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Intoduction: Common outcome measures for chronic neck pain are the Patient‐Specific Functional Scale (PSFS) and the neck disability index (NDI). The primary aim was to categorize the top‐rated, patient‐selected functional activity limitations of the PSFS to determine if there were consistent limited functional activities for individuals with chronic neck pain and how these compared to the constructs of activities on the NDI. The secondary aim was to determine the relationship between scores for individuals who completed both the NDI and PSFS. Design: A retrospective review of data extracted from the electronic medical record, EPIC, within two hospital‐based outpatient physical therapy clinics within a health care system. Methods: Retrospective analysis was performed on individual's characteristics, self‐selected functional activity limitations, and total scores of the PSFS and NDI. Most common categories of self‐selected functional activity limitations were developed by practicing physical therapists. These functional activity limitation categories of the PSFS were compared to the activities of the NDI. Mean PSFS total scores were correlated with the NDI total scores with Spearman's test. Results: Participants were individuals with chronic neck pain from January 2013–September 2018 (n = 2283). Movement‐based activities accounted for 60.8% of the functional activity limitations of the PSFS with the top functional activity limitations being cervical motion and exercise (32%). The PSFS total score moderately correlated with NDI (r = −0.50, p = <0.01) which may relate to the differences in constructs of the NDI and the top patient‐selected PSFS functional activity limitations found in this analysis. Conclusion: The results suggest that individuals with chronic neck pain present with similar categories of self‐selected functional activity limitations that differ from activities of the NDI. Additional research is needed to improve outcome measures to capture patient‐selected functional activity limitations and an individual's pain experience. [ABSTRACT FROM AUTHOR]

Background: High turnover rates and burnout are prevalent issues among registered nurses in public hospitals in Hong Kong. Pay level satisfaction is one of the crucial factors influencing organisational and professional turnover intention. Understanding whether pay level satisfaction can mitigate the negative impact of burnout on turnover intention can provide insights into the role of financial rewards in employee retention. Objective: This study aims to evaluate the relationship between job demands and turnover intention among registered nurses in Hong Kong public hospitals. Additionally, it seeks to examine the mediating role of burnout and explore the potential moderating effect of pay level satisfaction on the relationship between burnout and turnover intention. Methods: The study was a cross‐sectional online survey of public hospital staff in Hong Kong. A total of 502 registered nurses who had worked at their employing facility for at least 6 months participated in this cross‐sectional survey. Study variables included work overload, job stress, work–family conflict, family–work conflict, conflict with other nurses, burnout, pay level satisfaction and turnover intention. The collected data were analysed using bivariate Pearson correlation analysis and mediated moderation analysis with the PROCESS macro in SPSS 28.0. Results: Burnout mediated the relationship between job demands, including work overload, job stress, work–family conflict, family–work conflict and conflicts with nurses, and organisational and professional turnover intention. Pay level satisfaction did not exert a moderating influence on the relationship between job demands and turnover intention through burnout mediating this relationship. Conclusions: The importance of addressing job stress and burnout to mitigate turnover intention and promote nurse retention is underscored. Contrary to expectations, pay level satisfaction did not buffer the negative impact of job demands on turnover intentions via burnout. This suggests that compensation alone may not be sufficient to offset the detrimental effects of high job demands and burnout on nurses' intention to leave their jobs or the profession. Further research is warranted to explore potential moderators that may influence the relationship between job demands and turnover intention. [ABSTRACT FROM AUTHOR]

The purpose of this quasiexperimental study was to test the effects of wearing the NewGait rehabilitative device on walking abilities in individuals with foot drop. The study involved 16 participants with foot drops caused by stroke (11 participants), multiple sclerosis (one participant), and peripheral neuropathies (four individuals). During a single testing session, participants walked 12 m at their self‐selected speed in four experimental conditions: walking without any orthotic device; walking while wearing a regular plastic posterior leaf ankle foot orthosis (AFO); walking with the NewGait device assisting ankle dorsiflexion only; and walking with the NewGait device assisting the hip, knee, and ankle joint motions. Body motions during walking were recorded using a 3D system for motion analysis and analyzed with a set of spatiotemporal and kinematic parameters and a gait decomposition index. The gait decomposition index indicated sagittal interjoint coordination in the three joint pairs (hip–knee, knee–ankle, and hip–ankle) of the paretic (foot drop) leg during walking and was validated in a previous study. Overall, wearing all three orthotic devices improved the gait velocity, ankle dorsiflexion, and foot clearance compared to gait trials in which no assistive devices were used. However, wearing the AFO significantly restricted the plantarflexion range of motion and decreased interjoint coordination as measured by joint decomposition. In contrast, the NewGait device altered the ankle plantarflexion motions but also increased coordinated movement (reduced the decomposition) in most lower‐extremity joint pairs and conditions. Therefore, the NewGait rehabilitative device can be considered superior to a regular AFO in correcting gait deviations caused by foot drop. [ABSTRACT FROM AUTHOR]

