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Purpose: To investigate whether genetic variations in cytokine genes involved in the pathogenesis of peri-implantitis are associated with the occurrence of peri-implantitis, an issue that remains controversial and may vary according to the population evaluated. Materials and Methods: A cross-sectional analytical study was carried out on 102 Caucasian Portuguese individuals who were divided into two groups: (1) 43 individuals with peri-implantitis and (2) 59 individuals with good peri-implant health. Samples from the buccal mucosa were obtained, and genetic analysis was performed using the real-time polymerase chain reaction (PCR) technique for IL-1A and IL-1B and PCR for IL-1RN. Results: The IL-1A-889 C/T polymorphism presented with a higher prevalence of the less common allele (T allele) in patients with peri-implantitis (27.9%) than in healthy patients (16.9%), but without statistical significance (P = .060). For the IL-1B+3954 C/T and IL-1RN (variable number of tandem repeats [VNTR]) polymorphisms, analysis revealed that the allele and genotype frequencies did not differ significantly between groups. There was a significant association between a history of periodontitis and peri-implantitis (P = .020). Conclusions: The evaluated genetic polymorphisms had no influence on the occurrence of peri-implantitis in the study population. Further research into genetic variations in different populations is needed to elucidate the role of genetic factors in the onset and progression of peri-implant disease. [ABSTRACT FROM AUTHOR]

Driving posture can lead to musculoskeletal pain. Most work focuses on the lower back; therefore, we know little about automobile seat design and neck posture. This study evaluated an automobile driver seat that individualized upper back support to improve head and neck posture. Specifically, we examined the system's impact on anterior head translation with secondary outcomes of spine posture and perceptions of comfort/well-being compared with a control. Forty participants were block randomized to experience either the activated or deactivated version of the same seating system first. Participants completed two 30-minute simulated driving trials, separated by washout, with continuous measures of anterior head translation, spine posture, and pelvis orientation. Perceptions of comfort/well-being were assessed by survey and open-ended questions immediately following each condition. Small, but statistically significant decreases in anterior head translation and posterior pelvic tilt occurred with the activated seat system. Participants reported lower satisfaction with the activated seat system. Order of the 2 seat conditions affected differences in pelvis orientation and participant perceptions of comfort/well-being. An anthropometric-based seat system targeting upper back support can significantly affect head and pelvic posture but not satisfaction during simulated driving. Future work should examine long-term impacts of these posture changes on health outcomes. [ABSTRACT FROM AUTHOR]

This study sought to determine the effectiveness of utilizing game-based strategies in learning mathematics in the junior school specifically grade 10 students. In this study, embedded mixed methods research design was used to gather both quantitative and qualitative data from the participants in which the second served as supporting data to supplement the first. The results of the study revealed that game-based strategies provided a strong influence in maximizing learning mathematics and retention was also evident in the result of students' test performance allowing them to recall concepts learned and skillfully solve problems from the different activities they experienced with the use of the game-based strategies. Moreover, the participants shared meaningful experiences learning mathematics after the intervention. With the use of such strategies, they were able to recognize how lessons were discussed in a different manner with full of insights and realization that learning can be both engaging and rewarding. Moreover, the test performance result analyzed using mean showed an increasing average score indicating that the participants could still recall how to solve mathematical problems which took place after the intervention was utilized. Furthermore, results in the inferential statistics analyzed using Repeated Measures ANOVA also revealed that there were significant differences in the pretest, post-test, and retention test of the participants specifically majority on pretest and post-test, and pretest and retention test using post-hoc analysis. These results imply that with constant practice of utilizing teaching strategies like integrating games in class, it can improve learning outcomes, increase engagement, provide short-term retention, and promote pedagogical innovation. In education, these long-term knowledge and skills in mathematics will lead to higher test performance while aligning the 21st century skills essential in the success of teaching and learning. [ABSTRACT FROM AUTHOR]

Background: Occupational stress is a significant challenge for healthcare systems worldwide. It compromises the quality of healthcare and jeopardizes patient safety. Globally, the estimated economic impact of occupational stress in the healthcare system ranges from US $221.13 million to US $187 billion. Emotional intelligence has been recognized as a behavioral buffer against occupational stress. Hence, this study investigated whether nurses' perceptions of emotional intelligence impact their self‐perceived occupational stress. Design: A predictive correlational design was utilized. Method: A prior power analysis using G ∗ Power 3.1 was conducted. A convenience sample of 734 nurses was recruited from Taif Health Cluster. Data were coded and analyzed using IBM® SPSS® Statistics for Windows v.25. Descriptive and inferential statistics were used. A hierarchical regression technique was used. The level of significance was established at p < 0.05. The process of data collection started at August 2022 and continued through October 2022. Results: The results indicated that nurses' age and working area predicted occupational stress perceptions in the first model (β = −0.28 and β = 0.21, p = 0.001, respectively). The second model showed a significant improvement (ΔF(7,727) = 162.35, p < 0.000, ΔR2 = 0.226) and indicated a negative correlation between nurses' perceptions of emotional intelligence and occupational stress (β = −0.45, t = −12.8, p < 0.000). The nurses' sociodemographic characteristics in the first model explained 2.4% of the variance. The second model represented 25.0% of the variance when nurses' emotional intelligence perception was included. Conclusion: Our study shows a novel framework that indicates a positive perceived effect of emotional intelligence on nurses' perceptions of occupational stress in Saudi Arabia. Our findings propose that emotional intelligence is a significantly effective mechanism against occupational stress. [ABSTRACT FROM AUTHOR]

The success of digital learning initiatives is heavily dependent on teachers' ability to use digital tools, create pedagogically effective learning experiences, and master their subject matter. This study used a quantitative research approach with a descriptive survey design to investigate the role of teachers' competence as a predictor of their readiness for digital learning. The study included 208 randomly selected college teachers. The study made use of a 30-item self-made questionnaire. Content validity was ensured through evaluations by the experts, and feedback was incorporated into the final instrument. A pilot test with 30 participants resulted in acceptable internal consistency. The data were analyzed with both descriptive and inferential statistics. The findings revealed a significant and strong level of competence and readiness for digital learning among educators. Consistently high mean scores across various competencies indicate uniform proficiency in integrating digital tools into teaching. Additionally, the analysis showed strong, statistically significant positive relationships between various dimensions of competence and readiness for digital learning, with high correlation coefficients and a predictive power coefficient. This emphasizes the importance of teachers' competence in their readiness for digital learning. [ABSTRACT FROM AUTHOR]

Purpose.: Plantar fasciitis is the most frequent cause of heel pain. Custom-made plantar supports are a common treatment solution, while the application of kinesiology tape (KT) can be an effective measure to alleviate pain. The objective was to evaluate the effects of KT on the pain of patients with plantar fasciitis. Methods.: Randomized controlled trial including participants with plantar fasciitis. There was an experimental group (n = 17), whose participants underwent a KT treatment, and a control (sham tape) group (n = 17). The pain, measured with a visual analog scale (VAS), was the primary outcome and was assessed daily until the fifth day of wearing the tape and 24 h after removing it. Inferential statistics looked for time, group, and time per group differences with CI at 95%. Results.: The greatest between-group VAS difference was 3.5 points, and occurred at the 2-day follow-up assessment. Then, pain differences decreased over time until the last assessment point. Statistically significant time, group, and time*group differences were found with p < 0.001. Conclusion.: This study supports that KT is effective in reducing pain in the short term in patients with plantar fasciitis, and more effective than a sham intervention with tape. IMPLICATIONS FOR REHABILITATION: Kinesiology tape (KT) reduces pain in patients with plantar fasciitis. Pain is reduced from the first day and the tape can be worn up to five days. KT is an effective solution prior to the application of orthopaedic treatment. [ABSTRACT FROM AUTHOR]

