62%) received pre-arrival CPR, versus 324/705 (46%) without the use of video telecommunication, with an overall difference of 16.2% (95% CI, 4.6% to 27.9%; P = .008). When using video telecommunication, a larger proportion of the persons performing pre-arrival CPR were family members when compared to the cases where video telecommunication was not used (35% versus 17%).

Using video telecommunication to perform paramedic clinical dispatch telemedicine was associated with an increased rate of pre-arrival CPR. Further research will be required to show outcome-related results to determine if dispatch video and audio telemedicine can be used to increase survival in patients suffering OHCA.