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Objective: Identifying who participates in chronic disease management programs yields insights into program reach and appeal. This study investigated sustained participation in a remotely delivered weight loss maintenance program offered to Australian private health insurance members. Methods: All participants completing an initial 18-week weight loss program were eligible for a maintenance phase. A pre-post test design was used and sociodemographic and anthropometric characteristics of those who did and did not opt in to the maintenance phase were compared using binary logistic regression. Results: Maintenance phase participants lost more weight during the initial weight loss program (−2.2 kg (P < 0.001); body mass index −0.8 kg/m2 (P < 0.001)) than those who did not opt in. Participants who were obese (v. overweight) upon completion of the initial weight loss program were less likely to opt in to the maintenance phase (adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.35–2.30, P < 0.001) and participants aged ≥55 years were more likely to opt in (aOR 0.59, 95% CI 0.44–0.80, P < 0.001) than those aged <55 years. Conclusions: Understanding why health insurance members opt in to maintenance programs can assist the development of strategies to improve program reach. Younger participants and those who remain obese following a weight loss program may be targeted by private health insurers and service providers to increase weight loss maintenance program participation. What is known about the topic?: Australian private health insurers offer chronic disease management programs to support members to manage obesity-related chronic disease. An 18-week weight loss and lifestyle modification program was extended to assist participants maintain weight loss and health benefits resulting from the initial program. This weight loss maintenance phase is novel in the private health insurance setting and is thought to be important to sustained health improvement. Although program reach is important to benefit those most in need, little is known about who sustains the use (or does not) of such programs. What does this paper add?: This study provides an insight to the characteristics of participants more likely to opt in to a weight loss maintenance program. It highlights the sociodemographic and anthropometric characteristics associated with maintenance program uptake, identifying the subgroups less likely to opt in. These study findings are novel because they report on participation in a chronic disease management program with a focus on maintenance of weight loss. What are the implications for practitioners?: These results will benefit private health insurers and service providers implementing maintenance programs for weight loss, providing an awareness of which participant groups to target to increase maintenance and reach. In addition, they offer avenues for future exploration, such as the generalisability and sustainability of chronic disease management programs. Although those not opting in are a difficult-to-access group, a qualitative study of reasons for not opting in to such a program would provide further information for program design, recruitment and retention. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity.Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. What does the paper add to existing knowledge?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. What are the implications for practice?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. Introduction: Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim: The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods: A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results: Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice: Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support. [ABSTRACT FROM AUTHOR]

Lymph node migration results in poor prognoses for nasopharyngeal carcinoma (NPC) patients. Tricetin, a flavonoid derivative, regulates tumorigenesis activity through its antiproliferative and antimetastatic properties. However, the molecular mechanism of tricetin affecting the migration and invasion of NPC cells remains poorly understood. In this paper, we examined the antimetastatic properties of tricetin in human NPC cells. Our results demonstrated that tricetin at noncytotoxic concentrations (0–80 3M) noticeably reduced the migration and invasion of NPC cells (HONE-1, NPC-39, and NPC-BM). Moreover, tricetin suppressed the indicative protease, presenilin-1 (PS-1), as indicated by protease array. PS-1 was transcriptionally inhibited via the Akt signaling pathway but not mitogen-activated protein kinase pathways, such as the JNK, p38, and ERK1/2 pathways. In addition to upregulating GSK-3 β phosphorylation through Akt suppression, tricetin may downregulate the activity of PS-1. Overall, our study provides new insight into the role of tricetin-induced molecular regulation in the suppression of NPC metastasis and suggests that tricetin has prospective therapeutic applications for patients with NPC. [ABSTRACT FROM AUTHOR]

Background: Astragalin (AG), a flavonoid from many traditional herbs and medicinal plants, has been described to exhibit in vitro anti-inflammatory activity. The paper aimed to study the effects of astragalin on anti-inflammatory, anti-oxidative ability and apoptosis signaling pathway in brain tissue of rats with cerebral ischemia-reperfusion injury, and to explore its possible mechanism. Methods: The rat model of focal cerebral ischemia-reperfusion injury was established by suture method. It was randomly divided into 5 groups, sham operation group, ischemia-reperfusion (I/R) treatment group, and astragalin treatment I / R group (12.5, 25, 50 mg / kg). After 24 h of reperfusion, the neurological deficits of the rats were analyzed and HE staining was performed. The volume of cerebral infarction was calculated by triphenyltetrazolium chloride (TTC) staining, and the apoptosis of nerve cells was detected by TUNEL staining. In addition, the content of malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), glutathione (GSH) assay and glutathione peroxidase (GSH-Px) were measured in rat brain tissue. Western blot analysis was used to determine the expression of related proteins. Results: Compared with I/R group, the neurological deficit score and infarct volume of I/R rats were reduced in the astragalin treatment group. In the astragalin treatment group, MDA and NO levels in I/R rats were reduced, antioxidant enzymes and superoxide dismutase (SOD) activity were increased. In the astragalin treatment group, NF-κB (p65) and cyclooxygenase-2 (COX-2) expression levels were down-regulated, NF-E2-related factor 2 (Nrf2) nucleus and heme oxygenase-1 (HO-1) protein expression levels were up-regulated. In addition, the astragalin treatment can inhibit apoptosis, down-regulate Bax and cleaved caspase-3 expression, up-regulate Bcl-Xl expression. Conclusion: The antioxidant properties of astragalin may play an important role in improving cerebral ischemia-reperfusion injury. [ABSTRACT FROM AUTHOR]

Sound‐augmented toys producing factual knowledge were thought to encourage incidental, playful learning in children with visual impairments (VIs). A group of 15 children with VIs and 22 sighted controls played with a sound‐augmented savannah landscape and listened to an informative story in a counterbalanced order. Children's knowledge about savannah animals was assessed at baseline and after each condition in order to quantitatively compare knowledge gains between conditions. Results indicated that children with VIs gained more knowledge than sighted controls from playing with the sound‐augmented toy. Furthermore, offering both the augmented toy and the informative story led to higher knowledge gains than a single medium, especially in children with VIs. Sound‐augmented toys could therefore be a useful addition to the current curriculum in special education for children with VIs. Lay Description: What is already known about this topic: Game‐based learning is becoming more popular as educational context.Children with visual impairments are often unable to benefit from a predominantly visual learning context.Augmented environments encourage exploratory learning by enhancing physical materials with technology.Sound‐augmented toys might encourage playful learning in children with visual impairments. What this paper adds: This empirical study compared an innovative sound‐augmented toy with traditional verbal instruction.Both children with visual impairments and a sighted comparison group participated.The targeted learning outcome was factual knowledge about animals.Children gained comparable knowledge from the augmented environment as from verbal instruction.The augmented toy was a more effective learning context for children with visual impairments than in sighted children. Implications for practice and/or policy: Sound‐augmented environments encourage object interaction and playful learning in children with visual impairments.Sound‐augmented toys can be a useful addition to the current curriculum of children with visual impairments in special education. [ABSTRACT FROM AUTHOR]

