Author: Jason Curtis

Holistic management of juvenile idiopathic arthritis across all ages: British Society for Rheumatology Guideline scope (2026)

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Type of publication:

Conference abstract

Author(s):

Beesley R.P.; Bray L.; Bridges A.; Chaplin H.; Cleary G.; Cooray S.; Aragon Cuevas O.; Cuthbert V.; Deepak S.; Earle E.; Ferreira A.; Kearsley-Fleet L.; Gupta J.; Houston R.; Hum R.M.; Humphreys J.H.; *Jayasekera H.S.; Jones S.; MacFadyen C.; Nisbet J.; Arunath V.; Prior Y.; Rogers V.; Shoop-Worrall S.J.W.; Solebo A.L.; Waller R.; Williamson L.D.; Wilson D.; Wright C.; Sen E.S.; Roddy E.; Mewar D.; Kaul A.; Ciurtin C.; Compeyrot-Lacassagne S.; Kuttikat A.; Williams E.; Abhishek A.; Joyce C.; Merrison K.; Dhillon E.; Jones C.; Rose-Parfitt E.; *Jayasekera H.; Saha P.

Citation:

Rheumatology Advances in Practice. 10(2) (no pagination), 2026. Article Number: rkag052. Date of Publication: 2026.

Abstract:

Lay Summary: What does this mean for patients? Juvenile idiopathic arthritis (JIA) is the most common type of arthritis that starts before the age of 16 years. Many children and young people (CYP) continue to be affected by JIA and may need to be on treatment when they are adults. Most CYP with JIA have swollen, stiff and painful joints for at least 6 weeks. JIA can also affect other parts of the body. This includes the skin, the places where tendons join bones (called entheses) and sometimes internal organs. Some young people may also develop inflammation in their eyes, called uveitis. If this is not treated, it can affect eyesight and could lead to sight loss. People with JIA often need medicines to control inflammation. They are usually cared for by a team of healthcare professionals called a multidisciplinary team. This team may include doctors, nurses, pharmacists, physiotherapists, occupational therapists, podiatrists, psychologists and youth workers. They work together to help manage symptoms and prevent long-term damage. The British Society for Rheumatology (BSR) is the main organisation in the UK for healthcare professionals who care for people with JIA. BSR writes guidelines that help healthcare teams provide high-quality care. These guidelines are written with input from experts and people with lived experience. They help make sure that everyone receives good care wherever they live, including during the move from child to adult services. This article explains how BSR will develop a new guideline to diagnose, treat and monitor children, young people and adults with JIA. The guideline will follow the BSR protocol for creating clinical guidelines.

DOI: 10.1093/rap/rkag052

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Factors associated with time to stoma reversal after anterior resection across England: an observational study using administrative data (2026)

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Type of publication:

Conference abstract

Author(s):

*Olagunju N.; *Cheetham M.; Savage K.; Briggs T.W.R.; Gray W.K.

Citation:

Surgical Endoscopy. Conference: 33rd Annual Congress of the European Association for Endoscopic Surgery. Belgrade Serbia. 40(1 Supplement) (pp S210), 2026. Date of Publication: 01 Apr 2026.

Abstract:

Aims: A diverting stoma (DS) has been shown to reduce the impact of anastomotic leak following anterior resection for rectal cancer. While these are designed to be temporary, patients may wait over 18 months for reversal. This impacts quality of life, long-term bowel function, health care costs, and resource utilization. The National Bowel Cancer Audit (NBOCA) highlights stoma reversal within 18 months of anterior resection as a performance indicator. Our study aims to compare stoma closure rates across various service providers in England, trends over time and determine the factors associated with unreversed stoma beyond 18 months following anterior resection.
Method(s): This was an exploratory analysis of administrative data from the Hospital Episode Statistics (HES) database for England of patients who had anterior resection procedures with stoma creation during the same admission for rectal cancer. The study covered the period from 1st April 2016 to 30th September 2024. A subset of data up to 31st March 2023 for the index procedure were used for some analyses allowing all patients to have 18 months of follow-up. The primary outcome was stoma closure within 18 months of stoma creation. The secondary outcomes were 30-day emergency readmission, post-operative complications, and death after surgery.
Result(s): 5275 patients had anterior resections with DS and 3338 (63.5%) had stoma reversal within 18 months. Patients who had stoma reversal [ 18 months had higher rates of anastomotic leak during their index stay, 30-day readmission, and death within 1 year of discharge. Socio-economic deprivation (odds ratio (OR) for highest vs lowest quintile 1.67 (95% confidence interval (CI) 1.34 to 2.09), p \ 0.001), and frailty (OR for severe vs no frailty 3.03 (95% CI 1.08 to 8.53), p = 0.035) were associated with stoma reversal [ 18 months. Stoma closure within 18 months fell from 70.5% in 2016/17 to 62.0% in 2022/23.
Conclusion(s): More patients are waiting longer to have their stoma reversed. Frailty and socioeconomic deprivation were associated with stoma closure after 18 months. There was no association between age, sex, ethnicity or hospital volumes, and time to stoma reversal.