Background: There is overwhelming evidence of improved patient outcomes as a result of early mobilization in the intensive care unit (ICU). However, several barriers of ICU mobility remain understated with reference to clinical roles. The purpose of this study is to investigate the perceived barriers of early mobility of critically ill patients among ICU healthcare providers. Methods: In this cross‐sectional study, the Mobilization Attitudes and Beliefs Survey (PMABS‐ICU) was administered to ICU healthcare providers using an online survey. The study investigated barriers related to knowledge, attitudes, and behaviors regarding ICU mobility practices. These barriers were compared among different ICU clinical roles. Results: The survey yielded a total number of 214 healthcare providers with 41% female and 59% male. Respiratory therapists reported the highest perceived barriers to ICU mobility (M 39, IQR 36, 43) % compared to physical therapists (who reported the lowest barriers), occupational therapists, nurses, and physicians (p ≤ 0.05). ICU healthcare providers' behavior towards ICU mobility such as perceived benefits and safety is ranked as the primary barrier (M 49, IQR 42, 52) %. Professional experience did not significantly vary among all groups. Conclusion: Our findings highlight that ICU healthcare providers' perceptions, including both potential benefits and safety concerns regarding mobility, are significant barriers to implement mobility practices. ICU mobility barriers should be tackled by providing education and training. A focused effort to include RTs and nurses could advance interdisciplinary ICU mobility practice and reduce associated barriers. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, 3D printing technology has revolutionized various fields, including dentistry. Provisional restorations play a crucial role in prosthetic rehabilitation, necessitating the evaluation of their bond strength with different provisional cement agents. Aims: This study is aimed at assessing the immediate and long‐term bond strength of 3D‐printed dental crowns using three provisional cement agents. Materials and Methods: Provisional crowns (N = 36) were manufactured using 3D modeling software and cemented in dentin analogues (G10 Nema resin). After the crowns' fabrication, they were randomly divided into three groups (n = 12) for cementation with Relyx Temp 3M ESPE, Provicol—VOCO, and Meron—VOCO. Tensile strength tests were conducted using a universal testing machine, with half of the specimens subjected to 2000 thermal cycles before testing. Finite element analysis was employed to assess tensile stress distribution. Results: Statistical analysis (two‐way ANOVA and Tukey's test at a 95% confidence level) revealed significant effects of cement type (p = 0.006) and thermal aging (p = 0.001) on bond strength. Glass ionomer cement exhibited the highest immediate resistance, while all types of cement were adversely affected by thermal aging, resulting in decreased bond strength. Conclusion: Thermal aging significantly alters the properties of 3D printing resin and affects the bond strength of provisional cement with 3D‐printed crowns. Despite the adverse effects of thermal aging, glass ionomer cement demonstrated the highest immediate resistance. Clinicians should carefully consider these findings when selecting provisional cements for 3D‐printed crowns. [ABSTRACT FROM AUTHOR]

Introduction. Peripheral retinal refraction plays a crucial role in myopia, but the specific mechanism is not clear. We refined the retinal partitions to explore the characteristics of peripheral retinal refraction and its role in emmetropic, low, and moderate myopic children aged 6 to 12 years. Methods. A total of 814 subjects (814 eyes) were enrolled in the study. The participants were divided into three groups according to the central spherical equivalent refraction (SER), which were emmetropia group (E), low myopia group (LM) and moderate myopia group (MM). Multispectral refractive topography (MRT) was used to measure the retinal absolute and relative refractive difference value (RDV) in different regions. The range was divided into superior, inferior, temporal, and nasal RDV (SRDV, IRDV, TRDV, and NRDV) on the basis of several concentric circles extending outward from the macular fovea (RDV15, RDV30, RDV45, RDV30–15, RDV45–30, and RDV‐45). Kruskal–Wallis test was used to analyze the differences of peripheral refraction for all the regions among the three groups. Spearman rank correlation was performed to explore correlations between SER and RDV, axial length (AL) and RDV. Results. The absolute value of RDV decreased with increasing degree of myopia in all regions (P < 0.01). Subjects with different refractive degrees had different relative value of RDV. In nasal position within 45° and temporal position within 30°, the peripheral retina exhibited significantly different relative hyperopic refractive status among Group E, Group LM, and Group MM (P < 0.05). SER was negatively correlated with NRDV within 30° (especially in the range of NRDV30–15) (r = −0.141, P < 0.01), positively correlated with TRDV within 15° (r = 0.080, P = 0.023), and not significantly correlated with SRDV and IRDV when the retina was divided into four parts. AL was positively correlated with NRDV within 30° (especially in the range of NRDV30–15) (r = 0.109, P = 0.002), negatively correlated with TRDV within 15° (r = −0.095, P = 0.007). Conclusions. The peripheral defocus has significant implications for the genesis of myopia. The peripheral defocus of the horizontal direction, especially within the range of NRDV30, has greater effect on the development of myopia in children. Higher NRDV30 is associated with lower SER and longer AL. [ABSTRACT FROM AUTHOR]

Aim. To explore factors influencing Turkish nurses' intention to leave job, including nurse‐physician collaboration level, workplace's environment issues, job satisfaction components, and the effects of the COVID‐19 pandemic. Methods. A cross‐sectional hospital‐based nursing study was conducted between 1 April and 1 May 2022. The data were gathered using a self‐administered questionnaire including sociodemographic variables, region of childhood, priorities on job expectations, self‐score of job satisfaction level (0–10 points), intention to leave scale score, and nurse‐physician collaboration scale score. The E‐PICOS statistic program was used for descriptive and correlation analyses exploring data. Results. A total of 325 nurses were enrolled with an average age of 29.71 ± 6.39 and work experience of 7.88 ± 7.15 years. Female (73.5%) and male (26.5%) nurses had similar levels of intention to leave (p = 0.078). The most frequent priorities on job expectations were high salary (40.3%) and well‐planned working hours (26.8%), respectively. Priority rate on job expectations about academic advancement opportunities was seen in 17.5% of all. Participating in joint doctor‐nurse visits more than nurse‐nurse working and work experience time significantly impacted satisfaction (p = 0.012; p = 0.027, respectively). Job satisfaction has a positive relationship with a high level of socioeconomic and physical environment in workplace's environment characteristics (p = 0.035; r = 0.117) and a negative relationship with intention to leave the job (p < 0.001; r = −0.502). No correlation was found between an increased intention to leave and poorer collaboration between nurses and physicians (p = 0.370; r = −0.050). Despite the lack of significance, nurses who prioritize organizational culture and brand in their workplace expectations and who work in COVID‐19 areas reported higher job satisfaction than others (p = 0.133; p = 0.133, respectively). Furthermore, nurses who grew up in the Aegean Region, a highly developed part of the country, displayed the highest intention to leave and the lowest job satisfaction (p = 0.214, p = 0.359, respectively). Conclusions. Nurses' intention to leave job negatively correlates with job satisfaction, regardless of level of nurse‐physician collaboration. Additionally, variations in the intention to leave based on regions of upbringing highlight the importance of human resources based on geographical and cultural development levels. [ABSTRACT FROM AUTHOR]