Assistive Technology (AT) product use occurs within a socio-cultural setting. The growth internationally in the AT product market suggests that designers need to be aware of the influences that diverse cultures may have on the societal perception of an AT product through its semantic attributes. The study aimed to evaluate the visual interaction with an AT product by young adults from Pakistan, a collectivist society, and the United Kingdom (UK), an individualist society. A paper-based questionnaire survey was carried out with 281 first-year undergraduate students from the UK and Pakistan to evaluate their perception towards the visual representation of a generic conventional wheelchair image. A semantics differential (SD) scale method was used involving a seven-point bipolar SD scale incorporating sixteen pairs of adjectives defining functional, meaning, and usability attributes of the product. The mean (M) and standard deviation (sd) values were obtained for each pair of adjectives and compared between both groups by employing appropriate parametric tests. The results show that having a diverse cultural background did not appear to have overtly influenced the meanings ascribed to the generic manual wheelchair, which was unexpected. The University 'Internationalist' environment may have influenced the results. Some minor but critical differences were found for some pairs of adjectives (bulky-compact, heavy-light), having p-value less than.05 (p <.05) that related to previous experience of wheelchairs and/or their use. Further studies are planned to investigate and validate outcomes with other student and non-student groups. The semantic attributes of assistive technologies highlight a number of aspects that have implications for those involved in Assistive Technology (AT) product development, manufacturing and marketing. • For online sales, the AT products rely on the web page image to communicate the purpose and attributes of the product. There are limited explorations related to the semantic/communicative attributes of AT product presented in images, as perceived by individuals from diverse cultural backgrounds. • The knowledge towards semantic meaning ascribed to the AT product is important to investigate to provide a perspective that goes beyond practical functions of the AT product towards the communicative function. • Information of comprehending semantics and significance of the AT product from a social (non-users) viewpoint may benefits manufacturers in the development of AT products that best meet the societal needs, preferences and expectations. • A model of best practice, with a focus on semantic manipulation will offer Industrial Designers (ID) internationally with the suitable process and tools to reframe perceptions of disability and enhance acceptance of AT products not only for users, but also for the society around them. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to report on the implementation and evaluation of a Screening, Brief Intervention and Referral to Treatment (SBIRT) educational program into an undergraduate nursing curriculum and to recommend modifications for future trainings. Design and Sample: A one‐group pre‐test/post‐test design was used. The sample consisted of senior level undergraduate nursing students. Measures: Core knowledge, perceived competency, and program satisfaction were measured. Process evaluation activities were performed to gather feedback on the training and solicit ideas and recommendations for improvement. Results: Of the 354 nursing students enrolled in the training, 249 (70%) participated in the research portion, with 240 (96%) completed the pre‐ and post‐training evaluations. All four core knowledge components and 13 perceived competency indicators were statistically significant (p ≤.001) when comparing pre‐ and post‐t test values. Process evaluation data collected through 25 telephone interviews found that the training improved the students' confidence and ability to screen for substance misuse with patients. Conclusion: Findings support the implementation of SBIRT training into an undergraduate nursing curriculum. Modifications for future training and research are proposed. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Depression affects 1 in 20 Americans, and people living with HIV experience depression at 2–3 times the rate of the general population.Recent research has shown that a person's level of social connectedness (e.g., social networks) is important to understanding their health and ability to get help when they need it.The scientific rationale of this work is to determine whether there is a direct relationship between levels of depression and a measure of social connectedness in people with HIV who are at higher than normal risk of depression and depressive symptoms. What this paper adds to existing knowledge?: We examined the relationship between levels of depression and social capital in people living with HIV to determine whether depression may influence their beliefs about their social connectedness and available resources.We found that as depression increases, self‐reported social capital decreases, suggesting that people living with HIV who are depressed may feel less socially connected and/or not be confident they can access resources when they need them. What are the implications for practice: Mental health nurses are particularly well‐positioned to help people living with HIV who are living with depression by helping them build skills for building and maintaining relationships, adhering to co‐administered HIV and mental health medical treatments, and helping these individuals to identify and address barriers to social connectedness.Helping people living with HIV to address depression and promoting social connectedness can not only improve quality of life, but have major long‐term health benefits. Introduction: People living with HIV (PLWH) are disproportionately burdened by depression, with estimates as high as 80% of PLWH reporting depressive symptoms. Depression in PLWH is complex, and has been linked with biological and psychosocial causes, including low social capital. Few studies have examined the relationship between social capital and depression in PLWH. Aim/Question: We conducted a secondary analysis of the relationship between social capital (Social Capital Scale score) and depression (Beck Depression Inventory‐II scores) to determine whether depression predicted levels of social capital in a sample of 108 PLWH. Results: Depression was significantly associated with lower social capital r(105) = −.465 p <.001. Depression remained a significant predictor of social capital in the linear regression model, F(5,101) = 8.508, p <.000, R2 = 0.296, when controlling for age and education level. Discussion: Our results suggest that depression may be a significant predictor of low social capital, and these factors may have cyclical relationships that explain persistent depression in this population. Implications for practice: Mental health nurses are particularly well‐positioned to help PLWH who are living with depression by helping them build skills for building and maintaining relationships, adhering to co‐administered HIV and mental health medical treatments, and helping these individuals to identify and address barriers to social connectedness. [ABSTRACT FROM AUTHOR]

There has been an increasing attention to the study of stress. Particularly, college students often experience high levels of stress that are linked to several negative outcomes concerning academic functioning, physical, and mental health. In this paper, we introduce the EuStress Solution, that aims to create an Information System to monitor and assess, continuously and in real-time, the stress levels of the students in order to predict burnout. The Information System will use a measuring instrument based on wearable device and machine learning techniques to collect and process stress-related data from the students without their explicit interaction. In the present study, we focus on heart rate and heart rate variability indices, by comparing baseline and stress condition. We performed different statistical tests in order to develop a complex and intelligent model. Results showed the neural network had the better model fit. [ABSTRACT FROM AUTHOR]

Calls for transformational systems change that lead to improved outcomes for children in child welfare can only be answered by preparing an effective workforce and building an agency climate that is ready for change. The National Child Welfare Workforce Institute developed a comprehensive model for public, private, and tribal child welfare agencies to improve the health of their workforce. This paper describes the application of the model in one state agency. Through leadership development, a distributive teaming approach, and implementation of an evidence-supported practice model, they were able to significantly improve the organizational climate of their agency. The article discusses practice implications and recommendations for child welfare agencies and technical assistance providers for fostering positive organizational health and ultimately improving outcomes for families. [ABSTRACT FROM AUTHOR]

Children with developmental language disorders (DLD) are especially characterised by morphosyntactic difficulties. Nevertheless, previous studies have also shown that children with DLD have phonological difficulties. This paper aims to describe the productive and perceptive phonological speech profile of Spanish-Catalan children with DLD at the age of six in order to characterise the underlying nature of their difficulties. Fourteen Spanish-Catalan six-year-old children with DLD and 14 control children without language difficulties who attended the same class were assessed with the screening and discrimination tasks of the A-RE-HA: Análisis del Retraso del Habla (Speech Delay Analysis – Catalan and Spanish version). We analysed the production of words, syllables and phonemes, phoneme discrimination and phonological simplification processes used by these children. The results showed that children with DLD have a lower percentile in correct word structures, syllabic structures and phonemes, and have more difficulty discriminating phonemes. Detailed analyses revealed more difficulties with the most complex word and syllabic templates, and with almost all phonemes. Furthermore, children with DLD applied more phonological simplification processes than the control group. An individual analysis showed that only ten of the children with DLD also had a speech delay (percentile < 25), while four had scores in line with their age. These results show that most of the six-year-old children with DLD maintain speech difficulties, which are mainly phonological and not (or not only) articulatory. Therefore, individual differences with respect to speech delay in DLD must be taken into consideration to better detect these children. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mismatch between classroom furniture and the students' anthropometry have been identified as a major cause of musculoskeletal disorders (MSDs) among students. Such discomforts can affect students' performance. OBJECTIVE: This paper is aimed at investigating the prevalence of MSDs and the effect of furniture intervention among students of tertiary institutions in Northwest Nigeria. METHODS: The Cornell's MSD questionnaire was used to investigate the prevalence of MSDs in twelve body regions of students aged between 16 and 25 years. Eleven students' anthropometric dimensions were also measured and used to compute the ergonomically compliant furniture dimensions for the participants. A new set of furniture was introduced, and the questionnaire was used to investigate if the intervention made was significant or not. The academic performance of some of the students before and after the intervention was analyzed using the t-test statistical technique. RESULT: None of the furniture in use was suitable for the majority of the students. MSDs prevalence ranges from 14% to 67.3% among the body regions with the students reporting that low back pain is the most prevalent (67.3%), severe (19.4%) and interfering with their studies (15.8%). The intervention also reduced MSDs in all body regions except at the upper arm and the right side of the forearm. Only sitting, knee, and popliteal heights were significantly associated with MSD occurrence. There was also a significant improvement in the students' academic performance after the intervention (t = –3.239, p = 0.002). CONCLUSION: The limited success of the intervention is an indication of the need to carry out a more holistic intervention that incorporates other inputs such as continuous enlightenment and classroom facility design. [ABSTRACT FROM AUTHOR]

Both physical abuse and poor sleep quality are public health concerns among adolescents, particularly in mainland China, but examining any causal effect of physical abuse on adolescents' sleep quality using a randomized controlled trial is not possible for obvious ethical reasons. Researchers have proposed the use of propensity score matching with doses to minimize overt bias and estimate the effect of multidose treatments or varying degrees of risk exposure in observational studies. In this paper, we demonstrate the propensity score methods with a focus on matching with doses in an examination of the relationship between physical abuse levels (frequency and number of perpetrators) and self‐reported sleep quality among adolescents. Secondary analyses were conducted using data from the China Jintan Child Cohort. The sample comprised 707 adolescents (13.16 ± 0.90 years old) who had complete data on physical abuse, sleep, and covariates. Propensity scores were computed from eight covariates and used to carry out pair matching, matching with the frequency of abusive experience, and matching with the number of perpetrators. The standardized differences of covariates suggested an acceptable balance between groups after matching. The results derived from matching sets consistently indicated that adolescents being physically abused by parent(s) have worse sleep quality. Despite its inherent limitations, propensity score matching with doses provides a useful tool for nurse researchers analyzing observational data. [ABSTRACT FROM AUTHOR]

