Research Proposal: The Impact of Gentrification on the Sense of Community and Identity Among Long-Term Residents in Urban Neighborhoods

Research Proposal: The Impact of Gentrification on the Sense of Community and Identity Among Long-Term Residents in Urban Neighborhoods

Research Proposal: Teacher Perceptions and Challenges in Classroom Technology Implementation

Research Proposal: Teacher Perceptions and Challenges in Classroom Technology Implementation

1. Introduction
The rapid integration of technology in education has transformed teaching methodologies, yet its effectiveness hinges on educators’ acceptance and ability to adapt. This study examines how K-12 teachers perceive classroom technology (e.g., interactive whiteboards, LMS platforms, AI tools) and identifies systemic, pedagogical, and personal challenges they face. Despite technology’s potential to enhance engagement and personalize learning, disparities in training, resource access, and institutional support often hinder successful adoption. Understanding these factors is critical for designing targeted interventions that align edtech with

What factors contribute to the job satisfaction of remote workers in the technology industry?

Thesis Statement:
The job satisfaction of remote workers in the technology industry is influenced by a combination of organizational, psychological, and environmental factors, including flexible work arrangements, effective communication tools, managerial support, work-life balance, and opportunities for career growth. While remote work offers autonomy and reduced commute stress, challenges such as isolation, blurred work-life boundaries, and technological barriers can negatively impact satisfaction. Understanding these factors can help tech companies design better remote work policies to enhance employee well-being and productivity.

DNP 840 Discuss two bills or laws that influence nursing practice, one at the federal level and one at the state level

Nurse Practice Act (NPA) was primarily developed to protect the public and its patients (Young, 2019). It delineates what is considered safe practice which includes but not limited to the scope of nurse, delegation, and disciplinary process in each state. As practices differ from state to state, a nurse is held responsible to be knowledgeable in the similarities or differences that exist. The website of the National Council of State Boards of Nursing (NCSB) has a tool named “Find your Nurse Practice Act” to find specific state NPA

 DNP 840 Provide an example of a change in a health delivery model or process that has occurred in the past 3 years at the micro, meso, and macro system levels

Some of the recent changes in the healthcare sector involve advancements in wearable technology. A notable addition is the wearable blood pressure monitor. Different companies utilize different technologies to develop these devices and incorporate various functions. For example, the Omron HeartGuide, which is FDA-registered, allows people to take their blood pressure when necessary and use the data collected to make informed health decisions (Omron Healthcare, n.d.). Individuals can also use the device to track physical activity and sleep patterns. Like other wearable devices, the blood pressure monitors have the potential to provide numerous benefits to patients and the healthcare system.

 DNP 840 Provide an example of a change in a health delivery model or process that has occurred in the past 3 years at the micro, meso, and macro system levels Re: Topic 3 DQ 1 Change in Health care Delivery Model

 DNP 840 Provide an example of a change in a health delivery model or process that has occurred in the past 3 years at the micro, meso, and macro system levels

Re: Topic 3 DQ 1

Change in Health care Delivery Model

DNP 840 Select one bill from DQ 1 and discuss how it aligns with quality, safety, experience, or financial metrics in your organization

DNP 840 Select one bill from DQ 1 and discuss how it aligns with quality, safety, experience, or financial metrics in your organization

Thank you for your post. The bill you discussed resonates with me as a nurse leader. The challenge of nurse shortage is currently prevalent in healthcare and is expected to worsen. The political environment influences healthcare, and we as nurse leaders must get involved in advocacy and know-how politics that affect nursing practice. When the pandemic hit, the federal government passed the Coronavirus Aid, Relief, and Economic Security Act (CARES), including the Title VIII Nursing Workforce Reauthorization Act (S. 1399 / H.R. 728). The bill was signed into law, authorizing the nursing workforce development programs through 2024

DNP 840 Select one bill from DQ 1 and discuss how it aligns with quality, safety, experience, or financial metrics in your organization Re: Topic 4 DQ 2

DNP 840 Select one bill from DQ 1 and discuss how it aligns with quality, safety, experience, or financial metrics in your organization

Re: Topic 4 DQ 2

The reimbursement systems implemented under ACA affect the financial metrics within my healthcare organization. The legislation incentivizes healthcare organizations to concentrate on quality improvement and positive patient outcomes. The focus on quality as opposed to quantity in healthcare is critical, with ACA rewarding organizations that deliver quality care to their patients. This law has thus led to a significant shift in reimbursement systems towards a value-based payment model (Brown et al., 2021). In my organization, therefore, the current focus is on progressive improvement of the quality of care delivered to the patients. this approach has led to a significant decline in readmission rates or incidences of hospital-acquired infections that are often classified as indicators of poor healthcare services. This focus on quality care has also enabled the organization to reduce medical complications, readmissions, and duration of hospital stay. As a result, the facility has reported a significant reduction in the costs incurred by patients seeking healthcare services. The focus on preventive care in line with the recommendations of ACA has also led to increased affordability of healthcare services offered by the institution to both inpatients and outpatients. The alignment of ACA with the financial metrics of the organization has had a positive impact on both the patients and the facility. It has led to improved efficiency in service delivery, while the reduction in HAIs and duration of hospital stay has also led to increased patient satisfaction.

As a DNP prepared nurse, I can be actively involved in advocacy and patient care. In addition, I can actively participate in patient education while also influencing policies that are aligned with the core values of my organization (Williams et al., 2018). I strongly believe in evidence-based and individualized care that appreciate the uniqueness of each case. However, I am also aware of the challenges of costs of care in the country. Therefore, I can play a central role in pushing for the expanded coverage under ACA to ensure that the underprivileged in the society have access to healthcare services.

References

Brown, E. A., White, B. M., Jones, W. J., Gebregziabher, M., & Simpson, K. N. (2021). Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach. Health Research Policy and Systems, 19(1), 77. https://doi.org/10.1186/s12961-021-00730-0

Williams, S., Phillips, J., & Koyama, K. (2018). Nurse Advocacy: Adopting a Health in All Policies Approach. OJIN: The Online Journal of Issues in Nursing, 23(3). https://doi.org/10.3912/OJIN.Vol23No03Man01

Healthcare Delivery and Beneficiary Satisfaction in Private Hospitals in Gaborone: A critical analysis

This article provides an objective analysis of a thesis project that investigates healthcare delivery and beneficiary satisfaction in private hospitals in Gaborone, Botswana. The study employs a mixed-methods design, incorporating quantitative surveys and qualitative interviews to assess service delivery components and beneficiary experiences systematically.

The empirical investigation identifies that while certain aspects of the healthcare environment—such as facility cleanliness and professional conduct of staff—are positively evaluated, significant challenges remain in service availability and patient wait times. The research methodology adheres to rigorous academic standards, ensuring that data collection and analysis procedures meet established criteria for reliability and validity.

The study is framed by several theoretical models, including the Service Quality Model, Expectancy-Confirmation Theory, Equity Theory, and the Patient-Centered Care Model. These frameworks provide a structured approach to examining the alignment between patient expectations and service performance. The conceptual framework developed in the thesis facilitates a detailed understanding of the interrelationships between various dimensions of healthcare delivery and beneficiary satisfaction.

Key findings indicate that improvements in patient-centered care, resource allocation, and communication protocols are essential to enhancing overall service quality. The data suggest that strategic interventions, focused on refining operational procedures and integrating continuous quality improvement processes, could lead to measurable enhancements in beneficiary satisfaction.

In conclusion, the thesis underscores the importance of adopting systematic, evidence-based strategies in the management of private healthcare facilities. The recommendations presented are intended to inform policy formulation and guide administrative practices toward achieving higher standards of healthcare delivery in Botswana.

The Economics of Gender and Educational Achievement: Stylized Facts and Causal | PSYC FPX 4600 Assessment 4 Evidence

The Economics of Gender and Educational Achievement: Stylized Facts and Causal | PSYC FPX 4600 Assessment 4

Evidence

Hoff et al. (2024) investigate two significant gender disparities: girls frequently exceed males in school attainment but prefer specialties that lead to lower-paying employment. Their research looks at “gender differences in non-cognitive traits, behavior, and interests” as potential drivers of these gaps (Hoff et al., 2024). They identify assertiveness as a behavioral attribute that contributes to the formation of these gaps. The paper closes by advocating policy measures to address the issue, arguing that interventions targeting non-cognitive qualities might help reduce gender differences in school and job success.

The Relationship Between Gender and Academic Success Online

Yu, (2021) investigated the effects of gender on academic performance in online learning courses. Their study, which included 959 education majors from a Texas institution, sought to investigate the link between final grades and gender via the perspective of social identity theory. The researchers defined social identity theory as “that part of an individual’s self-concept which derives from his knowledge of his membership in a social group (or groups), together with the value and emotional significance attached to that membership” (Yu, 2021). This approach contributed to understanding variations in academic accomplishment between men and women in online education environments since social identity impacts self-perception and academic behavior. 

Baji, (2020) found that aspects of a student’s identity, specifically gender, have a major impact on the creation and accomplishment of academic objectives. The researchers used ANCOVA to evaluate demographic and academic data and studied how gender correlated with academic achievement. Their findings revealed that the interaction between gender and academic success was more robust among lower-performing students, implying that gender-related issues may have a bigger influence on individuals who struggle academically. This emphasizes the significance of gender identity for addressing academic differences in online education environments.

Influences of Gender on Academic Achievement

Stewart-Williams & Halsey, (2021) investigated the causes behind women’s underrepresentation in STEM areas, concluding that IQ or aptitude is not a determining factor. They point out that thorough research shows no difference between men and women in arithmetic and language ability. Despite girls performed similarly to boys in math and scientific courses, the researchers discovered that women have a lesser degree of interest in these areas during their junior and senior years. To address this, the researchers recommend developing treatments that make math and science careers more enticing to high-achieving young women, rather than focusing just on academic achievement.

Association Between Non-High-Density Lipoprotein to High-Density Lipoprotein Cholesterol Ratio and Bowel Health in U.S. Adults: A Cross-Sectional Study

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a robust predictor of dyslipidemia and cardiovascular disease, strongly linked to the development of various chronic conditions. However, there is a paucity of evidence exploring the relationship between NHHR and bowel health, particularly chronic diarrhea and constipation. Methods: This cross-sectional study utilized data from the National Health and Nutrition Survey (NHANES) 2005-2010. Sociodemographic, lifestyle, and health status data were collected alongside blood lipid levels. Weighted multivariate logistic regression models assessed the association between NHHR and bowel health. The restricted cubic spline (RCS) method was used to explore their dose-response relationship. Subgroup analyses and sensitivity analyses were conducted to further validate the robustness of our findings. Results:In our study of 11,268 participants, a significant positive association was identified between elevated NHHR levels and chronic constipation in women, with the highest quartile showing an adjusted OR of 1.57 (95% CI: 1.21-2.03) compared to the lowest quartile. This association was notably stronger among female smokers. Sensitivity analyses excluding individuals with hypercholesterolemia or inflammatory bowel disease confirmed the robustness of the correlation.No significant associations were found in men. Conclusion: The study findings provide novel evidence of the relationship between NHHR and bowel health in U.S. women, particularly chronic constipation. However, the cross-sectional design of the study limits our ability to establish causality. Additionally, reliance on self-reported bowel health data may introduce inaccuracies. Further research is needed to explore the mechanisms underlying this association and the impact of lifestyle factors.

The impact of social activity on cardiovascular disease risk among middle-aged and older adults in China: a nationwide cohort study based on the CHARLS database

Objective: This study aims to examine the relationship between social activity and the risk of cardiovascular disease (CVD) in middle-aged and older adults in China.

Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2020. The study followed 4,099 participants aged 45 and older, all free from cardiovascular disease at baseline (2011), over a 9-year period. CVD status was self-reported by participants. Kaplan–Meier survival curves were employed to illustrate the cumulative incidence of cardiovascular events across different levels of social activity. Cox proportional hazards regression models and restricted cubic spline (RCS) were used to

Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls

A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for

Key Influencing Factors Analysis on Life Satisfaction among Chinese Older Adults with Hypertension: A National Cross-sectional Survey

Objectives: This study aimed to assess the current situation and influencing factors of life satisfaction among Chinese older adults with hypertension and to identify its key factors.Methods: In this study, 4,197 hypertensive patients were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database for inclusion in the analysis. A multivariate logistic regression model was used to analyze the influencing factors of life satisfaction in hypertensive patients, and the random forest was further used to rank the importance of the significant influencing factors.Results: Overall, 29.52% of hypertensive patients reported dissatisfaction with their lives. The life satisfaction of these patients was influenced by a combination of factors. According to the results of the random forest, the variables that significantly influenced life satisfaction, in descending order of importance, are self-rated health, economic status, depressive symptoms, sleep duration, fruits, living arrangements, hearing impairment, heart disease, and gender.Conclusion: Our research indicates that currently, people with hypertension experience a high level of dissatisfaction with their lives, making it necessary to take preventive and intervention measures from multiple aspects.

Molecular and Clinical Profiles of T2DM, Dyslipidemia, and Periodontitis: Insights into Inflammatory and Metabolic Dysregulation

ype 2 Diabetes Mellitus (T2DM), dyslipidemia, and periodontitis are interconnected conditions that exacerbate systemic inflammation and metabolic dysregulation. Understanding the molecular and clinical profiles of these comorbidities is crucial for developing targeted interventions. This study investigates the molecular and clinical profiles of individuals with T2DM, dyslipidemia, and periodontitis to identify key markers and pathways underlying disease severity and progression.Peripheral blood mononuclear cells (PBMCs) were analyzed from five patient groups: T2DM poorly controlled with dyslipidemia and periodontitis (T2DMpoorly-DLP-H), T2DM wellcontrolled with dyslipidemia and periodontitis (T2DMwell-DLP-H), dyslipidemia and periodontitis (DL-P), periodontitis alone (P), and healthy controls (H). Correlations between molecular and clinical markers were assessed. The T2DMpoorly-DLP-H group exhibited the most extensive molecular dysregulation, including unique upregulation of Plasminogen Activator, Tissue Type (PLAT) and consistent overexpression of Vanin-1 (VNN1), a key regulator of oxidative stress. HbA1c and fasting plasma glucose were highest in this group (HbA1c >12%, glucose >300 mg/dL), correlating strongly (R² = 0.88, p < 0.001). In contrast, the T2DMwell-DLP-H group demonstrated reduced gene dysregulation and improved glycemic control (HbA1c ~6.5%). Sexspecific differences were observed, with females exhibiting higher glycemic markers (p = 0.014) and males showing elevated lipid levels (p = 0.021). This study identifies Vanin-1 (VNN1) as a potential biomarker for systemic inflammation and highlights the role of Plasminogen Activator, Tissue Type (PLAT) in vascular dysfunction, emphasizing the critical importance of glycemic control in mitigating molecular and clinical dysregulation. These findings underscore the need for personalized, sex-specific strategies to manage these comorbidities effectively.

Immunological Response and Implications of Ad26.COV2. S (Janssen COVID-19 Vaccine)Vaccine in Diabetic Patients: A Prospective Cohort Study in Ethiopia

Patients with Diabetes are at increased risk of severe COVID-19 and death, thus, it is imperative to provide them with vaccination. Ad26.COV2. S vaccine has proven its efficacy.However, the immunological response of the patients with diabetes in Ethiopia has not been well studied.Methods: This prospective cohort study assessed immune responses after vaccination with a single dose of the Ad26.COV2.S . The subjects were enrolled diabetic patients who were 18 years old and above and attended a diabetes clinic at Adama Hospital Medical College. A sufficient blood sample was collected from each participant, following established standard protocols. We evaluated correlations among selected immunological parameters (IgG, IgM, CRP, IL6, IFN-Y) and employed statistical techniques such as chi-square tests, independent t-tests, and Generalized Estimating Equations (GEE) to analyze differences between given vaccinated and non-vaccinated cohorts. Generalized Estimating Equations (GEE) are a statistical method for modeling longitudinal or clustered data, particularly useful when dealing with non-normal data like binary or count data, by estimating parameters of a generalized linear model while accounting for potential correlations between observations. Results: It was found that vaccinated subjects showed significant alterations in the immune response with IgM elevation and a temporary increase of inflammatory biomarkers CRP and IL-6. Younger age and females were associated with lower inflammatory markers, and no significant effects of lifestyle factors (alcohol, chat, smoking) on immunological outcomes were observed. This vaccine elicited significant immunological responses in diabetic patients, characterized by initial increases in inflammatory markers and subsequent stabilization, and with implications for the healthcare policies to design tailored approaches for diabetic groups.

Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and sarcopenia: evidence from CHARLS

BackgroundRecent studies have highlighted an association between lipid disorders and sarcopenia. The role of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has not been explored among Chinese adults. This study aimed to investigate the association between the NHHR and incident sarcopenia in the Chinese population.Methods: The study included a total of 4046 participants aged 50 years and older without a history of sarcopenia, from the China Health and Retirement Longitudinal Study (CHARLS). A multivariate logistic regression model and a restricted cubic spline model were used to investigate the association between NHHR and sarcopenia. Subgroup and sensitivity analyses were conducted to assess the robustness of the findings.Results: A total of 309 (7.6%) participants were newly diagnosed with sarcopenia in the 2015 wave. Participants in the highest NHHR quartile (≥3.99) had a significantly lower adjusted odds ratio for sarcopenia (OR=0.40; 95% CI, 0.280.58; p<0.001) compared with those in the lowest quartile (<2.24). Restricted cubic spline analysis revealed a nonlinear relationship between NHHR and sarcopenia risk (p for nonlinearity <0.05). In piecewise regression models, the adjusted OR for sarcopenia was 0.65 (95% CI, 0.550.78; p<0.001) among participants with NHHR <4.4, whereas no significant correlation was observed among those with NHHR ≥ 4.4. No significant interactions were found between NHHR and age, sex, hypertension, or diabetes in stratified analysis (p for interaction >0.05).Conclusions: There is an inverse relationship between NHHR and sarcopenia risk in the Chinese population. A higher NHHR is associated with a lower risk of sarcopenia below the inflection point, beyond which NHHR is no longer significantly associated with sarcopenia risk.Keywords: NHHR, sarcopenia, lipid metabolism, dyslipidemia

Protecting and rejuvenating skin aging by regulating endogenous hyaluronan metabolism using adipose-derived stem cell-secreted siRNAs

Background: Loss of moisture is the primary cause of skin aging and dysfunction. The skin’s hydration largely depends on hyaluronan (HA) and its ability to retain water. Ultraviolet (UV) irradiation, which accounts for 80% of skin aging (commonly referred to as photoaging), gradually disrupts the balance of HA metabolism, leading to a reduction in HA levels, dehydration and, ultimately, the formation of wrinkles. Methods: In this study, we develop an RNAi-based strategy to treat aged skin by modulating endogenous HA metabolism. Hyaluronidase 2 (HYAL2), an enzyme responsible for HA degradation, is selected as the therapeutic target, given its significant upregulation in photoaged skin. To deliver the siRNA targeting HYAL2 to the skin, human adipose-derived stem cells (ADSCs) are engineered to stably express and secrete HYAL2-targeting siRNAs (ADSC/siRH) via small extracellular vesicles (sEVs). Results: In vitro experiments demonstrate that ADSC-delivered siRNAs are successfully internalised by recipient cells, where they restore UV-induced HA reduction by inhibiting HYAL2 expression. In vivo experiments reveal that subcutaneous implantation of engineered ADSCs prior to UV exposure significantly protects mouse skin from accelerated HA degradation, helping to retain water content and prevent UV-induced dryness. Furthermore, application of engineered ADSCs to aged mouse skin can markedly restore HA and water content, effectively smoothing deep wrinkles and improving skin appearance. Conclusion: We develop an effective biological strategy to combat skin aging and damage by preserving endogenous HA levels, which could be applied for facial rejuvenation in the future.

The Effects of Different Oil Sources on Performance, Digestive Enzymes, Carcass Traits, Biochemical, Immunological, Antioxidant, and Morphometric Responses of Broiler Chicks

This research evaluate the influence of different oil sources, namely fish oil (FO), coconut oil (CocO), canola oil (CanO), or a mixture of the three oils (MTO)—included at 1.5% in broiler diets—compared to a no oil-supplemented diet. Hence, 250 unsexed, 1-day-old Cobb chicks were weighed and randomly allocated into five dietary treatment groups of 50 chicks each and five replicates per group. Oil-supplemented diets significantly increased the growth, improved the feed conversion ratio (FCR), and decreased the abdominal fat percentage compared to the control diet. Amylase was significantly elevated due to feeding the FO- or CocO-supplemented-diet compared to the control diet, whereas lipase increased due to offering CocO- and CanO-enriched diet; chymotrypsin increased due to different oil sources. High-density lipoprotein cholesterol (HDL-C) increased

Effect of Different Levels of Multienzymes on Immune Response, Blood Hematology and Biochemistry, Antioxidants Status and Organs Histology of Broiler Chicks Fed Standard and Low-Density Diets

This study was executed to investigate the effect of supplementing three multienzyme levels (0, 0. 1, and 0.2%) with two types of diet [standard diet (SD) vs. low-density diet (LDD)] on immune response, blood hematology and biochemistry, antioxidant status, and organ histology of broilers during 1–38 days of age. A total of 216 unsexed 1-day-old Arbor Acres broiler chicks were randomly distributed, on a factorial design (2 × 3), to six treatments each with six replicates. There were six chicks per replicate. Results showed that LDD significantly decreased body weight gain (BWG) of broilers, but did not affect the European Production Efficiency Index (EPEI). Addition of multienzymes at both levels (0.1 and 0.2%) significantly increased BWG and improved EPEI, compared to the control diet. Alanine aminotransferase (ALT), aspirate aminotransferase (AST), malondialdehyde (MDA),

The impact of community elderly care services on the quality of life of the elderly in China: the mediating role of social adaptation

Background: With the deepening trend of aging in China, community elderly care services occupy an important position in China's elderly care system. This paper aims to explore the impact of different types of community elderly care services on the quality of life of older adults and to analyze its underlying influencing mechanism.The research data are obtained from the 2020 China Longitudinal Aging Social Survey data. The Structural Equation Model is used to examine the relationship between of three types of community elderly care services on older adults'quality of life.(1) Three types of community elderly care services are positively associated with quality of life of older adults. Compared to basic elderly care services, extended elderly care services have a more significant impact on older people's quality of life. (2) It is found that the impacts of three types of community elderly care services on the quality of life of elderly people are heterogeneous in terms of age, registered residence, and disablement status. (3) Social adaptation mediated the relationship between three types of community elderly care services and older adults' quality of life.The results of this study show that three types of community elderly care services could improve the quality of life of older adults, and social adaptation plays a mediating role between three types of community elderly care services and quality of life. Therefore, it is necessary to strengthen the supply of community elderly care services, especially extended elderly care services. By accurately identifying the needs of the elderly and optimizing service supply, giving the elderly more useful services, improving their attitudes towards society and helping them better adapt to society, thereby improving the quality of life of older adults . This study provides a basis for optimizing community elderly care services and improving the quality of life of the elderly, and emphasizes the key role of social adaptation, which has important practical guiding significance for promoting the sustainable development of the elderly care service system

Integrated Multiomics Analysis Identifies PHLDA1+ Fibroblasts as Prognostic Biomarkers and Mediators of Biological Functions in Pancreatic Cancer

Background: Pancreatic cancer (PC) is marked by extensive heterogeneity, posing significant challenges to effective treatment. The tumor microenvironment (TME), particularly cancer-associated fibroblasts (CAFs), plays a critical role in driving PC progression. However, the prognostic and functional contributions of distinct CAF subtypes remain inadequately understood. Here, we introduce a novel 7-gene risk model that not only robustly stratifies PC patients but also unveils the unique role of PHLDA1 as a key mediator in tumor-stroma crosstalk.Methods: By integrating single-cell RNA sequencing (scRNA-seq), spatial transcriptomics, and bulk RNA sequencing data, we comprehensively characterized the heterogeneity of CAFs in PC. We identified five CAF subtypes and focused on matrix CAFs (mCAFs), which were strongly associated with poor prognosis. A 7-gene mCAF-associated risk model was constructed using advanced machine learning algorithms, and the biological significance of PHLDA1 was validated through co-culture experiments and pan-cancer analyses.Results: Our multiomics analysis revealed that the novel 7-gene model (comprising USP36, KLF5, MT2A, KDM6B, PHLDA1, REL, and DDIT4) accurately predicts patient survival, immunotherapy response, and TME status. Notably, PHLDA1 was uniquely overexpressed in CAFs and correlated with the activation of key protumorigenic pathways, including EMT, KRAS, and TGF-β, underscoring its central role in modulating the crosstalk between CAFs and malignant ductal cells.Pan-cancer analysis further supported PHLDA1's prognostic and immunomodulatory significance across multiple tumor types.Our study presents a novel 7-gene prognostic model that significantly enhances risk stratification in PC and identifies PHLDA1+ CAFs as promising prognostic biomarkers and therapeutic targets. These findings provide new insights into the TME of PC and open avenues for personalized treatment strategies.

Effects of fatigue on physiological, physical fitness, and stroke performance related parameters in healthy tennis players: A systematic review and meta-analysis

Fatigue is a multifactorial phenomenon involving central and peripheral mechanisms that could negatively affect performance-related measures in tennis players. The aim of this systematic review and meta-analysis was to quantify the effects of fatigue on physiological (e.g., blood lactate, heart rate), physical fitness (e.g., explosive muscle strength, speed), and stroke performance (e.g., stroke velocity or accuracy) related parameters in healthy tennis players and to provide insight into training and recovery strategies. A systematic literature search of PubMed, Web of Science, and SportDiscus identified studies that examined effects of fatigue in tennis. Inclusion criteria required that studies were conducted with healthy participants, applied fatigue-inducing interventions, and used pre-/post-test designs measuring physiological, physical, or stroke performance related parameters. Effect sizes were calculated using weighted standardized mean differences (SMD) to assess the impact of fatigue. The search identified a total of N=642 records. Eighteen trials (318 tennis players) were included. Fatigue evoked large to moderate negative effect on physiological (SMDw = -4.19), physical fitness (SMDw = -0.74), and stroke performance (SMDw = -0.60) related parameters. The larger negative effects of fatigue on physiological and physical parameters compared to stroke performance-related outcomes indicate the importance of targeted recovery strategies (e.g., hydration, nutrition or cold baths). For stroke performance, non-fatigued states are recommended for learning new skills, while practice under fatigued conditions may help to maintain biomechanical efficiency during prolonged games.

Effect of Traditional Chinese Exercise on Older patients with diabetes mellitus: a systematic review and Meta-analysis of randomized controlled trials

Objective: This systematic review and meta-analysis aimed to evaluate the effects of traditional Chinese exercises (TCEs) on blood glucose, glycosylated hemoglobin (HbA1c), body mass index (BMI), and health-related quality of life in older patients with diabetes mellitus (DM).Methods: Database searches were systematically conducted across multiple platforms. The review adhered to PRISMA guidelines, utilizing the Cochrane Risk of Bias Assessment Tool to gauge literature quality. Review Manager 5.3 was employed for data evaluation, calculating mean differences to ascertain pooled effect sizes.Results: This study encompassed 11 randomized controlled trials involving 944 individuals. The results showed that TCEs reduced fasting blood glucose (-0.76, 95% CI [-1.14, -0.38], P = 0.0001), HbA1c (-2.64, 95% CI [-4.81, -0.47], P = 0.02), and BMI (-0.83, 95% CI [-1.42, -0.24], P = 0.006), and improved health-related quality of life. Among the various forms of TCEs, Baduanjin (BDJ) appeared particularly beneficial.Conclusions: Traditional Chinese exercises can improve blood glucose levels, BMI and quality of life-related indicators to varying degrees in older diabetes patients, and may be a useful complementary therapy for this population.

Exploration of Fever Characteristics in Parturients under Continuous Temperature Monitoring during Labor Analgesia and Analysis of the Impact on Maternal and Neonatal Outcomes: An Observational Study

Objective: By continuous core temperature monitoring, this study aims to explore the patterns of fever in parturients receiving labor analgesia and analyze its impact on both the maternal and neonatal.Methods: Non-invasive temperature monitoring sensors (iThermonitor705) and labor analgesia temperature management system were used to collect temperature data from parturients. Based on the presence or absence of fever during the peripartum period, the subjects were divided into a fever group and a non-fever group. Maternal temperature data during the peripartum period, along with maternal and neonatal demographic and clinical characteristics, were collected.Results: Among the parturients receiving labor analgesia, 25.9% (43/166) developed a fever during the peripartum period. Of these, 25.6% (11/43) experienced their first fever after delivery, all occurring within two hours after delivery. Compared to the non-fever group, the fever group had longer durations of the first stage of labor, total labor duration, and epidural analgesia. Additionally, the fever group had a higher rate of meconium-stained amniotic fluid (grade III), used more analgesics, and had a higher rate of antibiotic use. However, no significant differences in adverse maternal and neonatal outcomes were observed between the two groups.Fever can occur not only during labor but also for the first time after delivery. Although fever during the peripartum period increases the rate of maternal exposure to antibiotics, there were no significant differences in maternal or neonatal outcomes between the two groups.

Experimental study on the failure mechanism and support optimization of deep soft rock roadway structures for coal mine safety

The effectiveness of roadway support in soft rock under high horizontal stress poses a critical technical challenge in underground engineering. It directly affects mine construction progress and mining safety. In response to support failures, such as significant deformation, sheet wall collapse, and roof fall, encountered during the high horizontal stress soft rock roadway support in coal mines, this study utilizes similar material model experiments to simulate actual roadway excavation processes, aiming to analyze the patterns of displacement, deformation, and failure in the surrounding rock during roadway excavation and assesses the effectiveness of different support methods. Simultaneously, FLAC 3D was employed to simulate the working face to obtain the deformation and stress distribution patterns of the surrounding rock in the roadway. Field test verification was conducted using the fiber grating anchor monitoring system to validate the findings.The research findings demonstrate that the novel support design scheme effectively restricts the deformation and stress distribution in the surrounding rock, these research results not only provide a solid scientific foundation for selecting an appropriate support method for the soft rock roadways subjected to high horizontal stress, but also contribute to the enhancement of process safety risk control in coal mining.

Gender and Multilingual Bias in Observations of Children with a Developmental Language Disorder

AbstractPurpose. The aim of our study was to clarify DLD characteristics specific to boys and girls and monolingual and multilingual children, including the detection of possible bias in observations made by speech-language therapists. Method. We used text-mining techniques on existing individual treatment plans for children diagnosed with DLD (N = 994) written by speech-language therapists. Specific analyses included analyses of unigrams, bigrams, and trigrams within lines (N = 9092) of individual treatment plans, followed by sentiment analyses of these unigrams, bigrams, and trigrams. Results. Not only were girls described with more negative words but the focus of the identified DLD characteristics also differed. Boys were described more in terms of tasks and girls in terms of personal characteristics, specifically hearing problems. Multilingual children were described far more negatively by their speech-language therapists than monolingual children, combined with what appeared to be a somewhat stronger focus on vocabulary in observations.Conclusion. The found differences can be due either to bias or actual differences in characteristics between these groups. Screening procedures should be adapted to detect these children earlier, and speech-language therapists should be made aware of the differences in their observations of girls and multilingual children with DLD to avoid bias.

Effects of off-line auricular transcutaneous vagus nerve stimulation (taVNS) on a short-term memory task: a pilot study

One of the commonly used indices of short-term memory (STM) is the digit span task. Prior studies have proposed pupil dilation as a measure of task engagement and as a promising biomarker of vagal activation. Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel non-invasive brain stimulation technique which might be used to improve cognition and modulate pupil size through its effects on the noradrenergic release in the locus coeruleus. No previous study has investigated the effects of off-line taVNS on a digit span task. With this single blind, sham controlled, crossover design trial, we aimed to assess whether taVNS was able to improve the digit span score, as well as to modulate the pupillary response to cognitive load in a sample of 18 elderly Japanese volunteers with no self-reported cognitive impairments. Subject were randomized to receive either real or sham taVNS during a digit span task while recording the pupil size and then switched over to the other treatment group. We found that real stimulation significantly reduced the mean number of errors performed at span length 7, 8, and 9 ( -0.83, -0.90 and -0.39 respectively compared to pre stimulation values and -0.71, -1.08, and -0.79 respectively compared to sham stimulation). Additionally, real taVNS stimulation slightly but significantly increased the pupil size at all span lengths during the encoding period of the task, with larger effects for span 7 to 10 compared to pre stimulation and for span 5 to 10 compared to sham. No effect over the pupil size was found during the recall period. Our results suggest that taVNS might selectively improve the cognitive performance during the encoding phase of the task. Although further studies are needed to better clarify the optimal stimulation parameters, findings from this study could support the use of taVNS as a safe neuromodulation technique to improve cognitive function

Beneficial effects of reduced soft tissue vibrations with compression garments on delayed neuromuscular impairments induced by an exhaustive downhill run

Soft tissue vibrations (STV) have been extensively researched for their effects on muscle fatigue and damage, but their influence during running remains unclear. As compression garments are known to lower STV, they have shown benefits on acute neuromuscular responses to downhill running. However, an in-depth analysis of changes in STV has never been proposed, and previous protocols did not overcome the repeated bout effect. This study aimed to investigate whether compression shorts could reduce STV parameters and related neuromuscular impairments using a unilateral compression protocol.Twenty healthy men performed a downhill run until exhaustion whilst wearing shorts that compressed one thigh with the contralateral leg serving as a control. Foot ground impacts (FGI), STV and muscle activation of the Vastus Lateralis were measured on both legs whilst running using accelerometers to obtain FGI and STV, and surface electromyographic sensors (EMG) for muscle activation. Time-frequency analyses were applied to acceleration and EMG signals with statistical nonparametric mapping applied to the continuous data to assess time and compression effects. Neuromuscular parameters such as maximal voluntary contraction torque, voluntary activation, and torque evoked by 10 and 100 Hz doublets stimulation were assessed before, after, and 48 hours postexercise, alongside perceived fatigue and muscle soreness. Mixed linear models and paired Student's t-tests were used to analyze neuromuscular outcomes.While results showed that both FGI and STV magnitude increased during the run by 19.7% (P=0.002) and 17.8% (P=0.003) respectively, compression reduced the magnitude and frequency of STV by 15.1% (P=0.013) and 11.7% (P=0.001) respectively, without influencing FGI or muscle activation. Although neuromuscular parameters were altered in both legs, losses of torque evoked by 10 and 100 Hz doublets were lower in the compressed leg 48-hours post-exercise (P<0.001 and P=0.001 respectively).This study revealed the potential of compression garments to act as a mechanical support that attenuates high-frequency STV during downhill running and mitigates subsequent delayed neuromuscular alterations.

Use of Preventable Risk Integrated Model (PRIME) on behavioral risk factors: A Scoping review and bibliometric analysis

Behavioral or habit-based risk factors lead to the development of non-communicable diseases, causing early deaths, disability due to these diseases, and high economic burdens on the public or private health system. The use of the Preventable Risk Integrated Model through the creation of counterfactual scenarios could simulate in the future the number of deaths that can be delayed or prevented if one or more risk factors associated with diet, tobacco, alcohol, or physical activity are modified. The objective of this research was to explore the scientific evidence available on the use of the Preventable Risk Integrated Model, identifying the main findings, the most productive authors on the subject, the most used keywords, the countries of origin of the research, and the scientific journals where these studies are published. Through the development of four research questions, the search strategy was established for the development of the scoping review and bibliometric analysis of the information obtained. A total of 24 articles were identified that used the Preventable Risk Integrated Model, which were available in their titles and research abstracts. Regarding the results obtained, this model was used in topics related to food consumption, food composition, nutrient intake, prevention of non-communicable diseases by reducing some nutrients related to sodium or saturated fats, in addition to the creation of new models supported by the Preventable Risk Integrated Model. In addition, the authors who research on the topic, the use of keywords, countries that have done the most research on the subject and indexed journals were identified. Finally, the use of the model allowed the projection of preventable deaths or those that could be delayed when modifying the risk factors that cause non-communicable diseases; however, caution must be taken in its proper use, due to the consultation of various sources such as databases, use of national surveys or international information repositories.

Association of plasma neurofilament light protein concentration with sleep disturbance after intracerebral hemorrhage

Background: Intracerebral hemorrhage (ICH) represents a critical subtype of stroke characterized by substantial morbidity and mortality. Emerging research indicates that neurofilament light protein (NfL), a biomarker indicative of neuronal damage, may offer valuable prognostic information regarding outcomes and recovery trajectories post-ICH. This study seeks to elucidate the relationship between plasma NfL (pNfL) concentrations and long-term patient outcomes, with a particular focus on sleep disturbances following ICH.Methods: We conducted a cohort study comprising 26 healthy controls and 49 patients who had experienced ICH. The Glasgow Coma Scale (GCS) was assessed upon admission. Plasma samples were collected at admission and on 3, 7, and 14 days post-ICH. Then pNfL levels were quantified using Enzyme-Linked Immunosorbent Assay (ELISA). Clinical outcomes were evaluated at 6 months post-ICH using the Glasgow Outcome Scale-Extended (GOSE) and the Pittsburgh Sleep Quality Index (PSQI).Receiver operating characteristic (ROC) curves and the areas under the ROC curves (AUC) were utilized to determine the accuracy of hemorrhage volume and pNfL levels in identifying sleep disturbances.Results: pNfL levels were elevated in patients with ICH compared to healthy controls. Longitudinal analysis indicated an increasing trend in pNfL levels over the initial 7 days post-admission. pNfL levels demonstrated an AUC for distinguishing ICH patients from controls (admission for 0.92, post-ICH 3d for 0.98). In ICH patients, pNfL levels showed a positive correlation with hemorrhage volume and PSQI, and a negative correlation with GCS and GOSE. The AUCs for pNfL levels and hemorrhage volume, which were indicative of sleep disturbances, were 0.82 and 0.75, respectively. Furthermore, the combined assessment of pNfL levels and hemorrhage volume exhibited superior predictive performance compared to the evaluation of each factor individually.Conclusions: pNfL represents a promising biomarker for predicting functional outcomes and evaluating sleep disturbances in patients following ICH. Elevated levels of NfL at admission are associated with poorer prognoses and increased sleep-related issues, indicating that monitoring pNfL could be valuable for prognostication and the implementation of targeted interventions.

Sensory driven neurophysiological mechanisms of concussion: a parsimonious and falsifiable theory

Every time a person sustains a blow to the head, they receive multiple atypical sensory inputs, often including pain. These directly stimulate the central nervous system. Yet, sensory input as a causal agent of neurophysiological dysfunction and post-concussion symptoms has never been explored. A new theory is proposed here of sensory driven neurophysiological mechanisms of concussion (i) which are causally linked to the momentary blow to the head, (ii) whose time courses and other properties correspond to those observed to date for acute, sub-acute, and chronic symptoms, and (iii) which give rise to testable questions with experimentally measurable consequences. The primary assertion of the theory is that trauma induced excitation of key brain regions including the salience network (SN) and locus coeruleus (LC) can produce persistent dysfunctional alterations in the stable patterns of network excitability on which symptom-free neurological function depends. This mechanism is in play with any physical trauma, with or without a blow to the head. That is because atypical, painful, and otherwise high intensity sensory stimuli excite the SN and thence the LC, inducing plasticity widely in the brain. Many of those sensory stimuli may persist through the recovery period and while the brain is plastic, enable one or another network to learn altered and potentially dysfunctional patterns of network excitability. The secondary assertion of the theory is that with a blow to the head, convergence of high-intensity sensory stimuli within the brainstem and midbrain can cause neurophysiological coupling between brainstem nuclei which normally function independently, so-called brainstem crosstalk. It is brainstem crosstalk which causes the signs and symptoms specific to head trauma, e.g. loss of consciousness, and oculomotor and vestibular dysfunction. The theory’s reliance on sensory input emphasizes the importance of studying putative mechanisms whose initiating cause is known to have been present for every head trauma. This is in contrast to the century-long focus on mechanisms whose initiating cause, brain injury, is undetectable by clinical exam, neuroimaging, and bioassay in fully 60% of all head trauma, i.e. 70-75% of all mild TBI. As formulated and described below, the theory is readily testable and falsifiable.

