Purpose: To determine the relationship between patient characteristics and treatment fidelity in adult ICU patients enrolled in the CYCLE Pilot randomized controlled trial. Method: We conducted a secondary analysis of a pilot trial in which patients were randomly assigned to in-bed cycling plus usual physiotherapy (PT) or usual PT alone. We calculated protocol fidelity for each patient as the proportion of planned days when the assigned treatment was delivered or did not occur due to medical instability. Using multiple linear regression, we assessed the association of protocol fidelity with admission severity of illness, sex, assigned treatment, baseline comorbidities, and frailty. Results: Sixty-six patients were enrolled in this pilot trial (36 cycling, 30 usual PT) with a median (1st-3rd quartiles) protocol fidelity of 100% (83%-100%), 89% (75%-100%) in cycling and 100% (90%-100%) in usual PT. By regression analysis, assignment to in-bed cycling plus usual PT was associated with a 9.7% (95% CI: -17.8, -1.5) lower protocol fidelity compared to usual PT alone. Conclusions: We found those in the usual PT group had higher protocol fidelity; no other associations were found. This study offers an analytic approach for trialists to assess treatment fidelity for rehabilitation interventions in clinical trials.

Published research on Paralympic sport in Central Asia remains limited despite the region's growing presence at the Games. This review focuses on elite, Games-level participation and achievement. We conducted a scoping review reported in line with the PRISMA extension for scoping reviews, alongside an analysis of International Paralympic Committee (IPC) archival data for five Central Asian countries (Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan, Turkmenistan) across Summer (1996-2024) and Winter (1994-2026) Games, framed through the SPLISS model and the constraint-led approach. The scoping review maps international knowledge; the IPC analysis documents regional outcomes, offering complementary evidence. The review identified three domains: income-, gender-, and technology-linked participation gaps (D1); discipline-specific age profiles ranging from a median of 25 years in Para Swimming to 38 years in Para Equestrian (D2); and ten national policy factors linked to Paralympic success (D3). IPC data showed Central Asian participation rising from 15 athletes in 1996 to 113 in 2024, led by Uzbekistan (n = 64, Paris 2024) and Kazakhstan (n = 44), concentrated in Para Athletics, Para Judo, and Para Powerlifting, plus a full Kazakhstani sitting volleyball squad and Para Swimming. Female representation rose from 0% in 1996 to 41.6% in 2024, near the ∼43% global benchmark. Medal efficiency was 0% before 2012, spiked to 73.5% at Rio 2016 (95% CI 59.7%-83.8%), driven by Uzbekistan winning more medals than athletes that edition, then settled at 32.9% (Tokyo 2020) and 31.0% (Paris 2024, 95% CI 23.2%-40.0%); the 2016 spike is statistically distinguishable from other editions, while Tokyo 2020 and Paris 2024 are not. Uzbekistan grew from 0 athletes in 1996 to 64 in 2024, with the sharpest rise from 32 (Rio 2016) to 64 (Paris 2024), coinciding with documented 2019-2024 state Paralympic-development measures-a plausible institutional account alongside classification reform and host-proximity effects. No study identified by our search has examined elite Paralympic sport development in Central Asia specifically. Four research priorities are proposed: epidemiological profiling, adapted policy analysis with regional researchers, longitudinal athlete tracking, and psychological support programs.

Metabolic acidosis is a frequent complication when chronic kidney disease (CKD) develops, plus it is linked to adverse outcomes such as muscle wasting, inflammation, and progression of kidney disease. This article is intended to evaluate how correcting metabolic acidosis affects adult CKD patients via summarizing evidence from systematic reviews with meta-analyses. We conducted an umbrella review. Systematic reviews with meta-analyses assessing alkali therapy in CKD patients were included. Methodological quality was assessed using a Measurement Tool to Assess Systematic Reviews (AMSTAR 2). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty of evidence approach was used for rating the certainty of evidence. Twelve meta-analyses that were published between 2007 and 2024 were analyzed, and these included 169 associations, out of which 128 remained after excluding single-study outcomes. Only 8 (6.2%) of these associations were supported by high-certainty evidence, which included a slower decline in glomerular filtration rate, reduced hospitalization rates, lower diastolic blood pressure, increased serum bicarbonate after short-term therapy, and reduced use of β-blockers and vasodilators. However, most associations (52.3%) were rated as having very low certainty. Less than 10% of the associations analyzed in the selected systematic reviews have high certainty of evidence, which underscores a significant gap between common clinical practices and the strength of the supporting evidence.