Aims. To identify the factors influencing hospital nurses' workplace bullying experiences (victim and perpetrator aspects) focusing on meritocracy beliefs, emotional intelligence, and organizational culture. Background. Workplace bullying remains a major issue in nursing despite decades of research and policy‐making. Therefore, comprehensively understanding the individual and institutional factors affecting workplace bullying from both the victim and perpetrator perspectives is crucial. Methods. In October 2022, 379 nurses working in South Korean tertiary hospitals were surveyed using a self‐reported online questionnaire. Meritocracy beliefs, emotional intelligence, workplace bullying experiences, and nursing organizational culture were measured using the Meritocracy Belief Scale, Wong and Law Emotional Intelligence Scale, Negative Acts Questionnaire‐Revised, and Positive Nursing Organizational Culture Measurement Tool, respectively. Results. Gamma regression analysis revealed that, for workplace bullying, the factors influencing the victim aspect were the experience of witnessing bullying in the workplace, organizational culture, and meritocracy beliefs. In contrast, the factors affecting the perpetrator aspect were emotional intelligence, meritocracy beliefs, and experience of bullying at work. Conclusion. Decreasing nurses' degree of meritocratic hubris in a positive organizational culture and increasing their emotional intelligence are necessary to prevent and intervene in workplace bullying. Implications for Nursing Management. Targeted approaches are needed to address and mitigate the detrimental effects of factors influencing workplace bullying. These approaches could include interventions that improve nurses' emotional intelligence, assess their level of meritocracy beliefs, and offer opportunities for self‐reflection on meritocratic hubris. Such initiatives may be necessary to effectively tackle workplace bullying and promote a healthier nursing work environment. [ABSTRACT FROM AUTHOR]

Background. This study aims to investigate the agreement between the NK and KS formulas in predicting the vault after implantation of an EVO‐implantable collamer lens (ICL). Methods. This retrospective study included 106 eyes of 57 patients who underwent ICL‐V4c implantation. Preoperative vault prediction was conducted by utilizing the NK and KS formulas, with postoperative measurements by anterior segment optical coherence tomography (AS‐OCT) at one month. The analysis focused on the consistency between predicted and achieved vaults, as well as the correlation between the achieved vault and various biometric parameters. Results. The mean achieved vault was 605.25 ± 212.72 µm, which was significantly smaller than the predicted vaults of 710.08 ± 195.08 and 673.80 ± 212.76 µm, using the NK and KS formulas, respectively (P < 0.05). The mean differences between the achieved vault and the predicted vault using the NK formula and KS formula were −104.82 μm (95% LoA: −600.38–391.19 μm) and −68.55 μm (95% LoA: −628.91–491.82 μm), respectively. Anterior chamber depth (ACD), vertical sulcus‐to‐sulcus (V‐STS) diameter, and crystalline lens rise (CLR) were independent factors associated with the achieved vault (P < 0.05). The two formulas showed no statistically significant difference in absolute prediction error (APE). Conclusion. The NK formula exhibited superior consistency and low predictive error compared to the KS formula in the 12.6 mm ICL group. AS‐OCT measurements overestimated the predicted ICL vault, especially in the 13.2 mm ICL size selection. Relying solely on the NK or KS formulas for predicting vaults before ICL surgery is not recommended. [ABSTRACT FROM AUTHOR]

Background. Emergency nurses may experience various fatiguing duties and suffer more pressure, so it is necessary to promote their professional or work‐related quality of life, especially during tough periods. Aim. To describe the development of the multidimensional narrative support system and explore its effectiveness and feasibility among emergency nurses. Design. An action research was conducted in Shanghai, China, from 2022 to 2023. Methods. Two cycles of action research were adopted in the emergency departments of two tertiary general hospitals in Shanghai, China. A total of 20 and 13 emergency nurses from different posts participated in each cycle. Multiple methods and tools, such as validated instruments, self‐designed questionnaires, and individual and focus group interviews, were used to collect short‐ and long‐term data. The EQUATOR guidelines on reporting action research were used as the guideline for this study. Results. The multidimensional narrative support system was gradually modified to promote its feasibility. Involved emergency nurses actively participated in different activities and proposed relatively positive and satisfying remarks. Quantitative data showed the significantly instant or long‐lasting improvements in emergency nurses' professional and work‐related quality of life, as well as their self‐compassion, and perceived social support. Various categories were summarized about the participants' experiences, perceived long‐term effects, and suggestions on the multidimensional narrative support system. Conclusion. The multidimensional narrative support system integrates narrative methods and psychological activities and provides multidimensional support for emergency nurses. In spite of various challenges, the system shows good feasibility and significant influences on emergency nurses' well‐being and quality of life. Implications for Nursing Management. The multidimensional narrative support system may action as a novel intervention for the overall improvements of clinical emergency nurses, which can be recommended to other populations with targeted modifications and training, so as to achieve good generalization in different departments. [ABSTRACT FROM AUTHOR]