Acquired ROS1 Fusion and Iruplinalkib Response in Advanced NSCLC after Multiple Lines of Systematic Therapy: A Case Report

This is the first report of a patient with lung cancer whose primary focus was the upper lobe of the left lung combined with multiple metastases in both lungs, initially diagnosed as a non-driver gene mutation, who subsequently developed SDC4-ROS1 fusion after multiple lines of systemic therapy. When diagnosis, a needle biopsy of the primary focus revealed no driver gene mutation and low PD-L1 expression (TPS < 1%, CPS 3). From November 2022 to December 2023, the patient received sequential chemotherapy-based systemic therapy including anti-angiogenesis treatment, concurrent chemoradiation and combined immunotherapy as determined by the clinician based on the initial evaluation. In December 2023, a needle biopsy of a metastasis in the left lower lobe of the lung showed a positive SDC4-ROS1 fusion. Subsequent treatment with the oral ALK TKI iruplinalkib was initiated based on the patient's preference, which exhibited a promising response over the next 2 months.

Effect of seasonal exposure in aeroallergen-sensitized patients with irritable bowel syndrome-diarrhoea

Background. Pollen allergy may have an influence on irritable bowel syndrome (IBS) symptoms, but data are scant. Aims. To assess symptom variability in atopic IBS patients. Methods. We retrospectively analysed consecutive adult IBS patients evaluated in 2021-2024. Patients from the overall IBS cohort and the IBS-diarrhoea (IBS-D) subgroup were classified according to their sensitization into Grasses positive, House-dust mite (HDM) positive or unsensitised. Symptom burden was assessed with the gastrointestinal symptom rating scale (GSRS) and visual analogue scale (VAS) for abdominal pain/distension out of the season period (T0) and at the pollination season (T1). Results. Overall, 61 IBS (median age 34 years, IQR 25-50, F:M ratio 3.6:1) of whom 38 (62.8%) IBS-D (median age 30 years, IQR,28-47, F:M ratio 2.8:1) patients were recruited. Atopy was common in the IBS-D subgroup, particularly respiratory manifestations. The mean GSRS significantly (p<0.01) increased at T1 (variance of 3.4 points) only in Grass-sensitized patients as opposed to those sensitized to HDM or unsensitised ones and this effect was present only in the IBS-D subgroup, while in the overall cohort no significant variation was observed. Conclusions. Pollination season has an influence on symptoms in IBS-D patients sensitized to seasonal allergens.

Can collaborative orientations strengthen or weaken effectiveness of improvisers' emergency response to an emergency incident? a conditional process model

Due to insufficient information on the on-site emergency incident, respondents face a huge challenge to react effectively. This may suggest that the individual response to emergency tasks is likely to differ from that in daily work contexts. This study aims to explore the conditional process of how individuals' improvisational cognitive appraisals (IICAs) in psychology affect their improvisational performance in an emergency setting and its consequences. Using the data garnered from the coal mine accident rescue teams we find that the level of IICAs positively impacts the individual's improvisational ability to effectively respond to the emergency incident and the improvisational performance of temporary emergency teams as a whole. Further, an individual's higher level of proclivity to seek cooperation with others in an emergency situation weakened the relationship between the individual's improvisational cognitive appraisals and the individual's improvisational performance team. Our work sheds light on how the improvisational performance of temporary emergency teams in a crisis setting is shaped, explaining why those who perform well in their day-to-day work often have difficulties in achieving the same good performance in a sudden crisis setting.

Application of intraluminal brachytherapy for malignant obstruction in the porta hepatis: a retrospective control study

Purpose and Background Malignant obstructions in the porta hepatis mainly include malignant obstructive jaundice (MOJ) and portal vein tumor thrombus (PVTT) . Stent placement has been one of the most commonly recommended methods to alleviate the physical suffering of these patients, but the long-term outcome has been frustrating in terms of stent occlusion. The aim of this study was to discuss the clinical effect and technical feasibility of intraluminal brachytherapy (ILBT) in patients with malignant obstruction in the porta hepatis Methods and Materials From 2016 to 2018, 68 patients diagnosed with malignant obstruction in the porta hepatis were retrospectively included in this study. Twenty-eight patients (group A) received stent placement with iodine-125 seed-strand implantation, and 40 patients (group B) received stent placement only. All patients underwent numerous transarterial chemoembolizations (TACE) after stent implantation. . . . All patients were followed up until death. Clinical data, stent patency and survival time were recorded for further analysis.There was no significant difference between the two groups in terms of length of malignant obstruction and baseline characteristics. 68 stents were successfully implanted in both groups. 28 iodine-125 seed strands were successfully deployed and completely covered the length of the stent in group A. Liver function and jaundice improved continuously in the first 9 months after treatment (P<0.05) . Compared to group B, the mean stent patency time was significantly longer in group A (5.5 ± 2.09 months versus 6.86 ± 1.82 months, P<0.001) . The mean survival time is longer in group A than in patients in group B (10.03 ± 3.04 months VS 7±2.44 months, P<0.001) . Conclusion ILBT in combination with stent implantation and TACE has proven to be a feasible and effective palliative treatment to maintain stent patency in patients with PVTT and MOJ. Under standardised surgical guidance, this procedure was worth popularising.

Identification and validation of shared biomarkers and drug repurposing in psoriasis and Crohn's disease: Integrating bioinformatics, machine learning, and experimental approaches

Psoriasis and Crohn's disease (CD) are chronic inflammatory diseases that involve complex immune-mediated mechanisms. Despite clinical overlap and shared genetic predispositions, the molecular pathways connecting these diseases remain incompletely understood. The present study seeks to identify shared biomarkers and therapeutic targets for psoriasis and CD. Initially, differentially expressed genes (DEGs) were identified from publicly available transcriptomic datasets related to psoriasis and CD. Simultaneously, weighted gene co-expression network analysis (WGCNA) was performed to identify gene modules associated with the clinical traits of psoriasis and CD. Subsequently, biomarkers were prioritized from shared key genes by integrating protein-protein interaction (PPI) networks with machine learning models. Gene Set Enrichment Analysis (GSEA), along with Gene Ontology (GO) and KEGG pathway analysis, highlighted the significance of cell cycle regulation and immune response pathways in comorbidities. Immune infiltration analysis underscored the involvement of hub genes in immune regulation, while single-cell transcriptomic analysis revealed the cellular localization of these hub genes.Additional targeted molecular biology experiments validated the shared biomarkers.Finally, KIF4A, DLGAP5, NCAPG, CCNB1, and CEP55 were identified as key regulatory molecules and shared biomarkers. DSigDB predictions and molecular docking simulations indicated strong therapeutic potential for Etoposide, Lucanthone, and Piroxicam, with Etoposide showing the highest affinity for key targets. In cellular models, Etoposide demonstrated promising therapeutic effects by significantly downregulating the expression of psoriasis-related keratinocytes marker genes (KRT6, KRT16) and CD-related inflammatory cytokines (IL6, IL8, TNF-α), highlighting its potential in treating psoriasis and CD. This study integrates bioinformatics, machine learning, and molecular validation to identify the shared molecular mechanisms of psoriasis and CD, uncovering novel biomarkers and potential combined therapeutic candidates. These findings provide valuable insights into potential treatment strategies for these diseases.

EBV-positive Diffuse Large B Cell Lymphoma Secondary to Activated Phosphoinositide 3 Kinase δ Syndrome Type 1 (APDS1): A Case Report and Literature Review

Activated phosphoinositide 3-kinase δ syndrome (APDS), an inborn error of immunity associated with gain-of-function mutations in the PIK3CD gene, is characterized by dysregulated PI3Kδ signaling. The clinical spectrum commonly includes recurrent respiratory infections and lymphoproliferative manifestations. We present an adolescent male with APDS1 manifesting recurrent sinopulmonary infections, generalized lymphadenopathy, hepatosplenomegaly, gastrointestinal manifestations, and combined T-cell/B-cell lymphopenia, complicated by Epstein-Barr virus-positive diffuse large B-cell lymphoma (EBV+ DLBCL). Whole-exome sequencing identified a heterozygous PIK3CD variant (c.3061G>A p.Glu1021Lys), supporting the molecular diagnosis of APDS1. This case adds to emerging evidence linking APDS1 with EBVdriven lymphomagenesis, thereby further supporting the critical role of PI3K δ pathway dysregulation in promoting EBV-associated lymphoid malignancies.

Study protocol for a randomized double-blinded placebo-controlled trial on ASA therapy for patients with chronic rhinosinusitis with nasal polyps, NSAID exacerbated respiratory disease and asthma

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinuses characterized by intense inflammation, accompanied by decreased health-related quality of life (HRQoL). NSAID-exacerbated respiratory disease (N-ERD), affects 17.7% of CRSwNP patients and often requires frequent sinus surgeries and rescue treatment. Compared to non-N-ERD patients, those with N-ERD have greater risks of asthma exacerbations, severe allergic reactions, and anosmia. Acetyl salicylic acid (ASA) treatment after desensitization (ATAD) has been proposed for N-ERD with severe CRSwNP, showing potential benefits for symptom relief, polyp reduction, and improved QoL but carries risks such as gastritis and bleeding. This randomized double-blind placebo-controlled clinical trial (RDBCT) evaluates ATAD's efficacy and safety compared to placebo in patients with severe CRSwNP, N-ERD, and asthma.Outcomes include polyp size reduction, QoL improvement, side effects, and analyses of molecular and microbiome markers from nasal, blood, and urine samples. Methods: AirGOs Medical is an investigator driven RDBCT of Helsinki University Hospital. ATAD and placebo treatment arms are compared. The primary outcome is the change in the SNOT-22 score at the 11-month follow-up. Secondary outcomes include the change in the nasal polyp score, clinical control of CRS, general health-related quality of life (HRQoL), loss of productivity, peak nasal inspiratory flow (PNIF) ± acoustic rhinometry (ARM), olfaction test (Sniffin' Sticks, identification), spirometry and peak expiratory force (PEF) and findings in pathological analysis at 12 -months of follow-up.Discussion: AirGOs Medical trial will lead to a better understanding of the efficacy and safety of ATAD in patients with severe CRSwNP, N-ERD and asthma.

Keywords: Trial registration: ClinicalTrials.gov, NCT03825757. Registere

Sustainable dyeing of cotton, silk and leather using natural dye from Bixa orellana seeds: Extraction, optimization and assessment of antibacterial activity

Using an array of extraction solvents (water, methanol, ethanol, ethanol: methanol (1:1)) and extraction techniques (direct heat (DH), ultrasonic water bath (USB), ultrasonic probe, (USP)), Bixa orellana seeds were utilized to produce a yellow-orange dye. The color strength of the extracted dye was investigated using a UV-Visible spectrophotometer to measure the absorbance wavelength. Using methanol as the solvent and 5 g of seed at 60°C for 60 min, the highest color yield was observed in USB. The functional groups identified in the extracted natural dye were described using an FTIR spectrophotometer. Using the ultrasonic water bath dyeing method at 60°C for 40 min without using any moderant, cotton, silk fabric, and leather were effectively colored in a yellow-orange color. The L * , a * , and b * values of the dyed material treated using the USB approach were 80. 95, 4.52, 75.35 for cotton, 88.65, -1.35, 62.85 for silk, and 79.55, 015.35, 66.45 for leather, respectively. Compared to the other bacterial reduction, 85.25% of the colored materials showed substantial antibacterial action against Staphylococcus sp. Vibrio sp. (76.69%), Pseudomonas sp. (75.83%), Klebsiella sp. (74.24%), and Micrococcus sp. (74.21%) were the following most prevalent bacteria. The ultraviolet protection factor (UPF) measurements showed that leather and cotton treated with B. orellana seed dye had higher UV radiation shielding properties.

Fetal Karyotyping in Adolescent Pregnancies: A Population-Based Cohort Study on Outcomes of Invasive Prenatal Testing

Background: Adolescent pregnancies present unique challenges in prenatal diagnostics, yet data on the prevalence and types of chromosomal abnormalities in this population remain limited.Objective: This study aimed to assess the prevalence and spectrum of chromosomal abnormalities and evaluate the effectiveness of invasive prenatal diagnostic procedures. Methods: A retrospective cohort study analyzed data from invasive prenatal diagnostic procedures (amniocentesis and transabdominal chorionic villus sampling) and fetal karyotyping in adolescent pregnancies, comparing them with data obtained from pregnancies in older women. Results: Abnormal karyotype prevalence varied by age. Trisomies were least frequent in adolescents (5.9%) vs. women 20-34 (9.3%) and ≥35 years (12.1%). Turner syndrome was more common in adolescents (4.6%) than in women 20-34 (2.8%) or ≥35 years (0.1%). Adolescents had a higher risk of unspecified fetal sex (RR=2.25, 95% CI: 1.16-4.35) and culture failure (RR=4.32, 95% CI: 2.07-9.00). Ultrasound abnormalities were the main reason for invasive testing (86.3%, p<0.001). More chorionic villus sampling procedures were needed per abnormal karyotype in adolescents (3.25) vs. women 20-34 (2.42) or ≥35 years (2.19), while fewer amniocenteses were required (6.68 vs. 7.37 and 8.44).Adolescents show unique chromosomal abnormalities, underscoring the need for tailored prenatal counseling and diagnostics.

Assessing Work-Related Musculoskeletal Disorders and Psychosocial Risks in Bus Drivers: Insights from a Municipal Company Case Study in Portugal

The public transport sector plays a crucial role in society, offering essential services and providing employment to a significant number of drivers. Despite the importance of this sector, it is essential to recognize that drivers are exposed to various occupational risks inherent to their daily work, which can have serious implications for their health. This study aims to characterize and analyse Work-Related Musculoskeletal Disorders (WMSD) and psychosocial risks in a public transport company. In the initial phase of the study, a questionnaire was administered to assess musculoskeletal symptoms and psychosocial risks. In the second phase, an inertial motion capture system was used to evaluate the risk of developing WMSD. The results revealed a significant and concerning prevalence of burnout, with over 60% of workers reporting high or severe levels across all dimensions (i.e., personal, work-related, and client-related burnout). Depression, anxiety, and stress were within typical ranges, though a relevant percentage of participants exhibited severe and extremely severe levels of depression (7.2%), anxiety (12.2%) and stress (8%). Musculoskeletal discomfort was highly prevalent, particularly in the lower back (68.3%) and neck regions (57.2%), regarding pain over the last 12 months. Additionally, the risk of developing WMSDs was high across the various microtasks, which were analysed across different bus lines and routes, with Rapid Upper Limb Assessment (RULA) scores ranging from 4 (Medium Risk) to 7 (Very High Risk). Based on the results, varying bus types and routes is recommended. Programs should enhance well-being, and studies should assess interventions on health, stress, and occupational risks.

Living donor liver transplantation for the treatment of recurrent pediatric acute liver failure with neuroblastoma amplified sequence gene mutation：a literature review

Background:Biallelic mutations in the neuroblastoma amplified sequence (NBAS) gene can cause recurrent acute liver failure (RALF) and multi-systemic disease.Case presentation: Herein, we report a 3-year-old Chinese boy with RALF due to a novel heterozygote mutation c.3596G> A(p.C1199Y)/c.1028G> A(p.S343N) in the NBAS gene, which was identified by whole-exome sequencing. The missense mutation c.3596G> A(p.C1199Y) was inherited from his father, and c.1028G> A(p.S343N) was inherited from his mother. He had suffered six acute liver crises triggered by fever. He eventually underwent living donor liver transplantation (LDLT) at 44 months, with his father donating the left lateral lobe liver, and is now healthy with no recurrence of ALF.We describe a novel pathogenic mutation in the NBAS gene of a patient with RALF and report that LDLT is a safe and efficient treatment for RALF caused by the NBAS gene mutation.

Fertility Preservation by Ovarian Tissue Cryopreservation of Children in China --Umbilical Single-Incision Surgery and Perioperative Experience

Background: Ovarian tissue cryopreservation and transplantation (OTCT) is an effective method for preserving fertility and endocrine function. This study aims to summarize the surgical techniques and perioperative experiences to provide clinical evidence for pediatric OTCT. Methods: This retrospective study reviewed the clinical data of 89 children who underwent umbilical single-incision laparoscopic oophorectomy at Children's Hospital, Capital Institute of Pediatrics between September 2020 and December 2024. The types of primary diseases were summarized, differences in preoperative complete blood count results, surgery methods and intraoperative conditions were explored among different primary diseases. Different surgical methods were reviewed. The surgery steps and techniques were summarized. The trends in surgical volume over time and the surgical learning curve were analyzed. The factors affecting follicle density were also explored.The primary diseases in this study included Turner syndrome, aplastic anemia, etc. Children received chemotherapy will experience a decrease in white blood cell (WBC) and neutrophil levels, necessitating granulocyte-stimulating therapy; children with aplastic anemia had a significant drop in hemoglobin level, thus requiring red blood cell transfusions; children with myelodysplastic syndrome and aplastic anemia showed a marked decrease in platelet levels, necessitating platelet transfusions. Children with Turner syndrome most commonly have the unclosed internal inguinal ring. The main steps of umbilical single-incision laparoscopic oophorectomy were incision, trocar placement, observation, suspension, dissection, removal, and incision closure. The number of umbilical single-incision laparoscopic oophorectomy had been increasing year by year. The learning curve analysis indicated that the first 35 cases were the learning and improvement phase. Follicular density was significantly correlated with age, primary disease and ovarian color. Conclusion: Pediatric OTCT has broad applications and a promising future. Perioperative preparation and the surgical process are important. It is necessary to adjust the complete blood cell count to ensure that WBC greater than 4*10^9/L, neutrophils greater than 1*10^9/L, hemoglobin greater than 70 g/L, and platelet greater than 100*10^9/L before surgery. Given the small volum of children's ovaries, it's necessary to remove the entire ovary. Energy devices can be utilized, however, it's essential to minimize mechanical, thermal damage, and warm ischemia time to the ovary, while also preserving surrounding tissues.

Clinical Application of Color Doppler Ultrasound for Assessing Hemodynamic Changes in Pediatric Moyamoya Patientsthe Children with Moyamoya Disease Undergoing Combined Revascularization Surgery

Objective: To investigate the advantages of color Doppler ultrasound (CDUS) in detecting hemodynamic alterations in children with moyamoya disease (MMD) following combined revascularization surgery. Methods: The common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and superficial temporal artery (STA) were measured by CDUS. Hemodynamic parameters including arterial diameter, peak systolic velocity (PSV), resistance index (RI), and blood flow volume (FV) were collected at three time points: pre-operation (T1), one week after operation (T2), and three months after operation (T3). Twelve children without intracranial arterial disease were recruited as the control group. Matsushima classification-based on digital subtraction angiography (DSA) was applied at T2. Results: Among the 12 children with MMD, 11 patients with bilateral arterial stenosis and 1 patient with unilateral being affected. Compared to the 24 control hemispheres, the diameter of the ICA was significantly smaller in the 23 MMD hemispheres (p < 0.001) with an increased PSV of CCA and ECA, and a decrease FV of carotid arteries (p < 0.05). In MMD group, CDUS revealed increased diameter and FV, decreased RI of STA at the operative side at T2. The PSV and FV of ECA at the operative side increased from T1 to T3 (p < 0.05). Six cases were allocated to satisfactory compensation group (S Group, Matsushima classification grade A and B) and six cases to dissatisfactory compensation group (DS Group, Matsushima classification grade C). The increase in FV of STA on the operative side was higher in S Group at T2 than DS Group (Spearman rho = -0.693, p = 0.039). Conclusion: As a noninvasive imaging modality, carotid and superficial temporal arteries ultrasound may serve as a valuable adjunct to invasive imaging techniques for children with MMD.

Comparisons of Liver Transplant from DCD outcomes in High-utilization centers versus Low-utilization centers in the US: A Systematic Review and Meta-Analysis

What are the differences in outcomes between high and low-utilization centers in liver transplants from donors after cardiac death (DCDs)?Findings: In this meta-analysis of 898 liver transplant patients from DCDs, the high utilization centers showed a 1-year graft survival of 90.9% (95% CI: 88.4 -92.9; I2 = 0%), and low utilization centers showed 89.4% (95% CI: 83.8 -93.2; I2 = 0%), with a pvalue between groups of 0.54. For 1-year patient survival, high utilization centers had a rate of 94.6% (95% CI: 92.4 -96.1; I2 = 0%), and low utilization centers had 93.7% ( 95% CI: 79. -99.23; I2 = 0%), with a p-value between groups of 0.84.Meaning: Although low-utilization centers have a higher selectivity for DCD organs, there is no statistically relevant difference compared to high-utilization centers, which may be caused by a compensatory higher experience in the latter.

Computer vision syndrome and its associated factors in health science students from a university in Peru

To estimate the prevalence and identify factors associated with Computer Vision Syndrome (CVS) among health science students at a university in Peru, we conducted a cross-sectional analytical study in Tacna, Peru, from October 12 to December 15, 2023. Participants were assessed through physical surveys. We evaluated 502 health science students; 59.2% were female, and the median age was 21 years (range 19 to 23 years). 78.1% had CVS, and 52% had moderate nomophobia. In the adjusted model, monthly family income of 2000 to 5000 soles (PR: 0.81; 95% CI: 0.73 to 0.91) and over 5000 soles (PR: 0.84; 95% CI: 0.74 to 0.95) was associated with a lower prevalence of CVS compared to families with income less than 2000 soles. Additionally, the prevalence of CVS was higher in students with mild nomophobia symptoms (PR: 1.57; 95% CI: 1.02 to 2.61), moderate nomophobia (PR: 1.91; 95% CI: 1.24 to 3.16), and severe nomophobia (PR: 2.07; 95% CI: 1.31 to 3.48) compared to those without nomophobia symptoms. The prevalence of CVS is high among health science students, especially in medical students. As the severity of nomophobia increases, so does the prevalence of CVS, and higher family income is associated with lower CVS.

Are Women More Likely to Engage in Extra Green Behaviors in the Workplace? Gender Differences in the Spillover Effect from Employee In-Role to Extra-Role Green Behavior

With the growing importance of green development, organizational research pointed that employee green behavior is an important micro foundation to addressing the environmental challenge. While past studies have categorized the in-role and extra-role green behavior as two dimensions of employee green behavior from the job performance perspective, they have overlooked the potential interaction between the two types of green behavior. This oversight may hamper organizations' green efforts since deeper engagement in green behavior needs more psychological motivations compared to compliance with green management policies. According to cognitive consistency theory, this study explores employees' psychology reactions to in-role green behaviors, and how these psychological changes induce extra-role green behaviors. Data of 351 employees in China revealed a moderated mediation model. SPSS 25 and Smart PLS 3.0 were used to test the theoretical model. Results show that reflective moral attentiveness and person-organization fit mediate the spillover between in-role to extra-role green behavior. Moreover, these effects were moderated by employee gender: reflective moral attentiveness plays a more important role for women in the green behavior spillover process; conversely, in-role green behaviors lead to stronger person-organization fit for man than for woman.

How Transformational Leadership of Managers Affects Employee Innovative Behavior in IT Corporations

Organizations are constantly challenged by new technologies that have the potential to transform their business models and organizational identity, and they are working to create an environment that supports innovation. Advances in digital tools for work have transformed the way we work, which used to be geographically constrained. Transformational leadership is becoming more important, facilitating access to information and knowledge sharing among internal constituents like never before. In addition, in innovation-oriented workplaces, frequent experiences of psychological capital and thriving at work, where employees enjoy an optimal state of challenge, are factors that promote innovative behavior. Based on the conservation of resources theory and social cognitive theory, this study explores the mechanisms through which transformational leadership influences the innovative behavior of IT workers. Specifically, it examines the dual mediating roles of psychological capital and thriving at work. Drawing on data from 394 valid responses out of 458 Korean IT workers surveyed, the results indicate that transformational leadership positively affects innovative behavior, with this relationship being partially mediated by employees' psychological capital and thriving at work. These findings offer practical insights into how psychological capital and thriving at work function as critical psychological processes through which transformational leadership, within internal collaboration platforms, fosters innovative behavior among team members.

Predictive modelling employing machine learning, convolutional neural networks (CNNs), and smartphone RGB images for non-destructive biomass estimation of pearl millet (Pennisetum glaucum)

Digital tools and non-destructive monitoring techniques are crucial for real-time evaluations of crop output and health in sustainable agriculture. Sustainable agriculture and environmental stewardship require precise AGB computation since it provides valuable insights into efficient crop management and carbon balance in ecosystems.This study uses cutting-edge computer vision and machine learning techniques to propose a novel, non-invasive approach for quantifying above-ground biomass (AGB) of pearl millet. We employed a transfer learning approach, leveraging pre-trained CNN models alongside shallow machine learning algorithms-such as Support Vector Regression (SVR), XGBoost, and Random Forest Regression (RFR). Smartphone-based RGB imaging was utilized for data collection. Convolutional neural networks (CNNs) were trained to predict the above-ground biomass of pearl millet using transfer learning, which incorporated the VegAnn model and its parameters into the convolutional layers of our model. Shapley additive explanations (SHAP) methodology was employed to evaluate predictor importance systematically. The SHAP analysis confirmed that the most influential features (such as Normalized Green-Red Difference Index, NGRDI, and plant height) substantially contributed to AGB estimation accuracy, whereas features with low SHAP values might be excluded from the final model without compromising predictive performance. A comparison of four machine learning models was performed using several feature sets, including all features, the five most significant, and the two most salient. The study found that XGBoost has a comprehensive feature set (R² = 0.98, RMSE = 0.26), while CNN-based models also showed high predictive ability. Notably, RFR performs best with the two most important features, whereas SVR is the least effective model throughout the analysis. These findings demonstrate the effectiveness of CNNs and shallow machine learning in estimating AGB non-invasively using cost-effective RGB imagery. The results show that our technique may be utilized to support automated biomass prediction and real-time plant growth monitoring. These tools could form the basis for small-scale carbon inventories to measure the carbon sequestered within vegetation biomass in smallholder agricultural systems. These inventories are crucial for understanding how agricultural practices contribute to carbon sequestration at the local level and for informing climateresilient strategies

The Prognostic Value of Homocysteine Levels in Hemorrhagic Stroke Patients: A Systematic Review and Meta-Analysis

Background: Hemorrhagic stroke is associated with significant morbidity and mortality, prompting the search for modifiable risk factors and prognostic indicators. Elevated homocysteine levels have been implicated in vascular diseases, but their link to hemorrhagic stroke outcomes remains unclear. This systematic review and meta-analysis aimed to evaluate the association between homocysteine levels and outcomes in hemorrhagic stroke patients.The MEDLINE, EMBASE, and Cochrane Central databases were searched for studies comparing the outcomes of hemorrhagic stroke in patients with high versus normal homocysteine levels. Data were pooled using random-effects models to calculate odds ratios (ORs) for mortality and poor functional outcomes and standardized mean differences (SMDs) for homocysteine levels, with respective 95% confidence intervals (CIs).The review included 10 studies. Pooled analysis showed no significant association between high homocysteine levels and increased risk of mortality (OR: 1.123, 95% CI: 0.589 to 2.143), poor functional outcomes (OR: 1.203, 95% CI: 0.962 to 1.504), or unfavorable neurological outcomes (OR: 1.001, 95% CI: 0.618 to 1.620). Substantial heterogeneity was observed among studies.High homocysteine levels were not significantly associated with mortality, functional outcomes, or unfavorable neurological outcomes in hemorrhagic stroke patients.The clinical utility of homocysteine as a prognostic marker in this population remains uncertain and warrants further research

Nanotechnology-Driven Advances in Intranasal Vaccine Delivery Systems Against Infectious Diseases

Outbreaks of emerging and re-emerging infectious diseases have consistently threatened human health. Since vaccinations are a powerful tool for preventing infectious illnesses, developing new vaccines is essential. Compared to traditional injectable vaccines, mucosal vaccines have the potential to offer more effective immune protection at mucosal sites. Mucosal immunization strategies include sublingual, oral, intranasal, genital, and rectal routes, in which intranasal immunization being the most efficient and applicable method for mucosal vaccine delivery.Nevertheless, low antigen availability and weak immunogenicity making it challenging to elicit a potent immune response when administered intranasally, necessitating the incorporation of immune delivery systems. However, there is a notable absence of reviews that summarize the intranasal vaccine delivery system against infectious disease. Therefore, this review summarizes the recent advances in intranasal delivery systems, classified by physical and chemical properties, and proposes potential improvement strategies for clinical translation. This review elucidates the potential and current status of intranasal delivery systems, while also serving as a reference point for the future development of intranasal vaccines.

Impact of Codon Optimization on vip3Aa11 Gene Expression and Insecticidal Efficacy in Maize

Codon optimization is critical for high expression of foreign genes in heterologous systems. The vip3Aa11 gene from Bacillus thuringiensis is a promising candidate for controlling Spodoptera frugiperda. To develop insect-resistant maize, we designed two codon-optimized vip3Aa11 variants (vip3Aa11-m1 and vip3Aa11-m2) based on maize codon usage bias. Both recombinant proteins expressed in Escherichia coli exhibited high insecticidal activity. However, in transgenic maize, Vip3Aa11-m1 exhibited strong insecticidal activity against Spodoptera frugiperda and Spodoptera exigua, while Vip3Aa11-m2 lost activity despite identical amino acid sequences. RT-PCR analysis confirmed that both genes were transcribed correctly, but western blot results demonstrated a smaller product for vip3Aa11-m2, suggesting a translation-level alteration. Segment replacement and point mutation experiments in maize protoplasts demonstrated that the synonymous codon AAT (Asn) at the fourth amino acid position in vip3Aa11-m2 was associated with the production of a truncated protein, suggesting that the AAT codon may influence the selection of the translation initiation site, potentially shifting it to a downstream ATG (Met) codon. These findings not only reveal the critical role of codon context in translation initiation and protein integrity but also provide a novel strategy for optimizing foreign genes in crop improvement, particularly offering valuable insights for engineering insect-resistant maize using Bt genes.

A Qualitative Study on the Challenges of Clinical Leadership in an HIV Care System: Insights from Healthcare Providers in Eldoret, Kenya

The provision of quality services to patients in healthcare facilities requires effective clinical leaders who will transcend their technical expertise, and coordinate and direct patient care through clinical leadership roles. Clinical leadership refers to using clinical experience to provide direction, inspire and promote values and vision, and promote quality clinical care. However, there is a limited understanding of the challenges faced by clinical leaders within HIV care systems in Kenya. This study explored the views of healthcare providers on clinical leadership challenges in HIV care highlighting the sources and consequences.We conducted an exploratory qualitative study between December 2019 to May 2020 marked by COVID-19 involving (n=22) healthcare providers who were purposively sampled to participate in in-depth interviews in the AMPATH-MTRH HIV facility in Eldoret, Kenya. Ethics approval was granted and participants consented to participation and audiorecorded interviews. All data that was collected from participants were de-identified and kept in a confidential format to protect participant anonymity. A thematic analysis approach was used to analyze data and Nvivo vs.12 software was used for data management.Results: Participants identified three broad themes that described clinical leader challenges in an HIV facility including (1) supply-side challenges: a shortage of resources, staff welfare, and team dynamics (2) demand-side challenges: unmet patient expectations, lack of appreciation by the patients, lack of additional gains and incentives, financial constraints, stigma (3) health system challenges: rigid health system structure, lack of management support, unavailable services in the facility. These challenges negatively impacted healthcare providers' performance including clinical leaders', compromised patient care, and created inefficiencies in the HIV care system.The results provided important insights from the perspectives of healthcare providers. They show that in HIV care systems, clinical leaders are faced with diverse challenges that emerge from the supply, demand, and health system sides that affect patient care and system performance. Healthcare system leaders can strengthen management support systems and leadership training for clinical leaders to improve HIV care provision as well as provide career growth opportunities for clinical leaders to maximize their expertise in improving HIV care and system performance.

Traditional knowledge and use of cowpea (Vigna unguiculata) wild cowpeas in selected communities of Tanzania

Wild cowpeas are utilized as food, medicine, and nutritious fodder. However, there are limited reports on the cultural significance of wild cowpeas across different agroecologies of Tanzania.This study analyzed the traditional knowledge and identified the most culturally important species.The study involved 260 respondents interviewed from 13 villages in seven districts, using descriptive and ethnobotanical methods to assess traditional knowledge. Fisher's exact test (p = 0.0403) revealed that knowledge of wild cowpeas depends on age, not gender and education. A Pearson's test showed significant differences in use categories of wild cowpeas among the Formatted: Not Highlight Deleted: G Deleted: T Formatted: Not Highlight Formatted: Not Highlightrespondents, with 31% as animal fodder, 6% as medicine, 3.5% as food, and 2.5% as green manure, while 57% did not use it. Spearman rank correlations revealed positive correlations among the variables tested, with FC and UR significantly having a high correlation index of 0.98, while the cultural value (CVe) index highly correlated with all ethnobotany indices evaluated. Vigna dekindtiana is the most culturally significant species, with the highest frequency of citation (FCs = 20), use reports (URs = 27), and cultural importance (CIs = 1.125). The leaves of V. dekindtiana have been used as animal feed and vegetables, while its roots have been used to treat gastrointestinal disorders. This study revealed that wild cowpeas can be utilized in various ways, such as ecological and social aspects, and in breeding programs to improve cultivated cowpeas.

Integration of Smart Sensors and Phytoremediation for Real-Time Pollution Monitoring and Ecological Restoration in Agricultural Waste Management

Global climate change and ecological degradation highlight the urgency of dealing with agricultural waste and ecological restoration. Traditional pollutant monitoring and ecological restoration methods face challenges in accuracy and adaptability, especially when dealing with complex environmental data. This paper proposes the Bio-DANN model, which combines biogeochemical models and deep learning techniques to improve the accuracy of pollutant monitoring and ecological restoration prediction. The model uses deep neural networks (DNNs) and attention mechanisms to process multidimensional environmental data in various agricultural and ecological scenarios in real time. Experimental results based on Open Soil Data and NEON datasets show that Bio-DANN performs well in pollutant prediction, with mean square errors (MSE) of 0.012 and 0.018, root mean square errors (RMSE) of 0.109 and 0.134, and accuracy of 0.92 and 0.90, respectively. In terms of ecological restoration assessment, Bio-DANN achieved ∆F and PIPGR of 0.15 and 18%, and 0.20 and 22%, respectively, and H' values of 1.5 and 1.7, which are better than other models. Bio-DANN provides a promising technical solution for environmental protection, resource recovery and sustainable agriculture, especially showing significant potential in pollutant monitoring, soil health assessment and ecological restoration evaluation.

Impact of Parenting Style Disparities on Mental Health of Medical College Students: An Analysis of Mediating Effects of Positive Psychological Qualities

Background: Research has shown that parenting style disparities have a significant impact on the mental health of college students. However, the underlying reasons behind this phenomenon have not been sufficiently explored. This study systematically examines the impact of parenting style disparities on the mental health of medical college students from the perspective of positive psychology and analyzes the mediating effects of positive psychological qualities.Method: This study administered questionnaires to 3,387 medical students in Wuhu, China, all of whom came from two-parent families. Specifically, the Short-Egna Minnen av Barndoms Uppfostran for Children (s-EMBU-C) questionnaire was used to assess parenting style disparities, whereas the SCL-90 scale was utilized to evaluate mental health problems. Additionally, the Chinese College Student Positive Psychological Quality Scale was employed to assess positive psychological qualities. The hypothesis is proposed that positive psychological qualities mediate the relationship between parenting style disparities and mental health problems, and the bootstrap method was employed to examine the mediating effect. Additionally, a multivariate linear regression model was utilized to identify the factors associated with mental health problems.Results: The study revealed a significant positive correlation between parenting style disparities and mental health problems (r = 0.152, p<0.01); conversely, parenting style disparities were significantly negatively correlated with positive psychological qualities (r = -0.070, p<0.01). Additionally, positive psychological qualities were significantly negatively correlated with mental health problems (r = -0.201, p<0.01). Furthermore, positive psychological qualities played a partial mediating role between parenting style disparities and mental health problems, accounting for 12.398% of the total effect.Conclusion: Parenting style disparities significantly negatively predict positive psychological qualities in medical college students, whereas positive psychological qualities significantly negatively predict mental health problems. Positive psychological qualities play a partial mediating role between parenting style disparities and mental health problems among medical college students. The main findings emphasize the importance of consistent parenting styles and the cultivation of positive psychological qualities for the mental health of medical college students.KEYWORDS: mental health, parenting style disparities, positive psychological qualities, mediating effect

Keywords: Mental Health, parenting style disparities, Positive psychological qualitie

Impact of Visceral Obesity on Postoperative Outcomes in Colorectal Cancer: A Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis aimed to assess the impact of visceral obesity (VO) on postoperative outcomes in colorectal cancer (CRC) patients. Methods: Primary studies were obtained from sources like Embase, PubMed, and Web of Science during the search, which ran until October 2024. Patients with colorectal cancer who had VO and those who did not had different intraoperative conditions, postoperative outcomes, postoperative complications, and long-term prognoses, including overall survival (OS) and disease-free survival (DFS). Results: 5,756 individuals with VO and 5,373 patients without VO were among the 11,129 patients who had colorectal cancer resected. Patients with VO had higher conversion rates (p = 0.03), fewer lymph nodes removed (p = 0.05), and longer recovery times for bowel movements (p = 0.009). Furthermore, patients with VO had a considerably greater overall incidence of sequelae than those without (p = 0.0003), including anastomotic leaks (p = 0.01), intestinal obstruction (p = 0.0003), intraabdominal abscesses (p = 0.004), wound infections (p < 0.00001), and pulmonary problems (p = 0.0003). OS and DFS, however, did not differ between the two groups (p > 0.05). Conclusions: Colorectal cancer patients with VO who have surgery tend to have fewer lymph nodes taken, more problems after surgery, and a higher rate of switching to open surgery.

Integration of Smart Sensors and IOT in Precision Agriculture: Trends, Challenges and Future Prospectives

Traditional farming methods, effective for generations, struggle to meet rising global food demands due to limitations in productivity, efficiency, and sustainability amid climate change and resource scarcity. Precision agriculture presents a viable solution by optimizing resource use, enhancing efficiency, and fostering sustainable practices through data-driven decision-making supported by advanced sensors and Internet of Things (IoT) technologies. This review examines various smart sensors used in precision agriculture, including soil sensors for moisture, pH, and plant stress sensors etc. These sensors deliver real-time data that enables informed decisionmaking, facilitating targeted interventions like optimized irrigation, fertilization, and pest management. Additionally, the review highlights the transformative role of IoT in precision agriculture. The integration of sensor networks with IoT platforms allows for remote monitoring, data analysis via artificial intelligence (AI) and machine learning (ML), and automated control systems, enabling predictive analytics to address challenges such as disease outbreaks and yield forecasting. However, while precision agriculture offers significant benefits, it faces challenges including high initial investment costs, complexities in data management, needs for technical expertise, data security and privacy concerns, and issues with connectivity in remote agricultural areas. Addressing these technological and economic challenges is essential for maximizing the potential of precision agriculture in enhancing global food security and sustainability. Therefore, in this review we explore the latest trends, challenges, and opportunities associated with IoT enabled smart sensors in precision agriculture.