Purpose: Patient motivation is essential for successful rehabilitation, so apathy may hinder physiotherapists' interventions aimed at increasing physical activity. We examined the relationship between apathy and physical activity to identify the factors that influence it. Methods: Pearson product-moment correlations were pooled from eligible studies to examine the relationship between apathy and physical activity. Subgroup meta-analyses and meta-regressions were also conducted. Results: From the systematic review (28 articles) and main meta-analysis (22 studies; N = 12,541), the results showed a negative correlation between apathy and physical activity (r = -0.13; 95% CI: -0.18, -0.09; p < 0.0001 based on Pearson's r-values; r = -0.40; 95% CI: -0.68, -0.02; p = 0.043 based on Spearman's ρ-values). The correlation was statistically significant in patients with Parkinson's disease and in older adults who were healthy, depressed, fallers, or had mild cognitive impairment. A meta-regression showed an effect of age, with a stronger correlation between apathy and physical activity in older adults compared to younger adults (p = 0.003). Conclusion: Higher levels of apathy are associated with lower levels of physical activity, and this negative association is stronger with age. Therefore, apathy may limit exercise therapy efficacy and carry prognostic implications for patients whose condition requires physical activity.

Acute abdominal pain is a common emergency department presentation and is often associated with diagnostic uncertainty. Historically, opioid analgesia was used cautiously because of concern that it could alter physical examination findings and interfere with diagnostic accuracy. Non-opioid and opioid-sparing strategies are increasingly used for pain management. This systematic review evaluates the efficacy and safety of analgesic strategies for acute, non-traumatic abdominal pain, with attention to pain relief, adverse effects, rescue analgesia, and diagnostic accuracy. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized comparative trials of opioid-containing treatment versus non-opioid, opioid-sparing, or placebo strategies. Eligible studies included adults aged 18 years or older with acute abdominal pain or an acute intra-abdominal cause of pain; studies limited to renal or ureteric colic were excluded. Of the 316 records identified, 45 duplicates were removed, 271 records were screened, 26 reports underwent full-text assessment, and 16 randomized trials were included. Across the included trials, opioids provided effective short-term analgesia but were not consistently superior to alternatives. Hydromorphone produced greater pain improvement than intravenous lidocaine at 90 minutes (between-group difference = 1.2 points, 95% confidence interval (CI) = 0.3-2.2) with less rescue analgesia. In acute pancreatitis, median Visual Analog Scale (VAS) reductions at 30 minutes were 45.5 (95% CI = 30-54) with tramadol, 41.5 (95% CI = 34-50) with paracetamol, and 40.5 (95% CI = 30-47) with dexketoprofen, with no statistically significant between-group difference. An erector spinae plane block produced lower pain scores and reduced rescue fentanyl compared with intravenous tramadol. In biliary colic, mean pain relief at 30 minutes was 3.8 (95% CI = 2.4-5.2) with ketorolac and 3.9 (95% CI = 2.4-5.3) with meperidine, with no statistically significant between-group difference. Butorphanol provided greater early pain relief than ketorolac at 15 minutes but not at 30 minutes. Low-dose morphine plus paracetamol did not significantly differ from standard-dose morphine, and intravenous lidocaine and morphine did not significantly differ at the primary 60-minute endpoint. Several placebo-controlled trials assessed diagnostic accuracy using different definitions and patient populations. In one trial, diagnostic accuracy was 86% with morphine and 85% with placebo (difference 1 percentage point, 95% CI = -11 to 12). This imprecise estimate does not rule out a clinically important difference, and the available trials do not establish whether opioids affect diagnostic accuracy across acute abdominal presentations. Some studies identified changes in tenderness, rigidity, or localization after analgesia, but these were not consistently associated with diagnostic error or adverse management outcomes. Adverse effects were generally short-term and included nausea, vomiting, dizziness, and sedation, although most trials were not large enough or followed long enough to reliably evaluate uncommon serious adverse events. Overall, the evidence supports an individualized approach to analgesia. Opioids remain effective when clinically indicated, but are not consistently superior to non-opioid or opioid-sparing alternatives, and analgesia should not be routinely delayed solely because of concern for diagnostic interference.