DOI: 10.1007/s00464-026-12641-8

Disparities in fall mortality among hypertensive older adults: An epidemiological analysis of geographic and gender differences (2026)

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Type of publication:

Conference abstract

Author(s):

Sarfraz M.R.; Mushtaq I.; *Ali A.; Anwar S.; Ikram F.; Hemida M.F.; Ajaz S.

Citation:

Age and Ageing. Conference: British Geriatrics Society Autumn Meeting 2025. Nottingham United Kingdom. 55(Supplement 1) (pp i32-i33), 2026. Date of Publication: 01 Feb 2026.

Abstract:

Introduction: Falls are a leading cause of death in older adults, with hypertension (HTN) potentially increasing this risk. However, trends in fall-related mortality with co-existing HTN remain understudied. We hypothesise an increasing trend in fall-related mortality among older adults with HTN, with disparities by sex, region, and place of death.
Method(s): A retrospective analysis of adults >=65 years was conducted using CDC WONDER (1999-2023). Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, region, and place of death. Trends were assessed using annual and average percentage change (APC & AAPC).
Result(s): From 1999 to 2023, 215,214 fall-related deaths with co-existing hypertension were recorded, showing a significant increasing mortality trend (p<0.000001).Males had higher mortality than females (20.39 vs. 17.13 per 100,000), with significant AAPCs of 11.24% and 10.57%, respectively. In males, AAMRs rose from 2.93 in 1999 to 42.59 in 2023, with sharp increases from 1999-2001 (APC: 45.19%) and 2018-2021 (APC: 13.56%). Females showed a similar trend, rising from 2.87 to 35.57, with notable spikes in the same periods (APC: 42.44% and 13.43%).Most deaths occurred in medical facilities (52.84%), followed by nursing homes (19.09%), hospices (12.99%), and homes (10.86%). Regionally, the Midwest had the highest AAMR (22.88), followed by the West (18.58), South (18.15), and Northeast (14.11), with corresponding AAPCs of 10.81%, 8.68%, 11.45%, and 10.86%.
Conclusion(s): Mortality rates among older adults has risen significantly over the past two decades, with consistently higher rates in males and marked regional disparities. The predominance of deaths in medical and long-term care facilities underscores the need for enhanced fall-prevention strategies in these settings. Targeted interventions, particularly in high-burden regions like the Midwest and sex-specific approaches are essential to mitigate this growing public health concern.

DOI: 10.1093/ageing/afaf368.115

Current management of patients with early breast cancer and an abnormal diagnostic axillary ultrasound: The AVOID prospective multicentre cohort study (2026)

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Type of publication:

Journal article

Author(s):

Potter S.; Blyuss O.; Cox K.; Davis E.; Dodwell D.; Evans A.; James J.; Lowes S.; McIntosh S.A.; Shaaban A.; Wallis M.G.; Sharma N.; Altaf S.W.N.; Armstrong L.; *Asprou F.; Babu G.; Baig M.; Bell N.; Bhide I.; Blackwell L.; Boyd C.; Brown A.; Coggles L.; Dadnam F.; Dalgliesh D.; Edwards D.; Elmosselhy A.; Elzuber W.; Gray K.; Griffiths A.; Gunarathne D.; Harmouche C.; Iqbal S.; Karatasiou A.; Khadtare K.; Khushbakht S.; Larney T.; Lee Q.Y.; Liew S.; Marriott C.; McMahon M.; Menezes R.; Millington S.; Oeppen R.; Pervez A.; Poolovadoo Y.; Rabone A.; Rainford S.; Reilly M.; Rigby D.-M.; Roychaudhury R.; Saha P.; Savaridas S.; Shannon J.; Sharma S.; Siddiqui S.; Singh S.; Taper J.; Vidyaprakash N.; Walajahi F.; Wilding L.; Wilkinson L.; Wong M.K.; Young P.