The Synergistic Retaining Effect of the Intermediate Bridge Between Adjacent Open-Pit Mining Areas and the Internal Dump on the Slope

To address the challenge of dynamic demolition of intermediate bridges, this study investigates the calculation method for slope stability under the synergistic support effect of the intermediate bridge and the internal dump. By constructing a mechanical model of the intermediate bridge and the internal dump, and applying the Mohr-Coulomb shear strength theory and soil pressure theory, mathematical expressions were derived to describe the variations in the supporting effect and the three-dimensional mechanical behavior of the internal dump during the demolition of the intermediate bridge. Additionally, a quantitative relationship between the dumping height and the demolition length of the intermediate bridge was established. Based on the principle of equivalence, a two-dimensional equivalent method for analyzing the synergistic mechanical effect of the internal dump was proposed. This method theoretically elucidates the influence of the internal discharge pressure height on the equivalent physical and mechanical parameters. The proposed method was applied to the Zahannaoer open-pit coal mine, where the intermediate bridge demolition project was designed in stages, and the slope stability at each stage was analyzed and verified. The results of this study provide a theoretical and practical foundation for the dynamic demolition design and engineering implementation of intermediate bridges in open-pit coal mines, ensuring both safety and efficiency in mining operations.

Association Between Oxidative Balance Score and Methylation Cycle Biomarkers in US Adults: Insights from the National Health and Nutrition Examination Survey

Background: Oxidative stress(OS) is implicated in various diseases, and the methylation cycle plays a critical role in numerous biological processes including DNA methylation and antioxidant defense. We aimed to investigate the relationship between oxidative balance score (OBS) and methylation cycle.Materials and methods: The study enrolled 28,061 adults ≥20 years old from the NHANES 2003-2014. Methylation cycle biomarkers included serum folate, RBC folate, vitamin B6, vitamin B12, homocysteine (HCY), and methylmalonic acid (MMA). OBS was scored by 20 dietary and lifestyle factors. We employed weighted linear regression and restricted cubic spline (RCS) models to analyze the correlations among OBS, and methylation cycle.Results: In a nationally representative cohort of US adults (mean age: 47.04±0.25 years; 51.76% female), OBS demonstrated significant associations with key methylation cycle biomarkers. After adjusting for potential confounders, OBS exhibited a positive association with serum folate, RBC folate, vitamin B6, and vitamin B12, a negative correlation with HCY (all P for trend<0.001), and no correlation with MMA (P for trend=0.07). Higher dietary OBS was correlated with increased levels of serum folate, RBC folate, vitamin B6, and vitamin B12, and decreased levels of HCY (all P for trend<0.001). Similarly, a higher lifestyle OBS corresponded to increased serum folate, vitamin B6, and vitamin B12, as well as decreased HCY (all P for trend<0.05). Stratified analyses demonstrated that OBS had a strong positive correlation with serum folate, RBC folate, vitamin B6, and vitamin B12, and a strong negative correlation with HCY. Additionally, the negative correlation between OBS and MMA was observed in the elderly population (≥ 60 years old) when stratified by age. RCS regression analysis revealed that with the increase in OBS, serum folate, RBC folate, vitamin B6, and vitamin B12 also increased, while HCY and MMA decreased.Conclusions: Our findings demonstrate a significant relationship between OBS and the methylation cycle. Higher OBS is positively associated with folate and vitamins B6/B12, and negatively with HCY.

Regulating mitochondrial oxidative phosphorylation and MAPK signaling: wedelolactone as a novel therapeutic for radiation-induced thrombocytopenia

Radiation-induced thrombocytopenia (RIT) is a serious complication of cancer radiotherapy and for which therapeutic options are limited. This study investigates wedelolactone (WED), a metabolite of botanical drug, as a potential treatment for RIT by promoting megakaryocyte differentiation and maturation. In vitro experiments using Meg-01 and K562 cells revealed that WED enhances megakaryocyte differentiation in a dose-dependent manner, increasing the expression of lineagespecific markers CD41 and CD61, and promoting polyploidization and cytoskeletal reorganization. In vivo, WED significantly restored platelet counts in the mice model of RIT, and promoted the production of hematopoietic stem cells (HSCs), megakaryocytes, and reticulated platelets. RNA sequencing and Western blot revealed that WED-induced megakaryocyte differentiation involves the regulation of mitochondrial oxidative phosphorylation mediated by AMPK signaling pathway, and activation of the MAPK signaling pathway. Inhibition of mitochondrial oxidative phosphorylation or MAPK signaling suppressed WED-induced megakaryocyte differentiation, highlighting the central role of these pathways. These findings indicate that WED could be a promising therapeutic candidate for RIT, acting through the modulation of oxidative phosphorylation and MAPK signaling pathway to enhance thrombopoiesis.

Transformational Leadership and Project Success: the Mediating Roles of Team Reflexivity and Project Team Resilience

Drawing from social cognitive theory, this study examines the mediating roles of team reflexivity and project team resilience in translating transformational leadership into project success. Data were collected from 261 project team members across various construction firms in China. The findings reveal that transformational leadership demonstrates a direct positive influence on project success. Moreover, transformational leadership significantly enhances both team reflexivity and project team resilience, which in turn contribute to project success. Furthermore, the results indicate that team reflexivity and project team resilience mediate the relationship between transformational leadership and project success. Based on these results, theoretical implications and practical recommendations are provided.

Prediction of pharmacokinetic/pharmacodynamic properties of aldosterone synthase inhibitors at drug discovery stage using an artificial intelligence-physiologically based pharmacokinetic model

The objective of this study is to develop an artificial intelligence-physiologically based pharmacokinetic (AI-PBPK) model to predict the pharmacokinetic (PK) and pharmacodynamic (PD) properties of aldosterone synthase inhibitors (ASIs), enabling selection of the right candidate with high potency and good selectivity at the drug discovery stage. On a web-based platform, an AI-PBPK model, integrating machine learning and a classical PBPK model for the PK simulation of ASIs, was developed. Baxdrostat, with the most clinical data available, was selected as the model compound. Following calibration and validation using published data, the model was applied to estimate the PK parameters of Baxdrostat, Dexfadrostat, Lorundrostat, BI689648, and the 11β-hydroxylase inhibitor LCI699. The PD of all five compounds was predicted based on plasma free drug concentrations. The results demonstrated that the PK/PD properties of an ASI could be inferred from its structural formula within a certain error range, providing a reference for early ASI lead compounds screening and optimization. Further validation and refinement of this model will enhance its predictive accuracy and expand its application in drug discovery.

Advanced Therapeutic Strategies and Safety Profiles in Heart Failure with Reduced Ejection Fraction: Contextualizing Recent Findings

Advanced Therapeutic Strategies and Safety Profiles in Heart Failure with Reduced Ejection Fraction: Contextualizing Recent Findings

Efficacy, Safety, and Tolerability of Soticlestat (TAK-935) as Adjunctive Therapy in Pediatric Patients with Dravet syndrome and Lennox-Gastaut syndrome: A Meta-analysis of 3 Randomized Controlled Trials

Purpose: To evaluate the efficacy, safety, and tolerability of soticlestat as adjunctive therapy in pediatric patients with epileptic encephalopathies of Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS). Method: We performed a computerized literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov to identify eligible randomized, placebo-controlled trials (RCTs) until December 2024. We calculated risk ratios (RRs) for efficacy of responder rate, and tolerability profiles in terms of serious adverse event (SAE) and dropout for adverse events as well as the most common side effects. Quality assessment of included RCTs was performed using the Cochrane Collaboration tool. Results: A total of 3 RCTs with 553 patients were included in the current study. Pooled RR for responder was 3.88 (95% CI 1.78-8.49, P=0.001) among patients with DS, and for patients with LGS was 1.56 (95% CI 0.91-2.68, P=0.11). Significantly more patients receiving soticlestat experienced discontinuation than placebo (RR 2.82 1.49-5.33, P=0.001) because of adverse events. No significant difference in SAE was observed between the two treatment groups with RR 0.87 (95% CI 0.55-1.39, P=0.57). Among the most common AE, only constipation occurred more often in the soticlestat group (RR 3.71, 95% CI 1.22-11.31, P=0.02). Conclusions: Soticlestat showed significantly higher efficacy in reducing convulsive seizures in patients with DS. Nonetheless, for patients with LGS, the difference between soticlestat and placebo was not statistically significant. The incidence of SAE in patients receiving soticlestat was similar to those receiving placebo; however, substantially more patients allocated to soticlestat discontinued prematurely because of side effects.

Integrating ensemble machine learning and multi-omics approaches to identify Dp44mT as a novel anti-Candida albicans agent targeting cellular iron homeostasis

Introduction: Candidiasis, mainly caused by Candida albicans, poses a serious threat to human health. The escalating drug resistance in C. albicans and the limited antifungal options highlight the critical need for novel therapeutic strategies. Methods: We evaluated 12 machine learning models on a self-constructed dataset with known anti-C. albicans activity. Based on their performance, the optimal model was selected to screen our separate in-house compound library with unknown anti-C. albicans activity for potential antifungal agents. The anti-C. albicans activity of the selected compounds was confirmed through in vitro drug susceptibility assays, hyphal growth assays, and biofilm formation assays. Through transcriptomics, proteomics, iron rescue experiments, CTC staining, JC-1 staining, DAPI staining, molecular docking, and molecular dynamics simulations, we elucidated the mechanism underlying the anti-C. albicans activity of the compound.Result: Among the evaluated machine learning models, the best predictive model was an ensemble learning model constructed from Random Forests and Categorical Boosting using soft voting. It predicts that Dp44mT exhibits potent anti-C. albicans activity. The in vitro tests further verified this finding that Dp44mT can inhibit planktonic growth, hyphal formation, and biofilm formation of C. albicans. Mechanistically, Dp44mT exerts antifungal activity by disrupting cellular iron homeostasis, leading to a collapse of mitochondrial membrane potential and ultimately causing apoptosis. Conclusion: This study presents a practical approach for predicting the antifungal activity of com-pounds using machine learning models and provides new insights into the development of antifungal compounds by disrupting iron homeostasis in C. albicans.

Socio-emotional and Personal Development Competencies as Assets Facilitating Psychosocial Adaptation in Socially Vulnerable Secondary School Students

Fostering positive developmental assets in the school student population could improve individuals' psychological adjustment processes and personal well-being. In view of the above, employing a nonprobability selective, cross-sectional design, this study evaluates the association between socioemotional and personal development competencies and psychosocial adaptation in a sample of 169 socially vulnerable secondary school students in the city of Cartagena de Indias (Colombia). Of these participants, 53.3% were female, and ages ranged from 11 to 19 years (M = 14.2; SD = 1.9). Participants completed scales that assessed their personal development (self-esteem, optimism, and satisfaction with life) and their socio-emotional development (empathy, attention, emotional clarity, and repair), as well as a psychosocial adaptation scale. Once data were processed through one-factor analysis of variance and multiple correspondence analysis, it was found that socio-emotional development assets associated with emotional intelligence had a significant relationship with the psychosocial adaptation processes of adolescents, despite the disadvantages and inequalities of the social environment in which they grew. Further studies with adolescent populations in this social context are required to confirm these findings and, eventually, create psychoeducational programs that promote these positive developmental assets.

Agility Development in Youth Soccer: The Efficacy of Fixed-Role Small-Sided Games

Purpose: This study aimed to evaluate the impact of Fixed-Role Small-Sided Games (FRSSGs) on youth soccer players' agility and its components: reaction time, linear speed, and change-of-direction speed (CODS). Methods: Thirty-one male U-12 regional soccer players were randomly assigned to the FRSSG group (n = 16; age: 10.63 ± 0.48 years) or the control group (CON) (n = 15; age: 10.89 ± 0.31 years). The intervention program lasted 18 weeks. Pre-and post-intervention tests assessed reaction time, linear sprint speed (10 m and 20 m), CODS (505 and zig-zag tests with/without the ball), and agility (Y-shaped with/without the ball and multiple-signal tests). Statistical analysis included paired t-tests, repeated measures ANOVA, and effect sizes (Cohen's d). Results: Significant baseline differences were observed between groups in 10-meter linear speed, and zigzag test performance (p < 0.05). Within-group improvements were observed for the FRSSG group in the 505 Test (-6.85%, p <0.001, d =1.3751.958), Zigzag Test (-10.77%, p <0.001, d =2.1484), CODS Zigzag Ball Test (-9.42%, p <0.001, d =1.86434), Y-shape Ball Test (-9.49%, p <0.001, d =2.195), and Agility Multi-signal Test (-8.42%, p =0.0023, d =0.82176). Significant between-group differences favoring FRSSG were found for the 505 Test (p =0.005, η² =0.038), Zigzag Test (p <0.001, η² = 0.435), CODS Zigzag Ball Test (p =0.004, η² =0.04), and Y-shape Ball Test (p =0.006, η² =0.027). Conclusion: FRSSGs have been shown to effectively enhance agility and change of direction speed, both with and without the ball, in youth soccer players

Bioactive Compounds Combination from Rhodiola tangutica Alleviates Pulmonary Vascular Remodeling in High-Altitude Pulmonary Hypertension Rat through PI3K-AKT Pathway

Background: Hypoxia-induced pulmonary vascular remodeling is central to the development of highaltitude pulmonary hypertension (HAPH). Rhodiola tangutica has traditionally been used to prevent chronic mountain sickness. While its active fraction (ACRT) shows therapeutic potential for HAPH, the main pharmacodynamic substances remain unclear due to the complex composition.Aims: This study aimed to identify bioactive equivalent combinatorial components (BECCs) of ACRT that alleviate pulmonary vascular remodeling in HAPH rats and to explore the underlying pharmacological mechanisms.Methods: Seventy adult Sprague-Dawley rats were divided into control, hypoxia, hypoxia+ACRT (150 mg/kg), hypoxia+BECCs (25, 50 and 100mg/kg) and hypoxia+Sildenafil (30 mg/kg) group. A HAPH rat model was induced using hypobaric hypoxia chamber simulating 5000-meter altitude. The effects of BECCs on pulmonary vascular remodeling in HAPH rats were evaluated based on hemodynamic indexes and histopathological changes, alongside antioxidant properties.Phosphoproteomics and Western blotting were performed to analyze AKT1-related protein expression in lung tissues. In vitro, 3% O2-induced pulmonary artery smooth muscle cells (PASMCs) models were utilized to evaluate the anti-proliferative effects of BECCs and identify the dominant components. The underlying mechanisms were explored using Western blotting and drug affinity responsive target stability test (DARTS) assay for binding affinity.Results: HAPH rat models were successfully established as evidenced by changes in physiological parameters. The BECCs showed the comparable efficacy as ACRT in recovering hemodynamic indexes and histopathological changes. Mechanistically, BECCs modulated AKT phosphorylation and related protein expression. In vitro, BECCs inhibited hypoxia-induced PASMCs proliferation.Particularly flavonoids (Fla) in BECCs exhibited stronger anti-proliferative activity than others, acting as the dominant contributors by regulating PI3K rather than PDPK or mTOR pathways to inhibit AKT phosphorylation. Within Fla, eriodictyol and quercetin were found to inhibit PASMC proliferation by targeting PI3K.BECCs demonstrated comparable efficacy to ACRT in alleviating HAPH progression, reversing hypoxia-induced vascular remodeling, inhibiting oxidative stress and PASMCs proliferation by targeting AKT protein. Flavonoids were identified as the key bioactive components contributing to the holistic effects of BECCs by regulating PI3K/AKT pathways. These findings could be extended to improve quality control and clarify bioactive components of R. tangutica, while inspiring development of combinatorial therapies for HAPH treatment.

Nitro-2-Phenylethane: a promising phytoconstituent to modulate neuroinflammation and oxidative stress with repercussions on neurological and psychiatric disorders

Neurologic and neuropsychiatric disorders are complex, with common pathophysiological mechanisms associated with inflammation, oxidative stress, and vascular damage. These shared features have stimulated interest in bioactive compounds with neuropharmacological potential. In this regard, the 1-Nitro-2-Phenylethane (1N2PE) emerges as a promissory compound to act on the multiple via of brain disturbances. However, its neuropharmacological mechanisms of action remain largely unknown. We aim to provide a comprehensive overview of the scarce literature on the effects of 1N2PE in brain disorders to highlight the importance of further research into the mechanisms of action and its potential applications in the field of neurology and psychiatry, focusing on the anti-inflammatory and antioxidant properties. The 1N2PE exhibits neuroprotective properties, including anti-inflammatory, antioxidant, and cholinergic-enhancing effects, which together may underlie its potential therapeutic benefits for various neuropsychiatric and neurological disorders, such as depression, anxiety, seizures, and cognitive impairments. This review compiles literature on 1N2PE potential central nervous system activities, highlighting its therapeutic potential in treating behavioral and neurological disorders. Despite promising findings, further research is essential to fully understand 1N2PE as a novel therapeutic agent.

Efficacy of Sodium New Houttuyfonate Against Aspergillus flavus: Insights from In Vitro and In Vivo Models of Invasive Pulmonary Aspergillosis

Aspergillus flavus is an opportunistic pathogenic fungus that causes invasive aspergillosis in humans. Due to the limited variety and quantity of clinical antifungal drugs and their adverse effects, the development of new broad-spectrum antifungal drugs is urgently required. Our preliminary research showed that sodium new houttuyfonate (SNH) was efficacious against A. fumigatus infection, but its effects against A. flavus remain unknown. In this study, we used the microdilution broth susceptibility method to determine the antifungal activities of four antifungal drugs and SNH against 12 clinical A. flavus strains, in vitro. To confirm the therapeutic effect of SNH on A. flavus infection, we established a mouse model of invasive pulmonary aspergillosis (IPA) with the nasal drip method. All the strains tested were resistant to fluconazole but sensitive to itraconazole, voriconazole, and amphotericin B. The minimum inhibitory concentration to inhibit the growth of 90% of cells (MIC90) of SNH against the test strains was 64-128 μg/mL. After the IPA mouse model was treated with SNH, the expression of genes encoding interleukin 6 (IL-6), IL-1β, and tumor necrosis factor α was significantly reduced. SNH also reduced the fungal load in the mouse lung, the extent of pathological damage, and the neutrophil/lymphocyte ratio in the blood. These findings indicated the potential utility of SNH in the treatment of A. flavus infections.

Assessment of causality in associations between serum adiponectin and the risk of Alzheimer's disease and Parkinson's disease: A Mendelian Randomization Study

Background: Until recently, the association between circulating adiponectin (ADPN) levels and the risk of Alzheimer's disease (AD) and Parkinson's disease (PD) was unclear.Methods: We utilized public data from the IEU GWAS database for two-sample bidirectional Mendelian randomization (MR) analysis and multiple sensitivity analyses. MR analysis was performed on the aggregated data utilizing the Genetic risk score (GRS) as an instrumental variable Results: The MR analyses revealed no significant causal association between the genetically determined ADPN and AD (ORIVW = 0.852, 95% confidence interval [CI]: 0.586-1.117, P = 0.235) or PD (ORIVW = 0.830, 95% CI: 0.780-1.156, P = 0.606) risk. In the opposite direction, AD and PD also did not demonstrate any causal association with ADPN. GRS approach yielded similar results (P>0.05).But, exhibited a negative correlation with interleukin 1 (IL1, βIVW = -0.31; 95% CI: -0.55 to -0.07, P = 0.011). The Cochrane test and MR-PRESSO analysis revealed no evidence of pleiotropy in MR results.Conclusions: Our findings yielded no evidence to substantiate a causal relationship between ADPN levels and the risk of AD and PD, or vice versa. However, elevated levels of ADPN may correlate with lower levels of IL1.

Recent Advances in Pheochromocytoma and Paraganglioma: Molecular Pathogenesis, Clinical Impacts, and Therapeutic Perspective volume II

PPGLs are relatively rare neuroendocrine tumors derived from chromaffin cells in the adrenal medulla and/or autonomic nervous system ganglia. Their clinical importance, including various associated complications, is due to catecholamine excess (1,2). Moreover, PPGLs could lead to pheochromocytoma multisystem crisis (PMC), which is a life-threatening endocrine emergency with reported mortality as high as 85-90% (3). Thus, updated knowledge of management of PPGLs, especially based on the molecular mechanisms and genetics, is necessary. Meanwhile, according to the WHO's classification in 2017, all pheochromocytomas could have metastatic potential and no histological system to assess the biological aggressiveness. Hence, "Malignant pheochromocytoma" in the 2004 WHO classification was replaced with "Metastatic pheochromocytoma" in the 2017 WHO classification (4). Considering the above, an updated understanding of clinicopathological advances and the management of PPGLs, mainly based on molecular mechanisms and genetics, is necessary (2,(4)(5)(6)(7).In this Research Topic, Saavedra et al. reviewed the clinical presentation, management, and treatment of patients with PPGLs. In this review article, early diagnosis, combined with an understanding of the genetic landscapes and comprehensive treatment strategies, was described as necessary to improve outcomes for patients with PPGLs. Nevertheless, surgery is the mainstay of treatment for patients with PPGLs. The utilization of Da Vinci robot-assisted laparoscopic surgery contributed to a favorable prognosis for a patient. In addition, Yang et al. reported a case of paraganglioma with a newly detected EPAS1 mutation, which may be the primary driver of the disease. Some therapeutic options in patients who could not receive surgery and/or have metastatic PPGLs have been reported in this collection. For example, Cyclophosphamide-Vincristine-Dacarbazine (CVD) chemotherapy is a conventional therapeutic option and was reported to be the first-line treatment for PPGLs with SDHB-mutation previously ( 8 Besides, Małgorzata et al. investigated a patient with pheochromocytoma, whose ACTH and cortisol values were elevated. Previously, ACTH-producing pheochromocytomas were reported (9,10). However, the patient described by Malgorzata et al. was negative for ACTH (and CRH).Hence, they described that catecholamine excess could activate the hypothalamic-pituitaryadrenal (HPA) axis. Considering the various complications of PPGLs, the phenotype of this case should be taken into consideration.In conclusion, the information presented in this Research Topic provides updated perspectives of the molecular mechanisms and genetics of PPGLs and their unveiled clinicopathological implications. These enrich the perspectives of PPGLs, which could lead to improved clinical outcomes for patients with PPGLs.

Efficacy and Exploratory Analysis of Potential Mechanisms of Stellate Ganglion Block in Alleviating Sleep Disturbance in Generalized Anxiety Disorder: A Randomized Controlled Trial Excluding Comorbid Depression

Objective: To investigate the efficacy and mechanisms of stellate ganglion block (SGB) in treating generalized anxiety disorder (GAD) with sleep disturbance, excluding patients with comorbid depression.Methods: This double-blind randomized controlled trial (RCT) enrolled 128 patients with GAD (Hamilton Anxiety Scale [HAMA] >14, Generalized Anxiety Disorder 7-item Scale [GAD-7] ≥5) and sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] ≥15), randomized to receive SGB (n=64, 4 ultrasound-guided 1% lidocaine injections) or conventional treatment (n=64, cognitive behavioral therapy [CBT] + estazolam 1–2 mg/day). Outcomes included anxiety (HAMA), depression (Hamilton Depression Scale [HAMD]), sleep quality (PSQI), polysomnography (PSG), and neurotransmitter levels (norepinephrine [NE], serotonin [5-HT], neuropeptide Y [NPY]).Results: After 4 weeks, SGB demonstrated higher efficacy (98.4% vs. 89.1%, P=0.028) and greater reductions in HAMA (9.36±2.34 vs. 11.87±2.71, P<0.001) and HAMD scores (6.87±2.01 vs. 8.09±2.04, P<0.001). PSQI improved significantly in the SGB group (5.74±1.64 vs. 8.03±1.86, P<0.001), with increased total sleep time (TST) (429.76±33.22 vs. 391.13±30.76 min, P<0.001) and efficiency (90.23±13.29% vs. 86.34±12.84%, P<0.001). Neurotransmitter analysis showed reduced NE (289.43±51.68 vs. 253.78±57.12 pg/mL, P<0.05) and increased 5-HT (138.56±19.73 vs. 124.93±18.44 ng/mL, P<0.05) and NPY (453.21±73.41 vs. 402.34±68.12 pg/mL, P<0.05). Adverse events were comparable (6.25% vs. 3.13%, P=0.403).Conclusion: SGB effectively improves GAD symptoms and sleep quality in patients without comorbid depression, potentially via modulation of NE, 5-HT, and NPY pathways. The exclusion of psychiatric comorbidities enhances the specificity of these findings.

Transforming Primary Education: Balancing Social Skills and Academic Achievement Through Global Inquiry-Based Learning Models

This study analyzes the Inquiry-Based Learning (IBL) model's application in enhancing social skills and academic performance in primary education across diverse international contexts. Using the CAQDAS (Computer-Assisted Qualitative Data Analysis Software) approach with NVivo 12 Plus, the study systematically examined qualitative data drawn from purposively selected literature focusing on IBL implementation in countries such as Finland, Australia, Singapore, and the United States. The analysis reveals that IBL significantly contributes to developing students' social skills-including collaboration, communication, and empathy-while improving academic engagement and performance. Countries with more flexible curricula, such as Finland and Australia, demonstrate higher IBL success rates, whereas systems with rigid, assessment-driven structures present notable challenges. The findings emphasize the importance of curriculum flexibility, teacher facilitation, and technological integration in supporting effective IBL practices. The study recommends greater curricular integration of IBL, comprehensive teacher training programs, and increased access to digital learning tools. These measures are essential to prepare students with the critical thinking, autonomy, and interpersonal skills needed to thrive in the 21st-century global landscape.

Corrigendum: Exome Sequencing Data Reanalysis of 200 Hypertrophic Cardiomyopathy patients: The HYPERGEN French Cohort 5 years after the initial analysis

Corrigendum: Exome Sequencing Data Reanalysis of 200 Hypertrophic Cardiomyopathy patients: The HYPERGEN French Cohort 5 years after the initial analysis

Association of reallocating time between physical activity and sedentary behavior on the risk of depression: A Systematic Review and Metaanalysis

Background and Aims: Sedentary behavior (SB) is a prevalent lifestyle factor and a risk factor for various health conditions, including depression (encompassing both clinically diagnosed depressive disorders and depressive symptoms). This study aimed to summarize the estimated impact of reallocating time spent in SB to light-intensity physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on the risk of depression from observational studies, as well as the impact of reallocating time spent in MVPA and LPA to SB. Methods: Four databases (PubMed, Scopus, SPORTdiscus, and PsycINFO (via EBSCOhost platform)) were searched and analyzed for relevant studies published up to August 2024. Meta-analyses were performed on the estimated regression coefficients (b) and 95% confidence intervals (CIs) for depression symptom scores. All statistical analyses were performed using STATA 16.0. Results: Twenty-seven studies involving 702,755 participants met the inclusion criteria. Reallocating SB to LPA and MVPA was significantly associated with reductions in depression risk (b = -0.04, 95% CI = -0.06 to -0.03, p < 0.001; b = -0.11, 95% CI = -0.19 to -0.03, p = 0.004). Subgroup analyses indicated that reallocating 30 and 60 minutes of SB to LPA or MVPA was significantly associated with reduced depression risk, with significant differences in PA intensity and age, but not for 10 and 15 minutes groups. Conversely, reallocating LPA and MVPA to SB was significantly associated with increased depression risk (b = 0.11, 95% CI = 0.01 to 0.21, p = 0.039; b = 0.17, 95% CI = 0.08 to 0.25, p < 0.001). Subgroup analyses indicated that reallocating 30 minutes of LPA or MVPA to SB was significantly associated with increased depression risk, with no difference in PA intensity. Conclusions:Reallocating SB to PA was beneficial, whereas reallocating PA to SB was detrimental to the risk of depression. The results highlight the importance of considering PA intensity and duration in the development of behavioral guidelines aimed at reducing the risk of depression.

Enhanced Diagnostic Precision of Colorectal Sessile Lesions with Blue Laser Imaging and JNET Classification: A multicenter Retrospective Study in Chinese Cohorts

Background Colorectal cancer (CRC), a leading global malignancy, underscores the need for precise endoscopic diagnosis. Blue Laser Imaging (BLI), a novel endoscopic technology enhancing mucosal surface visualization, combined with the Japan NBI Expert Team (JNET) classification, has shown promise in characterizing colorectal lesions. However, its diagnostic performance in Chinese populations and the impact of endoscopist experience remain underexplored.In this multicenter, retrospective study, 131 colorectal sessile lesions were enrolled.The lesions' characteristics were assessed by both expert and trainee endoscopists, utilizing magnified BLI in combination with the JNET classification system to establish diagnostic predictions. This approach allowed for a comparative evaluation of diagnostic accuracy between experienced and less experienced practitioners.Pathological diagnoses confirmed 2 hyperplastic/sessile serrated lesions (HP/SSL), and 70 low-grade dysplasia (LGD) among the 131 lesions. There were 36 high-grade dysplasia (HGD), 16 superficial submucosal invasive cancers (m-SMs), and 7 deep submucosal invasive cancers (SM-d) demonstrated. The performance metrics for expert and trainee endoscopists in evaluating JNET type 2A(LGD) were as follows: expert endoscopists demonstrated a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 93%, 93.3%, 94.3%, 91.8%, and 93.1%, respectively; trainee endoscopists showed a sensitivity, specificity,

Learning from the Kenyan Experiment: Key Takeaways for Implementing Managed Equipment Services in Developing Countries

In 2015, the Kenyan government signed 7-year contracts with 5 Original Equipment Manufacturers (OEMs) to improve healthcare accessibility and equity. The OEMs were to supply, install, maintain, and replace equipment and provide user training for 98 hospitals across Kenya's 47 counties through a Managed Equipment Services (MES) arrangement. This paper highlights the planning, procurement, and implementation of Kenya's first comprehensive MES arrangement.Methods: Retrospective review of the implementation process drawing data from program databases, reports, and other relevant sources.The MES program was successfully implemented in Kenya for the first time to upscale specializedspecialised health infrastructure and expand critical healthcare services across the 47 counties. Previously unavailable services in the county's hospitals, such as dialysis, were set up in 49 hospitals, critical care units in 11 hospitals, and theatre, sterilizationsterilisation, and imaging services were expanded in 98 hospitals. The program provided reliable equipment installation and maintenance, increased healthcare workers' capacity through training, and created a more conducive working environment. Key lessons learned include importance of defining were to have detailed equipment specifications, ensuring comprehensive involve all stakeholders engagement, and allowing cate sufficient enough time for assessment and implementation. Challenges encountered were prolongedincluded a lengthy procurement process, insufficient lack of stakeholder buy-in, and delays in implementation delays.We have described our experience of planning, procurement, and implementation processes and the lessons learned from a large and comprehensive MES project in Kenya. The MES process is intricate and time-consuming, requiring a team of skilled professionals. Prior to beginning the MES design, a well-planned hospital assessment can alleviate potential obstacles. Despite financial limitations, MES arrangement has the potential to enhance significantly healthcare services, particularly in low-and middle-income nations.

The prevalence and long-term effects of PTSD and moral injury in Swedish military veterans

In the context of international military operations, officers and soldiers are exposed to a variety of service-related stressors, which may have long-lasting effects on their health and everyday function. This study explored: (1) the prevalence of indications of both Post-Traumatic Stress Disorder (PTSD) and moral injury (MI), (2) how these conditions related to each other, and (3) how they are related to a selection of background variables, in Swedish military veterans who have previously been deployed on operations. The study was a selfreport survey, and the data was analyzed using correlation and regression analyses to explore potential statistical relationships between variables of interest. Data was also analyzed using between-group analyses (t-tests) to examine differences between different groups. Resultsshow that a low proportion of the participants showed prevalence of indications of PTSD, which are comparable to earlier Swedish studies on previously deployed veterans. An even lower proportion was found to show indications of moral injury compared to the assessment of PTSD. However, apart from the small group that fulfilled the cutoff score criteria, a number of respondents reported milder symptoms of psychological and moral distress. The second aim concerned the relationship between indications of PTSD and indications of moral injury.The findings suggest that there is a considerable overlap between the two constructs. In addition, the results suggest that the risk of PTSD and MI is highest when an event is perceived as both very stressful (fear-based) and morally challenging. The MI symptom subcluster shame accounts for the largest variance in the PTSD indicator scale within the study sample. Health-and deployment-related background variables were identified that may be related to indications of moral injury. Regarding practical implications, the study results highlight the type(s) of stressful experience, as well as health-and deployment-related factors, that should be monitored post-deployment, and which may serve as significant risk factors in developing indications of moral injury.

Re-conceptualizing implementation outcomes of health innovations as either modes or attributes: an integrated framework

The implementation of innovations in practice is challenging and often produces disappointing outcomes. Although the reasons for this are multifaceted, part of the challenge derives from the lack of consensus on how such implementation outcomes should be conceptualized and measured. In this review, we use a meta-ethnographic approach to enhance our theoretical conceptualization of implementation outcomes. By situating such outcomes within the overall process of implementation, we are able to unpack them analytically as the product of two major components, which we term 'modes' and 'attributes', respectively. Modes comprise engagement, active implementation, and integration to foreground focal implementation outcomes. The attributes associated with the modes comprise implementation depth, implementation breadth, implementation pace, implementation adaptation, and de-implementation to indicate the features of the modes of implementation outcomes. Taken together, our analysis based on modes and attributes provides an integrated framework of implementation outcomes. The proposed framework enhances our understanding of the way in which implementation outcomes have been conceptualized in previous literature, enabling us to clarify the relations and distinctions between them in terms of translatability and complementarity. The proposed framework thus extends the conceptualization of implementation outcomes to better align with the complex reality of implementation practice, offering useful insights to researchers, practitioners, and policymakers.

Thermal Hydraulic Safety Characteristics Analysis for The Natural Circulation Primary Loop under Inclined Condition on LFR

Abstract：Lead-cooled fast reactor (LFR) has been an important option for floating nuclear power plant. The design of 50 MW natural circulation LFR had been proposed by Lanzhou University for floating nuclear power plant. However, floating nuclear power plant was affected by the marine environment, which led to safety problems in reactor under inclined condition. To analyze the impact of different heat exchangers configuration and inclination angle on the thermal-hydraulic safety performance of the reactor, this study utilized RELAP5 software and established a thermal-hydraulic model of the 50MW natural circulation LFR. The results indicated that the core flow rate reduced to 95.12% of the flow rate at 100%FP power, when the inclination angle was 30°.When the angle between the heat exchanger and the central axis of floating nuclear power plant is 45°, the maximum outlet temperature difference in the heat exchanger is 1.86K. During the process of power increasing and decreasing, the reactor power was increased with rates of 0.5% FP/min, and the core cladding temperature was increased to the maximum 938.42K. This study provided technical reference for the design of natural circulation lead-cooled fast reactors in floating nuclear power plant.

Effectiveness of Mobile Health (mHealth) in Symptom Management of Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Background Mobile health (mHealth) is an accessible strategy to deliver health information and becoming increasingly popular as a form of follow-up among medical staff. However, the effects of mobile health on the physical and mental health outcomes of prostate cancer patients after discharge from hospital remain unclear. This meta-analysis evaluated the current evidence regarding the effects of mHealth interventions on prostate cancer patients outcomes.Methods Four databases (PubMed, Cochrane Central electronic database, EMBASE and Web of science) were searched from inception to November 8, 2024 for randomized controlled trials (RCTs) comparing the effects of mobile health versus usual care on prostate cancer patients outcomes.Pooled outcome measures were determined using random-effects models.Eleven RCTs including 1,368 patients met the criteria for inclusion in this meta-analysis.Meta-analyses revealed a significant effect of mHealth interventions on long-term bowel function outcomes (standard mean difference [SMD]=0.19, 95%CI=0.

Associations of weight-adjusted-waist index and systemic immuneinflammatory index with sKlotho: Evidence from the NHANES 2007-2016

Background: Klotho is an anti-aging protein, and obesity and inflammation have been identified as having a relationship with Klotho. This study investigated the correlation between weight-adjustedwaist index(WWI), systemic inflammation index(SII) and soluble Klotho (sKlotho) and explored the potential mediating role of SII.The association between WWI, SII, and sKlotho was investigated using weighted multivariate linear regression, subgroup analysis, and smoothed curve fitting in this cross-sectional study, which was based on NHANES data. The Bootstrap method was used to test for mediation effects. Covariate selection was validated using the variance inflation factor (VIF).The study involved a total of 9,506 participants. The results showed that WWI (β=-0.03; 95%CI:-0.04,-0.01; p<0.0001) was associated with SII (β=-0.00, 95%CI:-0.00,-0.00:p<0.001) and Ln-sKlotho.There was a negative correlation between both WWI and SII and sKlotho. Subgroup analysis showed that gender, age, education, marital status, family income, HEI, PA, hypertension, diabetes, CKD, alcohol use, smoking, and SII did not affect the negative correlation between WWI and sKlotho (FDR-corrected p>0.1). The mediation analysis showed that SII played a significant mediating effect in the role of WWI on sKlotho, with SII mediating 6.78% of the relationship between WWI and sKlotho.There is a negative correlation between WWI and sKlotho, and SII may be an important mediator between WWI and sKlotho. Reducing inflammatory conditions in obese populations may increase sKlotho levels, which in turn may delay organismal aging in middle-aged and elderly people.

Analysis of Pharmacotherapeutic Approaches for Multiple Myeloma and Correlated Renal and Pulmonary Impairments: A Retrospective Real-World Registry Study in the Greater Gulf Region (REPAIR Study)

Background: Multiple myeloma (MM) is a plasma cell malignancy with significant unmet medical needs, particularly in the treatment of relapsed and refractory disease. This study aims to describe the disease characteristics, various treatment regimens, and outcomes among patients with Relapsed/Refractory Multiple Myeloma (RRMM) in the Greater Gulf region. Methods: A regional, retrospective study was conducted in Gulf countries to collect real-world data from the medical records of 148 patients with RRMM who relapsed 1-3 times in the past two years before the data collection period (July 2022 and February 2023). Results: The mean age of the study population was 59.4 years, and 64.2% of the participants were male. The VRd regimen (Bortezomib, Lenalidomide, and Dexamethasone) was the most frequent first-line therapy among transplant-ineligible patients (40.2%) and the most common induction and consolidation regimen (43.9% and 66.7%, respectively) in transplant-eligible patients. Meanwhile, Rd (Lenalidomide and Dexamethasone) was the most common maintenance regimen (75%). DKd (Daratumumab, Carfilzomib, and Dexamethasone), KPd (Carfilzomib, Pomalidomide, and Dexamethasone), and PVd (Pomalidomide, Bortezomib, and Dexamethasone) were the most widely used second, third, and fourth treatment lines, respectively (16.6%, 9.2%, and 12.5%). About 52.7% of patients were eligible for stem cell transplantation (SCT), and among them, a complete response (CR) was achieved in 47.7%. Furthermore, CR and very good partial remission rates decreased across all treatment lines. Renal impairment decreased across different treatment lines, from 23.6% in the first line to 6.3% in the fourth line. In contrast, respiratory complications demonstrated the highest incidence (>18%) in the 3rd and 4th treatment lines. Moreover, refractoriness to treatment increased from 1.3% in the first line to 34.6% in the fourth treatment line. Additionally, isatuximab was incorporated into 80%, 15%, and 5% of the regimens administered as second-, third-, and fourth-line treatments, respectively. Conclusion: This study provides valuable insights into the real-world management and treatment choices for RRMM, including the utilization of SCT and novel therapies such as isatuximab.