Background: The study aims to assess the situational judgment capability of students in various professions, including medicine, surgical nursing, anesthesia nursing, and emergency medical technology, using a validated and adapted Situational Judgment Test (SJT). Methods: The cross-sectional study was conducted at Qom University of Medical Sciences in 2023–2024. The study consisted of two steps: (1) adaptation and validity assessment of the SJT in various health professions, and (2) evaluation of students' situational judgment capability using the adapted SJT. Participants included 207 students from surgical nursing, anesthesia nursing, medicine, and emergency medical technology departments, selected through stratified random sampling. The SJT included 10 constructed-response scenarios developed by Alkhuzaee and colleagues in 2022. The validation and adaptation process utilized consensus methods, and the SJT was modified to a selected response format based on a knowledge-based approach. Scores ranged from 0 to 30. Cohen's method and norm-referencing standard deviation were used to calculate a cut-off score. Data were analyzed using descriptive statistics (frequency, mean, standard deviation) and inferential statistics (independent t-test, ANOVA, and ANCOVA). Results: The face and content validity of the adapted SJT with a selected-response format was confirmed by expert agreement. The reliability of the SJT was approved, with a Cronbach's Alpha of 0.81. The mean score of students' situational judgment in professionalism was 11.90 (SD 4.54). Students' professions significantly impacted their situational judgment scores (F (3.201) = 3.67, p = 0.01, Partial Eta Squared = 0.052). Conclusion: The adaption and validation of SJT with a selected response format were confirmed by experts who evaluated the situational judgment capabilities of students in different clinical professions. The reliability of the SJT was acceptable—Cohen's method as a standard-setting approach assisted in identifying students needing support and training. The moderate level of situational judgment capacity confirmed the development of the educational program for the improvement of non-cognitive and non-technical skills such as judgment and decision-making in the field of professionalism. [ABSTRACT FROM AUTHOR]

Introduction: The mental health of populations is usually affected after a disaster event. However, it is not known what the level of mental health of Chinese population 1 year after COVID-19, nor what factors influence it. Aim: This study aimed to examine the mental health status of general population in Chengdu 1 year after COVID-19, and then analyse influencing factors. Method: This study is a cross-sectional survey based on the SCL-90 questionnaire. Continuous data were described as M and SD, and counting data were described as frequencies(n) and percentages (%). Chi-square test or Fisher's exact test were used for statistical inference, and significance variables were included in the binary logistic regression equation for multivariate analysis. Results: There were 172 participants with positive screening results. Age, marital status, number of kids, self-perceived health and the presence of chronic disease had an effect on screening results. Logistic regression analysis showed that age and self-perceived health were the main influencing factors. Discussion: Young people aged 18–19 and those who consider themselves not very healthy were at higher risk of poor mental health 1 year after the COVID-19 outbreak. Impact statement: Community institutions and community workers should focus on the mental health status of people 1 year after COVID-19, with a focus on people with poor self-perceived health and younger age groups, and take early preventive measures. [ABSTRACT FROM AUTHOR]

Introduction: The United Arab Emirates is among the countries affected by substance use disorders (SUDs), which have economic and social impacts. Relapse after successful rehabilitation is a major issue in the treatment of SUD. Several factors increase the risk of relapse in patients with SUD, such as craving and negative social experiences. Resilience could empower patients struggling with SUD. This study aims to explore levels of resilience and relapse risk in adult Emirati patients diagnosed with SUD, and also the possible correlation between the two variables. Methods: Two hundred eighty-six Emirati adult patients with SUD completed a self-administered questionnaire for demographics, resilience (Connor and Davidson Resilience Scale), and relapse risk (Stimulant Relapse Risk Scale). Descriptive statistics (frequency, percentage, mean, SD, etc.) were used to describe study participants and variables. Inferential statistics were used to analyze the relationships, associations, and correlations between resilience and relapse risk, the main variables, and the participants demographics. Result: Participants' mean total score for resilience was 72.92 out of a maximum possible score of 100 (SD = 16.99), while their mean total score for relapse risk was 59.07 out of a maximum possible score of 105 (SD = 12.23). Furthermore, examining the correlation between the resilience subscales and the relapse risk subscales revealed similar significant, negative, low-to-moderate correlations between all the subscales (r = -0.486). Discussion: Protective and risk factors to enhance resilience and reduce relapse risk in patients with SUD were discussed. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypothermia is a worldwide problem that can lead to a high impact on neonatal health outcomes if appropriate thermal care measures are not implemented. Tackling neonatal hypothermia from the time of delivery with appropriate thermal care measures will increase neonatal survival and decrease complications related to hypothermia. Objective: The study aims to determine the predictors of neonatal hypothermia within six hours of birth and explore its preventive practices among postnatal mothers. Methods: This is a mixed-method sequential explanatory study. The first phase will be a quantitative study with a hospital-based analytical cross-sectional design. 325 neonates and their mothers will be randomly selected through a 4-stage sampling technique. The data will be collected using a structured questionnaire, checklist and documentary review. Descriptive and inferential statistics will be used to analyse the data. The second phase will be a descriptive qualitative study involving postnatal mothers who participated in a quantitative study. The data will be collected via in-depth interviews, and thematic analysis will be used to analyse the data. The findings of quantitative and qualitative studies will be triangulated in the discussion. Discussion: This study will provide a wide understanding of neonatal hypothermia in the region which will help healthcare providers who are caring for neonates to be informed about the current situation, evaluate the care they provide, and find the best way to adhere to thermal care measures. Moreover, the practices of postnatal mothers will be known, which will help to develop tailored interactions to address this problem. [ABSTRACT FROM AUTHOR]

Background: Evaluating emergency room nurses' knowledge of radiation protection, health effects, and decontamination procedures is crucial for preparedness in nuclear and radiological emergencies. This study aims to evaluate the level of knowledge among emergency nurses in Saudi Arabia regarding medical responses to nuclear and radiological emergencies. Methods: A multicenter cross-sectional study was conducted via a self-structured questionnaire with 15 true‒false questions divided into three domains, namely, radiation protection measures, radiation health effects, and decontamination procedures, each with five items and a possible score of 1 point per correct answer. The collected data were analyzed via descriptive and inferential statistics. The study followed the STROBE checklist for methodological rigor. Results: A total of 594 emergency nurses participated in this study, with the majority being young (64.50% aged ≤ 30), female (68.69%), bachelor's degree-holding (67.68%), single (63.64%), having ≤ 4 years of experience (56.06%), working in public health facilities (88.89%), and lacking training in medical response (85.35%). The mean knowledge scores for participants were highest for radiation exposure effects (3.27 ± 0.91), followed by radiation protective measures (2.32 ± 0.99), and lowest for decontamination procedures (1.46 ± 1.07). Overall knowledge was measured at a mean score of 7.06 ± 1.68, with 97.47% of the nurses categorized as having poor knowledge level. Nurses in private hospitals scored higher (7.77 ± 1.82) than those in public hospitals (6.97 ± 1.65) on overall mean knowledge (P = 0.034). Concerning findings include emergency nurses' misconceptions about the protection provided by dense materials, the effectiveness of increasing distance from a radiation source, and prioritizing decontamination of victims over life-saving measures. Additionally, they were unaware of the immediate symptoms following radiation exposure and misunderstood that the primary threat in a radioactive bomb event is the explosion rather than the radiation itself. Conclusion: This study revealed poor knowledge among emergency nurses regarding medical responses to radiation emergencies and highlighted the critical need for enhanced and standardized training in radiation emergency preparedness among nurses. The gaps in knowledge identified in this study could significantly impact the effectiveness of healthcare responses in radiation emergency scenarios. Therefore, targeted educational interventions and policy changes are recommended to address these shortcomings. [ABSTRACT FROM AUTHOR]