Citation:

SSRN. (no pagination), 2026. Date of Publication: 25 Mar 2026.

Abstract:

Purpose To explore the current management of patients with early breast cancer and an abnormal pretreatment axillary ultrasound scan (USS).Methods Consecutive patients with newly diagnosed early breast cancer and an abnormal axillary USS undergoing pretreatment axillary biopsy were included. Simple demographic data and information regarding the number and cortical thickness of abnormal nodes, biopsy performed and results together with primary management and postoperative pathology were collected prospectively. Results were summarised with descriptive statistics and USS findings and pathological data compared. Results Between February 2024 and September 2025, 1,100 patients from 47 UK breast units were included. The median age was 58 (interquartile range (IQR) 48-69); most presented via the symptomatic pathway (n=828, 75.3%). Almost half (n=526, 48.1%) had one abnormal node on USS. Nodes with a median cortical thickness of 4.8mm (IQR 3.6-7.2mm) were sampled, most frequently with core biopsy (n=980, 89.1%). 1,062 (96.5%) participants had a diagnostic biopsy, two-thirds of which were malignant (n=761, 66.2%). No cortical thickness threshold for malignancy was identified. Most patients with a negative axillary biopsy underwent sentinel lymph node biopsy but the management of patients with biopsy-proven node-positive disease was highly variable. There was poor correlation between the burden of axillary disease on USS and surgical pathology, but an USS finding of 1-2 abnormal nodes was the best criterion for identifying patients with pathological pN1 disease. Conclusions Management of patients with biopsy-proven node-positive breast cancer in the UK is highly variable. Evidence-based multidisciplinary guidelines will be essential to standardise and improve patient care.

DOI: 10.64898/2026.03.06.26347693

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Clinical and genetic predictors of dementia in Parkinson's disease (2026)

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Type of publication:

Journal article

Author(s):

Solomons M.R.; Hannaway N.; Fox O.; Costantini A.; Real R.; Zarkali A.; Morris H.R.; Weil R.S.; Alty J.; Amar K.; Anthony A.; Arianayagam S.; Bennet C.; Buccoliero R.; Cosgrove J.; Croucher Y.; Dean S.; Dellafera D.; Dharia S.; Evans J.; *Gibson H.; Gregory R.; Guy J.; Henderson E.; Hodgson M.; Jones E.; Juada J.; King E.; Lewis A.; Mann C.; McDermott C.; Moffitt V.; Molloy S.; Niccolini F.; Pitman C.; Rhule N.; Saifee T.A.; Schrag A.; Sophia R.; *Stickley J.; Sullivan L.; Thompson A.; Wickremaratchi M.

Citation:

medRxiv. (no pagination), 2026. Date of Publication: 06 Mar 2026.

Abstract:

