Fast delivery of intravenous thrombolysis (IVT) and transportation to a comprehensive stroke center (CSC) are paramount for primary stroke centers (PSCs). We investigated outcomes and workflow times of patients treated with IVT at PSCs.

This is a secondary analysis of the AcT trial, a multicenter, phase-3, randomized, controlled, noninferiority trial comparing tenecteplase with alteplase in patients with acute ischemic stroke within 4.5 hours of onset. We compared baseline characteristics, imaging and clinical outcomes at 90 days, and workflow times between PSCs and CSCs.

Of 1577 patients enrolled in the trial, 99 (6.27%) were treated at PSCs and 1,478 (93.72%) at CSCs. Both groups had similar age, proportion of females, baseline NIHSS and presence of LVO. The proportion of patients achieving excellent functional outcome at 90 days was higher in PSCs compared to CSCs (mRS 0-1: 48.48% versus 35.01%, adjusted IRR, 1.42 [CI 95%, 1.04–1.95]). Patients at PSCs had longer door-to-needle times (median, 56.5 [42–70] versus 35 [27–47] minutes, p < 0.001). In the 24 patients transferred to CSCs, the needle-to-puncture time was more favorable for tenecteplase compared to alteplase (median, 35.5 [21–58] versus 52 [18–74] minutes, p < 0.001).

Our findings suggest that patients treated at PSCs may achieve outcomes comparable to those treated at CSCs, despite differences in workflow efficiency. These results should be interpreted cautiously, as this is a hypothesis-generating analysis, and observed differences may reflect multiple factors, including site-level practices, referral patterns and workflow characteristics.

Efficient triage in general practice is critical to optimize appointment allocation and minimize patient delays. Delays in receiving clinical information, such as photographs or symptom questionnaires, lead to unnecessary consultations and inefficiencies. This study evaluated the feasibility and impact of a structured pre-triage protocol requesting photos and questionnaires for common conditions (skin, eye, tonsillitis, and urinary tract infections).

A pre-post intervention quality improvement project was conducted in a UK general practice. Triage administrators were instructed to proactively request photographs for skin and eye complaints and symptom questionnaires for tonsillitis and UTIs at initial patient contact. Outcomes included process metrics (number of pre-triage requests, proportion of cases managed directly by the triage GP) and subjective measures of ease, speed, satisfaction, and confidence.

The protocol increased photo requests for skin (mean increase 4.0/session, Cohen’s d = 7.77) and eye (2.2/session, d = 4.09) conditions, while questionnaire requests remained unchanged. The proportion of skin cases managed directly by the triage GP increased significantly (from 0.2 to 2.2 cases/session, d = 1.65), and eye case management also improved. Questionnaire-based pathways showed minimal change in efficiency or direct management. Subjective feedback indicated a slight reduction in triage speed, but ease and satisfaction were maintained, while diagnostic confidence increased, particularly for photo-supported conditions.

A structured pre-triage protocol is feasible, acceptable, and potentially effective in enhancing triage efficiency, particularly for visually assessable conditions like skin and eye presentations. By enabling earlier access to essential information, such protocols may reduce unnecessary consultations, improve workflow, and support clinician confidence.

We tested the hypothesis that resuming dietary control in early-treated phenylketonuria (PKU) is associated with improvements in white matter integrity, using data from the ReDAPT study, which previously demonstrated cognitive and psychiatric improvements with reduced phenylalanine (Phe) levels.

We re-initiated dietary control for early-treated patients with PKU and assessed the T1w/T2w ratio from standard T1- and T2-weighted magnetic resonance images, a marker of myelination and microstructural integrity. General linear mixed model (GLMM) analyses were performed to assess change in the T1w/T2w ratio from baseline over twelve months after resumption of dietary control.

Seven participants (mean age 31 years; five female) with neuroimaging were included, with a mean of 16 years off diet and baseline Phe levels of 1157 µmol/L. GLMM analyses showed significant increases in T1w/T2w ratio over time for the whole brain (β = 0.47 [95%CI = 0.28, 0.66]), left hemisphere (β = 0.36 [95%CI = 0.19, 0.54]), and right hemisphere regions of interest (β = 0.52 [95%CI = 0.30, 0.72]). Longer time off diet was also positively associated with greater T1w/T2w changes. There was no evidence for the effects of gender or age at baseline.

This study demonstrated significant increases in the T1w/T2w ratio in PKU patients as they resumed dietary control over a 12-month period. Raw Phe levels were not strongly associated with neuroimaging measures. These findings support the importance of lifelong treatment for PKU, and also demonstrate the potential reversibility of white matter changes in the disease.

Yemen’s health care system has been critically disrupted by ongoing conflict, resulting in severe deficiencies in toxicology services. Toxicological emergencies, including poisonings, chemical exposures, and drug overdoses, represent a significant and underreported public health burden, compounded by systemic resource and training gaps.

To evaluate the availability, functionality, and safety of toxicology services in Yemen and identify key challenges faced by health care providers.

A cross-sectional, mixed-methods study was conducted using online surveys, key informant interviews, and facility audits. Quantitative data from 158 health care workers were analyzed using SPSS version 23, while qualitative data were thematically analyzed to provide contextual insights.

Toxicology services were unavailable in 72.4% of facilities, with 78.8% lacking dedicated toxicology units. Pesticide poisoning (73.1%), chemical exposure (58.3%), and drug overdose (49.1%) were the most frequently encountered emergencies. Significant barriers included a lack of antidotes (80.8%), diagnostic tools (85.4%), and adequately trained personnel (81.5%), with only 20% of health care workers receiving formal toxicology training. Furthermore, 70.1% of respondents reported no access to poison control centers, and 57.7% indicated the absence of referral laboratories.

Yemen’s toxicology services face critical gaps in resources, training, and diagnostics. Practical steps such as basic toxicology training, improved antidote access, and mobile health support can enhance emergency care in this resource-limited setting.

The double burden of malnutrition (DBM) – the coexistence of undernutrition and overweight/obesity – poses a critical global health challenge, particularly for children and adolescents. School meal programs offer an opportunity to address the DBM by providing nutritious meals that support growth, development, and lifelong health. However, limited school meal quality data hinders effective program design. This study evaluates global school meal quality through nutrient composition analyses and the Global Diet Quality Score (GDQS)-Meal and -Menu metrics.

Data were collected from the Global Child Nutrition Foundation’s 2024 Global Survey of School Meal Programs, grey literature, and in-country stakeholders. Nutritional content was compared to age-specific Nutrient Reference Values, including Harmonized Average Requirements. The nutritional quality of meals and menus was assessed using GDQS metrics based on 25 food groups.

Twenty-nine countries across diverse geographic and socioeconomic contexts.

Not applicable.

Most menus met or exceeded 30% of recommended daily nutrient values. Lunches had the highest nutrient contributions, followed by snacks and breakfasts. GDQS-Meal and -Menu scores revealed variability across age groups, meal types, and countries. Overall, 57% of menus achieved high nutritional quality, 37% medium, and 6% low. Few menus lost points for unhealthy components. Diverse, balanced menus with healthy food groups scored higher, though fortification also proved nutritionally valuable.

While most menus contribute significantly to daily nutrient needs, variability across countries, age groups, and meal types highlights opportunities for context-specific improvements through diversification and fortification. Learning from high-performing peer programs can help identify feasible improvements.