Aim. This study aims to investigate the level of organizational learning within urban Chinese Community Health Centres and reveal its potential association with primary care nurses' work performance and well‐being. Background. Globally, there is a push to establish learning healthcare systems for complex health reform challenges. Existing studies on organizational learning mainly focus on North American and European hospital settings, offering limited insights into primary care environments, particularly in developing countries. Design. Cross‐sectional study. Methods. We recruited 175 nurses from 38 community health centres in four Chinese cities (Shanghai, Shenzhen, Tianjin, and Jinan) using convenience sampling. Trained research assistants conducted face‐to‐face surveys, measuring organizational learning with the Learning Orientation Scale. Nurse‐level outcomes included self‐directed learning, quality of care, organizational commitment, and work stress. Data analysis employed multilevel linear modelling. Results. The 38 community health centres displayed a relatively high level of organizational learning, and there was a positive and significant association between organizational learning within community health centres and nurses' self‐directed learning as well as the quality of care. However, there was no significant association between organizational learning and nurses' organizational commitment or work stress. Conclusion. This study demonstrates a high‐level organizational learning capacity in urban community health centres in China. It provides a new perspective on the potential relationship between CHCs' organizational learning and primary care nurses' well‐being and work performance. Further research is needed to clarify unexpected findings and identify factors promoting organizational learning in primary care settings. Implications for Nursing Management. In China's evolving primary care system, nurses play a vital role amidst physician shortages. Policy should prioritize internal management reform alongside structural changes. This study highlights the importance of fostering organizational learning in primary care settings. Strategic interventions should promote a learning culture in CHCs, which may enhance nurses' self‐directed learning and improve the quality of care. [ABSTRACT FROM AUTHOR]

Background. In this study, we aimed to evaluate the relationships between burnout among doctors and nurses and stress levels and healthy lifestyle behaviors during the COVID‐19 pandemic. Methods. The study was carried out as a cross‐sectional design. The sample consisted of 258 nurses and doctors working at Ankara University Faculty of Medicine Cebeci Research and Application Hospital. Data were collected between April and October 2021 using a sociodemographic form, the Burnout Measure Short Version (BMS), the Perceived Stress Scale (PSS), and the Healthy Lifestyle Behaviors Scale‐II (HLBS‐II). T tests, one‐way analysis of variance (ANOVA), and post hoc (Tukey, LSD) analyses were used to analyze the descriptive characteristics and scale scores of the participants. Spearman's correlation analysis was used to examine the relationships between scale scores and continuous data. Regression analysis was performed to define the reason and result relationship between the scales. Results. As a result of the correlation analysis, a positive, moderate relationship was found between the participants' PSS total scores and BMS total scores (p < 0.05). There was a moderate and weak statistically significant relationship between the participants' PSS and BMS total score average and HLBS‐II total score and subdimensions (p < 0.05). In addition, it was determined that there was a statistically significant and negative correlation between the participants' PSS and BMS total score average and the HLBS‐II total score and subdimensions (p < 0.05). After the regression analysis, the relationship between the reason and the result among the total PSS, BMS, and HLBS‐II scores was found to be significant (p < 0.05). Conclusions. The results obtained from this study revealed that the rising burnout and stress levels of nurses and doctors during the pandemic decreased the level of healthy lifestyle behaviors and led them to use negative coping methods. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the quality of life (QoL) of patients with cervicofacial nonmelanoma skin cancer (NMSC) using the Brazilian Portuguese‐adapted and validated version of the skin cancer index (SCI). After collecting demographic and clinical data from 182 patients with cervicofacial NMSC, the Brazilian versions of the SCI and the Dermatological Life Quality Index (DLQI) were applied preoperatively (T0) and 4 months postoperatively (T1). Assessments were carried out using the Shapiro–Wilk test, Student's t‐test, Mann–Whitney test, Kruskal–Wallis test, and Spearman's correlation. The QoL was evaluated using the Student's t‐test in paired samples at T0 and T1. Significant results were observed, with an increase in scores on the SCI scale in all its dimensions and a decrease in scores on the DLQI scale, demonstrating better postoperative QoL. The variables that presented significant results on the total scale, which indicated better QoL, were men, without children, income above four minimum wages, from the private sector, did not report pruritus, and scalp lesions. The QoL measurement indicated a change from the baseline and improvement after 4 months postoperatively in all subscales, indicating that surgical treatment increased the QoL of these patients from an emotional, social, and physical appearance point of view. The multivariate analysis produced several statistically significant findings in relation to emotional, social, appearance, and total scores. [ABSTRACT FROM AUTHOR]

Background. Neutrophils play an important role in maintaining periodontal status in conditions of healthy homeostasis. They achieve their surveillance function by continuously migrating to the gingival sulcus and eradicating periodontal pathogens. In addition, neutrophils are considered an integral element in the pathogenesis of periodontal diseases. Among several neutrophil subsets, low‐density neutrophils (LDN) have recently received attention and are linked with cancer, immunological, inflammatory, and infectious diseases. However, the presence, phenotypes, and potential role of LDN in the pathogenesis of periodontitis have not yet been investigated. Objectives. To investigate the presence, subsets (normal, band, suppressive, and active), and phenotypes via marker expression surface protein known as the cluster of differentiation (CD) (CD16b, CD14, CD15, and CD62L) of LDN in patients with periodontitis. Materials and Methods. The observational case‐control study was conducted to estimate the potential role of LDNs in periodontitis. Venous blood and periodontal indices were obtained from 40 healthy control individuals and 60 periodontitis patients. Subsequently, CD16b, CD62L, CD14, and CD15 expression on the surface of LDN was examined by multicolor flow cytometry, and their subsets were classified as "normal" (CD16brightCD62Lbright), "bands" (CD16dimCD62Lbright), "suppressive" (CD16brightCD62Ldim), and "active" (CD16brightCD62Lnegative). Results. There was a significant difference in the expression of LDN markers for active and suppressive phenotypes, respectively, favoring periodontitis over the control group. In contrast, there were significantly higher levels of CD16b, CD62L, and CD15 ("normal") in the control group when compared with the periodontitis group. Conclusion. LDN was associated with periodontitis as it was significantly increased in the periodontitis group in comparison with the control group and was positively correlated with all periodontal parameters. Cells from both groups of patients (periodontitis and control) expressed a normal mature phenotype (CD16b + High, CD62L + High, CD15+, and CD14‐). Regarding subsets, the normal LDN (CD16brightCD62Lbright) was the most predominant phenotype in both periodontitis and control groups. However, the active subset increased in periodontitis compared to normal, indicating their destructive role in periodontitis. [ABSTRACT FROM AUTHOR]