Understanding Functional Abdominal Pain Disorders Among Children: A Multidisciplinary Expert Consensus Statement

Functional abdominal pain disorders (FAPDs) are pediatric gastrointestinal conditions marked by chronic or recurrent abdominal pain without anatomical and/or biochemical abnormalities. This position paper guides primary care providers in the early diagnosis and management of FAPDs to improve the well-being of affected children and their families. Methods: A 12-member expert advisory board reviewed current approaches to diagnosing and managing FAPDs in children. Based on literature and discussions, 23 statements were drafted and voted on to achieve an acceptable level of agreement. Results: First-line healthcare professionals are key in diagnosing FAPDs, using ROME diagnostic criteria and recognizing red flags for accurate assessment and referrals. Comprehensive evaluation, including medical, dietary, and psychosocial history, physical exams, and basic tests helped to identify the initial triggers. Probiotics such as Limosi-lactobacillus reuteri (L. reuteri) DSM 17938 and Lacticaseibacillus rhamnosus (L. rhamnosus) help in alleviating functional abdominal pain (FAP) in children along with primary measures, such as dietary modifications (a balanced diet advocating moderation in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)-rich foods) and physical activity. Probiotics should be given for 6-8 weeks and can be resumed if symptoms recur. Cognitivebehavioral and hypnotic therapy also help, with remote options such as web-based, compact disk (CD)based or application-based tools available. Discussion:This position paper provides expert insights to guide primary care providers in diagnosing and managing FAPDs, equipping them to make informed decisions for effective management of FAPDs.

Effects of quercetin on in vitro rumen fermentation parameters, gas production and microflora of beef cattle

Effects of quercetin on in vitro rumen fermentation parameters, gas production and microflora of beef cattle

Evaluation of sleep position shifts in patients with obstructive sleep apnea syndrome with the use of a mandibular advancement device

Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder characterized by repeated episodes of partial or total obstruction of the upper airway during sleep, thus leading to phenomena defined as hypopnea and apnea. An apnea episode, by definition, is the cessation of breathing for at least 10 s. Hypopnea is defined as a reduction in airflow of at least 50%, associated with a reduction in oxygen saturation of >4%. The apnea-hypopnea index (AHI), i.e., the total number of hypopneas and apneas per 1 h of sleep, is used to indicate the severity of obstructive sleep apnea (OSA). There are different categories of sleep apnea depending on the OSA index: normal sleep has an AHI of fewer than 5 events, mild sleep apnea has an AHI of 5-15 events, moderate sleep apnea has an AHI of 15-30 events, and severe apnea has an AHI of more than 30 events per hour (1-3).The prevalence of OSA is approximately 22% in men and 17% in women with a gender distribution of 2:1 (4). This distribution is perhaps related to different hormonal effects that induce an increase in upper airway muscle collapsibility, body fat distribution, and different anatomy. Hormonal effects have an important role in OSA pathogenesis, particularly in post-menopausal women compared to pre-menopausal women. Unfortunately, the role of hormones in OSA pathogenesis is still unclear (5).Obstructive sleep apnea syndrome is becoming an increasingly studied condition because of its many comorbidities and consequences, although there is a high prevalence of undiagnosed and untreated patients (6). Because of sleep deprivation and daytime sleepiness, patients with OSA have a higher risk of car accidents (7). Cardiovascular disease is correlated with OSA, with sympathetic activation, oxidative stress, and systemic inflammation defined as the main causes of this association. OSA is an independent risk factor for hypertension, coronary artery disease, heart failure, cardiovascular and cerebrovascular diseases (CVDs), and atrial fibrillation (8,9). OSA is related to many metabolic complications such as type 2 diabetes mellitus (T2DM) (10). The prevalence of T2DM in patients with OSA is higher than in the general population (11). Current research suggests that arousals and sleep fragmentation may have effects on systemic inflammation, sympathetic surges, glucose intolerance, β-cell dysfunction, and insulin resistance (12). Narkiewicz et al. (13) suggested an alternative way to explain the relationship between T2DM and OSA. Oxyhemoglobin desaturation and hypercarbia may alter epinephrine, norepinephrine, and cortisol secretion, which leads to increased gluconeogenesis and decreased glucose uptake.Sleep fragmentation in patients with sleep apnea can also lead to neurocognitive and behavioral consequences (14,15). Although there are questionnaires and several risk factors (age >40 years, male sex, obesity, smoking) and symptoms (snoring, nocturia, nocturnal gasping, daytime sleepiness) to identify patients with obstructive sleep apnea, the diagnostic standard to diagnose the condition is nocturnal polysomnography (16,17). OSA is evaluated by many questionnaires that focus on daytime sleepiness and health-related quality of life (HRQoL) (18,19). The Epworth Sleepiness Scale (ESS) and the STOP-Bang and Berlin questionnaires are the main questionnaires used to evaluate daytime sleepiness (20,21) Continuous positive airway pressure (C-PAP) is the first-line treatment for patients with obstructive sleep apnea. It is a noninvasive treatment method used to maintain airway patency by delivering constant airway pressure. Other alternative methods, such as oral appliances, are also used in patients with apnea, especially for those who do not tolerate the C-PAP mask. Surgery is only used in cases with anatomic obstructions that need to be corrected (25). The oral appliances used are tongue retainer devices (TRDs) and mandibular advancement devices (MADs). A TRD is made of a flexible material with a bulb-like receptacle in the anterior portion. It maintains the tongue in a forward position during sleep, reducing stress on the upper airway and against the posterior pharyngeal wall (26). A MAD has been recommended by the American Academy of Sleep Medicine as a treatment for mild to moderate OSA (27). Some studies suggest that it also has an excellent effect on severe apnea. A MAD is a device with important advantages: low cost, simple production, and portability (28). The effect of a MAD is to increase the upper airway space through a forward and vertical movement of the jaw along with a repositioning of the hyoid bone and tongue (29). A MAD is built as two occlusal splints, fully covering the teeth, allowing for an increase in mandibular sagittal movement and free vertical/transversal movement of the jaw (30). The role of the dentist is becoming increasingly important for both the diagnosis and treatment of snoring and obstructive sleep apnea (31).It is

Impact Factors of Arctic Research Stations on the Mental Health of Team Members

The extreme, closed, and isolated environments of Arctic research stations have resulted in substantial challenges in the daily life and work of polar science expedition team members, including various mental health problems. The mental health of the Arctic team members is related to the restorative quality of the station environment, which is primarily influenced by design factors. However, previous studies have mainly discussed these factors separately using a single approach, rarely providing comprehensive understanding into team members' perceptions of the station environment in an integrated manner. Therefore, this study uses a combination of qualitative and quantitative methods to determine the design factors and dimensions that affect the restorative potential of Arctic research stations, filling the gap in the design weight of restorative potential factors. First, environmental factors related to the mental health of team members in Arctic research stations were gradually screened through a literature review and semi-structured interviews. Then, questionnaire was used to collect the perspectives of 63 Chinese scientific research team members. Correlation analysis, principal component analysis, and statistical weight calculation were applied to the responses to investigate the restorative quality of design characteristics within a framework. The results showed that 24 design factors were associated with a restorative scientific research station environment. Among them, privacy of space was the most significant factor that could influence psychological recovery. Five primary components were identified: indoor conditions, configuration of space, physical environment, spatial perception, and space safety. Additionally, nine secondary components were identified: appearance design, spatial scale, interior facilities, space function, outdoor environmental influences, room adjustments, personal contact, interaction, and space safety. The weight calculation shows that indoor conditions and space configuration are the most significant dimensions that influence the restorative quality. In this study, the environmental factors and key dimensions of an Arctic research station were screened in a targeted manner to provide a theoretical basis and practical suggestions for architectural design of Arctic research stations that are more suitable for team members.

Efficacy and Exploratory Analysis of Potential Mechanisms of Stellate Ganglion Block in Alleviating Sleep Disturbance in Generalized Anxiety Disorder: A Randomized Controlled Trial Excluding Comorbid Depression

Objective: To investigate the efficacy and mechanisms of stellate ganglion block (SGB) in treating generalized anxiety disorder (GAD) with sleep disturbance, excluding patients with comorbid depression.Methods: This double-blind randomized controlled trial (RCT) enrolled 128 patients with GAD (Hamilton Anxiety Scale [HAMA] >14, Generalized Anxiety Disorder 7-item Scale [GAD-7] ≥5) and sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] ≥15), randomized to receive SGB (n=64, 4 ultrasound-guided 1% lidocaine injections) or conventional treatment (n=64, cognitive behavioral therapy [CBT] + estazolam 1–2 mg/day). Outcomes included anxiety (HAMA), depression (Hamilton Depression Scale [HAMD]), sleep quality (PSQI), polysomnography (PSG), and neurotransmitter levels (norepinephrine [NE], serotonin [5-HT], neuropeptide Y [NPY]).Results: After 4 weeks, SGB demonstrated higher efficacy (98.4% vs. 89.1%, P=0.028) and greater reductions in HAMA (9.36±2.34 vs. 11.87±2.71, P<0.001) and HAMD scores (6.87±2.01 vs. 8.09±2.04, P<0.001). PSQI improved significantly in the SGB group (5.74±1.64 vs. 8.03±1.86, P<0.001), with increased total sleep time (TST) (429.76±33.22 vs. 391.13±30.76 min, P<0.001) and efficiency (90.23±13.29% vs. 86.34±12.84%, P<0.001). Neurotransmitter analysis showed reduced NE (289.43±51.68 vs. 253.78±57.12 pg/mL, P<0.05) and increased 5-HT (138.56±19.73 vs. 124.93±18.44 ng/mL, P<0.05) and NPY (453.21±73.41 vs. 402.34±68.12 pg/mL, P<0.05). Adverse events were comparable (6.25% vs. 3.13%, P=0.403).Conclusion: SGB effectively improves GAD symptoms and sleep quality in patients without comorbid depression, potentially via modulation of NE, 5-HT, and NPY pathways. The exclusion of psychiatric comorbidities enhances the specificity of these findings.

Keywords: Stellate ganglion block, generalized anxiety disorder, Sleep disturbance, efficacy, Mechanis

Enhanced Diagnostic Precision of Colorectal Sessile Lesions with Blue Laser Imaging and JNET Classification: A multicenter Retrospective Study in Chinese Cohorts

Background Colorectal cancer (CRC), a leading global malignancy, underscores the need for precise endoscopic diagnosis. Blue Laser Imaging (BLI), a novel endoscopic technology enhancing mucosal surface visualization, combined with the Japan NBI Expert Team (JNET) classification, has shown promise in characterizing colorectal lesions. However, its diagnostic performance in Chinese populations and the impact of endoscopist experience remain underexplored.In this multicenter, retrospective study, 131 colorectal sessile lesions were enrolled.The lesions' characteristics were assessed by both expert and trainee endoscopists, utilizing magnified BLI in combination with the JNET classification system to establish diagnostic predictions. This approach allowed for a comparative evaluation of diagnostic accuracy between experienced and less experienced practitioners.Pathological diagnoses confirmed 2 hyperplastic/sessile serrated lesions (HP/SSL), and 70 low-grade dysplasia (LGD) among the 131 lesions. There were 36 high-grade dysplasia (HGD), 16 superficial submucosal invasive cancers (m-SMs), and 7 deep submucosal invasive cancers (SM-d) demonstrated. The performance metrics for expert and trainee endoscopists in evaluating JNET type 2A(LGD) were as follows: expert endoscopists demonstrated a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 93%, 93.3%, 94.3%, 91.8%, and 93.1%, respectively; trainee endoscopists showed a sensitivity, specificity,

Learning from the Kenyan Experiment: Key Takeaways for Implementing Managed Equipment Services in Developing Countries

Background: In 2015, the Kenyan government signed 7-year contracts with 5 Original Equipment Manufacturers (OEMs) to improve healthcare accessibility and equity. The OEMs were to supply, install, maintain, and replace equipment and provide user training for 98 hospitals across Kenya's 47 counties through a Managed Equipment Services (MES) arrangement. This paper highlights the planning, procurement, and implementation of Kenya's first comprehensive MES arrangement.Methods: Retrospective review of the implementation process drawing data from program databases, reports, and other relevant sources.The MES program was successfully implemented in Kenya for the first time to upscale specializedspecialised health infrastructure and expand critical healthcare services across the 47 counties. Previously unavailable services in the county's hospitals, such as dialysis, were set up in 49 hospitals, critical care units in 11 hospitals, and theatre, sterilizationsterilisation, and imaging services were expanded in 98 hospitals. The program provided reliable equipment installation and maintenance, increased healthcare workers' capacity through training, and created a more conducive working environment. Key lessons learned include importance of defining were to have detailed equipment specifications, ensuring comprehensive involve all stakeholders engagement, and allowing cate sufficient enough time for assessment and implementation. Challenges encountered were prolongedincluded a lengthy procurement process, insufficient lack of stakeholder buy-in, and delays in implementation delays.We have described our experience of planning, procurement, and implementation processes and the lessons learned from a large and comprehensive MES project in Kenya. The MES process is intricate and time-consuming, requiring a team of skilled professionals. Prior to beginning the MES design, a well-planned hospital assessment can alleviate potential obstacles. Despite financial limitations, MES arrangement has the potential to enhance significantly healthcare services, particularly in low-and middle-income nations.

Reducing scheduled evening training does not improve recruits' sleep duration or quality during British Army Basic Training Authors

Sleep is critical to the health, wellbeing and performance of recruits during Army basic training, however, is often sacrificed due to the constraints of basic training schedules. In an effort to improve sleep duration of recruits, the revised Common Military Syllabus 21 (CMS21) restricted daily scheduled military training from 1830, thus enabling greater opportunity for earlier bedtimes and longer nocturnal sleep periods. Our objective was to evaluate the effectiveness of the revised CMS21 basic training programme on measures of sleep-wake indices and compare against the previous programme (CMS18) as a control group. Several actigraphy-derived and self-reported sleep-wake indices assessed potential changes in sleep opportunity between groups (CMS21 vs CMS18) and across 12-weeks of basic training. Actigraphy was measured daily to deduce weekly averages and self-report measures (i.e., sleep diaries) were captured during weeks 1, 6 and 11 of basic training. Sleep-wake data are presented descriptively (mean±SD) and a series of linear-mixed models determined differences in actigraphy between groups and across each week. Compared to CMS18, no significant improvements in any sleep-wake indices were observed during CMS21. The average sleep duration for both groups remained below the minimum national sleep duration recommendations for young adults (deficit of ~1h20m), with 67% to 94% of recruits in CMS18 and 69% to 97% of recruits in CMS21 achieving an average of <7hrs sleep per night, respectively. Similar proportions of recruits reported poor-levels of sleep quality (≤ 60%) during CMS18 and CMS21, with excessive noise and early-morning wake times identified as the most common sleep disturbances. The contracted early-morning feeding times and the magnitude of non-scheduled late-evening military admin were determined as key factors preventing adequate sleep opportunity despite restricting scheduled military training from 1830 during CMS21. The results of this study warrant the application of improved sleep hygiene practices within the basic training environment. It is also recommended that the contracted early-morning feeding times and magnitude of non-scheduled training activity be considered as factors for change within future programme design to optimise sleep opportunity during basic training.

The influence of emotional stimuli on response inhibition: a systematic review in non-clinical adults

This PRISMA-compliant systematic review aimed to clarify the influence of emotional stimuli on the behavioural correlates of response inhibition, given the mixed and inconclusive findings in the existing literature. We searched Scopus, PsycINFO and PubMed databases up to March 2024 for studies published in peer-reviewed journals, conducted in adult non-clinical populations. Eligible studies used tasks where response inhibition plays a central role (primarily the Go/No-Go task [GNG] and stop-signal task [SST]) and included emotional stimuli presented concurrently with the task. Additionally, studies had to report, control for, analyze, or at least discuss both valence (positive-negative) and arousal (calming-arousing), two emotional dimensions that have been widely used to define emotions. Ninety-three studies, encompassing over 3400 participants, were finally included, and assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). Most studies report emotional modulation of response inhibition, with a larger proportion linking this influence to valence rather than arousal.However, inconsistent findings and methodological limitations prevent firm conclusions, with some suggesting the involvement of both or neither dimension, while others lack the appropriate design. Among studies reporting effects of emotional valence, most indicate that higher valence stimuli (more positive) impaired response inhibition. The effects of arousal remain unclear, with some studies linking high arousal to poorer inhibition, while others suggest the opposite. Interestingly, discrete emotions also modulate response inhibition independently of valence and arousal, suggesting that discrete emotion theories may complement the two-dimensional circumplex model in response inhibition research. While few differences exist, more studies report effects when emotional stimuli are task-relevant rather than task-irrelevant. Among other factors, using an SST instead of a GNG task seems to enhance emotional modulation of response inhibition. Overall, the influence of emotional stimuli on the behavioural correlates of response inhibition is likely shaped by a complex interplay of multiple factors, suggesting that future research should explore how these factors interact and combine. Moreover, further research is needed to explore how emotion interacts with other forms of inhibitory control beyond global reactive inhibition, including proactive and selective mechanisms.

The relationship between dietary vitamin B1 and stroke: A machine learning analysis of NHANES data

Background: Vitamin B1 deficiency is closely linked to damage in the cardiovascular system.However, the relationship between dietary Vitamin B1 intake and the risk of stroke remains ambiguous and requires further investigation.This study analyzed data from participants in the National Health and Nutrition Examination Survey (NHANES: 2005(NHANES: -2018) ) to investigate the relationship between dietary vitamin B1 and ischemic stroke. Weighted multivariable logistic regression models and restricted cubic spline (RCS)regression were employed to explore potential nonlinear relationships, and subgroup analyses were conducted to assess the robustness of the results. Additionally, the Least Absolute Shrinkage and Selection Operator (LASSO) was utilized for feature selection. Eight machine learning methods were employed to construct predictive models and evaluate their performance. Based on the best-performing model, we further examined variable importance and model accuracy, employing Shapley Additive Explanations (SHAP) analysis to interpret the model. Finally, a nomogram was created to enhance the readability of the predictive model results.After controlling for various variables, vitamin B1 exhibited a significant linear negative correlation with stroke risk. In comparison to the lowest quartile, the adjusted odds ratio (OR) for the fourth quartile was notably reduced to 0.66 (95% CI: 0.46, 0.94). Restricted cubic spline (RCS) analysis further confirmed a linear inverse relationship between vitamin B1 levels and stroke risk.Moreover, the Gradient Boosting Machine (GBM) model demonstrated robust predictive efficacy, achieving an area under the curve (AUC) of 91.9%.A large-scale study based on NHANES indicates that as dietary intake of vitamin B1 increases, the risk of stroke shows a gradual decline. Therefore, appropriately increasing dietary intake of vitamin B1 may reduce the risk of stroke occurrence.

Nationwide Analysis of COVID-19 Complications, Outcomes, and Costs of Childbirth in Spain

Introduction: Pregnant women are considered a vulnerable group for COVID-19 with an increased risk for complications. The objective of this study is to describe in-hospital mortality, pregnancy outcomes, and direct hospital costs associated with COVID-19 in women at the time of childbirth. Methods: This retrospective nationwide population-based registry study collects data on complications, outcomes, and direct hospital costs from women hospitalized for childbirth, recorded in the Minimum Basic Data Set obtained from the National Surveillance System for Hospital Data in Spain between 2020-2022. Hospitalization characteristics, complications related to pregnancy and childbirth, outcomes, and hospitalization costs are compared between COVID-19-positive and non-COVID-19 women at the time of childbirth. Results: A total of 779,387 women were admitted between 2020 and 2022 with a record of childbirth in Spanish hospitals. Of these, 15,792 (2.06%) had COVID-19 at the time of delivery. These women had a longer length of stay (3.53 days), higher rates of intensive care unit (ICU) admission (2.53%), ventilation/intubation (0.91%), and in-hospital mortality (0.06%)(p<0.0001). This group also exhibited higher rates of spontaneous premature onset of labor (7%) and postpartum hemorrhage (3.45%), as well as a higher rate of labor induction (6.27%)(p0.001). Additionally, a higher single stillbirth rate (0.73%) was found among COVID-19-positive women(p=0.0002). A significant (higher risk of postpartum hemorrhage(OR=1.14), embolism(OR=7.98), acute respiratory distress syndrome(OR=35.5), temporary tracheostomy(OR=4.89), ventilation/intubation(OR=6.85), and single stillbirth(OR=1.32) was found in COVID-19 women(p<0.05). The mean cost per patient was €4,066.48, 25.06% higher than that for non-COVID-19 women(p<0.0001). Stratification by age showed an increasing trend in costs with age, reaching €6,492.12 in women ≥45 years old, where the ICU admission rate reached 8.09%. Conclusion: These findings show that COVID-19 at the time of childbirth occurs in 2 out of every 100 cases and increases the risk of complications related to pregnancy and childbirth, as well as mortality and hospitalization costs. These data are related to SARS-CoV-2 variants circulating from 2020-2022, and current variants could give different risks. Our evaluation should be useful for health authorities to allocate resources and professionals to implement preventive measures, such as vaccination and screening, due to the increased morbidity and mortality in this group.

Augmented Reality Navigation Technology in Atlantoaxial Pedicle Screw Fixation for Atlantoaxial Dislocation Treatment

Objective: This study aims to evaluate the clinical safety and feasibility of augmented reality (AR) navigation technology in atlantoaxial pedicle screw placement. Methods: From May 2024 to December 2024, 20 patients with atlantoaxial dislocation undergoing internal fixation were enrolled. During surgery, a real-time CT scan was obtained using an O-arm imaging system, which was processed by the navigation workstation to generate AR images. These AR images can be overlaid directly onto the surgeon's field of view, guiding him to complete pedicle screw placement. The clinical feasibility and safety were evaluated based on operative time, user experience, and the Gertzbein-Robbins scale. Results: All 20 patients successfully underwent surgery, with a total of 80 pedicle screws placement All screws met clinical safety standards, and no severe complications were observed. The operative time ranged from 16 to 21 minutes, with an average implantation time of 104 seconds per screw. The average user experience score was 90.5 points. Conclusion: This study preliminarily validates the clinical value of AR navigation technology in atlantoaxial pedicle screw fixation, supporting further investigation.

Framing of disaster impact in online news media: A case study from Malawi on flood risk management

High-quality impact data is essential for several applications in disaster risk management including Early Warning Systems. Currently, most impact data have spatial and temporal gaps, especially in data-poor contexts. Local news media reporting on disasters can contain information to bridge these gaps. However, each news media outlet frames disasters differently, especially since disasters diffuse in time and space. This study addresses these challenges by interrogating the implications of varying depictions of disasters in media reporting and their added value for impact databases. Our case study focuses on Malawi for two reasons: first, it is a country prone to flooding and second, it is considered a data-poor country.Our dataset comprises of news articles from four quality leading national newspapers which were identified through a basic web search and an electronic database search of Malawian news outlets. We compare the impact information from these news articles with the disaster impact data from the international Emergency Events Database (EM-DAT).To comprehensively investigate our dataset, we applied natural language processing (NLP) techniques to break down and interpret news article texts and narratives, such as sentences and parts-of-speech. We worked with three linguistic annotations: part-of-speech tagging, named entity recognition, and sentiment analysis. The main conclusions from our analysis are that: (1) online news media has a human-focus framing -highlighting the role of crucial persons; and (2) online news media frame impact, such as economic consequences, at a granular level, which can help quantify flood damage.We argue that our study has many valuable applications in other disaster-prone countries in the Asia Pacific, given the high penetration of online news and social media Our study serves as a first step into better understanding the framing of disasters in online newspapers with social media presence to extract impact data and enrich institutional impact databases in a more insightful way. This study can help actors in disaster risk management focus on official information from local news media to enrich existing impact data and to define triggers for disaster risk management.

Publications of Systematic Review and Meta-Analysis in the Indexed Anesthesia Journals: A 10-Year Bibliometric Analysis Authors

BACKGROUND: Anesthesiology research is growing at a rapid pace. It is essential to understand the scope and trends over time to identify gaps and future areas for growth. Systematic reviews and meta-analyses (SRMA) are summaries of the best available evidence to address a specific research question via a comprehensive literature search, in-depth analyses, and synthesis of results. High-quality SRMA are increasingly used and play an essential role in medical research.We aimed to explore the trends of SRMA in indexed anesthesia journals METHODS: SRMA published in indexed anesthesia journals from 2013 to 2023 were retrieved from the Web of Science database. Data were presented via descriptive statistics. We used CiteSpace 6.1.R6 to analyze countries, institutions, journals, authors, and keywords through visual maps to explore the research hotspots and trends. The journal's Journal Citation Reports partition, impact factor, annual publications, journals H-index, and a number of highly-cited papers were calculated in the WoS database.A total of 34 indexed anesthesia journals and 3,004 SRMA were included. The year 2021 was the year with the most SRMA (385/3,004). Out of the 3,004 SRMAs, 36 (0.03%) were highly cited papers, and 22 of the 36 highly cited

Evaluating Indices of Insulin Resistance and Estimating the Prevalence of Insulin Resistance in a Large Biobank Cohort

Introduction: Insulin resistance (IR) is involved in the pathogenesis of various metabolic disorders. Several surrogate indices of IR have been proposed. We assessed the performance of seven clinically relevant indirect measures of IR and estimated the prevalence of IR in a large population-based cohort.The study was conducted on fasting individuals from the Qatar biobank (QBB) participants (n = 7,875). Individuals were considered insulin sensitive (IS) if lean, not diagnosed with diabetes, no hypertriglyceridemia, and not on lipid-lowering drugs, while individuals with Type 2 diabetes (T2D) were considered insulin resistant (IR). Cut-offs were determined as the top or lowest quartile values in the IS participants. The performance of IR indices was based on area under the curve (AUC), sensitivity and specificity.The cut-off for HOMA-IR was determined at 1.878, HOMA2-IR (insulin); 1.128, HOMA2-IR (C-peptide); 1.307, QUICKI; 0.347, TyG; 8.281, McAi; 7.727 and 1.718 for TG/HDL. All IR indices analyzed yielded AUC values ranging from 0.83 to 0.92. TyG was the most robust measure for IR (AUC = 0.92, Sensitivity = 0.90, Specificity = 0.79). The overall prevalence of IR in Qatar was estimated at ~51 -65%.Conclusions: TyG index was the most robust index for determining IR in the Qatari population. The proposed cut-offs could serve as a reference in the Middle East for IR screening.

Monitoring career impact and satisfaction in a graduate program in dentistry

The assessment of student outcomes is essential for monitoring the quality of graduate programs in healthcare sciences. As such, this study focused on developing a self-employed questionnaire that allowed for the evaluation of elements focused on career impact and levels of satisfaction regarding graduate program education, and utilized it in a cross-sectional study design with alumni that had obtained their degree (MSc or PhD) over a 25-year span (1995-2020) from a graduate program in dentistry located in Brazil. The employed instrument comprised a total of 40 questions presenting a mix of both close and open-ended questions coupled with 5-point Likert scales. The questionnaire was hosted online and a total of 528 alumni were invited to participate through e-mail and social media outreach. 376 alumni answered the questionnaire (71.2% response rate). The majority were female (69.9%), and with a MSc (58.5%). Levels of satisfaction towards the program as well the impact in career and life were higher in alumni that had obtained a PhD degree compared to MSc. After obtaining the degree, an increase in involvement in teaching/research positions (3.4% vs 21.5%, p<001) and a decrease in unemployment (21.9% vs 2.1%, p<001) were observed. The highest levels of impact were observed regarding the achievement of the professional goals as nearly 90% of the population agreed with this statement. This study highlighted the creation and employment of an assessment tool that can be utilized to monitor the perceptions of student outcomes. Among the findings, a decrease in unemployment and a high degree of career impact and satisfaction were observed in the population of this study. Moving forward, it is essential that monitoring educational outcomes remains a priority worldwide.

Effects of quercetin on in vitro rumen fermentation parameters, gas production and microflora of beef cattle

This study investigated the effects of quercetin on in vitro rumen fermentation parameters, methane production, and microflora in beef cattle. A completely randomized design was adopted. Quercetin was added to the fermentation substrates at 0% (group C), 0.5% (group Q1), 1% (group Q2) and 1.5% (group Q3). Anaerobic fermentation was carried out at 39°C for 48 h, gas production (GP) was recorded at different times, gas composition was determined, and methane (CH4) production was calculated. Fermentation parameters and dry matter digestibility (DMD) were determined after 48 h. Moreover, rumen fluid was collected for rumen bacterial and archaeal flora determination. The results were as follows: 1) After 32 h of fermentation, the GP decreased in response to the addition of quercetin. With increasing quercetin concentration, the theoretical maximum gas production decreased quadratically before 20 h (P quadratic = 0.032). There was a quadratic increase in gas production (P quadratic = 0.024). With increasing quercetin supplementation, the NH3-N content increased quadratically (P quadratic = 0.027). MCP increased linearly and quadratically with quercetin (P linear = 0.002, P quadratic = 0.005), whereas DMD decreased linearly and quadratically with quercetin (P linear = 0.013, P quadratic = 0.032). Both 0.5% and 1% quercetin significantly reduced the butyrate content (P quadratic = 0.002). With the addition of quercetin, the levels of butyrate, isobutyrate, isovalerate and total volatile fatty acid (TVFA) first decreased but then increased (P quadratic < 0.05). 2) With increasing quercetin concentration, methane production (P quadratic = 0.009) and the methane proportion (P quadratic < 0.001) decreased quadratically. 3) The ACE index and Chao1 index increased quadratically with quercetin supplementation (P quadratic < 0.05). The relative abundance of Succiniclasticum in groups Q1 and Q3 increased, whereas the relative abundances of norank_f__norank_o__Rickettsiales and Curtobacterium decreased in all quercetin groups at the genus level (P < 0.05). 4) Quercetin supplementation did not affect the diversity of the archaeal community, but the relative abundance of Methanobrevibacter in group Q2 decreased. Overall, quercetin influenced in vitro rumen fermentation and the bacterial flora to decrease methane production and promote rumen nitrogen utilization and MCP synthesis.

The influence of emotional stimuli on response inhibition: a systematic review in non-clinical adults

This PRISMA-compliant systematic review aimed to clarify the influence of emotional stimuli on the behavioural correlates of response inhibition, given the mixed and inconclusive findings in the existing literature. We searched Scopus, PsycINFO and PubMed databases up to March 2024 for studies published in peer-reviewed journals, conducted in adult non-clinical populations. Eligible studies used tasks where response inhibition plays a central role (primarily the Go/No-Go task [GNG] and stop-signal task [SST]) and included emotional stimuli presented concurrently with the task. Additionally, studies had to report, control for, analyze, or at least discuss both valence (positive-negative) and arousal (calming-arousing), two emotional dimensions that have been widely used to define emotions. Ninety-three studies, encompassing over 3400 participants, were finally included, and assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). Most studies report emotional modulation of response inhibition, with a larger proportion linking this influence to valence rather than arousal.However, inconsistent findings and methodological limitations prevent firm conclusions, with some suggesting the involvement of both or neither dimension, while others lack the appropriate design. Among studies reporting effects of emotional valence, most indicate that higher valence stimuli (more positive) impaired response inhibition. The effects of arousal remain unclear, with some studies linking high arousal to poorer inhibition, while others suggest the opposite. Interestingly, discrete emotions also modulate response inhibition independently of valence and arousal, suggesting that discrete emotion theories may complement the two-dimensional circumplex model in response inhibition research. While few differences exist, more studies report effects when emotional stimuli are task-relevant rather than task-irrelevant. Among other factors, using an SST instead of a GNG task seems to enhance emotional modulation of response inhibition. Overall, the influence of emotional stimuli on the behavioural correlates of response inhibition is likely shaped by a complex interplay of multiple factors, suggesting that future research should explore how these factors interact and combine. Moreover, further research is needed to explore how emotion interacts with other forms of inhibitory control beyond global reactive inhibition, including proactive and selective mechanisms.

Reducing scheduled evening training does not improve recruits' sleep duration or quality during British Army Basic Training Authors

Sleep is critical to the health, wellbeing and performance of recruits during Army basic training, however, is often sacrificed due to the constraints of basic training schedules. In an effort to improve sleep duration of recruits, the revised Common Military Syllabus 21 (CMS21) restricted daily scheduled military training from 1830, thus enabling greater opportunity for earlier bedtimes and longer nocturnal sleep periods. Our objective was to evaluate the effectiveness of the revised CMS21 basic training programme on measures of sleep-wake indices and compare against the previous programme (CMS18) as a control group. Several actigraphy-derived and self-reported sleep-wake indices assessed potential changes in sleep opportunity between groups (CMS21 vs CMS18) and across 12-weeks of basic training. Actigraphy was measured daily to deduce weekly averages and self-report measures (i.e., sleep diaries) were captured during weeks 1, 6 and 11 of basic training. Sleep-wake data are presented descriptively (mean±SD) and a series of linear-mixed models determined differences in actigraphy between groups and across each week. Compared to CMS18, no significant improvements in any sleep-wake indices were observed during CMS21. The average sleep duration for both groups remained below the minimum national sleep duration recommendations for young adults (deficit of ~1h20m), with 67% to 94% of recruits in CMS18 and 69% to 97% of recruits in CMS21 achieving an average of <7hrs sleep per night, respectively. Similar proportions of recruits reported poor-levels of sleep quality (≤ 60%) during CMS18 and CMS21, with excessive noise and early-morning wake times identified as the most common sleep disturbances. The contracted early-morning feeding times and the magnitude of non-scheduled late-evening military admin were determined as key factors preventing adequate sleep opportunity despite restricting scheduled military training from 1830 during CMS21. The results of this study warrant the application of improved sleep hygiene practices within the basic training environment. It is also recommended that the contracted early-morning feeding times and magnitude of non-scheduled training activity be considered as factors for change within future programme design to optimise sleep opportunity during basic training.

Understanding Functional Abdominal Pain Disorders Among Children: A Multidisciplinary Expert Consensus Statement

Functional abdominal pain disorders (FAPDs) are pediatric gastrointestinal conditions marked by chronic or recurrent abdominal pain without anatomical and/or biochemical abnormalities. This position paper guides primary care providers in the early diagnosis and management of FAPDs to improve the well-being of affected children and their families. Methods: A 12-member expert advisory board reviewed current approaches to diagnosing and managing FAPDs in children. Based on literature and discussions, 23 statements were drafted and voted on to achieve an acceptable level of agreement. Results: First-line healthcare professionals are key in diagnosing FAPDs, using ROME diagnostic criteria and recognizing red flags for accurate assessment and referrals. Comprehensive evaluation, including medical, dietary, and psychosocial history, physical exams, and basic tests helped to identify the initial triggers. Probiotics such as Limosi-lactobacillus reuteri (L. reuteri) DSM 17938 and Lacticaseibacillus rhamnosus (L. rhamnosus) help in alleviating functional abdominal pain (FAP) in children along with primary measures, such as dietary modifications (a balanced diet advocating moderation in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)-rich foods) and physical activity. Probiotics should be given for 6-8 weeks and can be resumed if symptoms recur. Cognitivebehavioral and hypnotic therapy also help, with remote options such as web-based, compact disk (CD)based or application-based tools available. Discussion:This position paper provides expert insights to guide primary care providers in diagnosing and managing FAPDs, equipping them to make informed decisions for effective management of FAPDs.

Genomic Characterization of Norovirus and Sapovirus from a Diarrhea Outbreak in a School Linked to Heavy Rainfall

Background: Diarrhea poses a serious threat to human health, and rainfall is known to increase the incidence of diarrheal diseases. On July 7, 2024, a diarrhea outbreak occurred in a school in Sishui County, Jining City, Shandong Province, China, following heavy rainfall. This study aimed to identify the pathogens responsible for the outbreak and characterize their whole genomes. Methods: On July 8, 2024, a total of 21 stool samples from diarrhea cases, 2 water samples from private wells, and 1 drinking water sample from the school cafeteria were collected. Real-time quantitative PCR was used to detect Rotavirus A (RV-A), Norovirus genogroup I (NV GI), Norovirus genogroup II (NV GII), Sapovirus (SaV), Human Astrovirus (HAstV), and Human Adenovirus (HAdV). Wholegenome sequencing was performed for NV GI and SaV-positive samples to determine their genotypes, construct phylogenetic trees, and analyze amino acid variation sites in encoded proteins. Results: Among the 21 case stool samples, 7 tested positive for both NV GI and SaV, 10 were positive for NV GI only, and 1 was positive for SaV only. Of the 2 private well water samples, one was positive for NV GI and the other for SaV. Whole-genome sequences were obtained for 11 NV GI strains and 2 SaV strains. The 11 NV GI sequences from the outbreak exhibited high homology, with whole-genome similarity ranging from 99.96% to 100%, and were all identified as the NV GI.6[P11] genotype. Phylogenetic analysis showed that these 11 sequences clustered within the same evolutionary branch.Similarly, the 2 SaV sequences were highly homologous, with 99.97% similarity, and were identified as the SaV GI.6 genotype, clustering within the same phylogenetic branch.This diarrhea outbreak was caused by the combined presence of NV GI and SaV following heavy rainfall. These findings provide valuable reference data for the prevention and control of diarrhea outbreaks caused by heavy rainfall or multiple pathogens.

Towards consensus: Using the Delphi Method to form an International Expert Consensus statement on Ultra-Processed Food Addiction

The recognition of an addictive disorder relating to the harmful use of certain foods is being called for by clinicians and researchers, which evidence supports as being distinct from eating disorders (EDs) and obesity. Critics cite a lack of consensus on the validity of associating the term addiction with food, claiming that characteristics of addiction 'are not observed in the context of eating behaviours' as a reason to dispute its consideration as a novel diagnosis. To move this field forward, Iit was decided to consult international scientific and clinical experts to review whether it would be possible to reach a consensus around this subject. and result in an improved application. The 12-month project, using a Delphi method, involved 40 clinicians, researchers and academics, from 10 countries and a team of four facilitators. Consensus was achieved between 37 out of the 40 participants. The discussions during the process demonstrated that it was not only possible to achieve several areas of agreement related to the clinical observation of addiction-like symptoms related to certain foods but also, that existing extensive scientific research findings confirm the biochemical, neurological and behavioural aspects of a substance-use disorder relating specifically to ultra-processed foods, exhibiting strong similarities with other acknowledged substance-use disorders. The consensus may provide a platform for future attempts for formal recognition of ultra-processed food addiction as a diagnosis. Areas for future research are discussed.

Prospects for distributed self-consumption generation in urban circuits with the use of photovoltaic systems

Electric distribution systems currently present a marked interest in solving problems related to technical losses, overloading of lines and being able to assimilate the increase in energy demand. Therefore, the objective of this research was to analyze the behavior of a network in the presence of distributed generation, taking into account the efficiency in operations, stability and compliance with the established technical standards. The problem studied is related to the inefficiency present in some systems to incorporate distributed generation and cover the demand in certain sectors, in the presence of overloads, increased costs and reliability losses. The methodology used in the research considers power flow, equivalent circuit modeling and computational simulations to evaluate the behavior of the network in different scenarios. The results show a favorable balance of loads at the nodes, thus achieving a more efficient use of existing assets and enhancing the planning of transmission routes. This research demonstrates the importance of incorporating DG and its technical feasibility in 75% of all nodes in the case studied, thus promoting energy sustainability, emphasizing the importance of implementing these strategies to ensure a reliable, efficient and scalable supply with an important contribution to the sustainable development of electricity systems in contexts of high demand and limited resources in distribution networks.