This structured narrative review evaluates endovascular thrombectomy (EVT) through an author-developed, population-level treatment-response framework. In this framework, treatment response is the causal contrast between EVT plus best medical care and best medical care alone on a specified patient-centered outcome; it is not the outcome observed after EVT, and it cannot be observed for an individual patient because the untreated counterfactual is unknown. The framework is an evidence-interpretation tool, not a statistical estimator, a validated decision aid, or an individual prediction model. It separates four clinically actionable questions: first, trial eligibility-does the patient resemble a population in which EVT was tested; second, baseline prognosis-which features predict outcome under either strategy; third, procedural feasibility and safety-can reperfusion be achieved promptly at acceptable risk; and fourth, treatment-effect modification-does randomized evidence support a different relative or absolute effect across levels of a baseline variable? We conducted targeted, purposive searches across PubMed/MEDLINE, supplemented by backward and forward citation tracking, to identify pivotal randomized trials, individual participant data meta-analyses, population-specific guidelines, and directly relevant secondary analyses through 15 August 2026. Randomized evidence supports EVT for proximal anterior-circulation large-vessel occlusion in the early window, selected 6-24 h anterior-circulation populations, trial-defined large-core infarction, and selected moderate-to-severe basilar artery occlusion. Dedicated randomized evidence remains absent beyond 24 h and incomplete for large-vessel occlusion with a low National Institutes of Health Stroke Scale (NIHSS) score. ESCAPE-MeVO, DISTAL, and DISCOUNT did not demonstrate average functional benefit in broad medium/distal-vessel populations, whereas ORIENTAL-MeVO reported benefit in an enriched population with NIHSS at least 6; these results should not be generalized across all distal occlusions. Failure to detect an interaction does not establish homogeneous effects because interactions are outcome- and scale-specific, and most EVT trials are underpowered to detect them. Poor outcomes after successful reperfusion are descriptive of post-treatment states, not proof that EVT was futile. This framework clarifies what randomized evidence establishes, what remains prognostic or procedural, and where prospective testing is still required.

Children and adolescents learn about food through digital and physical environments while developing an understanding of dietary effects on human and planetary health. Digital healthy-eating education, food-literacy education, and sustainable-diet education have nevertheless developed along largely separate trajectories. This focused Mini Review examines interventions that combine a substantive digital educational mechanism, a food-literacy capacity, and an explicit sustainability target in young people. Database-specific searches of Web of Science, Scopus, PubMed, and ERIC plus citation checking yielded three eligible studies; exploratory high-sensitivity checks did not reveal an evident additional match. The studies evaluated an adolescent food-systems simulation with guided inquiry, online family cooking with text-message support, and a seven-mission family mHealth program addressing food waste and plant-based proteins. They provide preliminary evidence for three educational configurations rather than a basis for comparative effectiveness claims. Mixed Methods Appraisal Tool assessment identified credible alignment between questions and data, alongside immediate qualitative outcomes, single-arm designs, selective outcome completion, and limited control of confounding. The synthesis distinguishes food literacy delivered through digital media-the eligibility construct-from critical literacy about digital food environments, which remains a proposed research direction. Current evidence supports explicit specification of digital affordance, literacy capacity, sustainability target, participant role, outcome tier, and inferential strength. Future trials should recruit more diverse populations, strengthen child-led participation, separate child and household outcomes, and test longer-term behavioral and material effects.