Background: Regional anesthesia (RA) can improve patient outcomes and reduce perioperative complications including deaths. Despite its benefits, RA is less utilised in low-resource settings. The purpose of this study was to assess practice and challenges related to RA in Amhara Regional Hospitals, Northwest-Ethiopia. Methods: A web- based survey was distributed among 360 anesthetists working in Amhara Regional Hospitals, Northwest-Ethiopia from November 15 - January 30, 2023. An English, semi-structure, self-administered questionnaire was disseminated by email and telegram following ethical clearance. The survey included questions about the use of RA, socio-demographic characteristics of anesthetist, types of practiced regional blocks, and barriers to perform RA. All volunteer respondents who filled online questionnaire during study period were included. The data were coded and analyzed using statistical package for social Sciences (SPSS) software-version 20. Both inferential and descriptive statistics were used to describe the results. Results: The overall response rate was 63.3% (223 out of 360 completed surveys). A total of 132 respondents (36.7%) did not provide a response, and 5 respondents (1.4%) submitted incomplete) surveys. The most frequently self-reported barriers to performing peripheral nerve blocks were a lack of equipment (regional procedure kit including block needle, ultrasound, nerve stimulator, or epidural set) 185 (82.9%), lack of knowledge 171(76.7%), lack of practical skills 112 (50.2%), and lack of drugs/medication 50 (22.4%). Conclusions: The principal findings indicate that all respondents perform spinal anaesthesia, while the practice of peripheral RA varies. Reported barriers to performing RA are related to knowledge and training, as well as a lack of equipment (there aren't enough regional procedure kits available that include an epidural set, block needle, nerve stimulator, and ultrasound). A more stringent approach with specific requirements, distinguishing between neuraxial and peripheral blocks, enhance training opportunities for peripheral nerve blocks are required in Ethiopia. [ABSTRACT FROM AUTHOR]

Introduction: Over the past decade, collagen peptide (CP) supplements have received considerable attention in sports nutrition research. These supplements have shown promising results in improving personal health, enhancing athletic performance, and preventing injuries in some but not all studies. Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) has been conducted to investigate the effects of long-term daily collagen peptide (CP) supplementation on strength, musculotendinous adaptation, functional recovery, and body composition in healthy adults, both with and without concurrent exercise interventions over several weeks. Methods: The PRISMA with PERSiST guidelines were followed for this systematic literature review, which was conducted in December 2023 using PubMed, Scopus, CINAHL, and SPORTDiscus databases. Eligible studies included healthy, normal to overweight adults over 17 years of age who engaged in exercise and daily collagen peptide (CP) supplementation for a minimum of 8 weeks (except one 3-week trial only included for maximal strength). Studies examining recovery-related outcomes were also eligible if they included a 1-week supplementation period without exercise. Methodological study quality was assessed using the PEDro scale. A random-effects model with standardized mean differences (SMD) of change scores was chosen to calculate overall effect sizes. Results: Nineteen studies comprising 768 participants were included in both the systematic review and meta-analysis. Results indicate statistically significant effects in favor of long-term CP intake regarding fat-free mass (FFM) (SMD 0.48, p < 0.01), tendon morphology (SMD 0.67, p < 0.01), muscle architecture (SMD 0.39, p < 0.01), maximal strength (SMD 0.19, p < 0.01), and 48 h recovery in reactive strength following exercise-induced muscle damage (SMD 0.43, p = 0.045). The GRADE approach revealed a moderate certainty of evidence for body composition, a very low certainty for tendon morphology and mechanical properties, and a low certainty for the remaining. Conclusion: This systematic review and meta-analysis represents the first comprehensive investigation into the effects of long-term CP supplementation combined with regular physical training on various aspects of musculoskeletal health in adults. The findings indicate significant, though of low to moderate certainty, evidence of improvements in fat-free mass (FFM), tendon morphology, muscle mass, maximal strength, and recovery in reactive strength following exercise-induced muscle damage. However, further research is required to fully understand the mechanisms underlying these effects, particularly regarding tendon mechanical properties and short-term adaptations to collagen peptide (CP) intake without exercise, as observed in recovery outcomes. Overall, CP supplementation appears promising as a beneficial adjunct to physical training for enhancing musculoskeletal performance in adults. Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/WCF4Y). [ABSTRACT FROM AUTHOR]

This mixed-methods study explores the incidence, manifestations, and drivers of secondary traumatic stress among service providers who work with Syrian refugees in Istanbul, Turkey. A survey of 104 social workers and other providers working in 17 public and civil society agencies in Istanbul in 2018 demonstrates that 54.81% had Secondary Traumatic Stress Scale scores indicating mild to severe secondary traumatic stress. In total, 28 qualitative interviews showed manifestations and possible drivers of secondary traumatic stress including weak supervision, heavy caseloads, and insecure working conditions. The findings suggest supervision and peer-support should be strengthened to address secondary traumatic stress among providers serving refugees. [ABSTRACT FROM AUTHOR]

Objective: To understand how students are coping one year after campuses were closed due to the COVID-19 pandemic. Participants: Students at a large state university in Midwestern USA. Method: Sequential mixed method study. A photo-survey of students' experiences was conducted as part of an ethnographic study of "college life." Student researchers and faculty collaboratively analyzed photos and accompanying text for coping strategies. Association of coping strategies with respondents' characteristics was assessed with inferential statistics. Results: Most respondents alluded to the negative mental toll of the pandemic and predominantly utilized emotion-focused coping strategies. Non-binary students and students who lived off but close to campus appeared to have fewer coping strategies than their peers. Conclusion: The experiences of diverse student sub-populations differ. Photos give researchers a unique vista into students' experiences. Students – as co-researchers – can help campuses understand the stresses associated with their college experiences and how they are coping. [ABSTRACT FROM AUTHOR]

Objective: To assess differences in internalized stigma of mental illness based on demographic characteristics and mental healthcare utilization among college students. Participants: Students with self-reported mental illness (n = 128) were recruited via random sampling. Methods: Participants completed an online survey, including questions related to demographic characteristics and mental healthcare utilization. The survey also included the Internalized Stigma of Mental Illness (ISMI) scale. Data were analyzed using descriptive and inferential statistics. Results: Students accessing mental healthcare (pharmacological and/or psychotherapeutic) reported higher ISMI scores than students who did not access services during past year. Students with sexual minority statuses also reported higher ISMI scores than their heterosexual counterparts. Conclusions: Results highlight differences in internalized stigma based on demographics characteristics and mental healthcare utilization among college students. More research is needed to better understand intersectional stigma. Further, universities need tailored and specific interventions to address internalized stigma among students with diverse backgrounds and needs. [ABSTRACT FROM AUTHOR]

Introduction: Older adults are at high risk of adverse health outcomes in the post–emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribute to these outcomes. To identify discharge comprehension gaps amenable to future interventions, we utilize meta‐analysis to determine patient comprehension across five domains of discharge instructions: diagnosis, medications, self‐care, routine follow‐up, and return precautions. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, two reviewers sourced evidence from databases including Medline (PubMed), EMBASE, Web of Science, CINAHL, and Google Scholar (for gray literature). Publications or preprints appearing before April 2024 were included if they focused on geriatric ED discharge instructions and reported a proportion of patients with comprehension of at least one of five predefined discharge components. Meta‐analysis of eligible studies for each component was executed using random‐effects modeling to describe the proportion of geriatric ED cases understanding the discharge instructions; where appropriate we calculated pooled estimates, reported as percentages with 95% confidence interval (CI). Results: Of initial records returned (N = 2898), exclusions based on title or abstract assessment left 51 studies for full‐text review; of these, seven constituted the study set. Acceptable heterogeneity and absence of indication of publication bias supported pooled estimates for proportions comprehending instructions on medications (41%, 95% CI 31%–50%, I2 = 43%), self‐care (81%, 95% CI 76%–85%, I2 = 43%), and routine follow‐up (76%, 95% CI 72%–79%, I2 = 25%). Key findings included marked heterogeneity with respect to comprehending two discharge parameters: diagnosis (I2 = 73%) and return precautions (I2 = 95%). Conclusions: Older patients discharged from the ED had greater comprehension of self‐care and follow‐up instructions than about their medications. These findings suggest that medication instructions may be a priority domain for future interventions. [ABSTRACT FROM AUTHOR]

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We consider the problem of estimating a low-dimensional parameter in high-dimensional linear regression. Constructing an approximately unbiased estimate of the parameter of interest is a crucial step towards performing statistical inference. Several authors suggest to orthogonalize both the variable of interest and the outcome with respect to the nuisance variables, and then regress the residual outcome with respect to the residual variable. This is possible if the covariance structure of the regressors is perfectly known, or is sufficiently structured that it can be estimated accurately from data (e.g. the precision matrix is sufficiently sparse). Here we consider a regime in which the covariate model can only be estimated inaccurately, and hence existing debiasing approaches are not guaranteed to work. We propose the correlation adjusted debiased Lasso , which nearly eliminates this bias in some cases, including cases in which the estimation errors are neither negligible nor orthogonal. [ABSTRACT FROM AUTHOR]