Background: The appropriate use of language in context depends on the speaker's pragmatic language competencies. A coding system was used to develop a specific and adult-focused self-administered questionnaire to adults who stutter and adults who do not stutter, The Assessment of Language Use in Social Contexts for Adults, with three categories: precursors, basic exchanges, and extended literal/non-literal discourse. This paper presents the content validity, item analysis, reliability coefficients and evidences of construct validity of the instrument. Methods: Content validity analysis was based on a two-stage process: first, 11 pragmatic questionnaires were assessed to identify items that probe each pragmatic competency and to create the first version of the instrument; second, items were assessed qualitatively by an expert panel composed by adults who stutter and controls, and quantitatively and qualitatively by an expert panel composed by clinicians. A pilot study was conducted with five adults who stutter and five controls to analyse items and calculate reliability. Construct validity evidences were obtained using the hypothesized relationships method and factor analysis with 28 adults who stutter and 28 controls. Results: Concerning content validity, the questionnaires assessed up to 13 pragmatic competencies. Qualitative and quantitative analysis revealed ambiguities in items construction. Disagreement between experts was solved through item modification. The pilot study showed that the instrument presented internal consistency and temporal stability. Significant differences between adults who stutter and controls and different response profiles revealed the instrument's underlying construct. Conclusion: The instrument is reliable and presented evidences of construct validity. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People with severe mental illness (SMI) have a life expectancy of 15–20 years less than the general population, partly due to increased risk of physical disease, including type II diabetes (T2DM) and cardiovascular disease.Little is known about changes in cardiovascular risk factors over time in people with both T2DM and SMI compared to those with T2DM and no SMI. What this paper adds to existing knowledge?: We investigated whether levels of cardiovascular risk factors, cholesterol, HbA1c, systolic and diastolic blood pressure associated with adverse clinical outcomes are different in T2DM patients with and without SMI. We found significant differences in systolic blood pressure and HbA1c between the two groups.Fifty‐five percent and twenty‐nine percent of T2DM patients with comorbid SMI are at increased risk of adverse clinical outcomes due to sub‐optimal HbA1c and systolic blood pressure levels, respectively. What are the implications for practice?: Many patients with T2DM and SMI have higher levels of cardiovascular risk compared to patients with T2DM only, and good management of risk factors is therefore particularly important in patients with both conditions.Achieving better control of HbA1c levels is likely to be central to addressing inequalities in outcomes for patients with both SMI and T2DM. Introduction: Patients with both severe mental illness (SMI) and type II diabetes (T2DM) have lower life expectancy than patients with T2DM alone, partly due to poor control of cardiovascular risk factors in comorbid patients. Aim: To compare levels of cholesterol, HbA1c and blood pressure in T2DM patients with and without SMI. Method: We analysed longitudinal clinical records of 30,353 people with T2DM (657 with SMI; 29,696 controls without SMI) between 2001 and 2013 using the Clinical Practice Research Datalink (CPRD). We used mixed‐effects regression models to compare cardiovascular risk factors between SMI and controls. Results: Patients with SMI had lower mean systolic blood pressure (SBP; β: −2.49; SE = .45 p = <.01) and were more likely to have extreme (high and low) values of HbA1c and SBP (OR: 1.38, 95% CI: 1.16, 1.64 and 1.76:1.40, 2.21, respectively). Discussion: People with T2DM and SMI have similar average values of cardiovascular risk factors to people with T2DM alone but are more likely to have values of HbA1c and SBP indicating increased risk of adverse clinical outcomes. Implications for Practice: Improved management of cardiovascular risk factors in general, glycaemic control in particular, is central to addressing the increased risk of adverse outcomes in people with both SMI and T2DM. [ABSTRACT FROM AUTHOR]

Purpose: To explore complex system behavior and subsequent team performance in professional rugby union. Methods: Here, we present 2 studies. In the first, we used global positioning system technology to measure player clustering during stoppages in play in nearly 100 games of professional rugby union to explore team (complex system) behavior and performance. In the second, we measured stress hormones (cortisol and testosterone) prior to team meetings and analyzed these relative to amount of time and the frequency with which players looked at peer presenters, as well as subsequent training performance, to explain how stress may lead to behaviors observed in the first study and subsequent match performance. Results: No link between player clustering during stoppages of play and performance was observed. When players (complex system agents) demonstrated greater levels of stress (as indicated by greater cortisol-awakening response and a greater decline in testosterone-to-cortisol ratio across the morning), they tended to look at peer presenters more; however, training quality declined (P =.02). Correlational analysis also showed that training quality was related to testosterone-to-cortisol ratio (P =.04). Conclusions: Team behavior is complex and can be unpredictable. It is possible that under stress, complex system agents (ie, rugby union players) look at (and cluster toward) their teammates more; however, meaningful interaction may not necessarily occur. Furthermore, while complex system (team) analysis may be valuable strategically in rugby union in the context of describing behavior, without understanding "how" or "why" intrateam/interagent behaviors emerge it may have little meaning. [ABSTRACT FROM AUTHOR]

Purpose: Children with cochlear implants (CIs) have less experience accessing spoken language. Mandarin Chinese uses pitch information to contrast word meaning, and the signal that the CI devices provide is degraded. Thus, Mandarin-speaking children with CIs may face more challenges in the development of language skills. This study examines preschool Mandarin-speaking children's performance in lexical access. We hypothesized that children with CIs and their peers with normal hearing (NH) have comparable naming ability, but they process phonological or semantic information differently. Method: Twenty children with CIs and 20 age-matched children with NH were tested. The cross-modal visual–auditory picture–word interference paradigm was applied. The distractor was either phonologically related (mao55 cat -mao51 hat), semantically related (mao55 cat -shu214 mouse) or unrelated (mao55 cat -zhi214 paper) to the target, and it was aurally presented at four different points in time relative to the picture. Accuracy was compared between the two groups to tap into the children's naming abilities, and reaction time was analyzed to examine the effects of phonological and semantic information. Results: No group difference in accuracy was found. The phonologically related distractors led to significantly higher accuracy scores and shorter reaction times, whereas the semantically related distractors did not. Unlike the NH group, the CI group did not respond significantly faster or slower in phonologically related condition when the distractor and picture occurred simultaneously. Finally, the CI group made overall quicker responses than the NH group. Conclusions: Children with CIs are as successful as children with NH in word retrieval and production, and the two groups both show phonological priming effect and lack semantic effect. However, children with CIs do not process phonological information as early as their NH peers, and they may be more tasks directed and hence make quicker responses. [ABSTRACT FROM AUTHOR]

Although substance use is prevalent in the United States, the majority of people who misuse substances do not receive appropriate treatment. This paper describes, (1) an interprofessional education (IPE) program for health professionals to provide Screening Brief Intervention and Referral to Treatment to rural substance use patients, and (2) compares registered nurses' [RNs] and behavioral health professionals' [BHPs] attitudes to work with those patients and their perceptions on IPE. A data analysis of 62 RNs and 36 BHPs shows statistically significant increases in both attitudes and perceptions. This paper discusses the implications of the IPE program vis-á-vis substance use treatment. [ABSTRACT FROM AUTHOR]

Latinos are more likely to delay HIV testing, present to care with an AIDS defining illness, and die within one year of learning their HIV-positive status than non-Latino blacks and whites. For this paper, we explore the role of partner-relationship characteristics and health behaviors, in predicting HIV testing among Latina adult women who engaged in risky sexual behaviors (i.e., unprotected vaginal and/or anal sex). Data from a convenience sample of 168 Latina adult women who engaged in risky sexual behavior in the year prior to assessment were analyzed for this paper. Rates and predictors of HIV testing among this sample were assessed after a five-year follow-up. Descriptive and analytical estimates include incidence rates and adjusted odds ratios (AOR) from multilevel models. At five-year follow-up, 63.7% (n = 107) women reported having been tested for HIV, of whom 12.2% (n = 13) were women who never tested before. Main reasons for not having been tested at follow-up included: low risk perception (62.1%) and trusting their partner(s)/being in a monogamous relationship/knowing their partner's HIV status (17.2%). Predictors of HIV testing included: age (AOR: 0.96; 95% CI = 0.92–0.99), provider endorsement of HIV testing (AOR: 4.59; 95% CI = 1.77–11.95), poor quality of their romantic relationships (AOR: 1.12; 95% CI = 1.03–1.26), and knowing the HIV sero-status of sexual partner (AOR: 3.61; 95% CI = 1.46–8.95). This study characterizes a group of Latina women at high risk for HIV infection and their HIV testing behaviors. Our findings underscore the need of increasing access to quality health-care services and HIV behavioral interventions, and to strengthen the adherence to HIV/sexually transmitted disease testing recommendations and guidelines among local health-care providers serving the Latino community in South Florida. [ABSTRACT FROM PUBLISHER]

Background Low levels of alcohol responses (low LRs) are genetically influenced phenotypes that are identified before alcohol dependence and predict future heavy drinking and alcohol problems. A recent paper described 13 LR-related blood oxygen level-dependent ( BOLD) response contrast patterns observed during an emotional face recognition task that might reflect cognitive processes contributing to LR and that might themselves predict adverse alcohol outcomes ( Paulus et al., Biol Psychiatry 2012; 72: 848). This paper evaluates the predictive implications of those functional magnetic resonance imaging (f MRI) patterns. Methods Of 120 subjects from Paulus and colleagues (2012), 114 (57 low and high LRs; ~50% females) were interviewed 5 years later at age 25. Correlations between baseline f MRI patterns and alcohol-related outcomes were evaluated, and regression analyses were used to determine if BOLD response contrasts incremented over LR in predicting outcomes. Results Baseline f MRI patterns in 5 of 13 baseline regions of interest correlated with adverse outcomes. Such patterns in insular regions, particularly the left anterior insula, and the right frontal gyrus, added to LR in predicting alcohol problems. The relationships remained robust when exact binomial procedures were used, but, reflecting the small sample size, it was not possible to adequately consider Bonferroni corrections. Conclusions The data suggest that f MRI BOLD response contrasts predicted heavier drinking and alcohol problems 5 years later, even after considering baseline low LRs. Future work will focus on whether f MRI results can predict outcomes in larger samples and among young nondrinkers, as well as how the imaging results increase understanding of the processes through which LR operates. [ABSTRACT FROM AUTHOR]

Objective. The number of cancer survivors is increasing, and the high prevalence of frailty not only reduces quality of life but also affects the treatment of cancer patients. This study aimed to identify the prevalence and risk factors of frailty in cancer patients and to construct a nomogram to predict the probability of frailty. Methods. Nine hundred fifty‐eight cancer patients were included in this retrospective study, randomly divided into a development set (n = 680) and a validation set (n = 278). Frailty was assessed using the Tilburg frailty indicator (TFI). Social support, medical coping styles, and psychological distress were assessed by the Social Support Self‐Rating Scale (SSRS), Medical Coping Modes Questionnaire (MCMQ), and distress thermometer (DT), respectively. Results. The prevalence of frailty in cancer patients was 45.93%. Cancer patients who exercised regularly, ate a balanced diet, and actively coped with diseases were less likely to become frail. The risk factors for frailty identified by a multivariate analysis were parenteral nutrition, advanced TNM staging, vegetarian diet, unemployment, psychological distress ≥4, low physical activity, and negative coping styles. These risk factors were used to construct a nomogram, and the C‐index, calibration curve, and decision curve analysis (DCA) were used to assess the performance of the nomogram. The C‐index was 0.762, and the calibration curve showed satisfactory coherence. The net benefit of the nomogram was better between threshold probabilities of 17%–96% in DCA. Conclusion. Special focus needs to be placed on frail cancer patients due to their high prevalence and severe outcomes. Clinical medical workers could use this nomogram to identify high‐risk patients and intervene early to prevent frailty. [ABSTRACT FROM AUTHOR]