Associations of weight-adjusted-waist index and systemic immuneinflammatory index with sKlotho: Evidence from the NHANES 2007-2016

Background: Klotho is an anti-aging protein, and obesity and inflammation have been identified as having a relationship with Klotho. This study investigated the correlation between weight-adjustedwaist index(WWI), systemic inflammation index(SII) and soluble Klotho (sKlotho) and explored the potential mediating role of SII.The association between WWI, SII, and sKlotho was investigated using weighted multivariate linear regression, subgroup analysis, and smoothed curve fitting in this cross-sectional study, which was based on NHANES data. The Bootstrap method was used to test for mediation effects. Covariate selection was validated using the variance inflation factor (VIF).The study involved a total of 9,506 participants. The results showed that WWI (β=-0.03; 95%CI:-0.04,-0.01; p<0.0001) was associated with SII (β=-0.00, 95%CI:-0.00,-0.00:p<0.001) and Ln-sKlotho.There was a negative correlation between both WWI and SII and sKlotho. Subgroup analysis showed that gender, age, education, marital status, family income, HEI, PA, hypertension, diabetes, CKD, alcohol use, smoking, and SII did not affect the negative correlation between WWI and sKlotho (FDR-corrected p>0.1). The mediation analysis showed that SII played a significant mediating effect in the role of WWI on sKlotho, with SII mediating 6.78% of the relationship between WWI and sKlotho.There is a negative correlation between WWI and sKlotho, and SII may be an important mediator between WWI and sKlotho. Reducing inflammatory conditions in obese populations may increase sKlotho levels, which in turn may delay organismal aging in middle-aged and elderly people.

Psychometric properties of the Transgender Identity Stigma scale in Argentina

Transgender identity stigma (TIS) threatens the well-being of transgender and gender-diverse (TGD) individuals. To the best of our knowledge, there are no validated TIS measures developed for TGD individuals living in Argentina. The purpose of this study was to evaluate the psychometric properties of a TIS scale among a sample of TGD individuals living in Argentina.This study consisted of a secondary data analysis of the TransCITAR cohort study. Participants were 484 TGD individuals living in Buenos Aires, Argentina. Items from the HIV Stigma Index and the Everyday Discrimination Scale were combined and adapted to design the TIS scale. Item reduction analyses were carried out. Keyser-Meyer-Olkin (KMO) test of sampling adequacy and Bartlett's Test of Sphericity were examined to verify the factorability of the scale. Exploratory factor analyses (EFA) were conducted using a principal component method with promax rotation to identify the underlying factors of the scale.The KMO value was 0.83 and the Bartlett's Test of Sphericity showed correlations between the variables (χ2 = 5,901.26, d.f. = 66, P <.001). Upon demonstrating factorability, an EFA was calculated with the 12 items selected for the final version of the TIS scale. Two factors were extracted, explaining 72% of the total variance.The TIS scale showed great internal consistency, reliability, and construct and criterion validity among TGD individuals living in Argentina, with applicability in both research and clinical settings.

Astragalus Polysaccharide Modulates the Gut Microbiota and Metabolites of Patients with Major Depressive Disorder in an In Vitro Fermentation Model: a pilot study

Previous studies have found that Astragalus Polysaccharide (APS) and Lactobacillus plantarum PS128 (PS128) have potential antidepressant effects, but their effects on the gut microbiota and metabolites of major depressive disorder (MDD) are still unclear. We examined the effect of APS on gut microbiota and metabolites of first-episode and drug naïve MDD patients using in vitro fermentation, and further explored whether PS128 could enhance the utilization ability of APS. Fresh fecal samples from 15 MDD patients were collected, and analyzed for differences in gas production, gut microbiota, and tryptophan (Trp) related metabolites after 48 hours of fermentation. APS fermentation increased the abundance of Bifidobacterium and decreased the abundance of Lachnoclostridium (P < 0.05). APS also increased total gas production and levels of indole lactic acid (ILA), Trp, and 5-hydroxytryptophan (5-HTP) (P < 0.05). Compared with APS, APS with PS128 synbiotics fermentation increased the abundance of Lactobacillus (P < 0.05), reduced total gas production and percentages of CO2, H2, and H2S (P < 0.05), and to some extent increased the levels of ILA, Trp, and 5-HTP, although not statistically significant (P > 0.05). Correlation analysis showed Bifidobacterium was positively correlated with ILA, Trp and 5-HTP; On the contrary, Lachnoclostridium was negatively correlated with ILA, Trp, and 5-HTP. All these results suggest that APS could regulate gut microbiota structure and Trp related metabolites in MDD patients; Compared to APS, APS and PS128 synbiotic fermentation could reduce gas production but shows limited ability to modulate gut microbiota structure or Trp related metabolites in MDD patients.

Small HSPs at the crossroad between protein aggregation, autophagy and unconventional secretion: clinical implications and potential therapeutic opportunities in the context of neurodegenerative diseases

Small HSPs at the crossroad between protein aggregation, autophagy and unconventional secretion: clinical implications and potential therapeutic opportunities in the context of neurodegenerative diseases

Role of lncRNA Xist-miR-124-CCL2 axis in HIV Tat-mediated microglial activation and neuroinflammation

HIV proteins, such as the Transactivator of transcription (Tat), have been shown to mediate neuroinflammation in the central nervous system, by triggering the release of pro-inflammatory cytokines and chemokines. Long noncoding RNAs (lncRNAs) play a crucial role in regulating gene expression by sponging competitive endogenous microRNAs (miRs), in turn, influencing the expression of downstream target genes. While several mRNAs have been implicated in HIV Tat mediated microglia activation, the role of lncRNAs in this process is not well examined. The current study was aimed at assessing the role of lncRNA Xist-miR-124-CCL2 axis in HIV Tatexposed microglial cells. Our findings suggest that HIV Tat upregulated the expression of lncRNA Xist while also downregulating the expression of miR-124 in mouse primary microglial cells. In silico analyses identified miR-124 as a novel binding partner of both lncRNA Xist as well as the 3′-UTR of CCL2. Both gene silencing of lncRNA Xist as well as overexpression of miR-124 approaches highlighted the role of the lncRNA Xist-miR-124-CCL2 axis in HIV Tat-mediated activation of mouse primary microglial cells. The interaction between lncRNA Xist and miR-124 was confirmed using the dual luciferase reporter and Argonaute immunoprecipitation assays. In vivo validation using doxycycline-inducible HIV Tat transgenic mice further validated the in vitro findings. Overall, these results indicated that HIV Tat upregulated the expression of lncRNA Xist, which, in turn, sponged miR-124, ultimately leading to increased CCL2 expression and subsequent microglial activation.

Anti-inflammatory effect and mechanism of stytontriterpene D on RAW264.7 cells and zebrafish

Stytontriterpene D ( STD ) is a compound isolated from dried resin of Styrax tonkinensis (Pierre) Craib ex Hartw. In this study, we explored the anti-inflammatory effect of STD in vitro and in vivo and examined its potential anti-inflammatory mechanism for the first time. In vitro, we evaluated the toxicity of STD to RAW 264.7 cells using the CCK8 method and detected the reactive oxygen species (ROS) and nitric oxide (NO) contents in cells using diacetyldichlorofluorescein (DCFH-DA) and the Griess method. We detected the levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), inducible nitric oxide synthase (iNOS), interleukin-10 (IL-10), and arginase-1 (ARG1) via enzyme-linked immunosorbent assay and measured the expression of related proteins in the NF-κB pathway via western blotting. The toxicity of STD to AB zebrafish was detected in vivo, and the recruitment of neutrophils and macrophages was evaluated in tail cut–induced and copper sulfate–induced zebrafish inflammation models. We used quantitative real-time polymerase chain reaction to study the expression of inflammation-related genes in zebrafish with inflammation induced by copper sulfate. In lipopolysaccharide (LPS)-induced RAW 264.7 cells, STD decreased IL-6, IL-1β, NO, ROS, and TNF-α production, and increased the expression of IL-10 and ARG1 while also blocking inhibitory κBα (IκBα) phosphorylation and suppressing P65 nuclear translocation. STD also reduced the recruitment of inflammatory cells in zebrafish with inflammation induced by tail cutting and copper sulfate. STD not only reduced the copper sulfate–induced gene expression of zebrafish inflammatory factors, but it also inhibited the mRNA levels of NF-κB p65 and IκBα. These results demonstrated that STD has an obvious anti-inflammatory effect, and its intrinsic molecular mechanism is possibly caused by inhibiting the NF-κB signaling pathway and regulating the phenotypic changes of M1 and M2 macrophages. Thus, STD may play a potential role in the treatment of inflammatory diseases.

Faster postnatal decline in hepatic erythropoiesis than granulopoiesis in human newborns

Background: During human foetal development, the liver is the primary site of blood cell production, but this activity declines in the third trimester and postnatally as haematopoiesis shifts to bone marrow. In humans, this postnatal decline is not well characterized due to the scarcity of appropriate samples.Objective: To characterize the effect of (i) gestational age at birth and (ii) length of survival after birth on hepatic haematopoiesis across various cell lineages involved.Methods: Autopsy liver samples from 25 born-alive infants, predominantly extremely preterm newborns who died mainly between 1 day and 3 weeks after birth, were analysed.Haematopoiesis was characterized using immunohistochemical staining of established cell type-specific protein markers. RNA-sequencing data from our previous study using the same samples were also explored.Results: Haematopoiesis negatively correlates with both the duration of prenatal development and the length of postnatal survival. The effect of these two factors varies across different haematopoietic cell lineages. Prenatally and early postnatally, erythropoietic cells dominated hepatic haematopoiesis but were rapidly suppressed within three days after birth.Granulopoietic activity declined more gradually after birth. Analysis of the gene expression data revealed the possible involvement of several transcription factors in lineage-specific regulatory mechanisms.This study enhances our understanding of the postnatal decline of hepatic haematopoiesis in human newborns, highlighting the differential regulation of erythropoiesis and granulopoiesis after birth. They bring new in-depth knowledge about the biological processes critical for postnatal adaptation of human newborns.

The Dialogue Dilemma: The Role of Patient-Clinician Communication for Low-Income People who Smoke and Manage Multiple Conditions

Introduction: Adults from low-income backgrounds who smoke face significant health disparities related to tobacco use, often at disproportionately high rates. These individuals are more likely to endure multiple mental and physical (MP) health conditions, which can negatively influence their selfrated health (SRH). The quality and effectiveness of patient-clinician communication (PCC) can influence how patients perceive their own health. Understanding how PCC influences SRH among low-income adults who smoke and suffer from multiple MP conditions is essential for clinical care as multimorbidity is on the rise. This study examines how PCC may influence the health perceptions of low-income adults who smoke and have varying MP conditions. Methods: Low-income adults who smoke (N = 58) were recruited from the San Francisco Health Network (SFHN) and were assessed for number of MP conditions, PCC, and SRH. A moderation analysis was performed to examine whether PCC moderated relations between MP conditions and SRH. Follow-up analyses were conducted to examine differences and relationships among variables. In planned exploratory analysis, all possible choices for moderator-independent-dependent-variable selections to explore the best model fit were conducted. Results: The results revealed that PCC moderated the association between MP conditions (p < .05) and SRH. In follow-up analyses, number of MP conditions predicted poorer SRH for low-income smokers who experienced low (p < .001) and average (p < .01) levels of PPC but not high levels of PCC. In planned exploratory analysis, based on the Akaike Information Criterion, a quantitative basis for considering SRH as the dependent variable was established. Conclusion: The intersection of tobacco-related disparities among low-income adults who smoke and manage multiple MP conditions is complex. Among this vulnerable population, poor and average PCC adversely influences how patients perceive their own health. Results highlight the importance of quality and effective communication between patients and providers. A culturally informed patient-centered approach to care may improve PCC as it encourages collaborative, individually tailored treatment that empowers patients to actively participate in their own health care.

Synergistic Effects of Retinol and Retinyl Palmitate in Alleviating UVB-Induced DNA Damage and Promoting the Homologous Recombination Repair in Keratinocytes

Ultraviolet B (UVB) rays are a type of ultraviolet radiation emitted by the sun, primarily responsible for skin photodamage. These rays mainly affect the epidermis, leading to direct damage to DNA and contributing to skin cancer development. Retinol and its derivatives are effective in combating skin aging and photodamage, but they often cause skin intolerance, limiting their use despite their potent effects. Therefore, investigating optimal compositions of retinoids is essential to enhance their efficacy against photodamage. In this study, we aimed to investigate the synergistic effects of retinol (ROL) and retinyl palmitate (RPalm) in alleviating UVB-induced DNA damage in human keratinocytes (HaCaT). Applying the ROL+RPalm combination after UVB exposure in HaCaT cells significantly reduced inflammation and apoptosis while promoting collagen synthesis compared to individual treatments with ROL or RPalm. Through bulk mRNA sequencing, we identified that the biological function of the ROL+RPalm synergy is primarily directed toward mediating DNA damage repair. Using comet assays, Western blotting, immunofluorescence, and flow cytometry, we demonstrated the anti-DNA damage effects of ROL+RPalm in HaCaT cells and reconstructed human epidermis. We further elucidated that the molecular mechanism underlying the ROL+RPalm combination involves the activation of RARβ, which subsequently triggers the ATM-CHK2-p53 signaling pathway and increases the expression of homologous recombination (HR)-associated repair genes. This combination presents a potential therapeutic strategy for UVB-induced photodamage and emphasizes the synergistic effects of ROL and RPalm in alleviating UVB-induced DNA damage.

A comprehensive review of natural products in rheumatoid arthritis: therapeutic potential and mechanisms

Rheumatoid arthritis (RA) is a classic autoimmune disease caused by a combination of genetic and environmental factors. The multiple and comprehensive pathologies involving the whole body's immune system and local organs and tissues make it challenging to control or cure them clinically. Fortunately, there are increasing reports that multiple non-toxic or low-toxicity natural products and their derivatives (NP&TDs) have positive therapeutic effects on RA. This review focuses on the potential mechanisms of NP&TDs against RA and aims to provide constructive information for developing rational clinical therapies. Active components of NP&TDs can play therapeutic and palliative roles in RA through multiple biological mechanisms. These mechanisms primarily involve immunosuppressive, anti-inflammatory, autophagic, and apoptotic pathways. Multiple targets-and receptor-coupled signal transduction can directly or indirectly modulates the nuclear transcription factors NF-κB, NFATc1, STAT3, and HIF-α, which in turn regulate the production of several downstream pro-inflammatory cytokines, chemokines, immunocytes maturation and differentiation, immune complexes, proliferation, and apoptosis regulatory genes. Among these NP&TDs, the tripterygium-type ingredients, the artemisinin-type ingredients, and the paeony-type ingredients have been reported to be the mainstay in treating RA. Mechanistically, immunosuppression and anti-inflammation are still the primary therapeutic mechanisms. Nevertheless, the direct binding targets and pharmacodynamic mechanisms require further in-depth studies.

De novo assembly and comparative analysis of the first complete mitogenome in Distylium (Distylium racemosum)

The genus Distylium (Hamamelidaceae) is highly valued for its applications in ornamental horticulture, industry, and construction. Although plastid genomes (plastomes) of multiple Distylium species have been characterized, no mitochondrial genomes (mitogenomes) have been reported for this genus. In this study, we assembled and annotated the complete mitogenome of Distylium racemosum using HiFi sequencing data. The mitogenome comprises a longer circular chromosome and a shorter linear chromosome (904,264 bp in total length), revealing a structurally complex conformation. We annotated 67 genes, including 43 protein-coding genes (PCGs), 21 tRNA genes, and three rRNA genes. Analyses identified exceptionally high repetitive sequence content, with 304 simple sequence repeats, 1,508 dispersed repeats, and 50 tandem repeats, representing the highest repeat content among Saxifragales mitogenomes to date. Additionally, 49 mitochondrial plastid DNA sequences were detected, including only one complete plastid-derived gene (trnC-GCA) transferred to the mitogenome. We predicted 697 RNA editing sites across 42 PCGs, further underscoring the genome’s dynamic evolution. Phylogenetic reconstruction based on mitogenomes and plastomes from 18 species indicated D. racemosum occupied a basal position within Saxifragales, which is consistent with the APG IV classification system. This study provides the first comprehensive mitogenomic resource for the Distylium genus, offering valuable insights for molecular classification, species identification, and germplasm conservation of Distylium plants.

Canagliflozin alleviates progestin resistance by suppressing RARβ/CRABP2 signaling in THRB knockout endometrial cancer cells

Introduction: Progestin resistance has emerged as a significant barrier to the conservative management of endometrial cancer (EC). The mechanisms underlying progestin resistance in endocrine therapy remain incompletely understood. Previous studies have suggested that silencing thyroid hormone receptor B (THRB) is associated with progestin resistance in EC cells. Methods: THRB-knockout RL95-2 (THRB(-/-)/RL95-2) cells were constructed to investigate progestin resistance mechanisms. Cell proliferation and apoptosis were assessed in RL95-2 and THRB(-/-)/RL95-2 cells treated with canagliflozin (CANA), medroxyprogesterone acetate (MPA), and their combination using CCK-8, EdU, and flow cytometry assays. In vivo, nude mouse xenograft models were used to evaluate the efficacy of CANA and MPA. Transcriptomic and proteomic analyses were performed to identify pathways associated with progestin resistance. Molecular dynamics simulations, along with western blotting and immunohistochemistry were utilized to validate the targets of CANA. Electrophoretic mobility shift assays and dual luciferase reporter assays were employed to investigate the interactions between TRβ, RARβ, and CRABP2.Results: THRB(-/-)/RL95-2 cells were successfully constructed. Both MPA and CANA suppressed proliferation in RL95-2 cells, but MPA was ineffective in THRB(-/-)/RL95-2 cells. CANA significantly inhibited proliferation and promoted apoptosis in THRB(-/-)/RL95-2 cells. In vivo, CANA, either alone or in combination with MPA, significantly reduced tumor growth in xenograft models derived from both wild-type and THRB(-/-)/RL95-2 cells. Transcriptomic and proteomic analyses revealed that progestin resistance in EC was linked to the retinoic acid signaling pathways. Western blotting confirmed that the expression of RARβ, RXRA and CRABP2 were significantly elevated in THRB(-/-)/RL95-2 cells. Treatment with CANA, alone or in combination with MPA, effectively reduced the expression of these proteins. Immunohistochemical analysis demonstrated that RARβ expression was significantly increased in uterine tissues from patients with progestin-insensitive EC or endometrial atypical hyperplasia. Electrophoretic mobility shift assays and dual luciferase reporter assays demonstrated TRβ negatively modulated RARβ expression by binding to its promoter, while RARβ positively regulated CRABP2 expression.Conclusions: THRB knockout activated retinoic acid pathway, leading to progestin resistance. CANA targeted RARβ and RXRA, downregulated CRABP2, restored BAX levels, and counteracted progestin resistance. The combination of CANA and MPA presented a novel strategy for alleviating progestin resistance and enhancing clinical efficacy.

Socioeconomic determinants of the leprosy risk in Yunnan Province, China: A county-level spatiotemporal study

Background: Making leprosy history in low-burden countries is a crucial step in achieving the World Health Organization's 2021-2030 Global Leprosy Strategy. Since leprosy has been contained at the national level in these countries, current efforts to eliminate leprosy have focused on specific leprosy high-risk areas. Quantifying the factors associated with leprosy risk would assist in identifying high-risk areas and the required efforts for leprosy elimination, which are still inadequate in these countries. To further progress a leprosy-free world, we investigated the associations between socioeconomic factors and the risk of leprosy in Yunnan Province, China. Methods: Socioeconomic factors and leprosy cases for 129 counties in Yunnan Province from 2004 to 2019 were collected. A spatiotemporal Bayesian model was used to evaluate the socioeconomic factors associated with leprosy risk. Results: 4361 leprosy cases were reported from 2004 to 2019 in Yunnan. Negative associations between disposable income per capita of rural residents (RR=0.947, 95%CI: 0.907, 0.989), population density (RR=0.920, 95%CI: 0.894, 0.945), the number of students enrolled by regular secondary schools (RR=0.990, 95%CI: 0.986, 0.994), and leprosy risk were found in Yunnan Province. The associations between the per capita product of the primary industry, proportion of male population, number of beds in health and medical institutions per 1000 population, and leprosy risk were not significant. Conclusions: This study revealed the associations between socioeconomic factors and leprosy risk in a low-burden country. These findings suggest that subsequent leprosy elimination efforts in Yunnan Province should prioritize rural areas, particularly those with lower population density and lower economic levels among farmers. Additionally, it is crucial to actively target poor rural farmers as a high-risk group for leprosy through strengthened early detection, multidrug therapy, and health education.

Where there's smoke, there's fire: Insights from murine models on the effect of cigarette smoke in rheumatoid arthritis development

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by joint inflammation and damage, leading to disability and pain. The etiology of RA is undefined but considered multifactorial, as interactions between genetics and environmental factors lead to the generation of autoantibodies that target synovial joints. Smoking is a wellestablished and widely studied risk factor for RA development and is associated with a reduced response to treatments and poor clinical outcomes. Murine models of inflammatory arthritis have provided many insights into the pathogenesis of RA and have recently been used to explore the relationship between cigarette smoking and RA. In this review, we comprehensively appraise the current literature investigating cigarette smoke exposure in murine models of inflammatory arthritis, focused on RA. The current literature indicates that the influence of smoke exposure on molecular and disease outcomes depends on the timepoint of exposure and genetic background of the mice. Further, dose-dependent increases in disease manifestations reproduce human clinical data that the intensity of smoking is linked to disease but demosntrate that there may be a plateau effect. Finally, we consolidate mechanistic findings to describe a potential mechanism through which cigarette smoke exacerbates murine arthritis. Understanding how these factors, genetics, timing, and intensity of exposure modulate response to CS in inflammatory arthritis models may lead to better drug development and personalized treatment strategies, ultimately improving outcomes for RA patients with a smoking history.

Analysis of Pharmacotherapeutic Approaches for Multiple Myeloma and Correlated Renal and Pulmonary Impairments: A Retrospective Real-World Registry Study in the Greater Gulf Region (REPAIR Study)

Background: Multiple myeloma (MM) is a plasma cell malignancy with significant unmet medical needs, particularly in the treatment of relapsed and refractory disease. This study aims to describe the disease characteristics, various treatment regimens, and outcomes among patients with Relapsed/Refractory Multiple Myeloma (RRMM) in the Greater Gulf region. Methods: A regional, retrospective study was conducted in Gulf countries to collect real-world data from the medical records of 148 patients with RRMM who relapsed 1-3 times in the past two years before the data collection period (July 2022 and February 2023). Results: The mean age of the study population was 59.4 years, and 64.2% of the participants were male. The VRd regimen (Bortezomib, Lenalidomide, and Dexamethasone) was the most frequent first-line therapy among transplant-ineligible patients (40.2%) and the most common induction and consolidation regimen (43.9% and 66.7%, respectively) in transplant-eligible patients. Meanwhile, Rd (Lenalidomide and Dexamethasone) was the most common maintenance regimen (75%). DKd (Daratumumab, Carfilzomib, and Dexamethasone), KPd (Carfilzomib, Pomalidomide, and Dexamethasone), and PVd (Pomalidomide, Bortezomib, and Dexamethasone) were the most widely used second, third, and fourth treatment lines, respectively (16.6%, 9.2%, and 12.5%). About 52.7% of patients were eligible for stem cell transplantation (SCT), and among them, a complete response (CR) was achieved in 47.7%. Furthermore, CR and very good partial remission rates decreased across all treatment lines. Renal impairment decreased across different treatment lines, from 23.6% in the first line to 6.3% in the fourth line. In contrast, respiratory complications demonstrated the highest incidence (>18%) in the 3rd and 4th treatment lines. Moreover, refractoriness to treatment increased from 1.3% in the first line to 34.6% in the fourth treatment line. Additionally, isatuximab was incorporated into 80%, 15%, and 5% of the regimens administered as second-, third-, and fourth-line treatments, respectively. Conclusion: This study provides valuable insights into the real-world management and treatment choices for RRMM, including the utilization of SCT and novel therapies such as isatuximab.

Effectiveness of Mobile Health (mHealth) in Symptom Management of Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Background Mobile health (mHealth) is an accessible strategy to deliver health information and becoming increasingly popular as a form of follow-up among medical staff. However, the effects of mobile health on the physical and mental health outcomes of prostate cancer patients after discharge from hospital remain unclear. This meta-analysis evaluated the current evidence regarding the effects of mHealth interventions on prostate cancer patients outcomes.Methods Four databases (PubMed, Cochrane Central electronic database, EMBASE and Web of science) were searched from inception to November 8, 2024 for randomized controlled trials (RCTs) comparing the effects of mobile health versus usual care on prostate cancer patients outcomes.Pooled outcome measures were determined using random-effects models.Eleven RCTs including 1,368 patients met the criteria for inclusion in this meta-analysis.Meta-analyses revealed a significant effect of mHealth interventions on long-term bowel function outcomes (standard mean difference [SMD]=0.19, 95%CI=0.

Bioactive Compounds Combination from Rhodiola tangutica Alleviates Pulmonary Vascular Remodeling in High-Altitude Pulmonary Hypertension Rat through PI3K-AKT Pathway

Background: Hypoxia-induced pulmonary vascular remodeling is central to the development of highaltitude pulmonary hypertension (HAPH). Rhodiola tangutica has traditionally been used to prevent chronic mountain sickness. While its active fraction (ACRT) shows therapeutic potential for HAPH, the main pharmacodynamic substances remain unclear due to the complex composition.Aims: This study aimed to identify bioactive equivalent combinatorial components (BECCs) of ACRT that alleviate pulmonary vascular remodeling in HAPH rats and to explore the underlying pharmacological mechanisms.Methods: Seventy adult Sprague-Dawley rats were divided into control, hypoxia, hypoxia+ACRT (150 mg/kg), hypoxia+BECCs (25, 50 and 100mg/kg) and hypoxia+Sildenafil (30 mg/kg) group. A HAPH rat model was induced using hypobaric hypoxia chamber simulating 5000-meter altitude. The effects of BECCs on pulmonary vascular remodeling in HAPH rats were evaluated based on hemodynamic indexes and histopathological changes, alongside antioxidant properties.Phosphoproteomics and Western blotting were performed to analyze AKT1-related protein expression in lung tissues. In vitro, 3% O2-induced pulmonary artery smooth muscle cells (PASMCs) models were utilized to evaluate the anti-proliferative effects of BECCs and identify the dominant components. The underlying mechanisms were explored using Western blotting and drug affinity responsive target stability test (DARTS) assay for binding affinity.Results: HAPH rat models were successfully established as evidenced by changes in physiological parameters. The BECCs showed the comparable efficacy as ACRT in recovering hemodynamic indexes and histopathological changes. Mechanistically, BECCs modulated AKT phosphorylation and related protein expression. In vitro, BECCs inhibited hypoxia-induced PASMCs proliferation.Particularly flavonoids (Fla) in BECCs exhibited stronger anti-proliferative activity than others, acting as the dominant contributors by regulating PI3K rather than PDPK or mTOR pathways to inhibit AKT phosphorylation. Within Fla, eriodictyol and quercetin were found to inhibit PASMC proliferation by targeting PI3K.BECCs demonstrated comparable efficacy to ACRT in alleviating HAPH progression, reversing hypoxia-induced vascular remodeling, inhibiting oxidative stress and PASMCs proliferation by targeting AKT protein. Flavonoids were identified as the key bioactive components contributing to the holistic effects of BECCs by regulating PI3K/AKT pathways. These findings could be extended to improve quality control and clarify bioactive components of R. tangutica, while inspiring development of combinatorial therapies for HAPH treatment.

Advanced Therapeutic Strategies and Safety Profiles in Heart Failure with Reduced Ejection Fraction: Contextualizing Recent Findings

Heart failure with reduced ejection fraction (HFrEF) remains a significant global health concern, characterized by high rates of morbidity, mortality, and frequent hospitalizations. Despite substantial progress in medical therapies over the past decades, the clinical course of HFrEF is often progressive, necessitating continuous research into novel and refined therapeutic strategies to improve patient outcomes. The management of HFrEF is a dynamic field, with clinical practice guidelines undergoing regular updates to incorporate the latest evidence and emerging treatment approaches. This constant evolution underscores the importance of ongoing investigation and the need for healthcare professionals to remain informed about the newest advancements in this area. The research topic "Advanced Therapeutic Strategies and Safety Profiles in Heart Failure with Reduced Ejection Fraction," published in Frontiers in Pharmacology, serves as a valuable platform for the dissemination of cutting-edge research focused on enhancing the treatment and safety profiles for individuals living with HFrEF. This topic encompasses a wide range of investigations, including the application of artificial intelligence and machine learning for predicting therapeutic outcomes, detailed evaluations of drug efficacy and safety across diverse patient populations, comparative studies of different treatment strategies, clinical trials exploring novel pharmacological agents, and the integration of advanced diagnostic tools to personalize treatment responses. This editorial aims to critically analyze and contextualize three specific studies recently published within this research topic, integrating their findings with the current understanding of HFrEF management up to the year 2025.By examining these recent contributions, this editorial seeks to provide an expert perspective on their significance and potential impact on the evolving landscape of HFrEF therapy.The cornerstone of contemporary HFrEF management lies in the implementation of guideline-directed medical therapy (GDMT), which has demonstrably improved survival and reduced hospitalizations (Heidenreich et al., 2022;Carrizales-Sepúlveda et al., 2024;Beghini et al., 2025). This foundational approach is built upon the synergistic effects of four main classes of medications: Angiotensin Receptor-Neprilysin Inhibitors (ARNIs), which are often preferred as first-line renin-angiotensin system inhibitors due to their superior efficacy compared to ACE inhibitors or angiotensin receptor blockers; betablockers, which play a crucial role in mitigating the detrimental effects of the sympathetic nervous system; mineralocorticoid receptor antagonists (MRAs), which help to counteract the effects of aldosterone; and Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2is), which have emerged as a transformative therapy demonstrating significant benefits in reducing heart failure hospitalizations and cardiovascular mortality across a broad range of patients with and without diabetes. Current guidelines increasingly emphasize the importance of initiating and rapidly up-titrating these four foundational therapies to their maximally tolerated doses within the first few months following diagnosis to achieve optimal clinical outcomes. Major guideline updates, such as the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure and the 2023 ESC Focused Update of the 2021 ESC Guidelines, have further refined the recommendations for HFrEF management (Heidenreich et al., 2022).

Integrating ensemble machine learning and multi-omics approaches to identify Dp44mT as a novel anti-Candida albicans agent targeting cellular iron homeostasis

Introduction: Candidiasis, mainly caused by Candida albicans, poses a serious threat to human health. The escalating drug resistance in C. albicans and the limited antifungal options highlight the critical need for novel therapeutic strategies. Methods: We evaluated 12 machine learning models on a self-constructed dataset with known anti-C. albicans activity. Based on their performance, the optimal model was selected to screen our separate in-house compound library with unknown anti-C. albicans activity for potential antifungal agents. The anti-C. albicans activity of the selected compounds was confirmed through in vitro drug susceptibility assays, hyphal growth assays, and biofilm formation assays. Through transcriptomics, proteomics, iron rescue experiments, CTC staining, JC-1 staining, DAPI staining, molecular docking, and molecular dynamics simulations, we elucidated the mechanism underlying the anti-C. albicans activity of the compound.Result: Among the evaluated machine learning models, the best predictive model was an ensemble learning model constructed from Random Forests and Categorical Boosting using soft voting. It predicts that Dp44mT exhibits potent anti-C. albicans activity. The in vitro tests further verified this finding that Dp44mT can inhibit planktonic growth, hyphal formation, and biofilm formation of C. albicans. Mechanistically, Dp44mT exerts antifungal activity by disrupting cellular iron homeostasis, leading to a collapse of mitochondrial membrane potential and ultimately causing apoptosis. Conclusion: This study presents a practical approach for predicting the antifungal activity of com-pounds using machine learning models and provides new insights into the development of antifungal compounds by disrupting iron homeostasis in C. albicans.

Prediction of pharmacokinetic/pharmacodynamic properties of aldosterone synthase inhibitors at drug discovery stage using an artificial intelligence-physiologically based pharmacokinetic model

Prediction of pharmacokinetic/pharmacodynamic properties of aldosterone synthase inhibitors at drug discovery stage using an artificial intelligence-physiologically based pharmacokinetic model

The objective of this study is to develop an artificial intelligence-physiologically based pharmacokinetic (AI-PBPK) model to predict the pharmacokinetic (PK) and pharmacodynamic (PD) properties of aldosterone synthase inhibitors (ASIs), enabling selection of the right candidate with high potency and good selectivity at the drug discovery stage. On a web-based platform, an AI-PBPK model, integrating machine learning and a classical PBPK model for the PK simulation of ASIs, was developed. Baxdrostat, with the most clinical data available, was selected as the model compound. Following calibration and validation using published data, the model was applied to estimate the PK parameters of Baxdrostat, Dexfadrostat, Lorundrostat, BI689648, and the 11β-hydroxylase inhibitor LCI699. The PD of all five compounds was predicted based on plasma free drug concentrations. The results demonstrated that the PK/PD properties of an ASI could be inferred from its structural formula within a certain error range, providing a reference for early ASI lead compounds screening and optimization. Further validation and refinement of this model will enhance its predictive accuracy and expand its application in drug discovery.

Socio-emotional and Personal Development Competencies as Assets Facilitating Psychosocial Adaptation in Socially Vulnerable Secondary School Students

Socio-emotional and Personal Development Competencies as Assets Facilitating Psychosocial Adaptation in Socially Vulnerable Secondary School Students

Fostering positive developmental assets in the school student population could improve individuals' psychological adjustment processes and personal well-being. In view of the above, employing a nonprobability selective, cross-sectional design, this study evaluates the association between socioemotional and personal development competencies and psychosocial adaptation in a sample of 169 socially vulnerable secondary school students in the city of Cartagena de Indias (Colombia). Of these participants, 53.3% were female, and ages ranged from 11 to 19 years (M = 14.2; SD = 1.9). Participants completed scales that assessed their personal development (self-esteem, optimism, and satisfaction with life) and their socio-emotional development (empathy, attention, emotional clarity, and repair), as well as a psychosocial adaptation scale. Once data were processed through one-factor analysis of variance and multiple correspondence analysis, it was found that socio-emotional development assets associated with emotional intelligence had a significant relationship with the psychosocial adaptation processes of adolescents, despite the disadvantages and inequalities of the social environment in which they grew. Further studies with adolescent populations in this social context are required to confirm these findings and, eventually, create psychoeducational programs that promote these positive developmental assets.

TNFRSF12A expression in gastric adenocarcinoma and its preliminary role in predicting immunotherapy response

Background: TNFRSF12A is abnormally expressed in various malignancies, especially stomach adenocarcinoma (STAD), which is related to tumor invasiveness and prognosis of patients. This study examined the expression pattern of TNFRSF12A in STAD and predicted immunotherapy response.Methods: Data were derived from The Cancer Gene Atlas (TCGA), Gene Expression Omnibus (GEO), and Gene Expression Profiling Interactive Analysis (GEPIA) to analyze the expression pattern of TNFRSF12A in pan-cancer and STAD, as well as its correlation with clinical features. Biological pathways involved in TNFRSF12A were analyzed by “clusterProfiler” package. Immune cell infiltration was evaluated by “GSVA” and “CIBERSORT” packages. Immunotherapy response was assessed by TIDE score and tumor mutation burden (TMB) level. Expression level of TNFRSF12A in the single cell of STAD was analyzed by scRNA-seq. Finally, in vitro test detected the mRNA expression of TNFRSF12A in STAD cells, Wound healing and Transwell assays were performed to measure the capabilities of STAD cell to migrate and invade.Results: TNFRSF12A was highly expressed in STAD. However, TNFRSF12A expression did not shown significant difference in relation to clinical features. TNFRSF12A exhibited notably positive correlation with many carcinogenic signaling pathways and immune cells infiltration such as T cells and macrophages. High TNFRSF12A expression group showed a higher TIDE score, Exclusion score, and TMB level than the low TNFRSF12A expression group, which indicated that STAD patients with high TNFRSF12A expression responded more poorly to immunotherapy. TNFRSF12A showed a positive relation with most of immune checkpoint genes. By scRNA-seq analysis, TNFRSF12A was chiefly expressed in Fibroblasts and Mast cells of STAD. Further, in vitro assays verified the high expression of TNFRSF12A in STAD cells, the migration and invasion capabilities of STAD cells were notably suppressed by TNFRSF12A silencing (p<0.05).Conclusion: The present study not only reveals the potential of TNFRSF12A as a therapeutic target for STAD, but also explores its great potential in STAD immunotherapy. This finding opens up a new way of thinking for the personalized treatment of STAD.

Genome-wide Identification of CDPKs in Jujube and Expression Profile Analysis in Response to Multiple Biological Processes

As calcium responders, calcium dependent protein kinases (CDPKs) play an important role in plant growth and development and in response to biotic and abiotic stresses. However, information on CDPKs in jujube (Ziziphus jujuba Mill.) (ZjCDPKs) is limited. In the current study, a total of 21 ZjCDPKs were identified, which are located on eight chromosomes. Gene structure and conserved motif analysis showed that all ZjCDPKs have similar gene structures and conserved motifs, except for ZjCDPK9 and ZjCDPK21. The CDPKs from Arabidopsis, rice, tomato, alfalfa, and jujube were divided into eight subgroups, and the members of ZjCDPKs were unevenly distributed across these subgroups. Colinear analysis revealed that 12 homozygous CDPKs were detected between jujube and Arabidopsis, and 14 pairs were found between jujube and tomato. Additionally, four types of cisacting elements were identified in the promoters of the ZjCDPKs, including hormone, stress, development, and light response elements. The expression profiles of ZjCDPKs at different fruit growth stages, in response to phytoplasma infection, cold, and salt stresses revealed that most ZjCDPKs were either up-or down-regulated. Finally, varying numbers of transcription factors were observed to interact with the promoter region of ZjCDPK4/6/7/8/10/14/16 and showed opposite expression patterns in response to cold or salt stress. The systematic analysis of ZjCDPKs provides important information for further functional characterization of CDPKs in jujube in response to multiple biological processes.

PU.1 dictates β-amyloid-induced TREM2 expression upregulation in microglia in a transgenic model of Alzheimer's disease

PU.1 dictates β-amyloid-induced TREM2 expression upregulation in microglia in a transgenic model of Alzheimer's disease

Microglial dysfunction is a typical feature of Alzheimer's disease (AD); the key players include triggering receptor expressed on myeloid cells 2 (TREM2) and the transcription factor PU.1. However, the relationship between TREM2 and PU.1 remains obscure. In this study, we investigated the expression patterns of TREM2 and PU.1 in the 5×FAD mouse AD model. We found that the expression of TREM2 and PU.1 was significantly correlated with Aβ deposition in the brain in an incremental manner and that PU.1 promoted Aβ-induced TREM2 expression upregulation and potently impacted microglial phagocytosis. Notably, PU.1 interacted directly with the promoter region of TREM2 and increased its transcription, suggesting a direct regulatory mechanism. These findings provide new insights into the regulatory role of PU.1 in the transcription of TREM2 and emphasize the importance of TREM2 and PU.1 in microglial responses, highlighting their potential as therapeutic targets in AD treatment regimens.