A geometric representation for multivariate extremes, based on the shapes of scaled sample clouds in light-tailed margins and their so-called limit sets, has recently been shown to connect several existing extremal dependence concepts. However, these results are purely probabilistic, and the geometric approach itself has not been fully exploited for statistical inference. We outline a method for parametric estimation of the limit set shape, which includes a useful non-/semi-parametric estimate as a pre-processing step. More fundamentally, our approach provides a new class of asymptotically motivated statistical models for the tails of multivariate distributions, and such models can accommodate any combination of simultaneous or non-simultaneous extremes through appropriate parametric forms for the limit set shape. Extrapolation further into the tail of the distribution is possible via simulation from the fitted model. A simulation study confirms that our methodology is very competitive with existing approaches and can successfully allow estimation of small probabilities in regions where other methods struggle. We apply the methodology to two environmental datasets, with diagnostics demonstrating a good fit. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the dyadic dynamics of benefit finding, stigma, and suicide risk on the depression severity of individuals with schizophrenia and their caregivers. Methods: We prospectively recruited a total of 72 individuals with schizophrenia and 72 caregivers of individuals with schizophrenia from a medical center in Taiwan between August 2022 and July 2023. Patients with schizophrenia and their caregivers were assessed using the Taiwanese Depression Questionnaire, Benefit Finding Scale, Explanatory Model Interview Catalogue, Suicide Assessment Scale, and Mini International Neuropsychiatric Interview. Results: The most prevalent psychiatric diagnoses in the caregivers were depressive disorders (29.2%). Using structural equation modeling, we found that patients' suicidal risk (β = 0.45, p < 0.001) may contribute to the severity of depression in individuals with schizophrenia. We also found that caregivers' BF degree (β = −0.25, p < 0.01) and suicidal risk (β = 0.64, p < 0.001) may contribute to the severity of depression in the caregivers of individuals with schizophrenia. Furthermore, we found that caregivers' suicidal risk (β = 0.28, p < 0.05) and caregivers' stigma (β = −0.31, p < 0.01) level may contribute to the severity of depression in individuals with schizophrenia. Discussion: Clinicians should actively manage caregivers' stigma and provide positive reinforcement for caregivers' BF, as this may help reduce depression in both caregivers and individuals with schizophrenia. Additionally, assessing suicide risk in both groups is essential for preventing suicides among individuals with schizophrenia and caregivers alike. [ABSTRACT FROM AUTHOR]

Background: Pregnancy termination (PT) is a major public health concern in low-and middle-income countries like Bangladesh. This cross-sectional study aimed to determine the prevalence and factors of PT using the nationally representative Bangladesh Demographic and Health Survey data 2017–2018. Materials and Methods: A weighted population-based sample of 8759 ever-married reproductive-aged women (15–49 years) was included in the study. The outcome variable was PT in any of the following forms: miscarriage, induced abortion, and stillbirth. A univariate analysis for mean, frequency, and percentage and multiple logistical regression were used to determine the factors associated with PT. Results: Around 18% of the women were found to have PT. The mean age of the women in the study was 25.79 years; 65.1% lived in the rural areas, and the majority of them were Muslims. Advanced age of the women (AOR:3.49, p = 0.004), residence in the countryside (AOR:0.81, p = 0.002), higher education (AOR:0.72, p = 0.027), not being a Muslim (AOR:0.74, p = 0.010), higher socio-economic status (AOR:1.28, p = 0.027), having a job (AOR:1.15, p = 0.041), being married at the age of >22 years (AOR:0.71, p = 0.036), and using a mobile phone (AOR:1.22, p = 0.002) were significant factors of PT. This study did not find any association between PT and contraceptive use. Conclusions: Age, living region, education, religion, wealth index, working status, marital age, and mobile phone use are the determinants of PT. Interventions including these factors need to be made to reduce PT in Bangladeshi women. These findings could be helpful in undertaking further epidemiological studies to understand the actual causes of PT in various rural and urban settings among different socio-demographic groups in Bangladesh. [ABSTRACT FROM AUTHOR]

Contact lens (CL) wear is a safe method for the correction of refractive errors. However, rare, severe ocular complications may occur which may lead to visual loss. As most of these complications are related to poor patient compliance with care and maintenance instructions, resulting in the contamination of hands, CLs and accessories, it was the purpose of this study to assess hand-washing habits in a sample of Spanish soft CL wearers. Hand hygiene was explored through a self-reported online survey and via an in-office practical demonstration in a subset of those users answering the survey. A total of 198 surveys were analyzed, and 18 CL users participated in the practical demonstration. Overall, hand-washing habits were not adequate, with 35 (17.8%) and 103 (52.2%) participants reporting not always washing their hands prior to CL or storage case manipulation, respectively. While 161 (81.3%) participants dried their hands after washing, 132 of these (82.1%) used non-disposable cloth towels. Participants receiving specific hand-washing information from their practitioners (141, or 71.1%) had better hand hygiene (p < 0.05). During the practical demonstration, 13 (72.2%) participants used water and soap to wash their hands, but only 3 (16.7%) displayed correct hand washing routines. Complete patient education, as well as practical reminders at all follow-up visits, are essential to ensure better hand hygiene in order to reduce the probability of ocular complications and to guarantee safe and satisfactory CL use. [ABSTRACT FROM AUTHOR]

This study aims to identify the influence of global governance on the sustainability performance of countries. The methodological approach is quantitative, employing descriptive and inferential statistics with multiple regression analysis for a sample of 127 countries. The independent variable corresponds to the governance measured by the world governance indicators. The dependent variables are measurements of sustainability performance, including the SDG Index Score, the Environmental Performance Index, the Human Development Index, and Gross Domestic Product per capita. The main results indicate that the governance indicators Voice and Accountability and Government Effectiveness positively affect the overall sustainability performance of countries. In environmental sustainability, the influence of the voice and responsibility and regulatory quality indicators was identified, while in the social and economic dimensions a positive influence of governmental effectiveness and regulatory quality was observed. On the other hand, the corruption control variable exerts a negative influence on general and social sustainability. In general, it can be concluded that the institutional quality of a country influences the government's ability to achieve sustainable development goals and targets, in addition to attaining favorable results in the environmental, social, and economic dimensions of sustainability. [ABSTRACT FROM AUTHOR]

Despite advances in precision medicine for non-small cell lung cancer (NSCLC), biomarker testing for these therapies remains frequently underused, delayed, and inequitable. Pulmonologists often play a critical role in the initial diagnostic steps for patients with lung cancer, and previous data show variability in their knowledge and practices regarding biomarker testing. The purpose of this study is to better understand how pulmonologists view their role in lung cancer care. With the increasing importance of biomarker testing and precision medicine, how do pulmonologists view their role in lung cancer care? An electronic survey consisting of 31 items focused on attitudes and practices regarding diagnostic steps for NSCLC was randomly distributed to a sample of practicing pulmonologists in the American College of Chest Physicians (CHEST) analytics database. Inferential statistics were performed using χ2 tests and multivariable logistic regression models. A total of 401 pulmonologists responded to the survey. Most (92%) were general pulmonologists, and more than one-half (62%) indicated they order biomarker testing. Longer practice tenure, higher case volumes, and participation in a multidisciplinary tumor board were associated with ordering biomarkers (P <.05). Pulmonology was identified to have the leading responsibility for the initial diagnostic biopsy by most respondents (83%) and less often for staging (45%), leading discussions about biomarker testing with patients (28%), and for ordering biomarkers (22%). The most common reasons for not ordering biomarkers included the following: oncology was responsible (84%), it was not within their scope of practice (46%), or lack of the necessary knowledge (51%). This study shows that pulmonologists vary in their practices for ordering biomarkers, and many defer this responsibility to oncology. Despite the role of bronchoscopy and pulmonology societal guidelines for staging, many defer leadership of this process. Many pulmonologists lack the necessary resources and multidisciplinary infrastructure likely required to efficiently accomplish biomarker testing. [Display omitted] [ABSTRACT FROM AUTHOR]