Background: Current prostate cancer treatments are associated with life-threatening side effects, prompting the search for effective and safer alternatives. Aspilia pluriseta Schweinf. ex Engl. has previously shown anticancer activity in lung and liver cancer cell lines. This study investigated its potential for prostate cancer. Methods: A crude extract of A. pluriseta root was prepared using dichloromethane/methanol (1:1 v/v) and partitioned into hexane, ethyl acetate, and water fractions. The MTT assay was used to assess the antiproliferative activity of the fractions. The active fractions were tested at 6.25–200 µg/ml on human prostate cancer DU-145 cells and non-cancerous Vero E6 cells. Qualitative phytochemical and gas chromatography-mass spectrometry (GC-MS) analyses were conducted to identify chemical compounds. Network pharmacology was employed to predict molecular targets and modes of action of the identified chemical compounds, with subsequent validation through molecular docking and real-time PCR. Results: Active extracts included crude dichloromethane/methanol, hexane, and ethyl acetate fractions, inhibiting DU-145 cell proliferation with IC50 values of 16.94, 20.06, and 24.14 µg/ml, respectively. Selectivity indices were determined to be 6.04 (crude), 3.62 (hexane), and 6.68 (ethyl acetate). Identified phytochemicals comprised phenols, terpenoids, flavonoids, tannins, sterols, and saponins. GC-MS analysis revealed seventy-nine (79) compounds, with seven (7) meeting ideal drug candidate parameters; their hub gene targets included MAPK3, MAPK1, IL6, TP53, ESR1, PTGS2, MMP9, MDM2, AR, and MAP2K1, implicating regulation of PI3K/Akt, MAPK, and p53 signaling pathways as potential modes of action. Core compounds such as 1-heneicosanol, lanosterol, andrographolide, and retinoic acid exhibited strong binding activities, particularly lanosterol with MAPK21 (-9.7 kcal/mol), ESR1 (-8.9 kcal/mol), and MAPK3 (-8.8 kcal/mol). Treatment with A. pluriseta downregulated AR expression and upregulated p53, while also downregulating CDK1 and BCL-2 and upregulating caspase-3. Conclusions: A. pluriseta extracts inhibited DU-145 cell growth without causing cellular toxicity, suggesting great potential for development as an anti-prostate cancer agent. However, further in vitro and in vivo experiments are recommended. [ABSTRACT FROM AUTHOR]

Background: Nurses' competence in clinical research is a key element in promoting high quality in the discipline of nursing, and the ethical aspects of research are of paramount importance. Therefore, nurses need to have a comprehensive understanding of the ethics associated with clinical research, which is an integral part of safeguarding the safety of subjects, ensuring the quality of nursing clinical research, and improving the ethical standardization of clinical research. Methods: A cross-sectional survey was conducted on 304 nurses in a province of China between April 2023 and September 2023, utilizing convenience sampling. The survey questionnaire comprised two sections: a general information form and a questionnaire focusing on nurses' knowledge and attitudes towards clinical research ethics. Data analysis encompassed descriptive statistics, t-tests, one-way ANOVA, and multiple linear regression. Results: A total of 320 questionnaires were distributed, of which 304 were valid. The ethical attitude of nurses in clinical research was better (91.17 ± 15.96), while the cognitive score was lower (63.08 ± 12.30). The results of multiple linear regression analysis showed that degree, grade of hospital (I, II or III), technical title, number of clinical projects chaired in one year and whether the respondent has ever participated in an ethics training were the five factors influencing the knowledge of clinical research ethics (F = 9.341, P < 0.001, R2 = 18.0%); degree, grade of hospital (I, II or III), technical title, number of clinical research projects chaired in one year, whether the hospital has an ethics committee and whether the respondent has ever participated in an ethics training were the six factors affecting ethical attitudes towards clinical research (F = 8.919, P < 0.001, R2 = 17.3%). Conclusions: Nurses in a Chinese province scored low on the cognitive dimension of clinical research ethics, but their attitudes were at a relative high level, with many influencing factors. Degree, technical title, and grade of hospital, all affect cognitive and attitude scores. It is also worth noting that whether the hospital has an ethics committee affects the attitude scores, but has no effect on the cognitive scores.Nursing administrators and educators should consider providing effective and targeted strategies (e.g., ongoing training, scholarly seminars, and scholarly exchanges) to enhance nurses' knowledge and competence in clinical research ethics to protect subject rights as well as to ensure the quality of clinical research. [ABSTRACT FROM AUTHOR]

Background: Limbic structures have recently garnered increased attention in Parkinson's disease (PD) research. This study aims to explore changes at the whole-brain level in the structural network, specifically the white matter fibres connecting the thalamus and limbic system, and their correlation with the clinical characteristics of patients with PD. Methods: Between December 2020 and November 2021, we prospectively enrolled 42 patients with PD and healthy controls at the movement disorder centre. All participants underwent diffusion tensor imaging (DTI), 3D T1- weighted imaging (3D-T1WI), and routine brain magnetic resonance imaging on a 3.0 T MR scanner. We employed the tract-based spatial statistical (TBSS) analytic approach, examined structural network properties, and conducted probabilistic fibre tractography to identify alterations in white matter pathways and the topological organisation associated with PD. Results: In patients with PD, significant changes were observed in the fibrous tracts of the prefrontal lobe, corpus callosum, and thalamus. Notably, the fibrous tracts in the prefrontal lobe and corpus callosum showed a moderate negative correlation with the Freezing of Gait Questionnaire (FOG-Q) scores (r = -0.423, p = 0.011). The hippocampus and orbitofrontal gyrus exhibited more fibre bundle parameter changes than other limbic structures. The mean streamline length between the thalamus and the orbitofrontal gyrus demonstrated a moderate negative correlation with Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III (r = -0.435, p = 0.006). Topological parameters, including characteristic path length (Lp), global efficiency (Eg), normalised shortest path length (λ) and nodal local efficiency (Nle), correlated moderately with the MDS-UPDRS, HAMA, MoCA, PDQ-39, and FOG-Q, respectively. Conclusion: DTI is a valuable tool for detecting changes in water molecule dispersion and the topological structure of the brain in patients with PD. The thalamus may play a significant role in the gait abnormalities observed in PD. [ABSTRACT FROM AUTHOR]

Background: Frailty in older people is a rising global health concern; therefore, monitoring prevalence estimates and presenting projections of future frailty are important for healthcare planning. Aim: To present current prevalence estimates of frailty and pre-frailty and future projections according to both dominant frailty models in a large population-based observational study including adults ≥ 70 years in Norway. Methods: In this population-based observational study, we included 9956 participants from the HUNT4 70 + study, conducting assessments at field stations, homes, and nursing homes. Frailty was assessed using Fried criteria and a 35-item frailty index (HUNT4-FI). Inverse probability weighting and calibration using post-stratification weights and aggregated register data for Norway according to age, sex, and education ensured representativeness, and population projection models were used to estimate future prevalence. Results: According to Fried criteria, the current prevalence rates of frailty and pre-frailty in people ≥ 70 years were 10.6% and 41.9%, respectively, and for HUNT4-FI 35.8% and 33.2%, respectively. Compared to previous European estimates we identified higher overall frailty prevalence, but lower prevalence in younger age groups. Projections suggest the number of Norwegian older adults living with frailty will close to double by 2040. Conclusion: Frailty in older people in Norway is more prevalent than previous European estimates, emphasising the imperative for effective interventions aimed to delay and postpone frailty and ensure healthcare system sustainability in an ageing population. Future planning should consider the great heterogeneity in health and functioning within the 70 + population. [ABSTRACT FROM AUTHOR]

Background: Tyrosine-rich amelogenin peptide (TRAP) is the main amelogenin digestion product in the developmental enamel matrix. It has been shown to promote remineralization of demineralized enamel in our previous study. However, direct evidence of the effect of TRAP on the morphology and nanostructure of crystal growth on an enamel surface has not been reported. This study aimed to examine the effect of TRAP on the morphology of calcium phosphate crystals grown on early enamel erosion using a pH-cycling model. Methods: Eroded lesions were produced in human premolars by 30-second immersion in 37% phosphoric acid. Forty-five samples of eroded human premolar enamel blocks were selected and randomly divided into 3 groups: deionized water (DDW, negative control); 100 µg/mL TRAP, and 2 ppm sodium fluoride (NaF, positive control group). For 14 days, the specimens were exposed to a pH-cycling model. Using scanning electron microscopy (SEM) and atomic force microscopy (AFM) methods, the surface morphology, calcium-phosphorus ratio, and enamel surface roughness were examined. X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR) were used to assess crystal characteristics. Results: After pH-cycling, compared to the two control groups, the surface of the eroded enamel of the peptide TRAP group shows a large number of new, densely arranged rod-like crystals, parallel to each other, regularly arranged, forming an ordered structure, with crystal morphology similar to that of natural enamel. The crystals are mostly hydroxyapatite (HA). Conclusion: This study demonstrates that the peptide TRAP modulates the formation of hydroxyapatite in eroded enamel and that the newly formed crystals resemble natural enamel crystals and promote the remineralization of enamel, providing a promising biomaterial for remineralization treatment of enamel lesions. [ABSTRACT FROM AUTHOR]