Evaluation of sleep position shifts in patients with obstructive sleep apnea syndrome with the use of a mandibular advancement device

Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder characterized by repeated episodes of partial or total obstruction of the upper airway during sleep, thus leading to phenomena defined as hypopnea and apnea. An apnea episode, by definition, is the cessation of breathing for at least 10 s. Hypopnea is defined as a reduction in airflow of at least 50%, associated with a reduction in oxygen saturation of >4%. The apnea-hypopnea index (AHI), i.e., the total number of hypopneas and apneas per 1 h of sleep, is used to indicate the severity of obstructive sleep apnea (OSA). There are different categories of sleep apnea depending on the OSA index: normal sleep has an AHI of fewer than 5 events, mild sleep apnea has an AHI of 5-15 events, moderate sleep apnea has an AHI of 15-30 events, and severe apnea has an AHI of more than 30 events per hour (1-3).The prevalence of OSA is approximately 22% in men and 17% in women with a gender distribution of 2:1 (4). This distribution is perhaps related to different hormonal effects that induce an increase in upper airway muscle collapsibility, body fat distribution, and different anatomy. Hormonal effects have an important role in OSA pathogenesis, particularly in post-menopausal women compared to pre-menopausal women. Unfortunately, the role of hormones in OSA pathogenesis is still unclear (5).Obstructive sleep apnea syndrome is becoming an increasingly studied condition because of its many comorbidities and consequences, although there is a high prevalence of undiagnosed and untreated patients (6). Because of sleep deprivation and daytime sleepiness, patients with OSA have a higher risk of car accidents (7). Cardiovascular disease is correlated with OSA, with sympathetic activation, oxidative stress, and systemic inflammation defined as the main causes of this association. OSA is an independent risk factor for hypertension, coronary artery disease, heart failure, cardiovascular and cerebrovascular diseases (CVDs), and atrial fibrillation (8,9). OSA is related to many metabolic complications such as type 2 diabetes mellitus (T2DM) (10). The prevalence of T2DM in patients with OSA is higher than in the general population (11). Current research suggests that arousals and sleep fragmentation may have effects on systemic inflammation, sympathetic surges, glucose intolerance, β-cell dysfunction, and insulin resistance (12). Narkiewicz et al. (13) suggested an alternative way to explain the relationship between T2DM and OSA. Oxyhemoglobin desaturation and hypercarbia may alter epinephrine, norepinephrine, and cortisol secretion, which leads to increased gluconeogenesis and decreased glucose uptake.Sleep fragmentation in patients with sleep apnea can also lead to neurocognitive and behavioral consequences (14,15). Although there are questionnaires and several risk factors (age >40 years, male sex, obesity, smoking) and symptoms (snoring, nocturia, nocturnal gasping, daytime sleepiness) to identify patients with obstructive sleep apnea, the diagnostic standard to diagnose the condition is nocturnal polysomnography (16,17). OSA is evaluated by many questionnaires that focus on daytime sleepiness and health-related quality of life (HRQoL) (18,19). The Epworth Sleepiness Scale (ESS) and the STOP-Bang and Berlin questionnaires are the main questionnaires used to evaluate daytime sleepiness (20,21) Continuous positive airway pressure (C-PAP) is the first-line treatment for patients with obstructive sleep apnea. It is a noninvasive treatment method used to maintain airway patency by delivering constant airway pressure. Other alternative methods, such as oral appliances, are also used in patients with apnea, especially for those who do not tolerate the C-PAP mask. Surgery is only used in cases with anatomic obstructions that need to be corrected (25). The oral appliances used are tongue retainer devices (TRDs) and mandibular advancement devices (MADs). A TRD is made of a flexible material with a bulb-like receptacle in the anterior portion. It maintains the tongue in a forward position during sleep, reducing stress on the upper airway and against the posterior pharyngeal wall (26). A MAD has been recommended by the American Academy of Sleep Medicine as a treatment for mild to moderate OSA (27). Some studies suggest that it also has an excellent effect on severe apnea. A MAD is a device with important advantages: low cost, simple production, and portability (28). The effect of a MAD is to increase the upper airway space through a forward and vertical movement of the jaw along with a repositioning of the hyoid bone and tongue (29). A MAD is built as two occlusal splints, fully covering the teeth, allowing for an increase in mandibular sagittal movement and free vertical/transversal movement of the jaw (30). The role of the dentist is becoming increasingly important for both the diagnosis and treatment of snoring and obstructive sleep apnea (31).It is

Correlation of Dermoscopic and Histopathological Features in Basal Cell Carcinoma Using Computerized Image Analysis

Correlation of Dermoscopic and Histopathological Features in Basal Cell Carcinoma Using Computerized Image Analysis

Background: Basal cell carcinoma (BCC) is the most common skin cancer, exhibiting local invasiveness despite its low metastatic potential. Dermoscopy and histopathology are essential for diagnosis, while quantitative assessments may enhance lesion characterization.Study: This study aims to analyze the dermoscopic and histopathological characteristics of BCC and investigate the correlation between dermoscopic pigmentation patterns and tumor depth to improve lesion classification and diagnostic accuracy. Patients and Methods: This retrospective study analyzed 41 patients with 42 histopathologically confirmed BCC lesions, evaluated at Nizip State Hospital and 25 Aralık State Hospital between April 2023 and February 2025. High-resolution dermoscopic images were analyzed alongside histopathological findings. AI-assisted computerized image analysis was employed to quantify lesion size and pigmentation percentage, while tumor depth and dermoscopic-histopathological correlations were manually assessed.Results: BCC was more prevalent in males (56.1%) and older adults, with a mean age of 67.1 years. The most commonly affected site was the nose (42.9%), followed by the cheek (14.3%) and upper lip (11.9%). Histopathologically, nodular (28.6%) and adenoid (28.6%) BCC were the most frequent subtypes. Dermoscopic analysis revealed blue-gray ovoid nests (57.14%) and arborizing telangiectasias (71.43%) as predominant features, particularly in mixed-type BCC, while blue-gray dots and globules (57.14%) were most common in micronodular BCC. Ulceration (45.24%) and multiple erosions (57.14%) were strongly associated with infiltrative BCC. A negative correlation was observed between pigmentation percentage and tumor depth, with deeper tumors exhibiting reduced pigmentation, though this trend was not statistically significant.Comprehensive characterization of the dermoscopic and histopathological features of BCC enhances lesion differentiation. AI-assisted lesion size and pigmentation analysis, combined with histopathological evaluation, improves diagnostic precision. Further studies with larger cohorts are needed to validate these findings and refine classification criteria.

Analysis of the diversity and function of the microbiota in infected root canals of type 2 diabetes mellitus with apical periodontitis

Analysis of the diversity and function of the microbiota in infected root canals of type 2 diabetes mellitus with apical periodontitis

Purpose: This study aimed to compare the compositional differences and functions of microbial communities in infected root canals of teeth with apical periodontitis (AP) and/or type 2 diabetes mellitus (T2DM) using 16S rDNA sequencing.Methods: Eighteen participants were categorized into two groups based on their health conditions: AP and AP complicated with T2DM (APDM). Infected root canal microbiota was clinically collected for 16S rDNA sequencing. Subsequent statistical and bioinformatics analyses were conducted after sequencing by NovaSeq, encompassing diversity analysis, intergroup difference analysis, and functional prediction analysis.The core microbiome of root canal microorganisms was similar in the two groups, which mainly consisted of Bacteroidota,

Unravelling the Infodemic: A Systematic Review of Misinformation Dynamics During the COVID-19 Pandemic

Unravelling the Infodemic: A Systematic Review of Misinformation Dynamics During the COVID-19 Pandemic

The COVID-19 pandemic caused both a health crisis and a rise in misinformation, known as the "infodemic," which led to fear, confusion, and distrust. This review looks at the reasons behind the spread of misinformation, including psychological, technological, and social factors. It explains how digital platforms promote false information through algorithms and how people's emotions and thinking patterns influence their belief in and sharing of misinformation. The review also examines how misinformation spreads worldwide and the role of laws in controlling its impact. One key finding is the need for more transparency in online algorithms to reduce the spread of misleading content. Understanding why people believe and share misinformation is important for creating effective solutions. The review highlights the need for global cooperation in research and policy-making and stresses the importance of community efforts to help those most affected by misinformation. It also looks at the effectiveness of policies like government regulations and public education while balancing misinformation control with freedom of speech. By combining insights from technology, psychology, and policy, this review offers a broad approach to tackling misinformation. Building trust in science, strengthening information systems, and reducing the harm caused by misinformation are crucial for handling health crises and future challenges

Factors Affecting the Productivity and Satisfaction of Virtual Workers

With the advancements in ICT and the Internet in the workplace, both small and large organizations have the ability to compete on a global scale, revolutionizing the business world (Madlock, 2012). Because of the continued advances in ICT, businesses realize the benefits of cost savings and improvements in productivity by leveraging the 4 technological progression of high-speed communications (Lojeski & Reilly, 2008). Through computers, email, and smartphones, employees can work from virtually anywhere in the world (Soukup, 2015). Advances in ICT and the global workforce can benefit a business in many ways, such as the elimination of corporate brick-and-mortar infrastructure across the organizations; consequently, businesses would need less real estate as they move toward the virtual workforce (Lojeski & Reilly, 2008). Although the advent of the virtual worker is a relatively new phenomenon, it has rapidly been expanding across the business industries (Lojeski & Reilly, 2010). Virtual workers are individuals who do not physically work at the office with co-workers or management. Typically, a virtual worker works from home and leverages technology to facilitate communications. The globalization of work has opened up the opportunity to virtual teams, and organizations have responded by supplementing their traditional team structures with a virtual workforce (Au & Marks, 2012; Hanif & Yunfei, 2013). The ability to work virtually has rapidly increased an organization's ability to develop a globalized diverse cultural team, which, in turn, positions an organization with a more extensive talent pool of professionals to draw from (Mockaitis et al., 2012). As the virtual worker has transformed the traditional brick-and-mortar organization structure to that of a virtual workforce, management’s role of the virtual workforce is still evolving. This study may add to the existing body of knowledge on virtual management communication in a way that researchers can use to expand the literature on the topi

Remote working and occupational stress: Effects on IT-enabled industry employees in Hyderabad Metro, India

The Impact and Risks of Artificial Intelligence on Employee Skills Development and Daily Work: An Analysis for Human Resources Development

AI's application in the workplace is increasingly defined by its ability to address demands for efficiency, cost reduction, and personalization. Organizations have adopted AI technologies for diverse functions, including human resources, training, and employee development. For example, Intelligent Employee Assistants (IEAs) enhance efficiency by automating repetitive administrative tasks such as scheduling and information retrieval. Similarly, personalized training platforms utilize AI to create customized learning pathways, targeting specific skill gaps and aligning training outcomes with career aspirations (Baki et al. 3). These advancements demonstrate how AI promotes operational efficiency and individual engagement simultaneously. Additionally, the predictive capabilities of AI allow for optimized resource allocation in recruitment and retention, further aligning organizational objectives with employee needs. Despite these benefits, the growing reliance on AI in human resource functions invites scrutiny regarding potential biases in algorithmic decision-making. For example, data-driven hiring tools may inadvertently perpetuate existing inequalities unless adequately monitored and audited for fairness. Tackling such issues requires organizations to establish ethical guidelines and maintain robust accountability frameworks to mitigate risks associated with AI deployment. AI's rapid adoption has also introduced ethical and operational challenges, particularly regarding algorithmic biases and transparency. Flaws in training datasets often result in biased AI outputs that reflect and potentially exacerbate societal inequalities. In recruitment processes, for instance, these biases can lead to discriminatory practices if not addressed. Transparency challenges also arise, especially with "black-box" syste

Leveraging Artificial Intelligence for Real-Time Cybersecurity: Automated Threat Detection, Response, and Ethical Challenges

Introduction The increasing reliance on digital technologies and interconnected systems has profoundly influenced various facets of society, including communication, commerce, and critical infrastructure. Yet, this growing dependence has also exposed vulnerabilities, as cyberattacks continue to grow in sophistication and frequency. Addressing these challenges requires innovative solutions, with artificial intelligence (AI) emerging as a key technological enabler in modern cybersecurity. AI offers unparalleled capabilities for analyzing vast datasets, identifying patterns, predicting threats, and automating responses in real time. Its integration into cybersecurity frameworks is transforming how organizations protect themselves from cyber threats, yet it also introduces complex ethical, legal, and technical dilemmas that must be critically explored. Cybersecurity as a discipline faces increasing pressure to evolve. Traditional methods, such as rule-based systems and manual monitoring, struggle to keep pace with dynamic attack vectors and the sheer volume of data generated by digital ecosystems. AI's capacity for machine learning (ML), deep learning (DL), and natural language processing (NLP) provides a paradigm shift in detecting and responding to threats with greater accuracy and speed. AI-driven systems not only enhance the capabilities of existing infrastructure but also enable proactive approaches to cyber defense, mitigating harm before incidents escalate. The significance of AI lies in its potential to drastically reduce response times, improve detection rates, and minimize the economic impact of cyber incidents, which cost global economies trillions of dollars annually. This research paper investigates how AI can be deployed to detect and mitigate cyber threats in real time, with a dual focus on its technical capabilities and the ethical and legal challenges associated with its application. The analysis includes AI-based anomaly detection, predictive analytics, and response automation, as well as an exploration of issues such as data privacy, algorithmic transparency, accountability, and regulatory compliance

Strengths and Weaknesses of the Quantitative Research Study Title: The Impact of Activity Mediation on Diminishing the Fall Hazard in Older Adults: A Meta-Analysis of Randomized Controlled Trials

The chosen quantitative technique entails doing a meta-analysis of randomized controlled trials (RCTs) to examine the impact of exercise treatments on reducing falls among older adults. The study uses the Pedro scale for quality assessment and complies with the Cochrane Collaboration Convention requirements (Poucher et al., 2019). It has a sample size of 648 people. In terms of methodology, the study includes searching reliable databases to provide a thorough evaluation.

The study’s strength is the strong evidence it presents for the usefulness of exercise programs in lowering older persons’ rates of falls (Radez et al., 2021).

 The study is noteworthy for its extensive scope, meticulous methodology, lucid conclusions, and useful ramifications. Nevertheless, drawbacks include the possibility of incompletely capturing the impacts of the intervention, inadequate attention to different factors impacting outcomes, and dependence on self-reported data.

Qualitative Improvement Project Aimed to Develop 1:1 Patient Monitoring Guidelines in the form of a Flowchart for Inpatients Diagnosed with Components of Disorganized Behaviors

Patient Monitoring Guidelines in the form of a Flowchart for Inpatients Diagnosed with Components of Disorganized Behaviors. Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges (Healthy people, 2020). Mental health is essential to personal wellbeing, family, and interpersonal relationships as well as the ability to contribute to community or society (Healthy people, 2020). Mental health inpatient hospitalizations have been on the rise with the increase in societal challenges reflected by an increase in social disparities, racial and ethical diversities, and this nations response to COVID that has brought uncertainties to all social groups. People with behavioral and psychotic experiences, increasing depression, drug or alcohol addiction are in disparate need of a safe and structured environment such as an inpatient mental

 DNP 835 Reflecting on the “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care,” describe the role of the DNP-prepared nurse in managing costs The “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care”

 DNP 835 Reflecting on the “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care,” describe the role of the DNP-prepared nurse in managing costs

The “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care” has assisted me to recognize, as a nursing leader, areas of opportunity in my facility throughout the organization. It is imperative to take the time to assess or reassess these areas to ensure that we are practicing good resource stewardship. Perez et al. (2018) noted that approaches for reducing overuse often reduce access to certain medical services, which may be alarming to those who equate more care with better care or are concerned about interference with doctor-patient decisions. The authors also stated that potential strategies to reduce overuse might threaten aspects of healthcare delivery that the public highly values, such as physician autonomy or patient choice.

DNP 835 Reflecting on the “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care,” describe the role of the DNP-prepared nurse in managing costs Re: Topic 2 DQ 1

DNP 835 Reflecting on the “IHI Module TA 103: Increasing Value and Reducing Waste at the Point of Care,” describe the role of the DNP-prepared nurse in managing costs

Re: Topic 2 DQ 1

DNP-prepared nurses play a critical role in managing costs in healthcare by using their advanced education and training to improve patient outcomes and reduce healthcare spending. They can do this through various means, including implementing evidence-based practices, utilizing technology to improve efficiency and communication, and developing innovative care delivery models. Additionally, DNP-prepared nurses may be involved in research to identify cost-saving opportunities and implement financial management strategies.

One common barrier to cost management and inappropriate resource use in healthcare is a need for more transparency in pricing and cost information. With clear and accurate information about the costs of different treatments, procedures, and medications, it can be easier for healthcare providers, patients, and payers to make informed decisions about care. Additionally, the lack of transparency can lead to the overuse of resources, as providers may need to be made aware of more cost-effective alternatives. Furthermore, patients may need help to make informed decisions about their care, leading to higher out-of-pocket costs and financial burdens.

One change theory that can be applied in nursing practice to integrate sustainable care delivery is Lewin’s Change Management Theory. This theory posits that change occurs in three stages: unfreezing, changing, and refreezing (Henry et al., 2021). In the unfreezing stage, individuals or groups are made aware of the need for change and their current attitudes and behaviors are questioned. In the changing stage, individuals or groups are provided with new information and skills needed to adapt to the change. In the refreezing stage, the new attitudes and behaviors are consolidated and become the new norm. In nursing practice, Lewin’s Change Management Theory can be applied to integrate sustainable care delivery by first unfreezing current attitudes and behaviors related to resource consumption and waste. This can be done through education and awareness campaigns about the environmental impact of healthcare and the benefits of sustainable care delivery.

In the changing stage, new sustainable care delivery practices and technologies can be introduced and implemented, such as the use of electronic medical records, telehealth, and green cleaning products. In the refreezing stage, the new sustainable practices and technologies are consolidated and become the new norm in the healthcare setting. Supporting evidence can be found in various studies that have applied Lewin’s Change Management Theory in healthcare settings. A study by Cone and Unni (2020) found that Lewin’s Change Management Theory was effective in improving faculty satisfaction in a pharmacy school. Another study by Harrison et al., (2021) found that Lewin’s Change Management Theory was effective in implementing a new guideline for the prevention of surgical site infections in a hospital setting.

References

Cone, C., & Unni, E. (2020). Achieving consensus using a modified Delphi Technique embedded in Lewin’s change management model designed to improve faculty satisfaction in a pharmacy school. Research in Social and Administrative Pharmacy, 16(12), 1711-1717. https://www.sciencedirect.com/science/article/abs/pii/S1551741119310484

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of healthcare leadership, 13, 85. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966357/

Henry, E. S., Robertshaw, S., & Stephenson, J. (2021). Improving accessibility to outpatient clinics for adults with suspected seizures from the emergency department: a quality improvement project. Seizure, 93, 160-168. https://www.sciencedirect.com/science/article/pii/S1059131121003514

 DNP 835 Reflecting on the “IHI Module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems,” describe how your direct practice improvement project achieves clinical improvement

Enhancing the quality and safety of health care is a main concern of governments, health care workers, and the public with endeavors often concentrated on contributions made towards having changes in how health care is structured and provided. Quality improvement projects have been done continuously in healthcare settings in an effort to enhance the quality of care of individuals, improve the health of community members and reduce healthcare costs thus attaining clinical improvement (Hill et al., 2020). Wounds can add substantially to healthcare costs and influence healthcare professionals’ time. The use of Mepilex Border dressings in hospital-acquired pressure injuries (HAPI) has been mentioned to achieve clinical improvement and has been clinically effective in numerous studies (Santamaria et al., 2018; Hahnel et al., 2020; Padula, 2017). Hill et al. (2020) mentioned that by decreasing the number of dressing changes, Mepilex foam dressings protect the wound, assure optimal healing, lowers material costs, and increase health service efficiency by releasing healthcare practitioners’ time to care for patients. This absorbent single dressing enables a longer wear time retains exudate, and avoids wound maceration and associated complications.

Widespread change can be accomplished through continuous professional education to ensure that healthcare professionals’ competencies, knowledge, and skills are aligned with current standards and evidenced-based practice (Nilsen et al.,2020). In Australia, a country with universal health care, foam dressing was compared with other absorbent dressings and was mentioned to be cost-effective when compared to saline dressings in treating HAPI (Walker et al., 2017). Padula (2017) was applicable in describing the usefulness of the foam sacral dressing and its cost-effectiveness in a country without Universal Health Coverage, the United States. This was a concern for this scholar’s DPI project, but the study highlighted its effectiveness when used prophylactically and financially and hence can be translated into practice to support this DPI project. This foam dressing will be initiated into a long-term care setting using Lewin’s theory of change over a period of eight weeks. The dressing is available at the facility however there is no policy providing the wound nurse with specific guidelines on its use. Hence, it is the aim of this DPI project to translate the use of the Mepilex foam dressings into practice and to continually educate staff on its usage.

References

Hahnel, E., El Genedy, M., Tomova-Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., Richter, C., Akdeniz, M., Blume-Peytavi, U., Löber, N., & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial. The British Journal of Dermatology, 183(2), 256– 264. https://doi.org/10.1111/bjd.18621

Hill, J.E., Stephani, AM., Sapple, P. et al.  (2020). The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review. Implementation Science, 15, 23. https://doi.org/10.1186/s13012-020-0975-2

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20(1), 147. https://doi.org/10.1186/s12913-020-4999-8

Padula W. V. (2017). Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study. Journal Of Wound, Ostomy, and Continence Nursing: Official Publication of The Wound, Ostomy and Continence Nurses Society, 44(5), 413–419. https://doi.org/10.1097/WON.0000000000000358

Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891

Walker, R. M., Gillespie, B. M., Thalib, L., Higgins, N. S., & Whitty, J. A. (2017). Foam dressings for tre

DNP 835 Reflect on the “IHI Module QI 201: Planning for Spread: From Local Improvements to System-Wide Change.”  Describe how change spreads according to Kurt Lewin and Everett Rogers.

Kurt Lewin and Everett Rogers present models explaining how changes spreads in different contexts. Kurt Lewin’s theory presents three stages of change, proposing that people are first loosened from their old way, and then transitioned before being molded into a new way. The three stages involve preparing for change, managing the change, and ensuring that the change becomes standard practice. The first stage is unfreezing in which people are adapted to the expectation of change. This involves loosening their attachment to the current way, practice or attitude, helping them to understand why the change is necessary, and getting clarification on how the change will be accomplished. It involves understanding the need for change through sharing resources, training and communication. The second stage in change in which the change process occurs with support provided for those who may be struggling. The third stage is freezing in which the change is adopted as standard practice and new normal with timely reminders and communication applied to reinforce the change (Finkelman, 2019).

DNP 835 Reflect on the “IHI Module QI 201: Planning for Spread: From Local Improvements to System-Wide Change.”  Re: Topic 5 DQ 1

According to Kurt Lewin to effect long-lasting change, people have to be loosened from their old way, transitioned, and then molded into their new way. This involves preparing people for change, managing the change, and then working to ensure that the change stays in place. The three stages of change are: Unfreezing: From Lewin’s perspective, the first stage in helping people adapt to change involves unfreezing or loosening their attachment to their current attitude or practice. That means helping them understand why change is necessary and clarifying how the change will be accomplished. When implementing a change in health care, this stage might include communicating with staff and sharing external research or internal data about the change. It may also focus on training or the distribution of resources that will help people understand the need for change. Change: In the second stage, the process of change actually occurs. This may be a difficult time for individuals affected by the change. These people will need lots of support as questions and frustrations arise. Freezing: Once the changes occur or something has transitioned to a new way of being, Lewin identifies a need to actively “re-freeze” the process in its new state so that it can continue to operate as designed. This ensures that people will not naturally return to the old way of doing things. This re-freezing may involve new protocols and procedures, periodic process checks to learn how the new process is working in relation to its design, and reinforcement through internal communications and other formats that remind people of the new process. (Berwick, D. M., et al, 2018).

Everett Rogers’ Diffusion of Innovation Theory is the process by which an innovation is communicated through certain channels over time among the members of a social system. Given that decisions are not authoritative or collective, each member of the social system faces his/her own innovation-decision that follows a 5-step process: Knowledge – a person becomes aware of an innovation and has some idea of how it functions,  Persuasion – person forms a favorable or unfavorable attitude toward the innovation,  Decision – person engages in activities that lead to a choice to adopt or reject the innovation,  Implementation – a person puts an innovation into use, Confirmation – person evaluates the results of an innovation-decision already made. The most striking feature of diffusion theory is that, for most members of a social system, the innovation-decision depends heavily on the innovation decisions of the other members of the system. In fact, empirically we see the successful spread of an innovation follows an S-shaped curve (Bennett, J., et al, 2018).

The IHI Framework for Spread provides a useful tool for assessing the current culture of an organization and determining how likely a new idea will spread. It is important to look at the factors that contribute to successful change, such as the degree of trust among staff, the level of communication, and the ability to take risks. Trust is a key factor in successful change, as it creates an environment where changes can occur. A high degree of trust among staff can help ensure that new ideas are discussed openly without fear of repercussions. Additionally, the level of communication among staff is important to ensure that new ideas are understood and accepted. Finally, the ability to take risks is essential to create a culture of experimentation and innovation (Weiner, B. 2019).

References

Bennett, J., & Bennett, L. (2018). A review of factors that influence the diffusion of innovation when structuring a faculty training program. Internet and Higher Education,6, 53-63.

Berwick, D. M., Nolan, T. W., Whittington, J., & Kirkpatrick, K. M. (2018). Spread of innovations in health care. The Journal of the American Medical Association, 299(11), 1372-1377.

Weiner, B. (2019). A theory of organizational readiness for change. Implementation Science, 5(67), 1-9.

DNP 835 Reflecting on the “IHI Module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems,” describe how your direct practice improvement project achieves clinical improvement

DNP 835 Reflecting on the “IHI Module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems,” describe how your direct practice improvement project achieves clinical improvement

The IHI module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems reflects on minor problems in healthcare systems and how to overcome these small problems to build safer systems. Steve Spear used various examples to make the readers understand the concept of small loopholes and workarounds which distract the employees resulting in mistakes, and sometimes these mistakes become catastrophes (Institute for Healthcare Improvement, 2022b). The “IHI” also highlighted eight steps for systems to support quality and safety, how to support the teams and how to support the patients and families. Each of these three highlighted sections in the module demonstrates a systems approach across the continuum of care to improve patient quality and safety. The direct practice improvement project achieves clinical improvement by reducing the number of adverse events that occur in the patient population.

My DPI project addresses the relationship between adherence to fluid and diet restrictions and interdialytic weight gain among ESRD patients undergoing hemodialysis. Previous studies have shown that a positive dialysate-to-plasma sodium gradient is associated with increased thirst and interdialytic weight gain among ESRD patients (Jalalzadeh et al., 2021). However, there is a need for further studies on the effect of patient education on fluid and diet restrictions on patient adherence to the set restrictions. End-stage renal disease adults require kidney transplants or hemodialysis to help them stay alive. The primary role of maintenance hemodialysis (HD) is the extracellular fluid volume (ECV) balance, which makes sodium balance possible between interdialytic sodium intake and sodium removal during HD sessions. The problem addressed in the project is the relationship between adherence to fluid and diet restrictions and interdialytic weight gain among ESRD patients undergoing hemodialysis. Previous studies have shown that a positive dialysate-to-plasma sodium gradient is associated with increased thirst and interdialytic weight gain among ESRD patients (Jalalzadeh et al., 2021). However, there is a need for further studies on the effect of patient education on fluid and diet restrictions on patient adherence to the set restrictions. Interdialytic weight gain can lead to several adverse health outcomes for ESRD patients. Fluid overload can increase the workload on the heart and lead to heart failure, while weight gain can exacerbate other underlying health conditions such as hypertension and diabetes (Weiner et al., 2017). Additionally, maintaining an appropriate weight through adherence to fluid and diet restrictions can improve the overall quality of life for ESRD patients.

The widespread change would be affected if the project were implemented in a country with universal health care (UCH). The health outcome would be impacted because patients would have access to healthcare regardless of race, color, or creed due to the benefits of UHC. After all, universal health coverage means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.  The health outcome would be impacted because patients would be less likely to experience an adverse event. After all, UHC covers essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.  According to the World Health Organization (WHO), to make health for all a reality, all people must have access to high-quality services for their health and the health of their families and communities. To do so, skilled health workers providing quality, people-centered care; and policymakers committed to investing in universal health coverage are essential. Universal health coverage requires vital, people-centered primary health care. Sound health systems are rooted in the communities they serve, and they focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life (WHO). Hopefully, this project will also contribute to an overall improvement in healthcare quality in the United States. The project’s contribution to bettering the country’s healthcare system will have a ripple effect on society.

Institute for Healthcare Improvement. (2022b, August). QI 202: Addressing small problems to build safer, more reliable systems. IHI. https://education.ihi.org

Jalalzadeh, M., Mousavinasab, S., Vil

DNP 835 Reflecting on the “IHI Module TA 102: Improving Health Equity,” describe two causes of health disparities in the United States, or in your local community, that lead to health inequity Re: Topic 3 DQ 1

DNP 835 Reflecting on the “IHI Module TA 102: Improving Health Equity,” describe two causes of health disparities in the United States, or in your local community, that lead to health inequity

Re: Topic 3 DQ 1

Increasing rates of obesity are thought to be a major contributor to disparity trends. Obesity rates have risen significantly over the last three decades in all women. While African American women weigh more than whites do on average, part of the BMI difference is explained by height differences. Byrd (2018), evaluates studies using birth cohorts from the mid-1940s through 2002, African American females were found to grow faster throughout childhood and reach their adult height at a younger age, resulting in a shorter final height. Recent evidence also suggests that the stature of African American females may be decreasing. An additional noteworthy trend, thought to be associated with rising obesity rates, is the declining age of menarche in all race/ethnic groups. However, the decline in age of menarche has been greater in African American girls than in whites. These findings present a mixed picture with respect to trends in African American and white women’s overall health. Although life expectancy has increased, except for the most disadvantaged white women, there is some evidence that chronic disease prevalence has increased, especially for those conditions associated with obesity. Some initiatives to help with this are lifestyle and behavioral changes. I propose we make physicians aware of these facts so they can start to implement changes early on in life and not just base everyone off the same BMI scale.

Another issue identified is Aging. Health is an invaluable resource for optimal aging, so much so that some scholars use terms such as “healthy aging” to draw attention to the advantageous position of growing older unencumbered by disease or disability. Some individuals and human collectivities, however, are noticeably challenged to age well because they face a host of threats to health. Within gerontology, research on minority health comparing the health of historically underrepresented minority groups to the majority population has revealed how structural disadvantages challenge individuals to age well. According to Ferraro et al (2017), despite higher health risk profiles than their non-Hispanic counterparts, Hispanic Americans displayed better mental health outcomes, lower prevalence of many chronic diseases, and even lower mortality rates. Given the diversity of human experience, it is crucial to consider physical, social, and historical context, but also to account for the conjoint influence of structure and agency in explaining racial and ethnic gaps in health.

Byrd AS, Toth AT, Stanford FC. Racial Disparities in Obesity Treatment. Curr Obes Rep. 2018 Jun;7(2):130-138. doi: 10.1007/s13679-018-0301-3. PMID: 29616469; PMCID: PMC6066592.

Ferraro KF, Kemp BR, Williams MM. Diverse Aging and Health Inequality by Race and Ethnicity. Innov Aging. 2017 Mar 1;1(1):igx002. doi: 10.1093/geroni/igx002. Epub 2017 May 26. PMID: 29795805; PMCID: PMC5954610.

DNP 835 As a future DNP leader describe what quantitative and qualitative data you could use to assess the culture of your practice site or organization Re: Topic 6 DQ 1

 DNP 835 As a future DNP leader describe what quantitative and qualitative data you could use to assess the culture of your practice site or organization

Re: Topic 6 DQ 1

Assessing the culture of my practice site will require data on the proportion of clinicians that have taken safety courses, the proportion of nurses that understand the safety risks, clinicians’ safety beliefs and attitudes, and the incidence of safety incidents and near misses (Azyabi, Karwowski, & Davahli, 2021). These qualitative and quantitative data will help create a more comprehensive picture of the overall culture in the practice site. Personal ideas and beliefs regarding safety captured by interviewing clinicians, patients, and culture experts will also be beneficial in assessing the culture in my practice setting.

The creation, shaping, and sustenance of a safety culture requires an understanding of each of the six domains of a culture of safety. Thus, I will endeavor to ensure that I understand the requirements in each of these domains. Secondly, implementing continuous monitoring of safety incidents will also be beneficial. Data from the monitoring systems will aid investigations into the root causes of errors and their elimination (Hunt et al., 2022). Patients will be involved in the reporting systems. The patients will be required to provide additional insights into safety incidents and near misses. Integration of evidence-based practices that have been proven to be effective in reducing safety incidents (Rosen & Kelz, 2021). I will keep abreast with research, guidelines, and best practices in research relating to safety within healthcare. I will then encourage my practice site to adopt some of these practices after assessing its readiness for change, the effectiveness of the intervention, and its relative efficiency. Motivating the worksite to create a culture of safety will require highlighting the costs and implications of safety incidents and corrective interventions to the facility, patients, and caregivers (Rosen & Kelz, 2021). These measures will ensure they develop an understanding of the gravity of safety issues and the value of proposed corrective interventions.

References

Azyabi, A., Karwowski, W., & Davahli, M. R. (2021). Assessing patient safety culture in hospital settings. International Journal of Environmental Research and Public Health, 18(5), 2466. https://doi.org/10.3390/ijerph18052466

Hunt, J., Gammon, J., Williams, S., Daniel, S., Rees, S., & Matthewson, S. (2022). Patient safety culture as a space of social struggle: Understanding infection prevention practice and patient safety culture within hospital isolation settings – a qualitative study. BMC Health Services Research, 22(1), 1446. https://doi.org/10.1186/s12913-022-08703-x

Rosen, C. B., & Kelz, R. R. (2021). Processes to create a culture of surgical patient safety. The Surgical Clinics of North America, 101(1), 29–36. https://doi.org/10.1016/j.suc.2020.09.008

DNP 825 Identify a population-based problem of interest you see in your community and identify relevant outcomes you would like to see from mitigating the scope and effects of this problem

DNP 825 Identify a population-based problem of interest you see in your community and identify relevant outcomes you would like to see from mitigating the scope and effects of this problem

I am not sure if this aligns with the topic, however, the CDC has made health literacy and health disparities a matter of concern for public health. That being said, Health Occupations Students of America has added a new event called Public Health. This event encourages high school and college level students to think of ways to increase community health. This years topic is 2022-2023 Public Health Topic: Heart Healthy for Life: What You Need to Know Now, however, I find it interesting that the CDC has lessons for students ages pre-K to college that focus on public health. I believe the next step is to promote these free lesson plans to public and private schools. For example, you may find a link to the health equity science and intervention strategy on their website. This is useful information as part of public health is using community resources to education and engage.

I will now shift subjects. Our professors asked how public health was effected by COVID. This is a hot topic as I have spent much of today working with the Medical Reserve Corp in DFW. This community emergency response organization lost a great deal of their staff during the pandemic. The MRC along with other health care entities were strapped for human resources and found themselves overworked, mentally and physically exhausted. COVID provided a rude awakening to the lack of resources needed to prepare for a pandemic. Unfortunately, COVID greatest impact was on populations with high levels of health disparities. Although, public health announcements encouraged social distancing the tight living quarters and lack of access to health care increased their mortality rates. However, as we review the roles of public health nursing we better understand part of their purpose is to address health equities. For example, COVID 19 was an unfortunate reminder of the need to close these gaps… as “Black, Hispanic, and American Indian persons in the US are more likely to live in crowded conditions, in multigenerational households, and have jobs that cannot be performed remotely, such as transit workers, grocery store clerks, nursing aides, construction workers, and household workers. These groups are more likely to travel on public transportation due to lack of having their own vehicle.” Public Health also recognizes other influences such as access to healthy food, medical care and mental health also effected COVID outcomes, this understanding may assist in the future.

https://hosa.org/wp-content/uploads/2022/09/22-23-PH-Sept1.pdf

https://www.cdc.gov/healthliteracy/education-support/schools.html

https://aspr.hhs.gov/MRC/Pages/index.aspx

DNP 825 Identify a population-based problem of interest you see in your community and identify relevant outcomes you would like to see from mitigating the scope and effects of this problem Re: Topic 1 DQ 1

When there is an outbreak of a disease, the older adults and the children are vulnerable to contracting these diseases. This significantly affect the elderly who are already suffering from chronic illnesses. Other conditions may affect the older adults that will affect the mortality and the morbidity rate of the older adults. There must be a public awareness on the prevention of these diseases. If patients are not educated on these diseases, the infection may spread in the community. The importance of hand hygiene must be taught to patients of all groups. Different diseases are preventable when the patient is educated on the danger of engaging in the practice.

 DNP 825 How could you better implement descriptive epidemiological methods in your current or future practice?  Re: Topic 2 DQ 1

The field of epidemiology has been broadly defined as “the study of how disease spreads and can be controlled or the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health. One may ask why a distinct field of research is needed in order to more effectively translate research into practice. Implementation science” is one of several terms that have been used to describe the science of putting knowledge or evidence into action and of understanding what, why, and how evidence or evidence-based practices work in the real world.

DNP 825 Evaluate the current political climate as it relates to health care and explain how politics influence health for both the individual and entire populations

The Healthcare system is evolving and would benefit from having highly educated nurses leading evidence-based practice (EBP), research, and improvements in healthcare quality. Disparities in healthcare, food distribution, education, and housing demand the attention of DNP graduates as they possess tools to make changes in our society, such as leadership skills, practical experience, and knowledge of research and EBP that allows them to be powerful advocates for healthcare policies and prepared to meet the country’s many healthcare demands and challenges (Chism, 2023).

Public health nursing increased significantly at the beginning of the 20th century because of the overwhelming public health problems as a result of urbanization, immigration, and industrialization in the US. Healthcare professionals recognized the importance of coalitions with other healthcare professionals to form a political base to advocate change and improve public health.

The political decisions upstream have large health effects downstream (Mishori, 2019). It has always been an integral role for nurses to be involved in political activities. DNP involvement in shaping healthcare policy and promoting advocacy is imperative, and any social policy initiatives and political decisions have an impact on nursing practice. A DNP graduate can proactively engage in developing and implementing all levels of healthcare policy, including local, state, institutional, regional, federal, and international levels (Chism, 2023).  The majority of political activities were focused on areas that promote the nursing practice, involvement in healthcare policy, and advocacy for the benefit of the general population.

References

Chism, L. A. (2023). The doctor of nursing practice: a guidebook for role development and professional issues 5th ed.Jones and Bartlett Learning.

The Doctor of Nursing Practice: A Guidebook for Role Development and Profes… – Google Books

Mishori, R. (2019). The social determinants of health? Time to focus on the political determinants of health. Medical Care, 57(7), 491-493.

https://doi.org/10.1097/MLR.0000000000001131

 DNP 825 Evaluate the current political climate as it relates to health care and explain how politics influence health for both the individual and entire populations Re: Topic 4 DQ 2

 DNP 825 Evaluate the current political climate as it relates to health care and explain how politics influence health for both the individual and entire populations

Re: Topic 4 DQ 2

Politics is closely associated with healthcare provision and the quality of individual and population health. The current political climate is favorable to healthcare because political leaders use healthcare manifestos to assure the public of better health and improve their chances of election. Besides, political leaders actively participate in healthcare policy formulation and distribution of resources that affect the day-to-day operations of healthcare systems. Politics determines healthcare resource allocation and other healthcare subsidies that determine the quality and access to healthcare services. Through policy implementation and enforcement, the leaders regulate the conduct of healthcare providers to limit quacks and advocate for better healthcare provision. The policies also address health inequalities and disparities to enhance individual and population health (McCartney et al., 2019). Thus, politics influence health for both individuals and the entire population through policy formulation and allocation of resources.