Introduction. PPIs, or proton pump inhibitors, are the most widely prescribed drugs. There is a debate regarding the relationship between long-term PPI use and the risk of type 2 diabetes mellitus (T2DM). A potential connection between T2DM and PPIs could be an elevated gastrin concentration. This study is aimed at investigating the long-term effects of PPI omeprazole (OZ) on glucose homeostasis and pancreatic gene expression profile in mice. Methods. Healthy adult male BALB/c mice were randomly divided into three equal groups (n = 10 in each one): (1) experimental mice that received OZ 20 mg/kg; (2) control mice that received 30 μl saline per os; (3) intact mice without any interventions. Mice were treated for 30 weeks. Glucose homeostasis was investigated by fasting blood glucose level, oral glucose tolerance test (GTT), insulin tolerance test (ITT), and basal insulin resistance (HOMA-IR). Serum gastrin and insulin concentration were determined by ELISA. Expressions of Sirt1, Pparg, Nfκb1 (p105), Nfe2l2, Cxcl5, Smad3, H2a.z, and H3f3b were measured by RT-PCR. Result. The ROC analysis revealed an increase in fasting blood glucose levels in OZ-treated mice in comparison with control and intact groups during the 30-week experiment. A slight but statistically significant increase in glucose tolerance and insulin sensitivity was observed in OZ-treated mice within 30 weeks of the experiment. The mice treated with OZ exhibited significant increases in serum insulin and gastrin levels, accompanied by a rise in the HOMA-IR level. These animals had a statistically significant increase in Sirt1, Pparg, and Cxcl5 mRNA expression. There were no differences in β-cell numbers between groups. Conclusion. Long-term OZ treatment induced hypergastrin- and hyperinsulinemia and increased expression of Sirt1, Pparg, and Cxcl5 in mouse pancreatic tissues accompanied by specific changes in glucose metabolism. The mechanism of omeprazole-induced Cxcl5 mRNA expression and its association with pancreatic cancer risk should be investigated. [ABSTRACT FROM AUTHOR]

Aim. This study was aimed to investigate whether the practice of laughter yoga in nursing students who just started university can help them cope with stress. Design. An experimental randomized controlled study was conducted. Methods. The research was conducted with first‐year students (n = 38) who were willing to participate in the study. The intervention group took part in six 45–50 minute laughter yoga sessions twice a week for three weeks. Results. The comparison of the mean and total scores obtained from the Coping Behavior Inventory and Physio‐Psycho‐Social Response Scale by the participants in the control and intervention groups before and after the implementation of the laughter yoga practices demonstrated that there was a statistically significant difference between the two tests in the intervention group and the difference was especially evident between the pre‐ and posttest scores obtained from the Coping Behavior Inventory. Conclusions. In this study, laughter yoga practice helped the participating nursing students who just started university to cope with stress. It can be recommended that laughter yoga should be integrated into the curriculum in schools where nursing education is provided as a way of coping with stress, that its use should be expanded, and that randomized controlled experimental studies in which its physiological and psychological effects in different groups are investigated with objective and subjective parameters should be conducted. [ABSTRACT FROM AUTHOR]

Purpose. The reference range for the preoperative anterior chamber angle width for ICL surgery is unclear. Our objective was to assess the clinical effect and the range of anterior chamber angle width of posterior-chamber implantable collamer lens V4c (ICL V4c) implantation in patients with anterior chamber depth (ACD) < 2.8 mm. Methods. Patients who underwent ICL V4c implantation with shallow ACD were included in this retrospective study. The patients' uncorrected and corrected distance visual acuity, angle of trabecular-iris (TIA), angle-opening distance (AOD500), trabecular-iris space area (TISA500), corneal endothelial cell density, vault, retinal nerve fiber layer thickness, intraocular pressure, visual field, and complications were analyzed. Results. Forty-one patients (68 eyes) completed at least 12 months of follow-up (median follow-up, 30 months). The effectiveness and safety indices were 1.09 ± 0.13 and 1.04 ± 0.21, respectively. The preoperative TIA values on the nasal and temporal sides were 39.78 ± 7.68 degree (range, 25.8-65.1 degree) and 41.54 ± 8.03 degree (range, 28.5-63.00 degree). Forty-seven eyes had uncorrected distance visual acuity ≥1.0, and 55 had corrected distance visual acuity ≥1.0 at the last follow-up visit. The TIA, AOD500, and TISA500 on the nasal and temporal sides were significantly reduced compared to those before surgery (all P < 0.01); no eye had an angle closure or elevated intraocular pressure. The ICL V4c vault was 290.88 ± 153.36 μm (range, 60.0-880.0 μm). No severe complications occurred in any patient. Conclusions. In patients with myopia with shallow ACD (2.55-2.79 mm), a preoperative TIA >25.8° is safe and effective for a relatively long time after surgery; however, an extended long-term close follow-up is needed. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the role of hearing aid (HA) usage in language outcomes among preschool children aged 3–5 years with mild bilateral hearing loss (MBHL). The data were retrieved from a total of 52 children with MBHL and 30 children with normal hearing (NH). The association between demographical, audiological factors and language outcomes was examined. Analyses of variance were conducted to compare the language abilities of HA users, non-HA users, and their NH peers. Furthermore, regression analyses were performed to identify significant predictors of language outcomes. Aided better ear pure-tone average (BEPTA) was significantly correlated with language comprehension scores. Among children with MBHL, those who used HA outperformed the ones who did not use HA across all linguistic domains. The language skills of children with MBHL were comparable to those of their peers with NH. The degree of improvement in audibility in terms of aided BEPTA was a significant predictor of language comprehension. It is noteworthy that 50% of the parents expressed reluctance regarding HA use for their children with MBHL. The findings highlight the positive impact of HA usage on language development in this population. Professionals may therefore consider HAs as a viable treatment option for children with MBHL, especially when there is a potential risk of language delay due to hearing loss. It was observed that 25% of the children with MBHL had late-onset hearing loss. Consequently, the implementation of preschool screening or a listening performance checklist is recommended to facilitate early detection. [ABSTRACT FROM AUTHOR]