Introduction: Digital health technologies (DHTs) have the potential to alleviate challenges experienced in clinical trials through more objective, naturalistic, and frequent assessments of functioning. However, implementation of DHTs come with their own challenges, including acceptability and ease of use for study participants. In addition to acceptability, it is also important to understand device proficiency in the general population and within patient populations who may be asked to use DHTs for extended periods of time. We thus aimed to provide an overview of participant feedback on acceptability of DHTs, including body-worn sensors used in the clinic and a mobile application used at-home, used throughout the duration of the Wearable Assessments in the Clinic and at Home in Parkinson's Disease (WATCH-PD) study, an observational, longitudinal study looking at disease progression in early Parkinson's Disease (PD). Methods: 82 participants with PD and 50 control participants were enrolled at 17 sites throughout the United States and followed for 12 months. We assessed participants' general device proficiency at baseline, using the Mobile Device Proficiency Questionnaire (MDPQ). The mean MDPQ score at Baseline did not significantly differ between PD patients and healthy controls (20.6 [2.91] vs 21.5 [2.94], p = .10). Results: Questionnaire results demonstrated that participants had generally positive views on the comfort and use of the digital technologies throughout the duration of the study, regardless of group. Discussion: This is the first study to evaluate patient feedback and impressions of using technology in a longitudinal observational study in early Parkinson's Disease. Results demonstrate device proficiency and acceptability of various DHTs in people with Parkinson's does not differ from that of neurologically healthy older adults, and, overall, participants had a favorable view of the DHTs deployed in the WATCH-PD study. [ABSTRACT FROM AUTHOR]

Background: Simulation-based training courses have been developed and widely accepted.The use of simulators can prevent bitter consequences that may sometimes put human lives in danger. Increasing the skill of nursing students in dealing with trauma patients is of great importance. The aim of this study is to evaluate the effectiveness of the simulation-based trauma training program for the management of trauma patients in nursing students. Method: It is an observational approach that focuses on improving the learning of trauma care skills. For this study, 6th and 8th semester nursing students were selected by appropriate sampling method. Previously, these students completed the trauma training course without simulation. Training of trauma skills was done using multi-purpose trauma mollage And we subsequently analyzed the effectiveness of the trauma simulation training program using the OSCE test. In the inferential statistics section, after examining the data distribution (Kolmogrove-Smirnov and Shapiro-Wilk tests), the Wilcoxon test was used to measure significance. SPSS 22 software was used. Results: The results indicated that the lowest mean score obtained based on a scale of zero to one hundred was for the movement limitation of the injured long bone and the highest was in the skill of oral-nasal intubation and ventilation. The results of the paired t-test showed that clinical skills for dealing with trauma-affected individuals in undergraduate nursingafter simulation training was significantly higher. Conclusion: The implementation of the simulation is accompanied by an increase in the skills of the participants, which leads to the application of the acquired knowledge in real-life scenarios and positive changes. In the learning of the participants, the evaluation of conventional trauma training in Iran, like other countries, shows the need for specialized training through simulation. To ensure the continued effectiveness of simulation-based trauma training courses, it is recommended that administrators and policymakers encourage regular faculty participation in the program. Long term effects of trauma simulators training in nursing student requires further study. Key messages: What is already known about the topic supports simulation-based trauma training as an acceptable style of trauma training.Training with the multi-purpose trauma simulator increases the skills of nurses in managing trauma patients. What is expected is that training with simulated models will change nurses' perspective on the reality of trauma patients. [ABSTRACT FROM AUTHOR]

Background: For patients with sepsis receiving non-invasive ventilation (NIV), early rehabilitation is crucial. The Sitting Baduanjin (SBE) is an efficient early rehabilitation exercise suitable for bed patients. There is no consensus about the effect of SBE on the early rehabilitation of septic patients with NIV. This study focused on how the SBE affected the early rehabilitation of sepsis patients with NIV. Methods: 96 sepsis patients with NIV were randomly assigned to either an Baduanjin group that received the SBE based on the routine rehabilitation exercise (n = 48) or a control group (n = 48) that received routine rehabilitation exercise. The primary outcome was the Medical Research Council(MRC)score, and the Barthel Index score, the duration of NIV, length of ICU stay, length of total stay, hospitalization expense as secondary outcomes. Results: A total of 245 sepsis patients were screened, with 96 randomly assigned. The study was completed by 90 patients out of the 96 participants.Results revealed that the MRC score increased in both groups, but the improvement of muscle strength in Baduanjin group was more obvious, with statistical significance (p < 0.001).There was statistically significantly difference between the two groups in Barthel Index at the day of transfer out of ICU(P = 0.028).The patients in the Baduanjin group had an average reduction of 24.09 h in the duration of NIV and 3.35 days in total length of hospital stay compared with the control group (p < 0.05).Of note, the Baduanjin group had significantly reduction the total hospitalization expense. No serious adverse events occurred during the intervention period. Conclusions: In patients with sepsis, the SBE appears to improve muscle strength and activities of daily living (ADL), and lowed the duration of NIV, the length of the total stay, and the hospitalization expense. Trial registration: The study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR1800015011 (28/02/2018). [ABSTRACT FROM AUTHOR]

Background: The primary objective of anesthesiologists during the induction of anaesthesia is to mitigate the operative stress response resulting from endotracheal intubation. In this prospective, randomized controlled trial, our aim was to assess the feasibility and efficacy of employing Index of Consciousness (IoC, IoC1 and IoC2) monitoring in predicting and mitigating circulatory stress induced by endotracheal intubation for laparoscopic cholecystectomy patients under general anesthesia (GA). Methods: We enrolled one hundred and twenty patients scheduled for laparoscopic cholecystectomy under GA and randomly allocated them to two groups: IoC monitoring guidance (Group T, n = 60) and bispectral index (BIS) monitoring guidance (Group C, n = 60). The primary endpoints included the heart rate (HR) and mean arterial pressure (MAP) of the patients, as well as the rate of change (ROC) at specific time points during the endotracheal intubation period. Secondary outcomes encompassed the systemic vascular resistance index (SVRI), cardiac output index (CI), stroke volume index (SVI), ROC at specific time points, the incidence of adverse events (AEs), and the induction dosage of remifentanil and propofol during the endotracheal intubation period in both groups. Results: The mean (SD) HR at 1 min after intubation under IoC monitoring guidance was significantly lower than that under BIS monitoring guidance (76 (16) beats/min vs. 82 (16) beats/min, P = 0.049, respectively). Similarly, the mean (SD) MAP at 1 min after intubation under IoC monitoring guidance was lower than that under BIS monitoring guidance (90 (20) mmHg vs. 98 (19) mmHg, P = 0.031, respectively). At each time point from 1 to 5 min after intubation, the number of cases with HR ROC of less than 10% in Group T was significantly higher than in Group C (P < 0.05). Furthermore, between 1 and 3 min and at 5 min post-intubation, the number of cases with HR ROC between 20 to 30% or 40% in Group T was significantly lower than that in Group C (P < 0.05). At 1 min post-intubation, the number of cases with MAP ROC of less than 10% in Group T was significantly higher than that in Group C (P < 0.05), and the number of cases with MAP ROC between 10 to 20% in Group T was significantly lower than that in Group C (P < 0.01). Patients in Group T exhibited superior hemodynamic stability during the peri-endotracheal intubation period compared to those in Group C. There were no significant differences in the frequencies of AEs between the two groups (P > 0.05). Conclusion: This promising monitoring technique has the potential to predict the circulatory stress response, thereby reducing the incidence of adverse reactions during the peri-endotracheal intubation period. This technology holds promise for optimizing anesthesia management. Trail registration: Chinese Clinical Trail Registry Identifier: ChiCTR2300070237 (20/04/2022). [ABSTRACT FROM AUTHOR]

Background: The nursing industry's stability and progress are adversely affected by the high attrition rate and shortage of nurses; therefore, it is critical to investigate the variables that influence the professional stability of nurses. The sense of professional mission and career success have positive significance for reducing nurses' job burnout. The purpose of this study is to explore the potential mediating role of psychological resilience in this relationship. Methods: Self-reported questionnaires were utilized by 335 intensive care unit (ICU) nurses to assess their sense of professional mission, psychological resilience, and career success in this cross-sectional study. A structural equation model was developed to validate the relationship between the variables. Results: There is a correlation among sense of professional mission, psychological resilience and career success. Significant mediating effect of psychological resilience exists between sense of professional mission and career success. Conclusions: In this study, psychological resilience plays an intermediary role between sense of professional mission and career success, which provides support for further understanding the mechanism between sense of professional mission and career success and bolstering the case for devising comprehensive intervention strategies for psychological resilience. Nursing managers should focus on nurses' sense of professional mission and psychological resilience, and implement strategies to enhance nurses' psychological resilience in order to boost their career success. [ABSTRACT FROM AUTHOR]