With the rapidly increasing availability of large-scale and high-velocity streaming data, efficient algorithms that can process data in batches without requiring expensive storage and computation resources have drawn considerable attention. An emerging challenge in developing efficient batch processing techniques is dataset shift, where the joint distribution of the collected data varies across batches. If not recognized and addressed properly, dataset shift often leads to erroneous statistical inferences when integrating data from different batches. In this article, two shift-adjusted estimation procedures are developed for updated estimation of the parameter in the presence of dataset shift. Under prior probability shift, we can obtain parameter estimation and assess the degree of dataset shift simultaneously. We study the asymptotic properties of the proposed estimators and evaluate their performance in numerical studies. The proposed methodologies are illustrated with an analysis of the Ford GoBike docked bike-sharing data. [ABSTRACT FROM AUTHOR]

Aim: Systematically evaluate the depth and quality of play recommendations provided in popular sources for parents of infants in the first year of life. Methods: This represents the second stage of a larger analysis of educational content available to parents. Two coders (>90% agreement) extracted and coded play activities from popular websites, applications, and books screened from a systematic online search. Depth of instruction variables were extracted. Activity quality was rated based on opportunities for child-initiated movement, problem-solving with objects, and responsive communication. Results: 4370 play activities from 214 sources were analyzed. Activities were likely to suggest specific ages for infants and that a caregiver be present. Less than half of the activities incorporated toys or provided guidance about how to position or physically support infants. Activity quality was low; most activities did not explicitly encourage parents to provide opportunities for child-initiated movement, problem-solving with objects, or quality communication. Conclusions: Parents may encounter a large number of play activities in popular sources, but the depth of instruction and quality of those activities could be improved. Provision of higher-quality education to parents may enhance parent-child play interactions to positively impact parent and child outcomes, especially for children at risk for delays. [ABSTRACT FROM AUTHOR]

Aim: Trauma-informed care (TIC) is a strengths-based organizational approach which recognizes the prevalence and impact of trauma on an individual's neurological, sensorimotor, and emotional responses and development. There is limited research on pediatric occupational therapy providers' (OTPs) and physical therapy providers' (PTPs) perceptions on incorporating TIC into their practice. This pilot study aims to describe the confidence, attitudes, barriers, and education of pediatric OTPs and PTPs regarding TIC. Method: OTPs and PTPs (n = 87) working in pediatric settings in the U.S. completed an electronic survey regarding their perceptions of TIC. Results: OTPs reported higher confidence in TIC compared to PTPs. Most participants reported favorable attitudes toward TIC, yet no statistical significance was identified between the two professions' overall attitudes toward TIC. Collectively, participants reported lack of time and training as barriers. There was a statistically significant difference between how the two professions rated competency, training, and concern over clients' retraumatization. There was significant association between years of professional experience and TIC education. Conclusion: Preliminary findings indicate an overall agreement of OTPs and PTPs with principles of TIC and common barriers to TIC practice. There are implications to further integrate opportunities for TIC training into foundational education and professional practice. [ABSTRACT FROM AUTHOR]

Aims: Compensatory coping, or maladaptive alterations in behavior with the intention of preventing or managing symptoms, is increasingly being explored as a key factor in how people respond to bladder conditions. Preliminary investigations have identified relations between coping behaviors and psychological distress in urologic conditions, including interstitial cystitis/bladder pain syndrome (IC/BPS). However, previous explorations of coping have not accounted for heterogeneity in coping behaviors or addressed the likelihood that some coping behaviors may be more adaptive than others. This study sought to examine how two specific types of coping behaviors, primary control coping and disengaged coping, are related to distress and symptoms in IC/BPS, and to explore the potential role of pain phenotype in this relationship. Materials and Methods: A secondary data analysis was conducted with a large community data set (N = 677 women with IC/BPS) and employed descriptive and inferential statistics to characterize coping patterns and explore novel predictors of distress. Results: Results indicated that almost all participants engaged in at least one compensatory coping behavior within the last week. Both types of coping behaviors correlated with psychological symptoms, and when controlling for relevant clinical variables (i.e., age and severity of urinary symptoms), disengaged coping behaviors were significantly associated with psychological distress. Further, the addition of pain phenotype to multiple regression models resulted in a more effective predictive model when considering the relation between coping behaviors and depression. Conclusions: By investigating more deeply the relationship between coping and distress, understanding of potential risk factors and mechanisms is increased, offering valuable insights for intervention strategies for IC/BPS patients. [ABSTRACT FROM AUTHOR]

This paper proposes a new way of modelling imperfect maintenance in degradation models, by assuming that maintenance affects only a part of the degradation process. More precisely, the global degradation process is the sum of two dependent Wiener processes with drift. Maintenance has an effect of the ARD1$ARD_1$‐type on only one of these processes: it reduces the degradation level of a quantity which is proportional to the amount of degradation of this process accumulated since previous maintenance. Two particular cases of the model are considered: perturbed ARD1$ARD_1$ and partial replacement models. The usual ARD1$ARD_1$ model is also a specific case of this new model. The system is regularly inspected in order to measure the global degradation level. Two observation schemes are considered. In the complete scheme, the degradation levels are measured both between maintenance actions and at maintenance times (just before and just after). In the general scheme, the degradation levels are measured only between maintenance actions. The maximum likelihood estimation of the model parameters is studied for both observation schemes in both particular models. The quality of the estimators is assessed through a simulation study. [ABSTRACT FROM AUTHOR]

In this study, we define a series system with n$n$ non‐independent and non‐identical components using a shock model with n+1$n+1$ sources of fatal shocks. Here, it is assumed that the shocks happen randomly and independently, following a Weibull distribution with various scale and shape parameters. A dependability model with 2(n+1)$2(n+1)$ unknown parameters is produced by this process. Making statistical conclusions about the model parameters is the main objective of this research. We apply the maximum likelihood and Bayes approaches to determine the model parameters' point and interval estimates. We shall demonstrate that no analytical solutions to the likelihood equations must be solved to obtain the parameters' maximum likelihood estimates. As a result, we will use the R program to approximate the parameter point and interval estimates. Additionally, we will use the bootstrap‐t and bootstrap‐p methods to approximate the confidence intervals. About the Bayesian approach, we presume that each model parameter is independent and follows a gamma prior distribution with a range of attached hyperparameter values. The model parameters' posterior distribution does not take a practical form. We are unable to derive the Bayes estimates in closed forms as a result. To solve this issue, we use the Gibbs sampler from the Metropolis‐Hasting algorithm based on the Markov chain Monte Carlo method to condense the posterior distribution. To demonstrate the relevance of this research, a real data set application is detailed. [ABSTRACT FROM AUTHOR]

Background: In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives. Aim: This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety. Research Design: A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale. Participants and Research Context: The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus. Ethical Considerations: Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles. Results: Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making. Conclusion: The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector. [ABSTRACT FROM AUTHOR]

Background: Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables. Objective: This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients. Methods: The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 (p <.05). Participants and setting: This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023. Ethical considerations: The protocol for this study was reviewed and approved by the University Ethics Committee. Findings: The patients' average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p <.001), r = −0.72, p <.001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p <.001). Conclusion: Even though patients' preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of baseline back pain severity on PROMIS mental health outcomes following minimally invasive lumbar decompression (LD). Methods: Patients undergoing elective, primary, single-level LD were retrospectively reviewed from a prospective single spine surgeon registry. Perioperative characteristics, demographics, and the following patient-reported outcomes (PROs) were extracted: Oswestry Disability Index (ODI)/Patient-Health Questionnaire-9 /PROMIS-Physical Function/Anxiety/Pain Interference/Sleep Disturbance (PROMIS-PF/A/PI/SD). Two cohorts were created: preoperative VAS-B < 7 and VAS-B ≥ 7. Change in PROs (ΔPROs) from baseline to six weeks/final follow-up were determined. Average patient follow-up was 13.4 ± 8.8 months. Minimal clinically important difference (MCID) achievement rates were calculated and compared through multivariable logistic regression. Postoperative scores and ΔPROs, were compared with multivariable linear regression while all other data was compared between groups with inferential statistics. Results: Altogether, 347 patients were included, with 190 in the VAS-B < 7 group. VAS-B ≥ 7 reported worse outcomes preoperatively (p ≤ 0.013, all). At six weeks, VAS-B ≥ 7 reported worse VAS-B (p = 0.017), with no other significant differences. At final follow-up, patients with worse VAS-B reported worse ODI (p = 0.040) and VAS-B while all other PROs were similar (p ≥ 0.078, all). VAS-B ≥ 7 experienced greater 6-week improvements in VAS-B/ODI/PROMIS-PI/PROMIS-SD (p ≤ 0.009, all), greater VAS-B/ODI/PROMIS-SD improvement by final follow-up (p ≤ 0.009, all) and greater MCID achievement in ODI/VAS-B (p ≤ 0.027). Conclusion: Patients with worse baseline back pain report inferior baseline scores that converge with those with milder preoperative back pain by 6 weeks after LD and reported greater 6-week improvements in disability, pain interference, and sleep disturbance by 6 weeks, and greater improvements in disability and sleep disturbance by final follow-up. [ABSTRACT FROM AUTHOR]