The mental health of healthcare workers was affected by physical and psychological challenges during the pandemic. The aim was to study how psychosocial considerations can help manage behaviour change, mental health, and work satisfaction of nurse trainees in the UK during the COVID-19 pandemic in 2021. This cross-sectional study involved ninety-nine students. Participants' anxiety, fear of the coronavirus, and perceived work satisfaction were measured by GAD-7, FCV19S, and COM-B scales and assessed using descriptive, correlational, and linear regression analysis. The significant zero-order correlations between job satisfaction and fear, anxiety, and psychosocial considerations were significant. They indicated moderate strength that allowed for further inferential development to find the best predictors of job satisfaction. The findings suggested that 50% of trainees showed anxiety above the suggested ≥8 cut-off on GAD-7, and 48% scored high for fear on FCV19S. There was a significant effect between year groups (F (2, 99) = 4.25, p = 0.02 , η2 = 0.081), with a Tukey post hoc test showing a significant difference between training years 1 and 2 with a p = 0.015. A significant linear regression found that psychosocial variables in behaviour change (p ≤ 0.001) and anxiety (p = 0.011) were significant factors in job satisfaction, explaining 53.4% of the variance. Conclusion. Satisfaction was associated with higher levels of psychosocial considerations and low levels of anxiety and fear, which adds to previous literature on job satisfaction in nurse education. Future implications must examine ways to alleviate mental health effects and support policies and curricula to address this need. [ABSTRACT FROM AUTHOR]

Purpose. To compare the refractive errors measured by the Spot photoscreener (with or without cycloplegia) to cycloplegic retinoscopy in 6- to 10-week-old infants. Materials and Methods. 101 right eyes from 101 healthy infants aged 6 to 10 weeks were recruited for this cross-sectional observational study. Refractive errors were measured using Spot photoscreener before and after cycloplegia, as well as cycloplegic retinoscopy. Comparisons between the refractive measurements were performed using one-way ANOVA with the post hoc Tukey HSD test or Kruskal–Wallis test with the Steel–Dwass test according to the data normality. Pearson's correlation test and 95% confidence intervals were calculated. The agreement was evaluated using a Bland–Altman plot with 95% limits of agreement of the differences. Results. Spot photoscreener was found to underestimate the spherical equivalent by 2.33 Diopters (D) in these infants. Following the induction of cycloplegia, the spherical equivalent measured by Spot photoscreener was in excellent agreement with cycloplegic retinoscopy with the mean difference of 0.01 D. Spot photoscreener overestimated cylindrical parameter by 0.2 D with poor agreement with cycloplegic retinoscopy no matter whether cycloplegia was induced. It had good agreement with cycloplegic retinoscopy in the J 0 vector than the J 45 vector measurement. Conclusions. With the induction of cycloplegia, Spot photoscreener can accurately evaluate spherical equivalent in hyperopic infants with mild-to-moderate astigmatism. While it may provide valuable measurements of astigmatism, discrepancies in cylinder and axis should be taken into account. [ABSTRACT FROM AUTHOR]

While previous reports have established the anti-inflammatory effects of hangeshashinto, the intracellular signal transduction pathways involved have yet to be elucidated. We aim to employ an experimental system using oral cancer cells to assess the impact of hangeshashinto on intracellular signal transduction pathways in response to stimulation by Porphyromonas gingivalis pathogen-associated molecular patterns (PAMP). Hangeshashinto demonstrated the ability to inhibit the production of interleukin (IL)-6 and IL-8 induced by P. gingivalis PAMP. Furthermore, hangeshashinto suppressed the activation of the IL-6 promoter stimulated by PAMP. Hangeshashinto, like Toll-like receptor (TLR) signaling inhibitors (resatorvid and C29) and an immunosuppressant (dexamethasone), exhibited the ability to suppress TLR-mediated activation of the transcription factor nuclear factor-κB (NF-κB) in response to PAMP stimulation. This study suggests that the anti-inflammatory effects of hangeshashinto may be attributed to the inhibition of TLR signal transduction pathways including NF-κB activation, thereby suppressing NF-κB-dependent gene expression. [ABSTRACT FROM AUTHOR]