Objective: To investigate in vivo 6-degree-of-freedom (DOF) vertebral motion in patients with isthmic spondylolisthesis (IS) during various functional weight-bearing activities. Methods: Fifteen asymptomatic volunteers (mean age 54.8 years) and fourteen patients with IS at L4-5 (mean age 53.4 years) were recruited. The positions of the vertebrae (L4-L5) in the supine, standing, flexion–extension, left–right twisting and left–right bending positions were determined using previously described CT-based models and dual fluoroscopic imaging techniques. Local coordinate systems were established at the center of the anterior vertebra of L4 isthmic spondylolisthesis (AIS), the posterior lamina of L4 isthmic spondylolisthesis (PIS) and the center of the L5 vertebra to obtain the 6DOF range of motion (ROM) at L4-L5 and the range of motion (ROM) between the AIS and the PIS. Results: The translation along the anteroposterior axis at L4-L5 during flexion–extension, left–right bending and left–right twisting was significantly greater than that of the healthy participants. However, the translation along the mediolateral axis at L4-L5 presented paradoxical motion under different positions: the ROM increased in the supine-standing and flexion–extension positions but decreased in the left–right bending and left–right twisting positions. The separation along the anteroposterior axis during flexion was significantly greater than that during standing, on average, reaching more than 1 mm. The separation along the mediolateral axis during standing, flexion and extension was significantly greater than that in the supine position. Conclusions: This study revealed the occurrence of displacement between the AIS and PIS, primarily in the form of separation during flexion. Symptomatic patients with isthmic spondylolisthesis exhibit intervertebral instability, which might be underestimated by flexion–extension radiographs. [ABSTRACT FROM AUTHOR]

Purpose: A diagnosis of dysphagia and/or depression after stroke can impact the physical, psychological, and social welfare of stroke survivors. Although poststroke depression (PSD) and poststroke dysphagia are known to occur concurrently, there is a paucity of research that has specifically investigated their association. Therefore, we aimed to study the relationship between PSD and poststroke dysphagia during acute inpatient hospitalization and within 90 days after discharge. Furthermore, we aimed to evaluate the odds and hazard of being diagnosed with depression after stroke and estimate the time to depression diagnosis from the initial stroke diagnosis in patients with and without a diagnosis of dysphagia. Method: Using the acute inpatient hospital data set from our previous work, we pulled additional postdischarge administrative claims data from the 2017 Medicare 5% Limited Data Set and conducted a retrospective, cross-sectional study of patients diagnosed with poststroke dysphagia and PSD. Results: Patients diagnosed with poststroke dysphagia had 2.7 higher odds of being diagnosed with PSD and had an approximately 1.75-fold higher hazard for PSD diagnosis in the 90 days after discharge compared to patients not diagnosed with dysphagia. Risk factors for PSD included having dysphagia, being female, and having dual eligibility Conclusions: Our results demonstrated a significant association between PSD and poststroke dysphagia. Additional research should further explore the impact of PSD on poststroke dysphagia. [ABSTRACT FROM AUTHOR]

Background: Bilingual assessment is particularly difficult in the very first period of children's second language (L2) exposure. This exploratory, longitudinal study examined L2 learning after 1 and 2 years of L2 exposure by young immigrants and how it is affected by their age at first exposure to the L2 (AoE). Method: Participants were 18 immigrants ranging in age from 2;11 to 14;2 (years;months), all within their first year in Montreal at Time 1, enrolled in a French school or day care, and from a Mandarin first language background. Participants were tested again a year later. Measures included receptive and expressive French vocabulary tests and conversational language samples analyzed using traditional measures of mean length of utterance (MLU) and morphological accuracy as well as novel measures of semantic and sentence-level patterns. Results: Performance was relatively high already at Time 1 and increased significantly at Time 2 in both vocabulary and MLU. At Time 2, vocabulary scores were below normative values, whereas MLU was within expected values relative to monolingual and simultaneous bilinguals for the majority of the participants. However, higher MLUs were accompanied by more instances of both semantic errors and creative semantic strategies. French performance was strongly related to AoE; with amount of exposure equivalent, older participants outperformed the younger ones on MLU and vocabulary. Semantic errors and creative uses were strongly predicted by AoE; however, morphological accuracy and number of agrammatical utterances were not. Conclusions: This initial period of French learning involved a rapid growth spurt for most of the participants. We argue that the pattern observed, particularly among the older children, constitutes an early stage of L2 learning characterized by long utterances that are also frequently hard to understand as speakers encounter challenges and use creative strategies in their attempt to convey meaning. Comparison with normative reference bases for monolinguals and bilinguals with greater cumulative L2 exposure who have similar MLUs should be done with much caution during this early period. [ABSTRACT FROM AUTHOR]

Frailty is a common condition in older adults that negatively impacts health and quality of life. This study evaluated a comprehensive, personalised, and coordinated intervention under the value-based care approach to address frailty's multidimensional nature in older people in the primary care setting. It employed a pre–post randomised controlled design involving 242 frail individuals aged over 65 years living in the community in Valencia (Spain) between 2021 and 2023. Assessments were conducted at baseline, 12 months (immediately post-intervention), and 18 months. The intervention included a personalised care plan supported by technology, with monthly motivational follow-ups and plan updates by health professionals and participants. Outcomes were measured using an assessment questionnaire that included the International Consortium for Health Outcomes Measurement dataset for the older population: physical health, physical functioning, general mental health, satisfaction with social activities and relationships, ability to carry out usual social roles and activities, pain, general quality of life, loneliness, physical frailty, psychological frailty, and social frailty. The study found significant improvements in physical frailty, quality of life, reduced health resource use and hospitalisations and lower levels of pain and depression/anxiety compared to baseline. The findings suggest further research into value-based care approaches, emphasizing the development and activation of personalised, comprehensive programs for older individuals with frailty. [ABSTRACT FROM AUTHOR]

Background: Attribution models have been examined in Western countries. However, little is known about the applicability of the attitude–emotion–behavior model within Chinese culture. This study aimed to examine the association between familiarity, perceived dangerousness, fear, and social distance towards persons with mental illness (PMI) in the Chinese context. Methods: An online cross-sectional survey was conducted from October to November 2022 in mainland China. A total of 1493 college students completed a questionnaire evaluating familiarity, perception of dangerousness, fear, and social distance regarding PMI. Path analysis was employed to validate the model proposed in this study. Results: Participants expressed moderate to high levels of stigma towards PMI. Familiarity was negatively associated with social distance (p < 0.01). Participants who perceived PMI as dangerous were more prone to exhibit a reaction of fear (p < 0.001), consequently leading to social distance (p < 0.01). However, the mediating effect of perceived dangerousness and fear on the relationship between familiarity and social distance was not significant (p > 0.05). Conclusions: The results of this study provide support for Corrigan's attributional model of stigma in the Chinese context. Contact-based interventions for stigma reduction should emphasize multiple elements of contact, including the quality of contact, rather than familiarity. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate the relationship between Hungarian nursing students’ career choices and nursing professionalism in the context of sex and gender roles. Design: A cross-sectional study. Methods: The study, conducted between March 2023 and June 2023, employed a combination of a self-developed questionnaire and validated measurement instruments (Bem Sex Role Inventory 12 – BSRI-12; Nurse Professional Competence Scale – NPC Scale; 10-item Gender Role Beliefs Scale – GRBS). Statistical analysis was performed using SPSS software. The sample consisted of 252 BSc nursing students in Hungary (53 males, 199 females). Results: It was found that most students surveyed exhibited feminine traits (n = 84) and adhered to traditional gender roles (n = 132). Statistical analysis demonstrated significant associations between nursing students’ gender roles (p = 0.004), adherence to traditional gender roles (p < 0.000), and levels of nursing professionalism. Notably, an androgynous gender role correlated with heightened nursing professionalism (p < 0.001). Additionally, career choice motivations were influenced by sex, gender role, and individual perceptions of gender roles. Conclusion: A diversity of gender roles which influence individuals’ future careers in nursing was identified. Different motivating factors play a role in male and female nursing students’ career choices, knowledge of which would be useful in student recruitment in order to reduce nursing staff shortages. [ABSTRACT FROM AUTHOR]

Autistic youth are more likely to experience depression than their non-autistic peers, yet research on risk and protective factors to depression in this population is limited. Behavioral activation (i.e., prioritizing and engaging in meaningful activities), including social activities, is an important mechanism in the pathway to depression in non-autistic youth that is understudied in autism. Ratings of youth depressive symptoms and behavioral and social activation at one timepoint from 100 autistic youth without intellectual disability and 100 of their caregivers were analyzed. The study aims were to examine caregiver and youth ratings of youth internalizing symptoms and behavioral and social activation, inter-rater reliability on study variables, and associations between depressive symptoms and behavioral and social activation in autistic youth by rater. Results revealed significant differences in youth and caregiver ratings on all variables and inter-rater reliability ranged from poor to moderate. Across both raters, more severe anxiety symptoms and lower behavioral activation were associated with more severe depressive symptoms; social activation, specifically the number of friends youth have, was significant in caregiver ratings only. Findings can be leveraged to enhance risk stratification and intervention efforts for autistic youth experiencing depression. [ABSTRACT FROM AUTHOR]

Introduction: Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis. Methods: All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted. Results: Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management. Conclusion: Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis. [ABSTRACT FROM AUTHOR]