Background: While there is growing evidence highlighting the prevalence of mental health concerns among university faculty, few studies have examined mental health interventions in this population. The objective of this systematic review and meta-analysis was to collect and critically appraise the available evidence about the effectiveness of interventions designed to improve the mental health of faculty. Methods: A systematic search was conducted by searching PubMed, EMBASE, Scopus, Web of Science, and CINAHL to identify relevant studies published in English language from January 1st, 2000 until October 1st, 2023. The search focused on studies done on academic faculty to describe interventions or support programs aimed at improving mental health outcomes, with comparison of mental health data before and after the intervention and an improvement in mental health as study outcome. A random effect meta-analysis method was used to estimate the effectiveness of interventions on faculty mental health. Results: Ten publications with 891 participants from 2,217 retrieved records were included. The random effect model showed substantial heterogeneity (I2 = 84.8%, 95% CI: 73.8 − 91.2%, p < 0.001). The pooled SMD was − 1.41 (95% CI: -2.81–0.004) showing a large effect, and it significantly favors the use of intervention for reducing mental health issues among faculty members. The effect size estimates for all included studies ranged from small to large, showing the positive effect of intervention on faculty mental health. Multimodal inference analysis showed that, of the many studied factors for faculty mental health, the region was the most important predictor of intervention effectiveness. However, when the significance of quantitative moderators was tested using meta-regression, age (p = 0.9491) and duration of intervention (p = 0.1284) were not statistically significant. Conclusion: Interventions aimed at enhancing the mental health of university faculty were overall significant; however, individual studies showed heterogeneous results. Making efforts to enhance the mental health of faculty is crucial and has been proven effective; nevertheless, the existing evidence necessitates further research in this area. For interventions to be effective, it is imperative to tailor them to the specific environment and to the unique characteristics of faculty members. PROSPERO registration number: CRD42023490388 [ABSTRACT FROM AUTHOR]

Purpose: Research-supported family programmes are proven to be effective in reducing dysfunctional behaviours in youth. A fundamental role is played by professionals with high competence levels and a positive attitude to evidence-based practice (EBP). The aim of the study was to assess the efficacy of prior training for the facilitators of the PCF-AFECT, in order to ascertain whether it led to improvements in their competence levels and whether favourable attitudes to evidence-based practice were associated with higher competence levels. Method: A quantitative method was used, with a sample of professionals from Spain (N = 150). Results: Results showed that the training was effective in the case of four categories of professional competencies. Favourable attitudes to EBP were associated with clusters of professionals with higher competencies. Discussion: Both findings contribute scientifically to the identification of the core components or gold standards of training that are needed for the facilitators of research-supported family programmes. [ABSTRACT FROM AUTHOR]

We develop a statistical inference procedure for the ubiquitous calendar effects in microstructure noise using high frequency data. This is, to the best of our knowledge, the first inference theory ever built for noise calendar effect under the general semi‐martingale‐plus‐noise setup for prices contaminated with non‐stationary, endogenous, and serially dependent microstructure noise. We devise a noise‐calendar‐effect estimator by an appropriately scaled average of high‐frequency returns that precede a time of day across a large number of trading days. Feasible central limit theorem for the estimator is established under a joint infill and long‐span asymptotics. Monte Carlo simulations corroborate our theoretical findings. An empirical study on the high‐frequency data of the e‐mini S&P 500 futures and a Chinese stock demonstrates that the noise calendar effect has undergone significant changes over time for the latter, yet remains stable for the former. [ABSTRACT FROM AUTHOR]

In the widely used predictive regression model, any possible serial correlation in innovations leads to estimation bias and statistical inference distortions. Hence, it is important to pretest the existence of such serial correlation. Nevertheless, in the presence of embedded endogeneity, which is a common problem in the predictive regression setting, traditional serial correlation tests such as Box–Pierce (BP) and Ljung–Box (LB) tests are found to perform poorly. Motivated by this, we develop a new portmanteau test in this article as a pretest for serial correlation in predictive regression under possible embedded endogeneity. This test is based on the sample splitting idea and the jackknife empirical likelihood method. The asymptotic distribution of the proposed test has been derived, and the Monte Carlo simulations confirm good finite sample performances. As an illustration, we apply our proposed test in pretesting the serial correlation in predictive regression, where financial variables are used to predict the excess return of S&P 500. [ABSTRACT FROM AUTHOR]

Background: Nurse managers need to possess specific knowledge, skills, and attitudes to fulfil their roles and responsibilities and exemplify that they are competent to do their jobs. However, there is a paucity of data on the performance-based training needs of middle-level nurse managers in Jordan. Aim: To identify the performance-based training needs of middle-level nursing managers working in Jordanian governmental hospitals and to evaluate the differences in perceived performance-based training needs based on their socio-demographic and professional characteristics. Methods: A descriptive cross-sectional design was utilized. The study recruited 132 nurses from three governmental hospitals in Jordan using convenience sampling. An online survey included the Hennessy-Hicks Training Needs Questionnaire was used for data collection. Ethical approvals were obtained to conduct the study. Data were analysed using descriptive and inferential statistics using SPSS version 28. Results: 'Designing a research study' item had the highest perceived need for training (M = 2.5, SD ± 2.5), while 'establishing a relationship with patients' item had the lowest (M = 0.4, SD ± 1.2). Nurses with more experience (F = 2.9, df = 131, P < 0.05), and nurses who worked in specialized units (F = 2.3, df = 131, P < 0.05) had significantly lower training needs than nurses with lesser years of experience, and nurses who worked in outpatient departments. In addition, age, gender, prior training in nursing management, and years of experience as middle-level nurse managers significantly predicted the levels of training needed (R2 = 0.23, P < 0.001). Conclusion: The findings reflected the need for training on several managerial competencies. Future research can help identify other personal and organizational factors affecting performance-based training needs. [ABSTRACT FROM AUTHOR]

Objectives:. This cross-sectional study aimed to evaluate the degree of children's adherence to the Mediterranean Diet (MD), to estimate the weekly cost of MD, and to assess the role of food cost and demographic/socio-economic factors as potential barriers to comply with a healthy dietary model. Methods:. Data collection was conducted through an online questionnaire sent to parents of children (6–11 years old) living in Italy. This survey allowed the collection of demographic/socio-economic information about the family and their dietary habits. Adherence to the MD in children was assessed through the KIDMED index. The weekly diet cost was calculated based on the food prices of two Italian supermarket chains. Descriptive statistics and inferential tests were run to evaluate the sample's characteristics and correlations between diet cost, socio-demographics, and adherence to MD. Results:. Data highlighted that 31.5% of the children achieved high compliance with the MD, whereas 22.2% showed low adherence. The average diet cost increased significantly with the increasing level of adherence to the MD (Spearman's Rho = 0.322, p = 0.018). Moreover, results showed that a high parent educational level was positively associated with the KIDMED score (Spearman's Rho = 0.323, p = 0.017). No significant correlations were found between dietary cost and other characteristics such as economic status and house type. Conclusions for Practice:. Despite the small sample size, our results suggest that nutrition education interventions targeted at children and their parents/caregivers might favour more conscious dietary choices, which in turn will help reduce the differences in diet quality caused by the educational level gaps existing in families. Significance: Mediterranean Diet (MD) adherence may be affected by many factors, among which demographic, social, and economic ones are of great relevance. Family characteristics may, in turn, have an impact on the dietary model and nutritional status of children, who represent a vulnerable and underinvestigated population in this specific context. This study explored the cost of MD in Italian families with at least one child and highlighted that parents' educational level correlates with children's compliance to MD more decisively than demographic and economic factors. This suggests that targeted nutrition education interventions might lead families towards healthier food choices, mitigating existing educational differences. [ABSTRACT FROM AUTHOR]