The recruitment and retention of in-patient psychiatric mental health registered nurses (PMH-RNs) remains a challenge. This qualitative study sought to identify factors impacting the recruitment and retention of PMH-RNs in acute-care settings. Participants (N = 15) were recruited for focus groups including one with in-patient unit administrators (n = 4), two with current PMH-RNs (n = 7), and two with nursing students (n = 4). Data were analyzed using a directed content analysis approach. Participants were informed about the study's purpose, procedures, potential risks, and benefits, and they provided verbal consent before participating. Administrators emphasized a focus on retention and described a variety of supports they provided PMH-RNs, including formal and informal support and education. PMH-RNs' most prevalent concerns were their safety, co-worker and/or management challenges, and emotional and/or physical exhaustion. Students also expressed concerns about safety in psychiatric settings and desired more interaction with PMH-RNs. They were also interested in learning more about the specialty as they valued the opportunity to see change in patients. All three groups mentioned a need for more interaction between students and PMH-RNs, while safety concerns were expressed by both PMH-RNs and students. Because PMH-RNs play a critical role for in-patient psychiatric care, recruiting and retaining specialist nurses can focus on increasing student engagement with the PMH-RNs, attending to PMH-RNs' management and staffing concerns, and providing additional resources for responding to events that threaten safety in the workplace to prevent burnout. [ABSTRACT FROM AUTHOR]

Aim. To examine the relationships among nursing professionalism, empathy, and clinical decision-making ability and the factors influencing shared decision-making awareness in hemodialysis nurses. Background. Self-management and treatment for hemodialysis patients are essential for maintaining health and life in daily life. In this process, shared decision-making in which patients, nurses, and medical teams participate and make decisions together has a greater impact on the health recovery and improvement of quality of life for hemodialysis patients than for any other chronic disease patients. Methods. A cross-sectional descriptive design was employed. Participants were 145 nurses working in the hemodialysis centers at hospitals in Seoul and Gyeonggi-do. Measures included the general characteristics of study participants, nursing professionalism, empathy, clinical decision-making ability, and shared decision-making awareness. Data were collected from May to July, 2022, and multiple linear regression analysis was used to examine the predictive factors of shared decision-making awareness. Results. The strongest predictor was empathy, followed by clinical decision-making ability and the level of education. The explanatory power of the final regression model was 23%. Conclusions. Empathy towards hemodialysis patients was an important factor influencing the shared decision-making awareness in hemodialysis nurses. Implications for Nursing Management. In nursing management, nursing managers or nurses should pay attention to influencing factors to improve the shared decision-making awareness of hemodialysis nurses. Empathy towards hemodialysis patients need to be reinforced to improve the shared decision-making awareness of hemodialysis nurses. [ABSTRACT FROM AUTHOR]

Objective. This research study investigated the effect of new decontamination protocols on the bonding capacity of saliva-contaminated monolithic zirconia (MZ) ceramics cemented with two different monomer-containing self-adhesive resin cements. Materials and Methods. Standardized tooth preparations (4 mm. axial height) were performed for eighty human maxillary premolars under constant water cooling system. Eighty monolithic zirconia crowns (Whitepeaks Supreme Monolith) (n = 8 / 10 groups) were manufactured by CAD-CAM. Specimens were kept in the artificial saliva at pH = 7.3 for 1 minute at 37°C except control groups. The specimens have not been prealumina blasted and grouped according to cleaning methods and resin cements: control groups (C) (no saliva contamination + GPDM + 4 ‐ META (N) (CN) and 10-MDP (M) containing resin cement (CM), alumina blasted AL + GPDM + 4 ‐ META (ALN) and 10-MDP containing resin cement (ALM), zirconium oxide containing universal cleaning agent (IC) applied + GPDM + 4 ‐ META (N) (ICN) and 10-MDP containing resin cement (ICM), pumice (P) applied + GPDM + 4 ‐ META (PN) and 10-MDP containing resin cement (PM), and air-water spray (AW) applied + GPDM + 4 ‐ META (AWN) and 10-MDP containing resin cement (AWM)). Monobond Plus was applied to all surfaces for 40 seconds before cementation. The thermal cycle was applied at 5,000 cycles after cementation. The crowns were tested in tensile mode at a speed of 1 mm/min. The mode of failure was recorded. SEM examinations were carried out at different magnifications. Data were analyzed using rank-based Kruskal-Wallis and Mann–Whitney tests. Results. No significant differences were found between the surface treatments and between the two types of resin cements. Interaction effects between surface treatments and resin cements were found to be significant by two-way ANOVA analysis. ICM group resulted in significantly better bond strength results compared with CN. ICM was found to result in better bond strength results compared with PM. The combination of universal cleaning agent and 10-MDP containing resin cement had significantly the highest cementation bond strength values. The increasing order of mean tensile bond strength values of decontamination protocols was C < AW < P < AL < IC. The mean tensile bond strength of 10-MDP containing resin cement was slightly higher than GPDM + 4 ‐ META containing resin cement. Conclusions. Universal cleaning agents can be preferred as an efficient cleaning method with 10-MDP-containing cement after saliva contamination for better adhesive bond strength of 4 mm crown preparation height of monolithic zirconia ceramics. [ABSTRACT FROM AUTHOR]

Objective. The growing evidence shows that parathyroid hormone (PTH) may affect glucose metabolism. However, the relationship between them is still controversial among diabetic patients. The current study aimed to investigate the relationship between PTH and glucose metabolism in the patients with newly diagnosed type 2 diabetes (T2D). Methods. A total of 532 participants, including 387 patients with newly diagnosed T2D and 145 healthy controls, were recruited in the present study. PTH and metabolic parameters were measured in all participants. Results. The PTH levels were significantly lower in the newly diagnosed T2D patients compared with the control group (35.10 (25.90, 47.20) vs. 47.15 (35.83, 58.65) pg/ml, P < 0.001). The T2D patients with a higher glycated hemoglobin (HbA1c) tertile had lower PTH levels than the patients with a lower HbA1c tertile (32.90 (24.85, 41.40) vs. 37.50 (26.10, 54.55) pg/ml, P < 0.001). Spearman correlation analysis showed that PTH was positively correlated with the body mass index (BMI), fasting insulin (FINS), homeostasis model assessment of β-cell function (HOMA-β), and homeostasis model assessment of insulin resistance (HOMA-IR) and negatively correlated with HbA1c, blood calcium (Ca), blood phosphorus (P), and 25-hydroxyvitamin D3 (25-OH-D3). Multiple linear regression analysis demonstrated that PTH was significantly associated with HbA1c (β = −1.475, P = 0.003) and HOMA-β (β = 0.090, P = 0.001) after adjusting for age, sex, BMI, season, 25-OH-D3, Ca, and P. Conclusion. PTH was negatively correlated with HbA1c in the newly diagnosed T2D patients. Our results suggested that the PTH level within the reference range is related to islet β-cell function and hyperglycemia. [ABSTRACT FROM AUTHOR]