Importance: Dementia is common in Parkinson's disease (PD), causing greater disability than other symptoms, but varies in timing. Although visual deficits are linked with PD dementia, how these interact with genetic factors to predict PD dementia has not been characterised.
Objective(s): To investigate whether visual deficits and genetic factors predict PD dementia.
Design(s): Large prospective longitudinal case-control study, mean follow-up 32.7 (SD=12.3) months.
Setting(s): Cases were recruited between 2017-2020 at 35 UK PD clinics.
Participant(s): People with PD without dementia at baseline were included.
Main Outcomes and Measures: Visual function was measured using a web-based platform. The main outcome measure was global cognition, measured as the Montreal Cognitive Assessment (MoCA). Blood samples were collected for genetics.
Result(s): 450 patients with PD were included. Mean age of PD patients was 71.7 (SD=7.8), 68% male. Mean baseline MoCA was 27.7 (SD=1.7). 263 patients with PD were classed as poor-vision based on baseline visual tests: mean age 74.4 (SD=6.8) compared to 69.7 (SD=7.5) with good-vision. Poor-vision PD patients had higher rates of progression to mild cognitive impairment (PD-MCI) (HR=2.34, CI=1.58-3.48, pFDR=0.00062, age- and sex-corrected). The combination of genetic factors together with vision influenced outcomes. In good-vision PD patients, high-risk GBA1 gene variants were linked with greater progression to PD-MCI (HR=4.61, CI=1.73-12.28, pFDR=0.0068). Polygenic Risk Score (PRS) for both PD and Alzheimer's disease (AD) also modified cognitive survival when combined with vision status. High PD-PRS was associated with greater progression to PD-MCI in good-vision patients (HR=2.66, CI=1.21-5.81, pFDR=0.0381); and high AD-PRS with greater progression to PD-MCI in poor-vision PD patients (HR=1.91, CI=1.10-3.32, pFDR=0.04999). Combining high PD- and AD-PRS, compared to low PD- and AD-PRS in good-vision PD showed even higher progression to PD-MCI (HR=6.14, CI=1.36-27.83, pFDR=0.046). Simulations showed that adding visual and genetic stratification reduced sample size from n=705 to n=160 for clinical trials. Conclusions and relevance: Poor vision in PD predicts progression to PD-MCI and dementia. This combines with the effects of genetic factors including GBA risk variants and PD- and AD-PRS. These findings can enable enrichment of clinical trials for patients at higher risk of PD dementia, for more efficient trial design for interventions to slow progression.

DOI: 10.64898/2026.03.06.26347693

Addressing the barriers: an innovative NHS staff menopause support model (2026)

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Type of publication:

Conference abstract

Author(s):

*Ritchie J.

Citation:

Post Reproductive Health. Conference: BMS 35th Annual Scientific Conference. Kenilworth United Kingdom. 32(3) (pp 185), 2026. Date of Publication: 01 Sep 2026.

Abstract:

Objective: Menopause is an increasingly recognised workforce wellbeing issue, yet access to timely menopause care remains limited. Within our trust, staff reported difficulty accessing support and long waits for specialist services. The Menopause Team therefore aimed to improve staff wellbeing, confidence, and understanding of menopause by providing an accessible, evidence-based education programme and to enable quicker access to care with a staff menopause clinic.
Method(s): The Menopause Team delivered a structured menopause education programme led by clinicians and specialists in menopause, women's health, psychology, and lifestyle medicine. The programme included monthly sessions, delivered both online and face-to-face, covering topics such as menopause, bone health, acupuncture, yoga, pelvic physiotherapy, and mental health. A Menopause Policy was introduced to support staff wellbeing through flexible workplace adjustments. Systems were implemented to identify menopause-related sickness absence to inform service development. A staff wellbeing survey showed the programme was highly valued but highlighted the need for more personalised support. The team subsequently secured 48,000 from the NHS Charities Workplace Wellbeing Fund to deliver a 12-month staff menopause clinic, offering initial group consultations with optional one-to-one follow-up with a menopause consultant, local GP, and menopause nurse, supported by dedicated administrative staff.
Result(s): 667 members of staff have attended education sessions, staff feedback from the education programme demonstrated improved knowledge, confidence, and self-management, with sessions consistently described as clear, practical, and accessible. Since launching in October 2025, 90 staff have self-referred to the menopause clinic, with 57 attending group consultations and a 70% conversion rate to individual follow-up. Participants reported that the combined group and one-to-one model created a safe and supportive environment, reduced isolation through shared experience, and increased confidence in managing menopause and its impact at work. Access to personalised clinical support was particularly valued.
Conclusion(s): Overall feedback demonstrated strong acceptability and perceived value, with clear support for continuation and expansion of the programme. A structured workplace menopause programme combining education, policy support, and innovative group consultation clinics can improve staff confidence, wellbeing, and access to care. This scalable model offers a practical approach for NHS organisations seeking to support and retain an experienced workforce.

DOI: 10.1080/20533691.2026.2715923

A meta-analysis on vitamin D deficiency in patients with sickle cell disease (2026)

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Type of publication:

Conference abstract

Author(s):

*Alawad M.

Citation:

British Journal of Haematology. Conference: 66th Annual Scientific Meeting of the British Society for Haematology. Liverpool United Kingdom. 208(Supplement 1) (pp S90), 2026. Date of Publication: 01 Apr 2026.