DNPs have a vital advisory role in policymaking and patient advocacy. One of the impacts a DNP can create through policymaking is actively advising the political leaders on matters of health, to ensure that healthcare policies are relevant and effective for improving healthcare quality and delivery (Williams et al., 2018). Through patient advocacy, they can facilitate programs to improve patients’ awareness of their rights during healthcare provision, to encourage patient-centered care, and hence better healthcare outcomes (Williams et al., 2018). They can also improve public awareness of health and well-being through healthcare education and health promotion to improve the population’s knowledge of the need for frequent health checkups for a better quality of life (Williams et al., 2018). Also, through policy and advocacy, DNPs can minimize healthcare disparities and improve healthcare access by advocating for proper healthcare resource allocation. Thus, DNPs play a vital role in healthcare policymaking and patient advocacy to improve population health awareness and facilitate a better quality of life.

References

Cepni, A. B., Hatem, C., Ledoux, T. A., & Johnston, C. A. (2021). The importance of health values among health care providers. American Journal of Lifestyle Medicine, 15(3), 224–226. https://doi.org/10.1177/1559827621992271

Haas, B. W., Hoeft, F., & Omura, K. (2021). The role of culture on the link between worldviews on nature and psychological health during the COVID-19 pandemic. Personality and Individual Differences, 170, 1–6. https://doi.org/10.1016/j.paid.2020.110336

DNP 825 Which epidemiological study design would you use to evaluate an intervention in your current or future practice?

Epidemiological studies are unified by their shared goals and basis in defined populations (Yoshida, K., 2015). The case series (or register-based study) examines trends in deaths, cancers, notifiable diseases, and hospitalizations (Yoshida, K., 2015). Cohort studies produce data on disease incidence and are especially good on associations between risk factors and disease outcomes. The design and interpretation should be in the context of traditional, systematic. Meta-analytic reviews (Bröckelmann, N., 2022). one of the basic requirements of a cohort-type study is that none of the subjects have the outcome of interest at the beginning of the follow-up period. Time must pass to determine the frequency of developing the outcome. The epidemiological study approach to be applied to my future clinical practice is an observational cohort study comparing the risk of developing uterine cancer between postmenopausal women receiving hormone replacement therapy and those not receiving hormones. There is consideration of specific eligibility criteria for the participants before the start of the study: 1) they should be female, 2) they should be post-menopausal, and 3) they should have a uterus. Among post-menopausal women, a number might already have had a hysterectomy, perhaps for persistent bleeding problems, endometriosis, or prior uterine cancer.  I chose this study because, in cohort studies, investigators enroll individuals who do not yet have the health outcomes of interest at the beginning of the observation period. I assess exposure status for a variety of potentially relevant exposures. The participants are then followed forward in time as longitudinal studies rather than cross-sectional, and health outcomes are recorded. With this data, I can sort the subjects according to their exposure status for one of the exposures of interest and compare the disease incidence among the exposure categories. Cohort and case-control studies are observational studies because investigators do not allocate exposure status. Some exposures are constituents (e.g., one’s genome), some are behaviors and lifestyle choices, and others are circumstantial, such as social, political, and economic determinants that affect health (Bröckelmann N. et al., 2022). According to Bröckelmann N. et al. (2022), cohort studies more clearly indicate the temporal sequence between exposure and outcome because, in a cohort study, subjects are known to be disease-free at the beginning of the observation period when their exposure status is established. In case-control studies, one begins with diseased and non-diseased people and then ascertains their prior exposures (Yoshida, K., 2015). This is a reasonable approach to establishing past directions, but subjects may have difficulty remembering them, and their recollection may be biased by having the outcome (recall bias). Some disadvantage of cohort study includes You may have to follow large numbers of subjects for a long time, and they can be costly and time-consuming, to name a few.

Yoshida, K., Solomon, D. & Kim, S. Active-comparator design and new-user design in observational studies. Nat Rev Rheumatol 11, 437–441 (2015). https://doi.org/10.1038/nrrheum.2015.30

Bröckelmann, N., Balduzzi, S., Harms, L. et al. Evaluating agreement between bodies of evidence from randomized controlled trials and cohort studies in medical research: a meta-epidemiological study. BMC Med 20, 174 (2022). https://doi.org/10.1186/s12916-022-02369-2

DNP 825 Which epidemiological study design would you use to evaluate an intervention in your current or future practice?  Re: Topic 2 DQ 2

Randomized Clinical tirals epidemiology design is well-designed medical research, gives cause and risk. Belbasis et al (2018) agrees that this Clinical design is my choice due to its components of dealing with health event, involves persons, locttion, timelline , cause , risk factors ad modes of transmission. This design would be used to evaluate the prevelence of Humnan immunodeficiency virus ( HIV) and pregnant women population in my future practice. This design choice is in agreement with article from Atiiola et al ( 2018) . Pregnant women are most vulnerable high-risk population impacted by HIV. Mode of transmission is prevalent in population with history of intravenous drug use, multiple sexual partners, blodd transfusion history. HIV infection becomes an epidemic for this population when coinfected with other viral disease such as Tuberculosis, Hepatitis B, Hepatitis C.  The authors of this article assessed epidemiology of HIV among women in ten facilities in south-west Nigeria. The result revealed positve HIV pregnant women were 6 time more likely to require more post partum care, blood loss and complictions (Atilola et al 2018).

The clinical deisgn will help to understand earlier disease characteristics , offer educational interventions, initiate antiviral prohylaxis and monotr medication adherenae to privent mother-to child transmission This design is best option due to the fact that it will provide overview of epdemiology and cinical manifestations of HIV infection in pregnant women, provide therapeutic modlities which includes psychological care plan ( Atewogbola et al 2021).

Belbasis L, Bellou V. Introduction to Epidemiological Studies. Methods Mol Biol. 2018;1793:1-6. doi: 10.1007/978-1-4939-7868-7_1. PMID: 29876887.

Atewogbola, G. O., Olufemi, B. T., Babawale, A. A., Taiwo, M. A., Tadese, S. A., Olaniyan, A. A., Sule, W. F. (2021). Multiple sexual partners as major predictor of human immunodeficiency virus seropositivity among pregnant women, osun state, nigeria. Viral Immunology, 34, 632-638. https://dx.doi.org/10.1089/vim.2021.0029

Atilola, G., Randle, T., Obadara, T., Komolafe, I. O., Odutolu, G., Olomu, J., Adenuga, L. (2018). Epidemiology of hiv and tuberculosis in pregnant women, south west nigeria. Journal of Infection and Public Health, 11, 826-833. https://dx.doi.org/10.1016/j.jiph.2018.06.004

DNP 825 Describe a scenario in which a patient’s culture might impact health literacy Re: Topic 3 DQ 2

Health literacy may present in various forms leading to inadequate and ineffective healthcare management with subsequent non-compliance and complications. When communication is disseminated between the provider and the patient it creates a healthy dangerous and threatening situation. Simmons et al. (2017) define health literacy describes how individuals obtain, process, and understand basic health information and services needed to make an appropriate decision as it concerns a person’s health decisions

Goldsmith et al. (2020) use the COMFORT communication model as a holistic set of principles that are practiced during patient and family care.  The COMFORT model communication promotes how some of the health literacy encountered can be managed effectively through collaborative nurse-patient and family interactions.

complex social determinants of health (SDOHs) emphasize those factors that reflect the conditions in which people are born, grow, work, live and age that influence their access and availability to health care. These include economic stability, neighborhood and physical environment, education, food, community, and social context, and the health care system (Goldsmith et al., 2020). The COMFORT model represents C—Connect, O—Options, M—Making Meaning, F—Family Caregivers, O—Openings, R—Relating, and T—Team (Goldsmith et al., 2020). This model was used to connect and interact meaningfully with a patient family who expressed some preference for how her mother should be cared for in a cancer unit about their cultural belief. Using this model permits the healthcare professional to create a mutual communication that incorporates a clearer explanation and understanding between the family and the healthcare professional.

C-for connects in this model helps the healthcare professional and the patient or patient family connect as a way to improve the quality of care and promote better outcomes. A patient family expresses dissatisfaction with the physician’s approach and lack of explanation concerning their family member laying critically unconscious in the hospital. The nurse can give a listening ear and connect with their concerns and be able to advocate and communicate the concerns with the physician creating a room to address the concern. O—Options, this helps to understand the uniqueness of each individual to remove stereotyping and assumptions based on appearance or origin. M—Making Meaning addresses how the healthcare professional discusses certain information especially serious illnesses as it may be interpreted and assumed culturally by the patient as some patients may think illnesses are punishment for bad behaviors. F—Family Caregivers should be acknowledged to promote cultural diversity. O—Openings indicate the need for the nurse to assist the patient in transition to the appropriate care once the opportunity warrants. R—Relating this where the nurse research the family’s perception and understanding and acceptance of the patient’s illness. Appropriate information must be communicated.  T—Team, the importance of teamwork cannot be overemphasized in patient care (Goldsmith et al., 2020). To involve flexibility, communication, and participation to achieve the goal. Embracing cultural competence is vital in addressing the factors impacting health literacy.

Reference

Goldsmith, J., Wittenberg, E. & Parnell, T. (2020). The COMFORT Communication Model. Journal of Hospice & Palliative Nursing, 22 (3), 229-237. doi: 10.1097/NJH.0000000000000647.

Simmons, R. A., Cosgrove, S. C., Romney, M. C., Plumb, J. D., Brawer, R. O., Gonzalez, E. T., … & Moore, B. S. (2017). Health literacy: cancer prevention strategies for early adults. American Journal of Preventive Medicine, 53(3), S73-S77.

DNP 825 How can large aggregated databases be used to improve population health?  Re: Topic 3 DQ 1

DNP 825 How can large aggregated databases be used to improve population health? 

Re: Topic 3 DQ 1

The adoption of electronic health records (EHRs) in healthcare systems as mandated by the US Department of Health and Human Services (HHS and some other great sources of healthcare data such as wireless health monitoring devices and behavioral social media sources the healthcare professionals can easily access abundant amounts of patient data that provide more significant insights of the patient health information. This wealth of databases form big data (Batarseh and Latif, 2016). Hernandez and Yuting Zhang (2017) define big data as notably large and complex databases that aggregate information of different types and scales, collecting data across time and distance from multiple sources, often requiring complex data processing applications. Further describing those big data that are used in the healthcare system as HER, administrative claims, clinical trial data, and data collected from smartphone applications, wearable devices, social media, and personal genomics services. Batarseh and Latif (2016) in their article explained how using big data helped to establish the vast majority of US citizens estimating up to 30 million individuals were diagnosed with the chronic diseases of diabetes and hypertension in 2010. This accounted for more than 80% of health system costs. As these chronic conditions are linked with other health-threatening complications, engaging these patients in preventative health education to empower them on how to take charge in improving their illnesses like lifestyle modification and follow-ups will not only improve the patient’s overall health but when health is improved, less medication is prescribed and subsequently reduce waste. Using the home blood pressure monitor that can report to the clinician’s office and some of the newer technological diabetes monitors like the Dexcom G6 pools data and aid in data aggregating.

References

Batarseh, F. A., & Latif, E. A. (2016). Assessing the quality of service using big data analytics: with application to healthcare. Big Data Research, 4, 13-24.

Hernandez, I., & Yuting Zhang. (2017). Using predictive analytics and big data to optimize pharmaceutical outcomes. American Journal of Health-System Pharmacy, 74(18), 1494–1500. https://doi-org.lopes.idm.oclc.org/10.2146/ajhp161011 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a2h&AN=125112221&site=ehost-live&scope=site

Qualitative Improvement Project Aimed to Develop 1:1 Patient Monitoring Guidelines in the form of a Flowchart for Inpatients Diagnosed with Components of Disorganized Behaviors

Qualitative Improvement Project Aimed to Develop 1:1 Patient Monitoring Guidelines in the form of a Flowchart for Inpatients DiagnoQualitative Improvement Project Aimed to Develop 1:1 Patient Monitoring Guidelines in the form of a Flowchart for Inpatients Diagnosed with Components of Disorganized Behaviors. Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges (Healthy people, 2020). Mental health is essential to personal wellbeing, family, and interpersonal relationships as well as the ability to contribute to community or society (Healthy people, 2020). Mental health inpatient hospitalizations have been on the rise with the increase in societal challenges reflected by an increase in social disparities, racial and ethical diversities, and this nations response to COVID that has brought uncertainties to all social groups. People with behavioral and psychotic experiences, increasing depression, drug or alcohol addiction are in disparate need of a safe and structured environment such as an inpatient mental health unit, to stabilize (Magoon et al., 2020). Due to the severity of mental health symptoms, which range from being suicidal, aggressive, disoriented or confused, intrusive, mental health patients are often placed on a 1:1 observation or sitters. During their stay in the hospital, 13–16% of psychiatric inpatients will be placed on continuous observation, which includes a staff member continuously remaining within eyesight of a patient at all times (Barnicot et al., 2017). This intervention is frequently utilized to monitor patient symptoms with a desired outcome of maintaining safety for the patient and the unit. This proposal will address a quality improvement project related to creating awareness on the financial and staffing impact of a 1:1 sitter utilization within the inpatient mental health units. This proposal will also seek to developsed with Components of Disorganized Behaviors

Health Coaching to Improve Glycemic Control Among Patients with Type 2 Diabetes Vivienne A Ayomanor Touro University, Nevada DNP Project III: In partial fulfillment of the requirements for the Doctor of Nursing Practice

1 Health Coaching to Improve Glycemic Control Among Patients with Type 2 Diabetes Vivienne A Ayomanor Touro University, Nevada DNP Project III: In partial fulfillment of the requirements for the Doctor of Nursing Practice DNP Project Team: Dr. Heidi Johnston, DNP, RN, CNE Dr. Bukola Olusanya, DNP, FNP-C, MSN, APRN February 20th, 2024 2 Abstract In the United States (US), Type 2 diabetes (T2DM) is a significant public health issue facing many patients in primary care settings. Diabetes in the US is classified as the seventh top root cause of mortality, and T2DM accounts for approximately 90-95% of diagnosed cases in adults. This DNP quality improvement project aimed to determine the efficacy of a health coaching intervention using the 2023 6th guideline of American Diabetes Association (ADA) Standards of Care to help improve glycemic levels from 22% to 37% over a 4-week time frame. Glucose level data was collected weekly, and SPSS version 29 software was

Effectiveness of In-service Education to Enhance the Knowledge of Newborn Pain and Nonpharmacological Management in the Mother-Baby Unit

Effectiveness of In-service Education to Enhance the Knowledge of Newborn Pain and Nonpharmacological Management

EFFECTIVENESS OF IN-SERVICE EDUCATION 3

Abstract

The need to enhance the effectiveness of in-service education of the nurses in the Mother and Baby Unit (MBU) on neonatal pain assessment and in providing comfort measures is an expected obligation. In-service education of nurses plays an essential role in improving the quality of newborn care, promotes empowerment, competency, professional skills development, best practices, and active participation at the unit level. The purpose of this project is to determine the effectiveness of the education of nurses in the MBU and their ability to assess neonatal pain and offer comfort measures (nonpharmacological). With a better understanding of Watson's comfort theory model, nurses will better recognize the effects of pain on the neonate and provide adequate comfort measures during a heel stick. The project was a quality improvement project. A pre-educational questionnaire was presented to the nurses on the MBU before the presentation of in-service education on newborn pain assessment and the provision of comfort measures during a heel stick. After the power-point presentation, a post-educational questionnaire was given to the nurses on the MBU. The knowledge level on pain assessment and the provision of comfort measures was assessed by analyzing the data, i.e., the comparison of the pre and post educational questionnaire findings using a descriptive method. The results of the project indicated that in-service education made a difference in the improvement in nurses’ knowledge in newborn pain assessment and the provision of comfort measures during a heel stick.

in the Mother-Baby Unit

Preoperative Nasal Decolonization: Impact on Surgical Site Infections in Patients Undergoing Total Joint Arthroplasty

Preoperative Nasal Decolonization: Impact on Surgical Site Infection in Patients Undergoing Total Joint Arthroplasty Surgical site infections (SSIs) are costly to a patients' quality of life and a hospital's finances and reputation (Torres et al., 2016). Hospital-acquired infections (HAIs) contribute to an increased length of stay, patient dissatisfaction, and increased mortality. SSIs contribute to a 3% mortality rate, with 75% of these deaths directly attributed to the SSI (CDC, 2020). SSIs are the most expensive of all HAIs that reportedly costs $10,000 to $25,000 per infection and over $90,000 if the infection involves a resistant organism or a joint implant (Torres et al., 2016). Romero-Palacios et al. (2019) state that surgical site infections following total joint replacement cost the United States (U.S) $1.62 billion annually. Preventing HAIs is critical to prevent financial strain for the hospitals since the Centers for Medicare and Medicaid Services (CMS, 2020) has stopped reimbursing hospital-acquired events, such as SSIs. Methicillin-resistant Staphylococcus aureus (MRSA), and methicillin-sensitive Staphylococcus aureus (MSSA) has been attributed to SSIs following total joint arthroplasty (Pelfort et al., 2019; Peng et al., 2018). A considerable portion of the population harbors different S. aureus forms, including 20%-36% with MSSA and 6% with MRSA (Peng et al., 2018; Septimus, 2016). Decolonization is an evidence-based intervention in reducing HAIs. Eliminating colonized bacteria with nasal decolonization has been shown in preventing S. aureus infections and using povidone-iodine statistically reduces SSIs (Urias et al., 2018). The guidelines for targeted decolonization require all patients to be tested for MRSA and then recommends treatment of those who test positive; while universal decolonization is treatment for all patients regardless of MRSA status. Both methods have been shown to decrease infections (Hayden et al., 2016). The purpose of this DNP project is to implement a universal preoperative NASAL DECOLONIZATION 7 nasal decolonizing procedure with povidone-iodine for adult patients undergoing elective total joint arthroplasty procedures to reduce surgical site infections (SSIs) caused by MRSA, and MSSA. Problem The Centers for Disease Control [CDC] (2020) defines SSI as an infection occurring within 30 days and 90 days of total joint replacements. Diagnosis of infection includes the presence of purulent drainage or organisms from sterile cultures and demonstration of pain, tenderness, localized swelling, redness, and heat and are categorized as superficial, deep incisional, or organ/space infections (CDC, 2020). According to the CDC, in 2014, approximately 14 million surgical procedures resulted in over 110,000 (0.78%) surgical site infections in the U.S. According to the Agency for Healthcare Research and Quality (AHRQ), more than 450,000 total hips replacements and 790,000 total knee replacements are performed annually in the U.S. (American Academy of Orthopedic Surgeons, 2020), with an infection rate of 2% to 4% (Franklin, 2020). In California, during 2018-2019, there were 211,417 total joint procedures performed, which resulted in 963 infections (0.46%) (U.S. Department of Health, 2020). S. aureus is one of the most common organisms that causes SSIs, which can lead to increased patient mortality, length of hospitalization, and healthcare costs (Hayden et al., 2016; Septimus & Schweizer, 2016, Zhu et al., 2020). S. aureus is the most common organism in total joint replacement infections (Pelfort et al., 2019; Peng et al., 2018). The anterior nares are a significant source for colonization, and the majority of S. aureus infections are from the patient's nasal flora (Hayden et al., 2016; Pelfort et al., 2019; Peng et al., 2018; Septimus & Schweizer

At the completion of the project (week ten, timeframe), all the adopted quality indicators suggested by National Institute for Health and Care Excellence [NICE] (2016b) will experience at least a twenty-percent improvement (specific, realistic, achievable) as evidenced by the depression case management documentation (measurable).

1.  
2. At the completion of the project (week ten, timeframe), all the participants will report being able to apply the new guidelines as evidenced by the documentation of the final discussion with them (specific, realistic, achievable, and measurable).

Determine the relationship between nursing certification status and transport safety competency scores. c. Hypothesis: There will be a significant and positive relationship between certification status and safety competency scores.

Determine the relationship between nursing certification status and transport safety competency scores.

1. 1. Hypothesis: There will be a significant and positive relationship between certification status and safety competency scores.

Anxiety and Coping Styles of First-Year Nursing Students During COVID

Anxiety and Coping Styles of First-Year Nursing Students During COVID

There is an increasing amount of anxiety experienced by college students affecting their mental health and success through college (Turner et al., 2018). The increase in the mental health needs of students is far exceeding current resources on college and university campuses across the United States. Many components impact a student’s mental health including previous educational experience and pressure of choosing their future career. When an individual is psychologically and intellectually ready, they will choose their profession and develop skills and tools allowing them to accomplish their professional goals. To choose a profession, an individual must be psychologically and intellectually ready to accomplish their profession goals by developing the skills and tools they need to be successful. Choosing a profession can be an important factor in the mental health of individuals (Karaca et al., 2019). The importance of this decision and the stress of college life impacts an individual’s mental health and development of coping styles. Students who experience negative emotional feelings often develop coping styles ineffective in dealing with those negative emotions (Sun et al., 2016). Mental health disorders often begin in early adulthood, a delay in diagnosis and treatment of these mental health disorders often leads

Doctor of Nursing Practice Inquiry Project Executive Summary Testing a Pediatric Palliative Care Education Workplace Intervention

Courtney James

Purdue University

EXECUTIVE SUMMARY

Problem Statement and Significance

            Pediatric palliative care is a beneficial service that aims to improve quality of life for children and their families suffering from serious illness (National Institute of Nursing Research, 2015). Through focus on the needs of the child and family, palliative care has the ability to increase comfort for its recipient (National Institute of Nursing Research, 2015). Despite its benefit, palliative care, in the adult and pediatric setting, is underutilized. An estimated 400,000 children and families who would benefit from palliative care services do not receive them (Center to Advance Palliative Care [CAPC], 2019). Although several barriers have been identified as causes to underutilization, the lack of palliative care provider education is one that directly impacts both providers and patients (Aldridge et al., 2015). Nurses are not exempt from this impact; and while they cannot initiate palliative care consults, nurses who are familiar with palliative care play crucial roles in advocating for this service (Fitch et al., 2015). Palliative care education has shown to be effective in improving knowledge and changing attitudes toward palliative care among nurses (Harden et al., 2017; Hughes et al., 2006; O’Shae & Mager, 2019; McClement et al., 2005). Current palliative care education focuses on adult palliative care. To address this gap in pediatric palliative care training, we created and implemented a brief online education that introduced a general overview of pediatric palliative care. We tested the effectiveness of this training on increasing awareness and improving perceptions of palliative care among registered nurses working in a hospital setting.

Methodology

A brief online education video was created to provide a general overview of pediatric palliative care. Eligible registered nurses across six clinical units at an academic pediatric hospital were recruited to complete a pre-test online education, and a post-test. The pre- and post-tests included questions assessing awareness of and perceptions toward palliative care using the Palliative Care Quiz for Nursing (PCQN). (Ross et al., 1996). The questions can be seen in Appendix A. The four questions had the following response options: “true”, “false”, and “I don’t know” (Ross et al., 1996). Three open-ended questions were used to gather qualitative data on hospice and palliative care definitions and the likelihood of suggesting a pediatric palliative care consult (see Appendix B). The project was IRB approved and registered nurses were recruited via email and flyers which included a Qualtrics link to the pre-test, education, and post-test. Data was collected for seven weeks. Descriptive statistics were used to summarize frequencies, central tendencies, and variation of demographic data. McNamar Tests were used to determine if a statistical significance existed between PCQN pre- and post-test responses. Open-ended responses were coded into recurring categories to identify trends before and after the education.

Results

The Utilization of Sunscreen Prescriptions to Increase Patient Use: Examination of Healthcare Provider Perceptions

The Utilization of Sunscreen Prescriptions to Increase Patient Use: Examination of Healthcare Provider Perceptions

James M. Roush, BSN, RN, Dr. Elizabeth A. Richards, PhD, MSN, RN, CHES, Dr. Katrina Masterson, DNP, RN, FNP-BC, DCNP, Dr. Janelle Potetz, DNP, RN, ANP-BC, CNE

Purdue University School of Nursing

502 N. University Street Johnson Hall of Nursing

West Lafayette, IN 47907

Significance and Problem Statement

            Each year an estimated three million people in the United States (U.S.) are treated for melanoma and non-melanoma skin cancers (Ruiz et al., 2019). These numbers have increased in recent decades with non-melanoma skin cancers equating to over ninety percent of skin cancer cases (Ruiz et al., 2019). Treatment costs currently average 8.1 billion dollars, representing over a one hundred percent increase since 2002 (AAD, 2021, Guy et al., 2015; Ruiz et al., 2019; Saes da Silva et al., 2018; Skin Cancer Foundation, 2021). A recent study found 56% of patients reported never receiving sunscreen counseling by a dermatologist or a primary care provider (Farberg, Rigel, & Rigel, 2016; Vasicek et al., 2018). Despite consistent research demonstrating the effectiveness of sunscreen in preventing deoxyribonucleic acid (DNA) damage from ultraviolet radiation when used properly, use of sunscreen remains low with less than 10% of men and 25% of women reporting regular application of sunscreen (Julian, 2019; Olsen et al., 2018; Zamoiski et al., 2015).

Applying prescriptions to help improve adherence to health behavior changes has been studied for several years. In 2003, a randomized controlled trial found those given a prescription for exercise showed greater improvement in important measures such as weight loss and blood pressure compared to the control group over a one-year period (Patrella et al., 2003). Further benefits of exercise prescriptions have been reported in more recent studies in which modest increases in physical activity were demonstrated (Orrow et al., 2012; O’Brien et al., 2017). Improved adherence to prescriptions has shown a decrease in mortality and an improvement in chronic disease outcomes; furthermore, lowering cost, increasing patient education, and finding ways to engage patients are all crucial in facilitating medication adherence (Neiman et al., 2018). While little research was found regarding sunscreen prescriptions, prescribing sunscreen in practice may provide a means by which conversation and education surrounding sunscreen and sun protective behavior is more likely to take place during office visits. This study seeks to investigate provider perceptions of using sunscreen prescriptions as a method to increase patient use.

Methodology

Due to lack of previous research studying providers’ perceptions of sunscreen prescriptions, it was necessary to look outside the research topic for a validated survey tool. This project measured provider perceptions of sunscreen prescriptions through use of a questionnaire originally developed to analyze provider attitudes pertaining to exercise prescriptions which demonstrated a high level of internal consistency (Smock & Chatfield, 2020). The modified questionnaire was reviewed by three experienced dermatology and internal medicine providers who gave suggestions to increase the content validity of the modified survey (see Appendix E). The questionnaire contained forty-six questions assessing providers’ perceptions of the following topics related to sunscreen prescriptions: efficacy, education, documentation, prescription practices, promotion, barriers and facilitation.

The questionnaire was sent to providers in dermatology, internal medicine, and family medicine. The survey was distributed through the Dermatology Nurses’ Association (DNA) and Society of Dermatology of Nurse Practitioners (SDNP). A convenience sample combined with snowballing technique was also utilized. Data was collected between March 2021 and June 2021. Quantitative data was evaluated using descriptive statistics via SPSS version 26. Descriptive statistics were employed to calculate the mean, standard deviation, minimum and maximum of Likert and one-to-ten scale questions. Further analysis using Independent-Samples T Test and One-Way ANOVA was used to assess for significant differences of means in participant responses when grouped by specialty and years of practice. Differenc

Executive Summary: Increasing Autism Spectrum Disorder Screening and Referrals in a Pediatric Clinic

Amber Barney, RN, MSN, MBA, APRN, CPNP

School of Nursing, Purdue University

Chair: Azza H. Ahmed, DNS, RN, IBCLC, CPNP

Committee Member: Karen J. Foli, MSN, PhD, RN, FAAN

Committee Member: Rose Mason, Ph.D., BCBA-D

Problem Statement and Significance

According to the Centers for Disease Control and Prevention (CDC) (2019), developmental delays occur in approximately 5% to 15% of all children. Without the use of standardized screening tools, 70% of those with developmental delays are not properly diagnosed. This also postpones intervention and treatments for those patients with developmental concerns (Agarwal et al., 2020). There has been a marked increase over the last ten years of patients with developmental delays given a concurrent diagnosis on the autism spectrum.  According to the most recent estimates, 1 out of 59 children has a diagnosis of autism spectrum disorder (ASD) (CDC, 2019). 

The earlier the ASD diagnosis can be made, the earlier intervention, therapies, and support can be provided for the child. The development of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (MCHAT-R/F; Robins, et al., 2014) has shown to be statistically reliable in helping to diagnose children as young as 18-months of age with ASD. The utilization of the MCHAT-R/F screening tool has allowed for diagnosis to occur two years ahead of the national median diagnostic age for ASD, which has provided the opportunity for earlier intervention and support for these patients and their families (Robins et al., 2014). An additional screening tool, the Ages and Stages Questionnaire (ASQ 3; Agarwal, et al., 2020) is also encouraged at 18- and 24-months in conjunction with the MCHAT-R/F to further assess the presence of developmental delay and behavioral concerns. 

The screening process can be considered logistically cumbersome. The MCHAT-R/F and ASQ 3 assessments have multiple, detailed developmental questions for the parents to answer about their child’s current abilities and behaviors. There are also open-ended questions regarding family history and any other concerns the parents may have about their growing child’s development and behaviors (Yuen et al., 2018).  The parents are typically given these tools to complete while waiting for the healthcare provider (i.e., physician or nurse practitioner) to come into the room for their well-child exam. The task of concentrating on these questions and responding, all while caring for a toddler often prove difficult, with the parent frequently leaving the tool unfinished when the healthcare provider enters the room for the examination (Fenikile et al., 2015). Optimally, the MCHAT-R/F and ASQ 3 data would be available during the visit with the healthcare provider so that scoring can be completed and areas of concern addressed with the parent during the visit. According to a study by Salisbury et al. (2017), when the tools are completed prior to the examination, education and dialogue can occur in real time with the healthcare provider and the parent.

Therefore, the primary purpose of this project was to improve the current MCHAT-R/F and ASQ 3 screening process; to facilitate early screening of children for autism and developmental delays at 18-months and 24-months at their well-child exams; and to support necessary referrals for those children who score as borderline on developmental milestones or score as high risk for autism on the MCHAT-R/F and/or ASQ 3 screening.

Methodology

Executive Summary: Introduction of a Conversation Starter Tool to Improve Health Habits in Young Children

Obesity rates in adults and children in the United States (US) continue to climb (Center for Disease Control and Prevention [CDC], 2021a; CDC, 2021c). Overweight in children is defined as a body mass index (BMI) at or above the 85th percentile, while BMI at or above the 95th percentile is considered obese (CDC, 2018). Currently, one in three children in the US is considered overweight or obese (American Academy of Pediatrics [AAP], 2020b). Children with obesity are more likely to suffer from hypertension, hyperlipidemia, insulin resistance, type 2 diabetes, asthma, sleep apnea, joint pain, fatty liver disease, cholelithiasis, gastro-esophageal reflux, orthopedic problems, and psychiatric disorders (Barlow, 2007; CDC, 2021b). Implementing individual and familial measures during early childhood development is essential, as treatment of obesity tends to become more difficult as the patient matures (Gortmaker et al., 2015; Wang et al., 2012). Unfortunately, many parents underestimate their child’s weight status, which may affect a parent’s motivation regarding changes that can be made in the home (Baughcum et al., 2000; Hackie & Bowles, 2007; Hernandez et al., 2017; Hidalgo-Mendez et al., 2019; Lydecker & Grilo, 2016; Mejia De Grubb et al., 2017; Pasch et al., 2016).

Problem Statement and Significance

A review of relevant literature reveals a significant public health issue, recommendations for treatment, and gaps in identifying effective, generalizable implementation strategies at the primary care level. The AAP has described the role of providers in the prevention and treatment of childhood obesity, citing the importance of becoming familiar with behavior modification techniques and general promotion of parenting interventions (Daniels & Hassink, 2015). For this study, a conversation starter tool was designed to assist providers in identifying health habits

How the use of technology to increase vaccination rates has the potential to beneficially impact our entire population through decreased risk of HPV infection and related cancers, increased quality of life, and reduced financial burden

Problem Statement

Human papillomavirus (HPV) is a virus that is spread through skin-to-skin contact. Certain strains of the virus, most of which are spread via sexual contact, are associated with cancers of the genitals, reproductive organs, and mouth/throat. It is estimated that as many as 4 out of every 10 cases of HPV-related cancers occur in males (CDC, 2020). However, males are significantly less vaccinated against HPV than their female counterparts. Reference?

Significance

HPV infection has been shown to cause genital warts, anal, penile, and oropharyngeal cancers in males. According to the U.S. Cancer Statistics Data Brief, 19,925 new HPV-related cases of cancer in males are reported annually; oropharyngeal cancers account for the majority of these, with 60,000 men affected annually worldwide (CDC, 2020; HPV and Cancer, 2021). Treatment for these cancers can require chemotherapy, radiation therapy, immunotherapy, and surgery. The United States spends approximately $1 billion dollars annually on treating HPV-related cancers in both men and women (Parton et al., 2018).

An effective prevention strategy against HPV and HPV-related cancers is the HPV vaccin

Best Shot: The Use of Motivational Interviewing to Decrease Vaccine Hesitancy in Parents of Children 0-12 months of Age

Best Shot: The Use of Motivational Interviewing to Decrease Vaccine Hesitancy in Parents of Children 0-12 months of Age

Kristin Jamison

Purdue University

NUR 689: DNP Project II

Dr. Azza Ahmed DNSc, RN, IBCLC, CPNP; Deborah A. Spoerner, DNP, MSN, APRN, CPNP; Daniel Kinney, MD, MS, FAAP

Problem Statement and Significance

The use of vaccines, which prevent up to 3 million deaths worldwide each year, have been identified as an economic solution for disease prevention (World Health Organization [WHO], 2019). Despite the well documented benefits of vaccines along with the historic eradication of preventable diseases such as the measles in the United States (US), the number of parents who choose not to vaccinate their children is increasing (Dubé et al., 2021). An analysis of national vaccine status data identified that over 40% of all children 19-35 months old in the US are not up to date on their vaccines and of those being vaccinated over 30% are utilizing an alternative or unknown schedule (Hargreaves et al., 2020). The term used to describe this decrease in vaccine confidence and acceptance is vaccine hesitancy (VH). The World Health Organization (WHO) Immunization Practices Advisory Committee (IPAC) defines VH as a fluid state that involves the refusal of or deviation from the recommended vaccine schedule despite vaccine access (Immunization Practices Advisory Committee [IPAC], 2019).

In 2019, WHO identified vaccine hesitancy as one of the top ten threats to global health (WHO, 2019). In the US each year, adherence of children to the standard seven vaccine series schedule precludes 14 million illnesses, prevents 33,000 deaths, and decreases direct costs of health care by nearly $10 billion (Office of Disease Prevention and Health Promotion [ODPHP], 2020). Understanding vaccine hesitancy and addressing parental apprehensions is imperative for clinicians to improve vaccination coverage. 

One tool that may assist practitioners in addressing vaccine hesitancy among parents is the incorporation of motivational interviewing. Motivational interviewing (MI) is a communication tool that uses a guiding approach for “eliciting from patients their own good motivations for making behavior changes in the interest of their health (Rollnick et al., 2008, p. 6) Motivational interviewing allows the provider to work in partnership with the parent by eliciting and affirming vaccine concerns while guiding the individual towards a desire for change and vaccine compliance (Rosengren, 2018).  Although some benefits of MI have been identified, additional research is essential to determine the impact of using MI in an outpatient clinic (Lemaitre et al., 2019; Limaye et al, 2021; Mical et al., 2021).

The purpose of this study was to determine if the use of motivational interviewing by pediatric providers during routine well child appointments, when compared to standard of care, increase vaccine rates in children 0-12 months of age? In addition, provider comfort talking to parents about vaccines, provider comfort using MI, provider confidence in the use of MI to decrease vaccine hesitancy, and caregiver vaccine hesitancy were also explored in this study.

Methodology

Design

Upon Institutional Review Board (IRB) approval from Purdue University and Beacon Health, a quasi-experimental study was conducted on a convenience sample of caregivers presenting with children for a 0-12 month well child check (WCC) from June 1, 2021, to August 31, 2021. A data-sharing agreement was completed between the researchers, the medical group, and the overseeing university. Retrospective data was obtained for both intervention and control providers in the corresponding months of 2019 and 2020 and repeated during the intervention period in 2021. Providers were recruited through an email with an attached provider flyer. Caregivers were recruited using informational cards in both English and Spanish that were displayed at all participating practices. Intervention providers received training on MI in May prior to the study onset. During the well child visit the Parent Attitudes about Childhood Vaccines (PACV) survey was completed, and the MI intervention was implemented. 

Settings & Participants

The setting included three urban clinics in a midwestern county. Both family practice and pediatric providers participated in the study. All clinics accepted both private insurances and Medicaid. A range of clinics was used to increase the generalizability of findings. Caregivers of children who we

Problem Statement Despite the availability of a vaccine as well as its proven efficacy in cancer prevention, many parents and adolescents are hesitant to get the human papillomavirus vaccination leading to low HPV vaccination rates around the country.

DNP Executive Summary Emily Fusiek Purdue University School of Nursing Problem Statement Despite the availability of a vaccine as well as its proven efficacy in cancer prevention, many parents and adolescents are hesitant to get the human papillomavirus vaccination leading to low HPV vaccination rates around the country. Significance Human papillomavirus (HPV) are pathogens that can cause cancers of the cervix, vulva, vagina, anus, penis, mouth and throat as well as genital warts. The American Cancer Society (2019) estimates that 13,800 new cases of cervical cancer will be diagnosed and around 4,290 women will die from cervical cancer in the United States in 2020. In the most recent study published by the National Cancer Institute in 2015, 91% of cervical cancers were caused by HPV (Sariya et al, 2015). This would mean that approximately 12,558 newly diagnosed cases and 3,904 deaths in the United States 2020 will be due to the human papillomavirus

Doctor of Nursing Practice Inquiry Project Report Executive Summary Impact of Surgery Department Mass Casualty Mini Drills on Improvement of Staff Knowledge in a Level 2 Trauma Center: A Pilot Study

Problem Statement and Significance The United States (US) is witnessing an epidemic in mass casualty incidents (MCIs) with mass shootings being the most common (Melmer, et al., 2019). An MCI is an event where the number, severity, and type of casualties require resources beyond what is available (Lowes & Cosgrove, 2016). Almost a third (31%) of the world’s mass shootings have occurred in the US where there has been a mass shooting nearly every 12.5 days (Meindl & Ivy, 2017). With the rise in MCIs in the US, it is imperative that acute care hospitals and trauma centers be prepared for immediate MCI patient management. Many US hospitals are operating at full capacity which complicates the ability to surge patients from an MCI which is further complicated by the recent pandemic, COVID-19. A mass incident may happen quickly and patients from an MCI may arrive at the hospital with no prior notice. A surge of injured patients requires knowledgeable staff, appropriate supplies, a structured plan, and a systematic response to respond efficiently and effectively. Many hospitals across the US feel that they are not prepared for no-notice MCIs (Hollister, 2019)

Examining Knowledge and Knowledge Retention in Nurse Practitioners after the Implementation of an Online Educational Module on Obstructive Sleep Apnea

Significance and Problem Statement Obstructive Sleep Apnea (OSA) is a highly prevalent, under-recognized, and critical health concern characterized by repeated episodes of upper airway obstruction during sleep, causing intermittent hypoxemia and sleep fragmentation (Bonsignore, 2017; Chung et al., 2016; Ononye et al., 2019). It is estimated that about 15-30% of males and 15% of females between the ages of 30 to 69 have moderate to severe OSA in the United States, with 936 million individuals suffering from OSA worldwide (Kline, 2022; Wickwire, 2021). The prevalence of OSA is high and continues to rise due to the epidemic problem of obesity, which is the major predisposing risk factor of OSA (Morsy et al., 2019). When OSA is not recognized or left untreated, it can lead to several life-threatening comorbidities such as cardiovascular disease, hypertension, stroke, metabolic disorders (i.e., diabetes), cardiac arrhythmias, myocardial infarction, and depression, which can ultimately lead to death (American Academy of Sleep Medicine, 2016; Ononye et al., 2019; Osman et al., 2018; Rebelo-Marques et al., 2018; Semelka et al., 2016;

Doctor of Nursing Practice Inquiry Project Executive Summary Screening of Postpartum Depression and Stress among Mothers of Infants in a Pediatric Cardiovascular Intensive Care Unit: A Pilot Study

Problem Statement and Significance

Postpartum depression (PPD) is defined as depression after having a baby (CDC, 2020). According to a meta-analysis by Shorey et al. (2018), the prevalence of PPD among mothers with no previous history of depression to infants without congenital anomalies is 12%. PPD screening is recommended by the American Academy of Pediatrics (AAP) at 1-, 2-, 4-, and 6-month well-child visits (Earls et al., 2019). Mothers of hospitalized, critically ill infants may never see these routine well-child visits. Therefore, this is a missed opportunity to screen and refer mothers for postpartum depression within the hospital. 