Objectives: Beginning in February 2022, the United States faced an infant formula shortage that severely impacted access and affordability. Little is known about how this shortage impacted infant feeding intentions among expectant mothers. Our study sought to determine the impact of the formula shortage on prenatal feeding intentions and to understand expectant mothers' feelings and perceived stress related to the shortage. Methods: This cross-sectional, exploratory, observational study of pregnant women (n = 57) residing in New York City utilized a self-administered online survey in May–July 2022. Results: The results indicate that ten (17.5%) respondents changed their feeding intentions during the infant formula shortage for months 0–3 or 3–6 of infancy to include more breastfeeding than originally intended. These mothers also reported significantly higher stress levels related to the shortage than their non-changing peers. Conclusions for practice: Our results suggest that the formula shortage influenced feeding intentions among a subset of surveyed expectant mothers. The stress associated with the shortage influenced prenatal feeding intentions to include more breastfeeding than intended prior to the shortage. Prenatal healthcare providers should consider the availability of infant formula as one of myriad factors that influence infant feeding intentions, and that the stress associated with whether infant formula is readily available may influence these intentions as well. Significance: Numerous factors, including social, cultural, and economic influences, can shape prenatal infant feeding intentions. Our results suggest that availability of infant formula may be an additional element in this decision-making process. Our study found that the 2022 infant formula shortage influenced expectant mothers to include more breastfeeding in their feeding plans than they had originally intended as a result of the shortage. To our knowledge, there has been no research published that examines the effect of an infant formula shortage on the feeding intentions of expectant mothers. [ABSTRACT FROM AUTHOR]

Aim: To evaluate midwives' level of stress and burnout during the COVID‐19 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies. Design: A mixed‐methods study was undertaken from July to December 2022. Methods: Data were collected using a national online observational survey. Descriptive and inferential analyses were performed to evaluate stress, burnout and the impact of the pandemic on personal and professional dimensions. A deductive qualitative approach was used to analyse open‐ended responses, that were merged with quantitative data following a convergent mixed‐methods approach. Results: A total of 1944 midwives participated in the survey. The stress summary score mean was 10.34, and 562 midwives (28.91%) experienced burnout. The intention to reduce working hours was reported by 202 midwives (10.39%), with 60.40% (n = 122) of them experiencing burnout. The intention to leave clinical practice within the following 2 years was reported by 239 (12.29%), with 68.20% (n = 163) of them experiencing burnout. All the personal dimensions and professional activities considered were defined by more than half of midwives as being impacted 'Moderately' or 'To a great extent' by pandemic. Stress and burnout frequencies increased when the midwives' perception of the pandemic effects was higher. Potential supporting strategies described by midwives as the most important in increasing their ability to cope with the pandemic were 'Women's awareness of the midwives' role' (n = 1072; 55.14%) and 'Family and friends' emotional support' (n = 746; 38.38%). Conclusion: Our findings suggested strategies to support a positive and safe working environment for midwives during a pandemic emergency, with potential transferability to similar contexts when human resources are lacking. It is recommended that maternity services provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Impact: Studies conducted during the first COVID‐19 pandemic wave showed an increased level of stress, anxiety, burnout, post‐traumatic stress disorder and depression experienced by healthcare professionals; moreover, midwives experienced drastic changes in care pathways and policies with struggles identified when providing high‐quality woman‐centred care following pandemic restrictions. Although it is recommended, there is lack of knowledge about long‐term psychological effects of COVID‐19 for midwives. Our study highlights that during the Omicron wave midwives experienced a high level of stress and burnout with an impact on individual dimensions and professional activities. Their stress and burnout were influenced by several factors, including restrictions in place, lack of organizational acknowledgement, work overload and need for extra childcare cover. Maternity services should provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Recommendations on how to facilitate this are suggested. Reporting Method: During the writing process, we referred to 'The Strengthening the Reporting of Observational Studies Epidemiology Statement', the guidelines for reporting observational studies from the Equator network. Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community?: Work overload conditions negatively impacted on the quality of maternity services. Improving organizational aspects, reducing working hours, promoting family and friends' emotional support and improving women's awareness of midwife's role were the main strategies reported by midwives. These suggestions for ensuring a positive and safe working environment for midwives during a pandemic emergency could potentially be applied to similar situations where human resources are lacking. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic highlighted the negative impact of moral injury on nurses' well-being. However, there is a lack of research about generational differences among nurses, particularly on newer nurses who have been identified as having a higher rate of intention to leave. Objective: This study examines generational differences among nurses on moral injury, well-being, resilience, and intention to leave their nursing position and profession. Methods: This is a secondary analysis of cross-sectional data from registered nurses in clinical practice in Ohio between July and August 2021. Data on demographics, moral injury, resilience, and well-being were collected using an online survey. Participants were categorized into 4 generational groups based on their age in 2021: Baby Boomers (57-75 years old), Generation X (42-56 years old), Generation Y (27-41 years old), and Generation Z (12-26 years old). Descriptive and inferential statistics, including logistic regression and analysis of variance, were employed for analysis. Results: Significant generational differences were found in years of clinical experience, moral injury, resilience, and well-being. Baby Boomers reported higher well-being and resilience and lower moral injury. Notably, the intention to leave the profession was more strongly associated with well-being and moral injury levels than with the years of experience or generational group. Conclusions: The findings suggest that interventions to improve nurse retention should prioritize enhancing well-being and addressing the root causes of moral injury. Tailored strategies addressing the needs of different generations are necessary for mitigating the adverse effects of current healthcare challenges on nurse attrition. [ABSTRACT FROM AUTHOR]

Background: Vitamin D plays various roles in different stages of reproduction, and abnormalities in its levels are associated with diseases such as polycystic ovary syndrome (PCOS). This study aimed to determine the relationship between initial vitamin D levels and in vitro fertilization (IVF) outcomes in PCOS patients. Methods: This retrospective cohort study included 1174 PCOS patients who consulted the Acıbadem Maslak Hospital IVF Clinic between January 2015 and March 2021. We investigated the effect of preconceptional vitamin D levels on IVF outcomes using data analysis with SigmaPlot 14.5. Results: We found a significant positive correlation between preconceptional vitamin D levels and positive clinical pregnancy rates (p < 0.001) as well as increased endometrial thickness (EMT) on human chorionic gonadotropin (hCG) day (p < 0.001, r = 0.262). The optimal vitamin D cut‐off value for predicting positive hCG test results was identified as 13.24 ng/mL, as determined by receiver operating characteristic curve analysis (sensitivity = 0.839, specificity = 0.677). No association was observed with other IVF outcome parameters, miscarriage rates, or clinical pregnancy rates based on EMT. Conclusions: The study suggests that PCOS patients with vitamin D levels above 13.24 ng/mL are more likely to achieve positive hCG results after IVF. These findings highlight the potential importance of vitamin D supplementation in improving pregnancy outcomes for PCOS patients. Additionally, increased EMT on hCG day may explain the higher clinical pregnancy rates associated with elevated vitamin D levels. [ABSTRACT FROM AUTHOR]