Abstract:

Vitamin D Deficiency (VDD) is reported to be more frequent with serious clinical outcomes in patients with Sickle Cell Disease (SCD). There is a wide disparity in data in the existing literature regarding the prevalence and risk of VDD in patients with SCD. These data require further summary and analyses for better accuracy. This review aimed to assess the association between VDD and SCD, and was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline/PubMed, World Health Organization Virtual Health Library, ScienceDirect, and Google Scholar were used for the systematic search. A random effects model was used to estimate the pooled prevalence, Risk Ratio (RR), and Standardized Mean Difference (SMD) estimates with the corresponding 95% Confidence Interval (CI) using OpenMeta Analyst software version 10.10 (Tufts Medical Center, Boston, MA, USA). Twenty-five studies fulfilled the eligibility criteria. The prevalence of VDD among patients with SCD was 63.8% (95% CI 52.5-75.1). The risk of VDD among patients with SCD was more than two times that of the general population (RR = 2.129; 95% CI 1.024-4.423; p < 0.001). Serum vitamin D levels were significantly lower in SCD patients than in their controls (SMD = -1.883: 95% CI -3.006 to -0.760; p < 0.001). This review provides a comprehensive view of the association between vitamin D status and SCD.

DOI: 10.1111/bjh.70471

576eP Observational study in UK patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer receiving abemaciclib (2026)

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Type of publication:

Conference abstract

Author(s):

Koliou P.; O'Brien C.S.; Levitt N.; Twelves C.J.; *Pettit L.; Nathan M.; Khan S.; Luttropp K.A.; Pastrello D.; Jarvis R.S.; Oikonomidou O.

Citation:

ESMO Open. Conference: ESMO Open Science for Optimal Cancer Care. Berlin Germany. 11(Supplement 4) (no pagination), 2026. Article Number: 107596. Date of Publication: 01 May 2026.

Abstract:

Background: This subgroup analysis of UK patients from a prior multi-national chart review described characteristics and outcomes of those with HR+/HER2- advanced/metastatic breast cancer (ABC) receiving the cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) abemaciclib with an aromatase inhibitor (AI) or fulvestrant as initial endocrine-based therapy (ET), or who had received prior ET.
Method(s): The analysed patient population received abemaciclib 150 mg twice daily plus AI or fulvestrant per licensed indication. Effectiveness outcomes included real-world progression-free survival (rwPFS) and time to chemotherapy (rwTTC), assessed using Kaplan-Meier by treatment line.
Result(s): Median age of the 101 patients was 62 (interquartile range 55-72) years, 78 (77.2%) were post-menopausal. At abemaciclib start, 88.1% had stage IV disease; 5.0% stage III; and 6.9% unknown. The ET partner was fulvestrant in 68.3% and AI in 31.7%. Fifty patients received abemaciclib as first-line (1L) and 34 as second-line (2L) treatment; third-line cases (n=17) are not reported. Median rwPFS was 30.0 and 17.7 months for patients in 1L or 2L, respectively (Table). Of those who received abemaciclib in 1L and 2L, 13 (26.0%) and 15 (44.1%) patients, respectively, required chemotherapy in a subsequent line; rwTTC for 2L was 23.1 months. At 24 months, 27.0% of 1L and 57.0% of 2L patients had started chemotherapy. Based on time-to-discontinuation data (n=101), 54 patients discontinued abemaciclib due to: disease progression (n=16), toxicity (n=27), physician choice (n=6), or unknown/other (n=5). [Formula presented]
Conclusion(s): In these UK patients with HR+/HER2- ABC, abemaciclib with ET showed meaningful real-world clinical benefits that were consistent with findings from clinical trials. The outcomes reinforce that adding abemaciclib to ET can prolong rwTTC and delay disease progression, supporting ongoing clinical utility in UK patients with HR+/HER2- ABC. Editorial acknowledgement: Medical writing support was provided by Laura Wesley, and Sarah Birch (Rx Communications Ltd, Mold, UK), and funded by Eli Lilly. Legal entity responsible for the study: Eli Lilly and Company.