            It is estimated that 11 to 18 percent of childbearing women suffer from PPD symptoms (AAP, 2019). The incidence increases up to 40 percent for mothers of children in the neonatal intensive care unit (NICU) (Vaughn & Hooper, 2020). Currently, PPD screening within a NICU is not considered the standard of care (Mounts, 2009; Hollen, 2018). According to Hynan et al. (2013), routine screening should be done in the NICU due to the potential trauma of having an infant hospitalized in the NICU.  PPD can have long-term consequences and affect the child, mother, and family’s health, finances, cognitive and social well-being (Earls et al., 2019). Recent research by the National Institutes of Health (2020) suggests that postpartum depression may persist up to 3 years after birth. The cost of maternal health care is 90% higher for those with PPD due to the use of mental health services and emergency room visits by both mother and child (Dagher et al., 2012). According to a meta-analysis by Slomian et al. (2017), PPD has negative consequences for the mother and the child until age three. Some of the negative effects include lack of mother-to-infant bonding, discontinuation of breastfeeding, increased infant health concerns, and decreased infant motor, language, social and emotional development (Slomian et al., 2017).  Research also indicates that 42% of children of mothers with PPD during the early postpartum period were evaluated as depressed themselves by the age of 16 (Murray et al., 2011, as cited in Hynan et al., 2020).

Mothers of neonates admitted to a NICU are a population at increased risk for PPD and stress. Mothers of fetuses with confirmed anomalies for which they will be hospitalized after birth are at increased risk for postpartum distress (Cole et al., 2018). In a study done by Solberg et al., 2011 severe congenital heart defects were a predictor of heightened symptoms of PPD. Parental stress due to their child’s admission to an intensive care unit (ICU) is expected; however, assessment of parental psychological status during ICU admission is limited. Still, screening, support, and referral may help minimize the traumatic reactions of parents and the possible adverse effects of those outcomes on children (Hynan et al.,2013). According to Miles et al. (1993), a NICU environment may be a significant factor that contributes to parent’s distress and can potentially affect parenting behaviors. This project aimed to develop a PPD screening program within the cardiovascular intensive care unit (CVICU). The main objectives of this project were to assess the utility, feasibility, and effectiveness of a PPD screening program in a busy CVICU.

Methodology

Design

This study was a pilot project to establish the utility and feasibility of a PPD screening program for mothers whose infants are admitted to a cardiac intensive care unit for a prolonged (>1 week) hospital stay.  This cross-sectional observational research study used survey methodology combined with descriptive data. 

The following variables were collected for each participant: 

Age, race, socioeconomic status, previous history of depression, the first eligible screening date for Edinburg Postnatal Depression Scale (EPDS) and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU), PSS: NICU scores, whether or not a recommendation for an obstetrician and gynecologist (OBGYN) was indicated, recommendation information given based on EPDS score PPD screening score, whether or not participant acted on the recommendation information provided by the research team (documentation of appointment made). In addition, if participants failed to obtain an appointment as indicated, barriers to scheduling this appointment were assessed. Furthermore, the following infant-related variables were collected: severity of the cardiac diagnosis and need for ECMO during current hospitalization. 

Setting and Population

Following institutional board review (IRB) approval from Purdue University and Indiana University, this study was conducted in

Care of the Obstetric Patient in the Intensive Care Unit: A Quality Improvement Study Executive Summary Problem Statement and Significance

Care of the Obstetric Patient in the Intensive Care Unit: A Quality Improvement Study Executive Summary

Problem Statement and Significance

Maternal mortality, as defined by the World Health Organization (2020), is the death of a woman while pregnant or within 42 days of being pregnant, from any cause related to or aggravated by the pregnancy or its management, though not due to accidental or incidental causes. Though considered preventable in as many as sixty-three percent of cases, the United States has seen a steady rise in its maternal mortality rate from 7.2 deaths per 100,000 live births in 1987 to 17.4 deaths per 100,000 live births in 2018 (CDC Foundation, 2018; Centers for Disease Control and Prevention, 2020; Hoyert & Minino, 2018). On average, women in the United States, at the time of their first live birth, are older than they have ever been, with the mean age of women rising 1.4 years, from 24.9 years of age in 2000 to 26.3 years of age in 2014 (Mathew & Hamilton, 2016). Women are also larger than they have ever been. In the forty-eight states who adopted the revised U.S. Standard Certificate of Live Birth, the District of Columbia, and New York City, the prevalence of women with a pre-pregnancy body mass index (BMI) categorized as overweight has increased by two percent while the prevalence of women with a pre-pregnancy BMI categorized as obese has increased by eight percent from 2011 to 2015 (Centers for Disease Control and Prevention, 2018a). Finally, obstetric patients are more chronically ill than they have ever been. There has been a rise in gestational diabetes rates from 5.2% in 2012 to 5.6% in 2016 and in cases of both chronic and pregnancy induced hypertension: from 6.1 cases in 10,000 hospital deliveries in 1993 to 166.9 cases in 10,000 hospital deliveries in 2014 and 528.9 cases in 10,000 hospital deliveries in 1993 to 912.4 in 10,000 hospital deliveries in 2014, respectively (Centers for Disease Control and Prevention, 2018b and 2019). All of this contributes to a rise in the risk for a variety of maternal and fetal complications, up to and including death.

When an obstetrics patient experiences complications and faces an increased threat of morbidity and mortality, she is often admitted or transferred to an intensive care unit (ICU); with the goals of placing her in a scenario where nursing staff are

Leadership & Organization Development Journal Article information:),"A review of servant leadership attributes: developing a practical model", Leadership

Abstract

This case study used the variables of both Patterson's and Winston's models of servant leadership and examined the attitudes of employees at Heritage Bible College toward their leader to determine if the leader was a servant leader and if the variables of the two models helped explain the process by which leaders and followers serve each other in the organization. Thirteen employees and the leader provided data triangulated by three methods of data collection: the researcher's observations over a two-year period, the data from the Servant-Shepherd Leadership Indicator, and responses to ten in-depth interview questions. This case study supports the use of Patterson's and Winston's models of servant leadership, or at least confirms the specific variables examined by the interview question/topics: trust, empowerment, vision, altruism, intrinsic motivation, commitment, and service.

Promoting Leadership Effectiveness in Organizations: A Case Study on the Involved Factors of Servant Leadership

Abstract

The world is crying out for ethical and effective leadership that serves others, invests in their development and fulfills a shared vision. Among the many leadership styles (i.e., authoritarian, benevolent dictatorship, participatory, etc.) the one that best represents the ideals embodied in the human factor is servant-leadership. Servant-leadership incorporates the ideals of empowerment, total quality, team building, and participatory management, and the service ethic into a leadership philosophy. This model of leadership emphasizes increased service to others; a holistic approach to work; promoting a sense of community; and the sharing of power in decision making. Servant-leaders must be value-and character-driven people who are performance and process oriented. The aim of this paper is determining the drivers of servant leadership in order to put servanthood behaviors activities into practice among leaders. So at first we developed literature on servant leadership. Then Thirty-three measurement items were developed on the basis of opinions from leaders and the literature. Then Data collection occurred via a questionnaire. To validate the measurement scales for servant leadership, we performed a factor analysis. The results show that a six-factor measurement model (including emotional dimension, commitment to community, egalitarianism, altruism, managerial skills and human skills) fits the data acceptably. All of the measurement items significantly loaded on the constructs on which they were hypothesized to load. These results gave us confidence that the measures are indeed valid and reliable.

Implementing a New Screening Tool in the Clinic and Improving Documentation of Critical Lab Values

Implementing a New Screening Tool in the Clinic and Improving Documentation of Critical Lab Values

To enhance patient care and safety, our clinic is implementing a new evidence-based screening tool designed to identify high-risk conditions early, ensuring timely intervention. The process begins with selecting a validated screening instrument that aligns with our patient population’s needs, such as a depression screening tool (e.g., PHQ-9) or a chronic disease risk assessment. Staff training is essential to ensure proper administration and interpretation of the tool, which will be integrated into our electronic health record (EHR) system for seamless documentation. Standardized workflows will be established, including automatic prompts during patient intake and clear protocols for follow-up on positive screens. Regular audits will track screening rates and intervention outcomes, allowing for adjustments to maximize effectiveness.

Simultaneously, we are improving the documentation and communication of critical lab values to reduce delays in treatment. A structured process will be implemented, including real-time EHR alerts for abnormal results, standardized reporting templates, and mandatory acknowledgment fields to confirm provider review. Critical values will be flagged with color-coded urgency levels, and a secondary verification system—such as nurse or pharmacist oversight—will ensure no results are missed. Staff will receive training on the new documentation protocols, emphasizing the importance of timely follow-up. Compliance will be monitored through EHR tracking and periodic chart reviews, with feedback provided to teams to reinforce adherence. By streamlining these processes, we aim to enhance patient safety, reduce diagnostic delays, and ensure consistent, high-quality care

Creating and implementing new protocols, implementing clinical practice guidelines Quality improvement involves improving patient care through identifying patient care problems and implementing a plan for improvement.

describe in paragraphs Creating and implementing new protocols, implementing clinical practice guidelines Quality improvement involves improving patient care through identifying patient care problems and implementing a plan for improvement.

Edit

Creating and Implementing New Protocols and Clinical Practice Guidelines

Quality improvement in healthcare is a systematic approach to enhancing patient care by identifying gaps in current practices and implementing evidence-based solutions. The process begins with a thorough assessment of existing workflows, patient outcomes, and adherence to established standards. By analyzing data from electronic health records (EHRs), incident reports, and patient feedback, healthcare teams can pinpoint areas where care may be inconsistent, inefficient, or below national benchmarks. Engaging multidisciplinary stakeholders—including physicians, nurses, administrators, and even patients—ensures that the identified issues are well-understood and that proposed solutions are practical and feasible.

Once care gaps are identified, the next step involves selecting or developing evidence-based clinical practice guidelines (CPGs) that align with best practices. These guidelines should be sourced from reputable organizations such as the CDC, NIH, or specialty medical associations. However, simply adopting national guidelines is not enough; they must be tailored to fit the specific needs, resources, and workflows of the local healthcare setting. For example, a rural clinic may need modified protocols compared to a large urban hospital due to differences in staffing, technology, and patient demographics.

Implementation requires a structured plan that includes staff education, workflow integration, and continuous monitoring. Training sessions, simulations, and just-in-time learning tools (such as quick-reference guides or embedded EHR prompts) help ensure that all team members understand and follow the new protocols. Pilot testing in a single department or unit allows for real-world adjustments before full-scale rollout. Additionally, integrating CPGs into electronic health records—through standardized order sets, clinical decision support alerts, and automated documentation—helps reinforce adherence.

To sustain improvements, ongoing monitoring and feedback are essential. Key performance indicators (KPIs), such as compliance rates, patient outcomes, and process efficiency, should be tracked regularly. Plan-Do-Study-Act (PDSA) cycles can be used to refine protocols based on real-time data and staff input. Celebrating successes and addressing barriers—such as resistance to change or resource limitations—fosters a culture of continuous improvement. Ultimately, the goal is to create a dynamic system where evidence-based care becomes the standard, leading to better patient outcomes, reduced variability in practice, and a more efficient healthcare delivery model.

Theoretical Model What theory will help accomplish your overall project goal? Lewin's change theory would be appropriate for both example interventions. Unfreezing-change-refreezing of the current process for the addition of the new screening protocol

Theoretical Model What theory will help accomplish your overall project goal? Lewin's change theory would be appropriate for both example interventions. Unfreezing-change-refreezing of the current process for the addition of the new screening protocol. Answer: Lewin’s Change Theory is a systematic process of bringing change through processes of Unfreeze, Change, and Refreeze (Burnes, 2021). The process of unfreezing involves creating awareness of nurse burnout and the need for immediate intervention. This is done by informing employees of how burnout is affecting them, securing top management’s buy-in, and creating a sense of urgency to change. The Change stage is where supportive measures and well-being programs that have the aim of reducing job dissatisfaction and stress are executed. Mindfulness training, peer support groups, and flexible scheduling will be implemented to help nurses cope with job challenges. Ongoing feedback, along with adaptations, will ensure that interventions address the challenge of burnout. In the final stage, Refreeze, the success of these interventions will be evaluated, effective measures will be integrated into hospital practice, and progress will be evaluated through frequent checks using measures like the Maslach Burnout Inventory (MBI), allowing gaps to be addressed. By integrating these wellbeing programs into hospital culture, sustainability on a long-term scale and sustained improvement to nurses' well-being can be promote

Exploring the Effects of Mindfulness Meditation on Stress and Burnout Among Teachers

Stress and burnout among teachers are significant problems that can affect teacher well-being and student outcomes. Mindfulness meditation is a promising intervention that has been shown to reduce stress and burnout in various populations. However, research on the effects of mindfulness meditation among teachers is limited. The aim of this research is to evaluate the effects of an 8-week mindfulness meditation program on stress and burnout among a sample of 50 teachers from a public school district in the United States.

Literature Review: Challenges Facing EFL Teachers in Mixed-Ability Classes and Strategies

 Furthermore, the lack of training in the skills and methodologies to deal with MACs (Butterworth, 2010;Kantor, 2011;Xanthou & Pavlou, 2010) and the lack of MAC teaching strategies (Morris, 2008) are some of the challenges teachers faced. Besides, the inability to adapt materials/tasks (Loiacono & Allen, 2008;Perera, 2010) to accommodate the different ability levels of students (Mathews, Aydinli & Horne, 2006;Morris, 2008) and failure to address advanced or struggling students (Al-Shammakhi & Al-Humaidi, 2015) are also worth mentioning challenging. When teachers fail to teach and address all levels of students, they teach to the average ignoring the advanced and struggling groups (Al-Shammakhi & Al-Humaidi, 2015;Reed, 2004). ...

... Besides, the inability to adapt materials/tasks (Loiacono & Allen, 2008;Perera, 2010) to accommodate the different ability levels of students (Mathews, Aydinli & Horne, 2006;Morris, 2008) and failure to address advanced or struggling students (Al-Shammakhi & Al-Humaidi, 2015) are also worth mentioning challenging. When teachers fail to teach and address all levels of students, they teach to the average ignoring the advanced and struggling groups (Al-Shammakhi & Al-Humaidi, 2015;Reed, 2004). Teaching to the middle level disappoints struggling students and influences them to fall farther behind, while the advanced students remain unchallenged, and lose motivation to learn (Reed, 2004). .

Briefly summarize the study you found, and then include the citations for both the mass media and the peer-reviewed articles.

Briefly summarize the study you found, and then include the citations for both the mass media and the peer-reviewed articles.

The study by Yang et al. (2024) is a population based matched cohort study looking at the long-term cardiovascular disease (CVD) outcomes in non hospitalized Medicare beneficiaries with COVID 19. In utilizing Medicare claims data, the researchers compared people with a prior COVID 19 diagnosis with a matched control group with no COVID 19 and the risk of major cardiovascular events like heart attack, stroke, and cardiovascular related mortality over a multi year follow up period. The study found that People with a history of COVID-19 had a significantly increased risk of long-term CVD complications, and the risk was persistently high even when preexisting conditions and other potential confounders were accounted for. These findings further support the long term cardiovascular risks of COVID-19 and the importance of surveillance and preventive measures in affected persons.

Summary of the Chosen Economic Issue and Its Impact NHS FPX 6008 Assessment 2 Needs Analysis for Change

Nurses strive to provide care that promote outcomes such as safety, quality, and efficiency in their practice. Often, they translate evidence-based interventions into practice with the aim of aligning care interventions with the needs and expectations of their patients. However, organizational issues such as shortage of nurses threaten the realization of these outcomes. Therefore, this paper builds on the previous projects by examining further the issue of nursing shortage and the need for addressing it in healthcare.

NURS FPX 4040 Assessment 4 Data Review Project Report and Presentation Value Proposition/Contribution to My Professional Interests/Goals The project will help develop my data analysis skills for quality improvement in various care settings. Background: Review of the Literature

Value Proposition/Contribution to My Professional Interests/Goals

The project will help develop my data analysis skills for quality improvement in various care settings.

Background: Review of the Literature

DNP 815 Case Report: Application of Theory to Organizational Mission, Vision, and the Christian Worldview

Organization’s Mission and Vision to Theory and Model

Organizational mission and vision are essential for any organization as they indicate and explain why an organization exists and what the organization aspires to achieve, both in the current terms and in the future. Grand Canyon Univerity has mission and vision statements that are rooted in Christianity and have biblical connections. Therefore, this section explores the mission and vision of Grand Canyon University.

DNP 815 Case Report: Application of Theory to Organizational Mission, Vision, and the Christian Worldview

Nursing clinical practice, like many other fields, has experienced various challenges in the past and in recent times, which has seen a rise in calls for better strategies to mitigate the challenges. Among the challenges are improving patient outcomes and ensuring that patients are safe in the care environment. One of the chronic conditions that have attracted a lot of attention is diabetes. The condition affects millions of people worldwide, leading to a continued need for better interventions (Hildebrand et al., 2020). Central to such interventions is the use of nursing theories that can be connected to a particular organization’s mission and vision and the Christian worldviews. Therefore, this paper aims to explore the application of theory to the organizational vision, mission, and Christian worldviews. The next section introduces the purpose of the Project.

Purpose of the Project

High Infant and Maternal Mortality Rate in Sierra Leone With a Focus on King Harman Road Satellite Hospital

1. Introduction

1.1 Background

The maternal mortality rate mainly occurs due to complications during pregnancy, delivery and post-partum. Along with these, other factors such as poor and inadequate health service access for mothers also result in a high mortality rate—similarly, lack of facility for neonatal care results in the death of infants. In Sierra Leone, the maternal mortality rate is very high, as according to statistics, with every 10,000 childbirths, approximately 1,360 mother’s die. Globally, the mortality rate of neonates, children and infants under the age group of five is the highest in Sierra Leone as per 1,000 lives, 111 children die (Unicef, 2016). King Harman Road satellite hospital is a government-run hospital that would be required to develop its maternity ward and deploy efficient healthcare workers for reducing the infant and maternal mortality rate in Sierra Leone.

Information Communication Technology and the Marketing of the Hospitality Sector

The study aims to critically evaluate the marketing of the hospitality sector impacted by ICT. The study has found that ICT supports hospitality organisations in providing effective customer service by applying CRM technology. Organisations like Travelodge, IHG has successfully applied ICT-enabled CRM system for providing better facilities to customers. ICT enables organisations to provide Integrated Marketing Communication (IMC) for developing effective interaction with customers. The study has found out that digital marketing strategy can effectively be developed by organisations like Travelodge, Premier Inn and GLH hotel due to the development of ICT. However, ICT has a threat of security issues such as malware attacks. ICT has increased the expectation of customers from the hospitality industry and motivates organisations to invest more in technology rather than employees.

1. Introduction

Information Communication Technology (ICT) refers to the infrastructure that supports modern computing systems. ICT includes networking components, devices, systems, and applications that permit organisations and people to develop interaction in the digital world. ICT supports the hospitality sector in enhancing communication with customers, the guest service system, and the reservation system. The study aims to critically analyse the impact of ICT on the marketing of the hospitality sector considering customer relationship management, Integrated Marketing Communication and digital marketing strategy. The study will analyse the impact with respect to the examples from the hospitality industry.

2. Impact of ICT on the marketing of hospitality sector

2.1 Customer Relationship Management

ICT enabled customer relationship management support organisations of the hospitality sector to develop better communication with target customers. CRM support hospitality organisations to track room occupancy and food inventory effectively. ICT enables organisations in the hospitality industry to use CRM software for quickly identifying information related to customers (Sota et al., 2020). It also helps organisations develop personal interaction with customers by responding to their queries on time and meeting their requirements which is beneficial for customer retention and allows the hospitality industry to enhance the customer conversion rate as CRM software enables customers to interact with the organisations for their queries and feedbacks. It has been identified that 77% people see at least 6 to 12 reviews before booking a hotel (Sharifi, 2019).

An Investigation Into Blockchain and Its Application to Internet of Vehicles

Background

Main components of internet of vehicles

Intelligent autonomous vehicles have onboard computer technology, which is known as Blockchain technology. It is very advantageous because of the shorter reaction time, precise control and better sensors [3]. The main components on the internet of vehicles to avail these facilities are vehicle, personal device, a sensing device, network infrastructure, roadside device and, skilled person.

Communication between components

Pain Management Strategies for Acute Patients: Effective Approaches and Techniques

Acute Patient Assessment

Emergency Departments are dynamic healthcare settings in which time and effectiveness pose significant challenges to the delivery of the necessary level of care. Unlike other hospital wards, where nurses will have more opportunities to efficiently conduct patient assessments, acute settings require appropriate time management skills in addition to assessing and observing patients according to the established rules of practice.

In the current assignment, the role of a nurse in conducting the assessments of acutely ill patients admitted to Emergency Departments will be analysed. This goal can be achieved through following several steps. First, it is essential to provide a description of professional nursing experience regarding the care for a specific patient at a certain time in practice. Second, the undertaken evaluations will be discussed in relation to the appropriate physiology measures, and the break-down of the performed ABCDE assessment will be presented. Lastly, the management of the chosen patient by the nurse will be critically discussed to find positive and negative aspects of the efficiency and the quality of administered care.

Nursing Experience: An Appendicitis Patient

Giger and Davidhizar Transcultural Assessment Model: Application

Giger and Davidhizar Transcultural Assessment Model: Introduction

Karabudak, Tas, and Basbakkal (2013) argue that “the Transcultural Assessment Model of Giger and Davidzar is a powerful tool that can help health professionals assess the cultural values of patients about disease behaviors and their implications” (p. 343). The model was developed by Joyce Newman Giger and Ruth Elaine Davidhizar in 1988 (Eggenberger, Grassley, & Restrepo, 2006).

The purpose of the model was to ensure more practitioners provided culturally-competent care to patients from diverse backgrounds. The six major cultural phenomena outlined by the model include “space, environmental control, social organization, communication, time, and biological variations (Giger & Davidhizar, 2002, p. 186). These aspects have been widely used by health professionals to offer culturally-sensitive medical support to their clients.

Use of Nurse Burnout PICOT Question Frame: Qualitative Study

This qualitative descriptive study investigated nurses’ burnout at their places of work and the efficiency of stress strategies in reducing burnout impact. The study whose title is “Occupational stress and job satisfaction among nurses” was conducted by Gulavani and Shinde in 2014. It is closely linked to the study problem and the PICO question because it provides important information on the effectiveness of stress strategies compared to leaving the profession to mitigate stress level and give nurses work balance. Much information in the article discusses the cause of burnout and its effects on nurses. The study utilized an explorative re

A Conceptual Framework for Scheduling Constraint Management

A Sample Research Proposal with Comments A research project or thesis will take at least two semesters to complete. Prior to starting a research, i.e. enrolling in the first semester research course, students must go through the proposal stage, during which students will develop their proposal and have it reviewed by his/her research advisor. This means that students need months of planning and background research work before the start of the first semester research. Students are not allowed to enroll in a research course without an approved proposal. For students planning to start their research in the fall semester, the deadline for the proposal submission (to your advisor) is July 15. For those who plan to start in the spring semester, the proposal deadline is December 1. During the proposal stage, students should discuss their research interests with CM faculty members, identify a research topic, conduct preliminary literature review and develop a project proposal. The proposal should discuss problem statement, objectives, research methodology, research activities, and a time schedule in about 3-5 pages. A sample proposal is attached here for your reference. Sample proposal text Comment A Conceptual Framework for Scheduling Constraint Management Provide a brief and meaningful title to your project 1. Introduction Every construction project is unique and has its own operating environment and sets of technical requirements. As a result, the execution of a construction project is subject to numerous constraints that limit the commencement or progression of field operations, which invariably have significant negative impact on overall project performance. By definition, constraints refer to any condition, such as temporal/spatial limitations and safety/quality concerns, which may prevent a project to achieve its goals. Successful execution and control of a construction project relies on effective identification and management of constraints through master planning and short-term look-ahead scheduling. While the master schedule provides a global view of a project and the overall execution strategy, a look-ahead schedule offers a detail account of operational constraints and a detailed plan showing work to be done within a relatively short time window. Ideally, these detailed schedules should reflect actual field conditions and provide field personnel with operation instructions free of constraints and conflicts (Hinze 2008). This look-ahead scheduling and constraint analysis procedure is also a critical component of the last-planner methodology proposed by Ballard (2000). This research project will provide an overview of state-of-art schedule constraint analysis practice during look-ahead scheduling. In addition, it will propose a conceptual framework for managing constraints. Background or introduction section provides a description of the basic facts and importance of the research area - What is your research area, the motivation of research, and how important is it for the industry practice/knowledge advancement? 2. Problem Statement The importance of developing a constraint-free and reliable work plan has long been recognized by the industry. However, numerous construction projects are still plagued by delays and cost overruns, which can frequently be traced to ineffective identification and treatment of constraints. First, when a constraint is not properly identified during scheduling, subsequent conflicts in the field are inevitable. Today’s projects are becoming more and more technically complex and logistically challenging, which exposes construction operations to even more complex constraints. Second, the traditional scheduling methods, bar charts and Critical Path Method (CPM) which are widely used as a basis for constraint analysis, greatly limit our capability in modeling and resolving constraints Problem statement provides a clear and concise description of the issues that need to be addressed - What is the specific problem in that research area that you will address (e.g. lack of understanding of a subject, low performance …)? during look-ahead scheduling. These methods have long been blamed for their limitations in modeling and communicating constraints, including inability to cope with non-time-related precedence constraints and difficulty to evaluate and communicate inter-dependencies at the field operation level (e.g. Sriprasert and Dawood 2002; Chua and Shen 2001). In summary, there is a need for a better understanding of constraints in construction and a structured approach in identifying and modeling constraints to ensure a constraint-free work plan. More specifically, the following research questions need to be addressed: 1. What are the typical constraints found in various construction projects? 2. How to classify these constrains for easier identification and modeling? 3. What are the current industry practice as well as research advancements in modeling and resolving

NURS-FPX 9100 Defining Nursing Doctoral Project ​​​​​​​Project Charter Table 1: Project Charter Information

NURS-FPX 9100 Defining Nursing Doctoral Project

Project Charter

Table 1: Project Charter Information

NURS-FPX 9902 Nursing Doctoral Project 2 Improvement Opportunities Related to Literature Synthesis

Prof. Name

Date

Reflection

Hello, I am… As I approach the culmination of this course, I take a moment to ponder the advancements in my doctoral project and the experiences garnered throughout the duration. Reflection serves as a potent instrument, enabling the assessment of achievements, confrontations with challenges, and identification of areas for enhancement. It fosters the refinement of critical thinking and problem-solving skills, offering profound insights into the trajectory of the project and personal growth as a researcher. This virtual check-in provides an opportunity to delve into these reflections, facilitating discussions on my progress, gaining clarity on the work, and devising strategies for sustained development.

Improvement Opportunities Related to Literature Synthesis

NURS FPX 9902 Assessment 3 Literature Synthesis identifying a patient-related problem at the project site and formulating a PICOT question for caregivers of chronic obstructive pulmonary disorder (COPD) patients.

Prof. Name

Date

Literature Synthesis

This evaluation provides in-depth insights into the doctoral student’s search strategy and methods used to locate literature for synthesis. Its primary objective is to facilitate the synthesis of literature discovered during the research process. The doctoral learner will comprehensively outline the process used to identify literature sources, elucidate the interrelations among these sources, and discern commonalities and differences in research questions, methodologies, and findings.

Search Strategy

The development of a literature search strategy is crucial for the success of a doctoral project. The references obtained offer evidence-based support to define patient problems and suggest improvements in quality. The literature search commenced after identifying a patient-related problem at the project site and formulating a PICOT question for caregivers of chronic obstructive pulmonary disorder (COPD) patients. The project site and Capella Institutional Review Board (IRB) approved this PICOT and quality improvement project.

Data Analysis Plan Understanding the Relationship Between Past and Present Performance RSCH-FPX 7864 Research Question: Is there a significant correlation between the total number of points earned in the class and the number of correct answers on the final exam?

Data Analysis Plan

Understanding the Relationship Between Past and Present Performance

The exploration of the association between past and present performance can provide valuable insights into the consistency and trajectory of student learning. A student’s previous grade point average (GPA) serves as a broad indicator of their academic history and capabilities, contributing to their success in a given course. In this analysis, four variables (Quiz 1, GPA, Final, and Total) are treated as continuous variables.

Total-Final Correlation:

Evidence based DNP project Title: Improving an Aromatherapy Program by Implementing an Evidence-based Clinical Guideline Using Empowered Holistic Nursing Education

Running head: IMPROVING AROMATHERAPY Improving an Aromatherapy Program by Implementing an Evidence-based Clinical Guideline Using Empowered Holistic Nursing Education

DNP Project Submitted in Partial Fulfillment Of the Requirements for the Degree of Doctor of Nursing Practice xxxxxx University xxxxx xxxxx June 2023 1 IMPROVING AROMATHERAPY Notice of Copyright Copyright All Rights Reserved 2 IMPROVING AROMATHERAPY Advisor Approval Page xxxxx UNIVERSITY xxxxxx This is to certify that I have examined this Doctor of Nursing Practice DNP project manuscript written by xxxxx and have found that it is complete and satisfactory in all respects, and that any and all revisions required by the final examining committee have been made. Graduate Programs Faculty

DNP project background review Title: Educating Clinicians about Potential risk of Metabolic Syndrome among Patients on antipsychotics

Metabolic Syndrome (MetS) is a combination of obesity (abdominal), elevated triglycerides, high blood pressure, hyperglycemia, and low high-density lipoprotein cholesterol (Penninx & Lange, 2018). MetS was coined to assist clinicians in identifying patients at risk for cardiovascular diseases (CVD) and Type 2 Diabetes Mellitus (T2DM). The author seeks to develop a quality improvement (QI) project using the Institute for Healthcare Improvement’s (IHI) Model for Improvement to assist mental health providers in detecting patients at-risk for MetS.

Clinical Background

 Psychiatric and mental health patients have a higher risk of premature death. The current epidemiology studies suggest that the life expectancy rate of seriously mentally ill (SMI) patients is seven to 20 years lower compared to the general population (Penninx & Lange, 2018). The low life expectancy rate among psychiatric patients is due to numerous factors of which physical comorbidities play a vital role. MetS makes up most of the medical comorbidities present among mental health patients, and it’s also 58% higher in SMI patients than in the general population (Penninx & Lange, 2018). Patients diagnosed with schizophrenia are more likely to die from cardiovascular disease than those in the general population (Gautam & Meena, 2011). Mental health patients suffer from comorbid medical conditions that often go untreated or overlooked by mental health providers (McBain, Lamotagne-Godwin, Haddad, Simpson, Chap, Jones & Mulligan, 2018). McBain et al. (2018) found that although T2DM, a component of MetS, is prevalent among mental health patients, the management of T2DM at psychiatric inpatient hospitals remains peripheral.

The impact of a pediatric critical incident simulation on the perceived importance of and need for a critical incident stress debriefing protocol for anesthesia providers

The term second victim was created to describe the effects of adverse events or critical incidents on healthcare providers and can be defined as a healthcare provider who becomes traumatized, and therefore victimized, after being involved in an adverse event, medical error, or patient related injury (AANA, 2014; Burlison, Quillivan, Scott, Johnson, & Hoffman, 2016; Winning et al., 2018). Among healthcare providers, a CI can be an event that causes or has potential to cause patient harm, a medical error, a non-error patient safety event, or a near-miss; these events can lead to the second victim effect, which impacts both psychological performance and physical well-being and causes symptoms of posttraumatic stress disorder (PTSD) (Burlison et al., 2016; Stone et al., 2017). Using a self-reported Second Victim Experience and Support Tool (SVEST) completed by 155 nurses involved in patient care, Burlison et al. (2016) found statistically significant correlations with second victim distress, absenteeism, and turnover intentions. These authors concluded that organizational support, especially coworker support, mediated these correlations with statistically significant results.

A cross-sectional online survey of 463 neonatal ICU (NICU) healthcare providers was conducted by Winning et al. (2018) to examine the impact of adverse events on distress and professional quality of life. The authors also studied the role of coworker support. According to Winning et al. (2018), 23% of participants observed an adverse event and 19% were involved in an adverse event within the preceding 12 months. The healthcare providers who observed or were involved in an adverse event had higher levels of anxiety, depression, burnout, and

traumatic stress when compared to those who did not experience an event. Statistically significant results revealed adverse events were associated with increased anxiety and depression when coworkers were thought to be less supportive, but not when they were highly supportive (Winning et al., 2018). The authors concluded that although coworker support reduced emotional distress, the healthcare providers wanted additional support.

Health in Healthcare Providers

Melnyk et al. (2018) performed a descriptive study on the physical and mental health, the relationship between health and medical errors, and the perceptions of wellness support and health among 1790 nurses. This study demonstrated that just over 1/2 of the nurses studied had suboptimal physical and mental health with 1/3 to 1/2 of the nurses reporting depression, anxiety, and stress. In addition, nearly half of the nurses studied reported a medical error in the last 5 years and interestingly, nurses with poorer mental or physical health were more likely to have a medical error, with depression being the strongest predictor of medical errors. Moreover, the nurses in this study who felt their wellness was supported in their workplace were twice as likely to have better health and nearly six times more likely to have a high professional quality of life.

Burnout in Healthcare Providers

Burnout is a state of mental, physical, and emotional exhaustion caused by involvement in demanding situations for a long period of time that can be caused by moral distress (Appleton, Nelson, & Wedlund, 2018). CISM can decrease burnout, compassion fatigue, and moral distress and increase workforce health (Appleton et al., 2018; Clark, Polivka, Zwart, & Sanders, 2019). Appleton et al. (2018) additionally discussed the potential for improved staff satisfaction and patient outcomes and the positive implications for healthcare finances when burnout is reduced.

Educating Clinicians about Potential risk of Metabolic Syndrome among Patients on antipsychotics

Educating Clinicians about Potential risk of Metabolic Syndrome among Patients on antipsychotics

Educating Clinicians about Potential risk of Metabolic Syndrome among Patients on antipsychotics

Metabolic Syndrome (MetS) is a combination of obesity (abdominal), elevated triglycerides, high blood pressure, hyperglycemia, and low high-density lipoprotein cholesterol (Penninx & Lange, 2018). MetS was coined to assist clinicians in identifying patients at risk for cardiovascular diseases (CVD) and Type 2 Diabetes Mellitus (T2DM). The author seeks to develop a quality improvement (QI) project using the Institute for Healthcare Improvement’s (IHI) Model for Improvement to assist mental health providers in detecting patients at-risk for MetS.

Clinical Background

 Psychiatric and mental health patients have a higher risk of premature death. The current epidemiology studies suggest that the life expectancy rate of seriously mentally ill (SMI) patients is seven to 20 years lower compared to the general population (Penninx & Lange, 2018). The low life expectancy rate among psychiatric patients is due to numerous factors of which physical comorbidities play a vital role. MetS makes up most of the medical comorbidities present among mental health patients, and it’s also 58% higher in SMI patients than in the general population (Penninx & Lange, 2018). Patients diagnosed with schizophrenia are more likely to die from cardiovascular disease than those in the general population (Gautam & Meena, 2011). Mental health patients suffer from comorbid medical conditions that often go untreated or overlooked by mental health providers (McBain, Lamotagne-Godwin, Haddad, Simpson, Chap, Jones & Mulligan, 2018). McBain et al. (2018) found that although T2DM, a component of MetS, is prevalent among mental health patients, the management of T2DM at psychiatric inpatient hospitals remains peripheral.

Convincing evidence shows that antipsychotic medications have an established risk of MetS (Bozymski, Whitten, Blair, Overly, & Ott, 2017). Based on this evidence, there should be periodic clinical assessment and medication evaluation for individuals initiated on antipsychotics (Toalson, Ahmed, Hardy, & Kabinoff, 2004). Furthermore, due to the immense burden of CVD and T2DM, patients who suffer MetS incur a heft healthcare cost annually (Nichols & Moler, 2011). Identifying potential at-risk patients will not only reduce healthcare cost but significantly, treat MetS and halt the progression of CVDs and T2DM (Bozymski et al., 2017). It is, therefore, paramount to educate mental health providers about the prevalence of MetS in patients on antipsychotic medications. The available literature shows that improving staff’s knowledge on the use of practice guidelines for monitoring MetS should increase the adherence for MetS screening, and ultimately produce a positive patient outcome (Omile, 2019; Kioko, Williams, & Newhouse, 2016).

NURS FPX 9100 Assessment 1 Obesity Topic Approval NURS-FPX 9100 Defining Nursing Doctoral Project

Preceptor Adita Flagg, MSN, RN – Director of Clinical Quality, Risk &amp; Safety at Adelante Healthcare. Robert Babyar, MD – CMO of Adelante Healthcare.

PROJECT DESCRIPTION PICOT:

For personnel and vendors the usage of the on line portal messaging systems, how does the implementation of a patient-provider response time coverage in contrast to the cutting-edge country have an effect on response instances over a two-month period?

Brief Summary:

The motive of the satisfactory enchancment mission is to beautify the verbal exchange response fee from clinicians to sufferers with the aid of affected person portal messages. A January 2023 record pulled through analysts at the mission website printed 75% of affected person messages are no longer reviewed in the first three days. A 2019 qualitative find out about carried out with the aid of Kaiser Permanente throughout 4 months observed persistently responding to affected person messages saves on time as delayed responses inevitably generate extra affected person calls to the exercise (Lieu, et al., 2019). An extra learn about by using North et al., (2018) performed a cohort learn about which includes six hundred sufferers and implementation of a response time coverage that furnished team of workers route to reply to all affected person messages inside 24 hours, with the exception of vacations ensuing in timelier responses to affected person inquiries.

Primary Objective:

NURS FPX 9100 Assessment 6 Project Charter NURS-FPX 9100 Defining Nursing Doctoral Project