Introduction: It has been suggested that inhibin B (InhB), Anti-Müllerian hormone (Müllerian-inhibiting substance, AMH) levels, and 2D/4D finger length ratios are related to sex differences in neurodevelopmental disorders. The aim of this study is to investigate the role of InhB, AMH levels, and 2D/4D finger length ratios in male children with specific learning disorder (SLD). Methods: The study included 38 male children diagnosed with SLD and 38 males of similar ages without SLD as the control group. Tests used in the evaluation were the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version, Specific learning disorder clinical observation battery, Wechsler Intelligence Scale for Children-Revised (WISC-R), and Conners' Parent Rating Scale-Revised: Short Form. Serum AMH, InhB, and Testosterone levels were measured using an enzyme-linked immunosorbent assay. Results: Male children diagnosed with SLD demonstrated significantly higher levels of serum InhB compared to controls (t= 2.59 p=0.009); both groups had similar levels of serum testosterone and AMH. The 2D/4D finger ratios in the SLD group were found to be lower than those in the control group (t= 2.92 p= 0.005). Serum InhB levels were positively correlated with WISC-R verbal scores (p= 0.003). Conclusion: Our findings suggest that serum InhB levels and the 2D/4D ratio, which is an indicator of prenatal testosterone exposure, may play a role in the male predominance of SLD. [ABSTRACT FROM AUTHOR]

Background: This study compared the concentrations of interleukin (IL)-6, IL-17, and IL-35 in the gingival crevicular fluid of periodontally healthy participants with individuals who had stage III and IV periodontitis. Methods: In total, 60 participants with stage III grade B-C (n = 12)—stage IV grade C (n = 18) periodontitis and 30 healthy controls were included in this cross-sectional study. Full-mouth clinical periodontal measurements were performed. Concentrations of IL-6, IL-17, and IL-35 were determined using enzyme-linked immunosorbent assays. Parametric/nonparametric methods, Pearson's/Spearman's correlation, and logistic regression methods were used for data analyses. Results: The periodontitis group exhibited significantly higher levels of IL-6, IL-17, and IL-35 compared with the healthy group (p < 0.001). IL-17 levels had a positive correlation with pocket depth (PD) (r = 0.395; p = 0.031) in the periodontitis group. IL-6, IL-17, and IL-35 levels were associated with periodontitis (odds ratio [OR] = 1.344, 95% confidence interval [CI] = 1.159–1.56; OR = 1.063, 95% CI = 1.025–1.102; OR = 1.261, 95% CI = 1.110–1.434, respectively) (p < 0.001, p = 0.001, p < 0.001, respectively). Full-mouth and sampling sites PD and clinical attachment loss (CAL) values were significantly higher in the periodontitis group than in the healthy group (p < 0.001). Conclusions: This study revealed upregulated levels of IL-6, IL-17, and IL-35 in periodontitis patients compared to healthy individuals. IL-17 shows a correlation with increased PD. These findings suggest a potential association between these cytokines and severe and advanced periodontitis. Trial registration: The trial was registered in ClinicalTrials.gov with this identifier NCT05306860 on 24/01/2022. [ABSTRACT FROM AUTHOR]

Background: Female nurses with high occupational stress are one of the groups at risk of premenstrual syndrome (PMS). The symptoms of this syndrome may affect the reduction of work efficiency, accuracy in doing work, concentration, and increased absenteeism of nurses and can lead to significant economic losses. This study aimed to determine the predictive role of common PMS symptoms in the clinical performance of nurses in public hospitals in Sanandaj, Iran. Methods: The present study was a descriptive-analytical and cross-sectional study. In this study, 318 nurses participated in the census method based on the inclusion criteria. Data collection tools were premenstrual symptom screening questionnaires and nurses' clinical performance evaluations. Data analysis was done with Spearman's correlation tests, simple linear regression, multiple regression, t-test, one-way variance analysis, Tukey's post hoc tests, and LSD using SPSS version 22 statistical software. Results: The average PMS score of the participants was 30.8 ± 11.45, which indicates severe PMS. Nurses' average clinical performance score was 45.78 ± 35.29, indicating an average performance. The findings showed that PMS has a significant inverse correlation with clinical performance and its components. Simple linear regression showed that PMS can predict 26.5% of nurses' clinical performance variance. Simple regression showed that with an increase of one standard deviation in the PMS score, the nurses' clinical performance score decreased by 0.517 standard deviations and vice versa. However, by controlling confounding variables, with an increase of one standard deviation in the PMS score, the clinical performance score of nurses will decrease by 0.396 standard deviations and vice versa. Conclusions: Paying attention to reducing or controlling PMS symptoms may help improve nurses' performance. Therefore, hospital and nursing managers can improve the performance and efficiency of their workforce by identifying nurses and other employees suffering from PMS and planning and using different methods to reduce its symptoms. [ABSTRACT FROM AUTHOR]

Background: Established evidences have demonstrated that hypertension was associated with the cognitive impairment. But the associations between the duration of hypertension exposure and cognitive performance are still inconclusive. Objectives: The objective of this study was to assess the association between the duration of hypertension diagnosis and cognitive performance in older adults by the National Health and Nutrition Examination Survey (2011–2014). Methods: To evaluate the relationship between the hypertension duration and cognitive performance, we conducted the logistic regression analysis. Furthermore, we also performed the Restricted cubic spline (RCS) analysis to assess the nonlinear relationship between the duration of exposure to hypertension and cognitive performance. Results: Initially, total 19,931 participants were included in this study, and 2928 individuals were enrolled. With the increase of hypertension duration, more risk of cognitive impairment was observed in the Digit Symbol Substitution test (DSST) (OR = 1.012, 1.006–1.019), and a similar trend was observed in Animal Fluency test (AFT) (OR = 1.009,1.003–1.016). The RCS results showed that the hypertension duration pattern was linear associated with the risk of cognitive impairment in DDST (P for non–linearity = 0.758). Meanwhile, subgroups analysis of midlife hypertension, we revealed that linear association with the risk of cognitive impairment in DSST (P for non–linearity = 0.391) and CERAD (P for non–linearity = 0.849) among hypertension diagnose < 55 years populations. Conclusion: Collectively, our finding indicates that longer duration of exposure to hypertension worsens the cognition performance, especially for middle-aged hypertension. [ABSTRACT FROM AUTHOR]

Background: Enhancing the antibacterial properties of polymethyl methacrylate (PMMA) dental resins is crucial in preventing secondary infections following dental procedures. Despite the necessity for such improvement, a universally applicable method for augmenting the antibacterial properties of PMMA without compromising its mechanical properties and cytotoxicity remains elusive. Consequently, this study aims to address the aforementioned challenges by developing and implementing a composite material known as zinc oxide/graphene oxide (ZnO/GO) nanocomposites, to modify the PMMA. Methods: ZnO/GO nanocomposites were successfully synthesized by a one-step procedure and fully characterized by TEM, EDS, FTIR and XRD. Then the physical and mechanical properties of PMMA modified by ZnO/GO nanocomposites were evaluated through water absorption and solubility test, contact angle test, three-point bending tests, and compression test. Furthermore, the biological properties of the modified PMMA were evaluated by direct microscopic colony count method, crystal violet staining and CCK-8. Results: The results revealed that ZnO/GO nanocomposites were successfully constructed. When the concentration of nanocomposites in PMMA was 0.2 wt. %, the flexural strength of the resin was increased by 23.4%, the compressive strength was increased by 31.1%, and the number of bacterial colonies was reduced by 60.33%. Meanwhile, It was found that the aging of the resin did not affect its antibacterial properties, and CCK-8 revealed that the modified PMMA had no cytotoxicity. Conclusion: ZnO/GO nanocomposites effectively improved the antibacterial properties of PMMA. Moreover, the mechanical properties of the resin were improved by adding ZnO/GO nanocomposites at a lower range of concentrations. [ABSTRACT FROM AUTHOR]

Background/Objective: Pain is one of the most common chronic conditions in the US, estimated to affect 20.9% of the population (51.6 million people). We evaluated the Partners Aligned in Transformative Healing (PATH) program at University Medical Center's Comprehensive Pain Program clinic. Feasibility, initial clinical and financial results were assessed to inform payers' support for PATH, an integrative transdisciplinary program within a bundled payment format. Methods: Participants completed a multi-week program including integrative therapies, with empirically validated assessment surveys administered at the beginning and end of the program. Insurance claims data were analyzed 12 months pre- and post-program. Statistical significance of pre-post differences was assessed by paired T-tests with P < 0.05. Results: Between June 2019 and August 2022, 170 individuals enrolled in PATH, 151 (88.8%) completed the program, and 121 participants completed outcome surveys. Participants were predominately White, non-Hispanic (98%), female (76%), with an average age of 49.8. All participant-reported clinical outcomes (PROs) showed statistically significant improvement from baseline to final assessment, and some but not all were clinically significant. PEG subscale of average pain interference, enjoyment of life, and interference with general activity each decreased. The T-scores for the following domains of PROMIS-29 decreased: Pain interference; fatigue; sleep disturbance; anxiety, and depression. The PROMIS-29 domains of overall physical function and social roles and activities mean T-scores increased. Per Member Per Month (PMPM) total cost of care decreased by $462 (18%). Emergency room utilization for all diagnoses decreased by 457 visits/1000 patients (65%), and for pain-related diagnoses by 194 visits/1000 patients (67%) during the observation period. Conclusions: Results suggest that the PATH Program is a feasible and acceptable model that shows initial effectiveness relative to short-term patient-reported clinical outcomes and shows signs of durability in both utilization and financial outcomes at 1 year. The results support continued study including a multi-site RCT. [ABSTRACT FROM AUTHOR]