DOI: 10.1016/j.esmoop.2026.107596

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What should be discussed when considering an induction of labour? A UK-wide, multi-centre Delphi study to develop a core information set for induction of labour (2026)

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Type of publication:

Journal article

Author(s):

Bunni, Eve; Kingdon, Carol; Bradley, Vicky; Hunt, Alexandra; Mahdi, Amy; Axcell, Thomas; Jagadish, Ria; Fox, Sophie; O'Dair, Millie; Simms, Charlotte; Munn, Yee Tan; Bonnett, Laura; Greenfield, Benjamin; Cunningham, Caroline; Holt, Siobhan; Burden, Christy; Ficquet, Joanna; Otero-Romero, Elena; *Parry-Smith, William; Black, Mairead; Merriel, Abi.

Citation:

BMJ Open. 16(5):e118024, 2026 May 27.

Abstract:

OBJECTIVE: To develop a core information set for induction of labour. Rates of induction of labour for childbirth are rising in many high-income countries. In England, a third of women have their labours induced. National guidelines recommend women receive information to make informed decisions about induction.

DESIGN: Two-stage consensus study using modified Delphi.

SETTING: UK.

PARTICIPANTS: Pregnant people, parents and professionals.

OUTCOMES: Stage 1: A long list of information points was identified through a systematic review of reviews, reviewing patient leaflets, qualitative interviews and a stakeholder survey, with ongoing patient, public and professional involvement. Stage 2: Think-aloud interviews were undertaken to refine the Delphi survey before a two-round modified Delphi process where participants voted on the importance of the information items. Pre-specified criteria were used to select items taken forward to a consensus meeting.

RESULTS: 199 information points were identified through systematic review (110), patient information leaflets (162), qualitative interviews (58) and a survey (93). 46 unique information items entered the first Delphi round after four think-aloud interviews, 2 items were added following round 2. 368 people (310 parents/58 professionals) participated in round 1 and 177 people (154 parents/23 professionals) in round 2. 44 items met inclusion criteria; one item excluded, and three items were carried forward for consensus meeting discussion where 12 overarching information points were agreed on.

CONCLUSIONS: This study has established a consensus-based core information set for induction of labour from a sample of the birthing population and staff providing their care. The resultant set has been populated with evidence in line with national guidelines. It can be used by women and clinicians as a standardised starting point from which to personalise discussions about birth.

TRIAL REGISTRATION NUMBER: COMET Initiative registration 2600: Developing a core information set for induction of labour.

DOI: 10.1136/bmjopen-2026-118024

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What do student and educator perspectives reveal about assisted dying in the UK medical curriculum? A narrative review (2026)

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Type of publication:

Journal article

Author(s):

Smith, Benjamin; Roberts, Megan; *Talha, Saarah.

Citation:

Annals of Palliative Medicine. 15(2):24, 2026 Mar.

Abstract:

OBJECTIVE: Assisted dying is a highly complex and evolving ethical area in the United Kingdom (UK) healthcare, with ongoing legislative developments creating urgency. UK medical students, potentially the first generation to navigate its legalisation, face an inconsistent curriculum. This review examined the inclusion and quality of assisted dying education in UK undergraduate medical schools, analysing curricular extent and alignment with General Medical Council (GMC) end-of-life care expectations.

METHODS: A narrative literature review was conducted. Searches of PubMed and Scopus (2004-2025) focused on assisted dying, palliative care, and UK medical undergraduate education. Six publications were included and analysed thematically regarding student attitudes, ethical education, and curricular gaps.

KEY CONTENT AND FINDINGS: Teaching on assisted dying is fragmented, inconsistent, and often superficial, typically confined to isolated workshops. Active-learning modules improve ethical reasoning, but general progression often conveys only current legal frameworks. Student attitudes are diverse, influenced by religious background and clinical exposure. A major finding is the scarcity of robust UK-specific research on implementation. This deficiency risks future doctors being unprepared to professionally and ethically navigate the evolving legal landscape.

CONCLUSIONS: The UK medical education system lacks a standardised, integrated approach to teaching assisted dying. The curriculum is insufficiently robust, and evidence for implementation is scarce. Medical schools must be proactive to potential legislative change. A standardised framework incorporating case discussions, dedicated ethics/law sessions, and communication skills training is essential to prepare the future workforce for this challenging issue.

DOI: 10.21037/apm-2025-1-138

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