Objective: To perform a morphometric analysis of the upper cervical spine (UCS) by means of cone-beam computed tomography (CBCT) for the diagnosis of malformations or craniocervical instabilities in patients with cleft lip and palate (CLP) and class III malocclusion. Materials and Methods: A total of 72 CBCTs from adult patients (48 male and 24 female) with Angle Class III malocclusion were divided into three groups: 1) Unilateral cleft lip and palate (UCLP) (n = 29; male = 65.5%; age = 24, 2 ± 4.2 years); 2) Bilateral cleft lip and palate (BCLP) (n = 18; male = 83.3%; age = 26.4 ± 6.0 years); 3) Control group (CON) (n = 25; male = 56.0%; age = 27.8 ± 9.3 years). The version 11.7 of the Dolphin® software (Chatsworth, California, USA) was used to evaluate the morphometric measurements and anomalies of the UCS. Data were analyzed by descriptive and inferential statistics (p ≤ 0.05). Results: For the UCLP, BCLP and CON groups, respectively, the measures were: atlantodental interval (2.1 ± 0.5; 2.1 ± 0.4; 2.0 ± 0.3 mm), basion-opisthion (35.9 ± 3.2; 36.4 ± 3.0; 34.7 ± 1.9 mm), hyoid-C3 (34.5 ± 3.7; 34.5 ± 5.2; 35.3 ± 4.5 mm), and hyoid-sella (108.1 ± 9.8; 111.3 ± 9.2; 109.7 ± 10 mm); clivus-canal angle (152.3 ± 13; 150.3 ± 10; 150.7 ± 10°) and Torg-Pavlov index (1.0 ± 0.2; 1.0 ± 0.1; 1.1 ± 0.2). Potentially unstable anomalies and malformations were more prevalent in the UCLP group (34,4%). Conclusion: Subjects with UCLP presented compressive or unstable anomalies on upper cervical spine, more frequently than controls and BCLP, despite the lack of statistically significant differences among groups. Future studies could increase the safety of patients and healthcare professionals specialized in craniofacial anomalies. [ABSTRACT FROM AUTHOR]

Background: The opening up of the laws to medicinal cannabis in recent years is a key factor in the growth of this therapy, but there is little information about what nurses know and think about it. The present paper seeks to analyze the knowledge, opinions, and experiences of nurses and nursing students in Portugal regarding the use of cannabis and to understand gender differences. Methods: A self-completion questionnaire was drawn up and published online. It received face and content validity and was approved by the Ethics Committee. The instrument includes socio-demographic data, questions about knowledge, opinions, experiences, and training in cannabis. The data was collected and processed by applying descriptive and inferential statistics using the chi-square test and Fisher's exact test on the SPSS platform. Results: The majority of the 610 participants were women. The therapeutic benefits of medical cannabis were appreciated by 79,6% of nurses and 84,3% of students. When asked about the functions of the endocannabinoid system, 71,7% of nurses and 79,5% of students had never heard of it. There is a statistically significant gender difference concerning personal experience of cannabis use to treat symptoms or illnesses. Conclusions: As the levels of knowledge were low and a minority had education on medical cannabis, there is a need for further education of nurses and for this emerging area to be included in the curricula. [ABSTRACT FROM AUTHOR]

Background: Usually non-pathogenic in immunocompetent individuals, mucormycosis is an aggressive, angio-invasive fungus. It is a rare, opportunistic infection belonging to the zygomycete family. The second wave of COVID-19 saw the emergence of a more dangerous and a potentially deadly invasive fungal sinusitis evolving in rhino-cerebral mucormycosis thus compounding and complicating the pandemic. Alarming and exponential rise in the number of cases of rhino-cerebral mucormycosis in India versus the rest of the world when the treatment protocols essentially remained the same needs to be probed scientifically along with its prompt management. Here an attempt has been made to explore this in the study of 50 cases of rhino-cerebral mucormycosis. This study aims to explore the cause and extension of the disease along with its treatment and outcome in 50 cases of post COVID rhino-cerebral mucormycosis. Results: This is a retrospective cohort study conducted on 50 patients with post COVID-19 invasive mucormycosis of the paranasal sinuses with extension to surrounding structure visiting Otorhinolaryngology department at Acharya Vinoba Bhave Rural Hospital, Wardha. Among 50 patients, 86% males in 4th to 7th decade with mean age of 51.08 years. Large majority had mild–moderate severity on high-resolution computed tomography thorax with 84% having uncontrolled diabetes and 18% newly diagnosed diabetic cases. Seventy-two percent had history of steroid intake for COVID-19 management. Maxillary sinus was most commonly involved sinus in 94% cases while 32% had commonest extra nasal spread hard palate. Seventy-eight percent of the post operated mucormycosis cases are alive with no recurrence, 8% are alive and had recurrence of the disease while 14% resulted in death. Conclusion: Effective management and control of the infection can be achieved with the use of strong antibiotics, oral or systemic antifungal drugs, extensive surgical excision of diseased tissue, and addressing underlying risk factors can effectively manage and control the infection. This approach results in positive outcomes and reduced morbidity compared to the time prior to the COVID-19 pandemic including cases with extensive disease. [ABSTRACT FROM AUTHOR]

Purpose: The specific objectives of this study were as follows: (1) to translate and adapt the English version of the International Outcome Inventory for Hearing Aids (IOI-HA) into Hindi, (2) to present data obtained from the hearing aid users, (3) and to investigate the effect of different factors on effective hearing aid use using the Hindi version of the IOI-HA. Method: The English version of IOI-HA was translated to Hindi by three native Hindi speakers who were proficient in both Hindi and English and had Hindi as their first language. The Hindi version of IOI-HA along with a demographic questionnaire was given to 100 experienced hearing aid users who were literate and more than 18 years of age. Results: The findings indicated 53% of individuals utilize their hearing aids for over 8 h daily, while 46% use them for 4 to 8 h a day. A greater number of participants experienced benefits from wearing their hearing aids, suggesting their overall effectiveness for users. Also, 64% of people said their HA was fulfilling their expectations. Sixty-seven percent of participants said life has become quite a lot better with HA usage. The results revealed that age, gender, and type of hearing loss showed no significant association with any test item. Conclusion: The Hindi version of the IOI-HA has proven to be a valuable self-assessment tool for hearing aid users. It aids clinicians and audiological practitioners in comprehending the challenges faced by users and can offer guidance for counseling and assessing the benefits derived from hearing aids. [ABSTRACT FROM AUTHOR]

Aim: This study was designed to examine the nurse managers' boundary-spacing leadership's impact on the relationship between nurses' work embeddedness and innovative work behaviors. Background: In today's evolving healthcare environment, innovation is essential for enhancing patient care, optimizing resources, and supporting healthcare professionals. Nurses are pivotal in driving bedside innovation, but cultivating a culture of innovation within nursing teams involves more than just promoting creative ideas. Methods: This is a descriptive correlational study that was conducted at one governmental hospital in Tanta, Egypt. Using Nurse Managers Boundary-Spacing Scale for assessing boundary-spacing leadership, The Global Job Embeddedness Scale for measuring work embeddedness, and Innovative Work Behavior Scale for assessing innovative work behavior, 250 nurses were surveyed. Data analysis was run using descriptive and inferential analysis. Correlation and regression analysis were used to examine the study hypotheses. Results: There is a statistically significant positive relationship between boundary-spacing leadership and work embeddedness (r = 0.615, p < 0.001). Boundary-spacing leadership accounted for 56% of the variance in work embeddedness and 36% of the variance in nurses' innovative work performance. These results highlight the pivotal role of boundary-spacing leadership in both enhancing nurses' work embeddedness and boosting their innovative behaviors. The substantial variance explained by boundary-spacing leadership underscores its critical influence on fostering a supportive and innovative work environment within the nursing field. Conclusion: Boundary spacing leadership style involves connecting internal and external resources, fostering information exchange, and advocating for the nursing team. While work embeddedness positively correlated with innovative work performance, its impact was less significant than boundary-spacing leadership. This suggests that feeling attached to the organization fosters innovation, but leadership style has a stronger influence. Furthermore, the study found a positive and significant correlation between innovative work performance and both work embeddedness and nurse managers' boundary spacing leadership. Practical Implications: The findings emphasize that boundary-spacing leadership is crucial for enhancing both nurses' work embeddedness and innovative behaviors. Healthcare organizations should focus on developing these leadership skills to create a supportive work environment, foster innovation, and improve staff retention [ABSTRACT FROM AUTHOR]