This study aimed to identify differences among body mass index (BMI) categories of older family caregivers (=60 years) and their care recipients (=65 years). Secondly, this study aimed to examine group differences and factors associated with weight change during a nutrition and oral health intervention. This secondary analysis of a randomized controlled trial (ClinicalTrial.gov (NCT04003493)) involved individually tailored nutritional guidance from a clinical nutritionist and oral health guidance from a dental hygienist. Baseline BMI differences were analyzed, followed by further analyses of group differences and associated factors of weight change over a 6-month period using generalized estimating equations. Among the participants (113 family caregivers and 107 care recipients), 36.3% and 35.1% were overweight (BMI >29 kg/m²), while 18.6% and 21.6% were underweight (BMI <24 kg/m²) at baseline, respectively. For family caregivers differences in BMI categories included age, mid-arm and calf circumferences, and plasma prealbumin concentration. For care recipients differences were observed in medication use, mid-arm and calf circumferences, Mini Nutritional Assessment scores, physical function, and number of teeth. During the 6-month intervention, there were no differences in weight change between intervention and control groups for both caregivers and care recipients. Factors significantly associated (p < 0.05) with weight loss included female sex for both caregivers and care recipients, and frailty for caregivers. Family caregivers' characteristics were not significantly associated with weight change in their care recipients. In conclusion, being overweight is a prevalent among older family caregivers and care recipients. Factors such as age, medication use, physical function, number of teeth, and Mini Nutritional Assessment scores varied across BMI categories. Female sex was associated with weight loss in both older family caregivers and care recipients, and frailty was associated with weight loss in caregivers. However, the characteristics of family caregivers did not explain the weight loss of their care recipients. [ABSTRACT FROM AUTHOR]

Background: Given the significance of motor competence (MC) for healthy development and as a cornerstone for lifelong physical activity (PA), it is crucial to understand the manifold factors that are associated with MC. Thus, the aim of the present study was to investigate correlates of children's MC and their fundamental movement skills (FMS) within their daily life from a comprehensive biopsychosocial-ecological perspective. Methods: This is a cross-sectional sub-study of the 'Physical Literacy for Communities (PL4C)' WAVES cohort study conducted in the West Vancouver School District, Canada. Motor competence was assessed using the PLAYfun tool including overall MC score and five FMS category scores, namely, running, locomotor skills, upper and lower body control and balance skills. By means of structural equation modeling (SEM), direct associationswith MC and with the specific FMS categories addressing physical activity behavior, self-perceived physical literacy, parenting, and school ground design were investigated. Results: A total of 355 children with a mean age of 7.5 years and 111.1 min of MVPA per day participated. The group comprised 51% boys and 47% girls from 14 elementary schools. Most children were at an emerging MC-level (71%), while those at a competent MC-level exhibited significantly more daily minutes of MVPA (123 versus 109, p = 0.001). Additionally, they played outdoors more frequently and engaged in more instructor-led PA. The results revealed that logistical support from parents had not only a direct positive association with overall MC, both for girls and boys, but also with most of the FMS categories. However, the correlates of MC varied between genders and showed different patterns across the five FMS categories. While time spent in sports or coach-/instructor-led physical activities had a significant SEM generated direct effect only for boys' MC and for locomotor, upper body object control and balance, the aesthetic design of the school grounds was only associated with girls' MC and those same three FMS categories. Multivariate SEM could explain 26% of variance for girls' MC and 30% for boys'. Conclusions: This exploratory baseline assessment revealed parental logistical support as an important correlate of MC, irrespective of gender. There were distinct gender patterns across biopsychosocial-ecological correlates influencing MC and FMS. Despite the heterogeneity of the results, our findings indicate a potential role of school ground design in supporting the development of children's MC, especially for girls. Key Points: • The influence of biopsychosocial-ecological correlates on motor competence (MC) varied based on gender and the specific fundamental movement skill (FMS) categories. • While parental logistical support demonstrated a positive direct association with both genders' MC and most of the FMS categories, coach-led physical activities appeared to enhance only boys'. • The positive direct association of outdoor play on boys' MC and of school ground aesthetics on girls' MC might suggest the role of the physical environment in MC development. [ABSTRACT FROM AUTHOR]

Clostridioides difficile infection (CDI) is a major cause of antibiotic-associated diarrhea and colitis. It is recognized as one of the most significant hospital-acquired infections. Although CDI can develop severe complications and spores of Clostridioides difficile can be transmitted by the fecal-oral route, CDI is occasionally overlooked in clinical settings. Thus, it is necessary to monitor high CDI risk groups, particularly those undergoing antibiotic treatment, to prevent complications and spread. We developed and validated a deep learning-based model to predict the occurrence of CDI within 28 days after starting antibiotic treatment using longitudinal electronic health records. For each patient, timelines of vital signs and laboratory tests with a 35-day monitoring period and a patient information vector consisting of age, sex, comorbidities, and medications were constructed. Our model achieved the prediction performance with an area under the receiver operating characteristic curve of 0.952 (95% CI: 0.932–0.973) in internal validation and 0.972 (95% CI: 0.968–0.975) in external validation. Platelet count and body temperature emerged as the most important features. The risk score, the output value of the model, exhibited a consistent increase in the CDI group, while the risk score in the non-CDI group either maintained its initial value or decreased. Using our CDI prediction model, high-risk patients requiring symptom monitoring can be identified. This could help reduce the underdiagnosis of CDI, thereby decreasing transmission and preventing complications. [ABSTRACT FROM AUTHOR]

Background. Nursing professionals are pivotal in coordinating care and incorporating quality and safety strategies to enhance patient outcomes. Therefore, nursing education is paramount in preparing nurses to deliver safe care. Aim. In this study, we aimed to explore the self‐reported patient safety competence acquired by undergraduate nursing students in classroom and clinical settings and to compare their perceptions of how broader patient safety issues are addressed in their programmes. Methods. We conducted a cross‐sectional study in a public university in London, United Kingdom, and included Bachelor of Science nursing students from all fields of nursing and Nursing Associate students (n = 250, response rate 21.3%). Students completed the Health Professional Education Patient Safety Survey (H‐PEPSS). Paired t‐tests examined the differences in learning (classroom versus clinical setting). Analysis of variance was used to explore differences in self‐reported patient safety competencies across programmes and to compare students' perceptions of how broader patient safety issues are addressed in their curricula. Results. Mean domain scores indicate high confidence levels in patient safety competence for learning gained in both classroom and clinical settings for all students (>4.0/5.0). Results also indicate a consensus among students from various programmes that broader patient safety issues are adequately addressed in the curricula. Self‐reported confidence was highest in respondents enrolled in the Nursing Associate programme and students with prior experience in a clinical setting. Students were confident about their learnings of patient safety in their educational programmes. Conclusions. Greater patient safety competence indicates comprehension and familiarity with knowledge boundaries, which in turn acknowledges the limitations of autonomous practice. Our findings underscore the need for targeted educational interventions to enhance specific areas of patient safety competence and emphasise the shared responsibility of educators in fostering a culture of safety within healthcare. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic resulted in unprecedented changes to cancer care in many countries, impacting cancer patients' lives in numerous ways. This study examines the impact of changes in cancer care on patient's health-related quality of life (HRQL), which is a key outcome in cancer care. The study aims to estimate patients' self-reported HRQL before and during the pandemic and identify predictive factors for their physical and mental wellbeing. Method: The study employed the large-scale Outpatient Cancer Care (OCC) Patient Experience Survey, including the Veterans RAND 12-Item Health Survey, to evaluate cancer patients' experiences and HRQL before (January to May 2020) and during the COVID-19 pandemic (May to July 2021). Paired t-tests were conducted to compare differences in Physical Component Scores (PCS) and Mental Component Scores (MCS) before and during the pandemic. Multivariable linear regressions were employed to investigate the factors (sociodemographic, clinical, and patient-reported experience) influencing PCS and MCS during the pandemic. Results: PCS decreased significantly during the pandemic, while MCS remained stable. Lower PCS contributors included older age, more telehealth visits, self-reported hospitalization, and a longer time since the last cancer diagnosis. Higher PCS was associated with urban residence, higher MCS during the pandemic, and perceived active Healthcare Provider (HCP) involvement. For MCS, lower scores related to female gender and more telehealth visits, while higher scores were associated with being white, higher education, high MCS before the pandemic, and perceived active HCP involvement. Conclusion: The OCC Patient Experience Survey provides a unique patient level data set measuring HRQL pre- and post- the onset of the COVID-19 pandemic. The study highlights challenges faced by cancer patients during the pandemic, with a significant reduction in PCS. However, the stability in MCS suggests effective coping mechanisms. Sociodemographic, clinical, and telehealth-related variables play a complex role in shaping both PCS and MCS. Perceived HCP involvement emerges as a crucial factor correlating with higher PCS and MCS. Navigating the post-pandemic era necessitates interventions fortifying patient-provider relationships, optimizing healthcare support systems, such as telehealth services, and prioritizing mental-well-being given its impact on both PCS and MCS. Plain English summary: This study delves into the impact of changes in cancer care and COVID-19 measures on the well-being of cancer patients. As cancer care shifted during the pandemic, we aimed to understand how it affected patients' quality of life. The study discovered that physical well-being significantly decreased, especially for older patients with more telehealth visits, while mental well-being remained stable, indicating effective coping strategies. Factors like the number of telehealth visits, healthcare provider engagement, and pre-pandemic mental health status played pivotal roles in shaping the mental and physical well-being of cancer patients during the COVID-19 pandemic. This study emphasizes the challenges faced by cancer patients during the pandemic and highlights the importance of supportive interventions for patient-provider relationships and prioritizing mental-wellbeing in the post-pandemic era. [ABSTRACT FROM AUTHOR]