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]

Background. Obesity is expected to hinder efferocytosis due to ADAM17-mediated cleavage of the MER tyrosine kinase receptor, producing soluble MER (sMER) that disrupts MERTK binding to cell death markers. However, the intracellular efferocytosis pathway in central obesity remains elusive, particularly the role of low-grade chronic inflammation in its initiation and identification of binding signals that disrupt efferocytosis. Objective. We investigate the efferocytosis signaling pathway in men with central obesity and its relationship with inflammation, cell death, and related processes. Methods. A cross-sectional study was conducted, and clinical data and blood samples were collected from 56 men with central obesity (obese group) and 29 nonobese individuals (control group). Clinical evaluations and predefined biochemical screening tests were performed. The efferocytosis signaling pathway was investigated by measuring phosphatidylserine (PS), ADAM17, TNF-alpha (TNF-α), and sMER. Results. Metabolic syndrome was detected in more than half of the participants in the obese group according to the predefined tests. Mean levels of PS, TNF-α, and sMER were higher in the obese group but not significantly different from those of the control group. Further analysis based on waist circumference (WC) ranges in the obese group revealed a significant increase in PS and sMER levels between the control group and the obese group with WC greater than 120 cm. ADAM17 levels were significantly higher in the obese group than in the control group. PS was positively correlated with WC and ADAM17. ADAM17 was positively correlated with TNF-α and sMER, indicating impaired efferocytosis. Conclusions. Central obesity appeared to cause a disturbance in efferocytosis that began with cell damage and death, along with an enlargement of the WC and an ongoing inflammatory response. Efferocytosis was disrupted by proinflammatory cytokine regulators, which induced the production of sMER and interfered with the efferocytosis process. [ABSTRACT FROM AUTHOR]

Objectives. Throughout the world, medical trainees have experienced psychological distress during the COVID-19 pandemic due to substantial changes in their educational programs and COVID-19 patient care. When medical trainees live with a disability, their psychological distress may be exacerbated. This study aimed to explore how having a disability may be associated with an additional emotional toll for medical trainees during the COVID-19 pandemic. Methods. Participants in the study were 201 medical trainees (62 interns and 138 residents) and 147 medical attending physicians in various fields of medicine. Participants completed an online survey including the Fear of COVID-19 scale, the Depression Anxiety and Stress Scale, and the Mental Health Continuum Scale measuring aspects of wellbeing, including emotional wellbeing, belonging, and sense of psychological meaning. Results. Disabled participants experienced higher levels of fear of COVID-19, depression, anxiety, stress, and lower levels of emotional wellbeing, sense of belonging, and psychological meaning compared to participants with no disabilities. Residents generally experienced higher stress levels and lower wellbeing levels than attendings. Residents living with disabilities were more prone to experience stress and fear of COVID-19, and residents and interns living with disabilities experienced higher levels of depression, anxiety, and stress compared to their peers who live without disabilities and compared to attendings living with disabilities. Conclusions. Medical trainees living with disabilities were more prone to experience high levels of psychological distress and lower levels of wellbeing during the COVID-19 pandemic compared to their peers without disabilities. Therefore, there is a need to address this emotional toll and provide support in medical education programs promoting trainees' wellbeing, sense of belonging, and psychological meaning. [ABSTRACT FROM AUTHOR]

Background. Nurses' creativity is an imperative necessity for healthcare organizations to grow. The creative abilities of nurses are affected by many factors; some of these factors are stimulants and some of these are inhibitors. Supervisors' knowledge sharing behavior and the capacity to absorb new knowledge and technologies are important factors in the recent era that delineate the creativity of nurses. Aim of the Study. Assess the effect of supervisor knowledge sharing behavior and organizational absorptive capacity on nurses' creativity. Method. Cross-sectional multicenter descriptive correlational exploratory research design was used to conduct the study. Data were collected conveniently from 700 nurses recruited from five large hospitals at Alexandria, Egypt, using three self-administered printed questionnaires. Findings were investigated via descriptive and inferential statistics as well as structured equation modeling. Results. Nurses' creativity was positively associated with supervisor knowledge sharing behavior and organizational absorptive behavior (r = 0.619, p value <0.001, and r = 0.545, p value <0.001, respectively). Supervisor knowledge sharing behavior accounted for 87% of variance in nurses' creativity, while organizational absorptive capacity accounted for 55% of variance in nurses' creativity. Conclusion. Supervisors' knowledge sharing behavior and absorptive capacity of organization are powerful significant stimulants for nurses' creativity. Implications to Nursing Management. Hospital directors, managers, and nursing leaders should cultivate knowledge sharing behavior in healthcare settings by establishing a reward and incentive system for healthcare workers who share their knowledge with their colleagues for mutual benefit and organizational development. [ABSTRACT FROM AUTHOR]

Objectives. To examine the relationship of QRS voltages and left ventricular (LV) mass across the spectrum of individuals with different LV mass. Methods. Twenty QRS voltage measurements or combinations were determined in a consecutive series of 159 adults with an ECG and echocardiogram without previous myocardial infarction, left or right bundle branch block, pre-excitation, or electronic pacemaker. Results. The four strongest and significant correlations between QRS and LV mass were S in V4, deepest S wave in any precordial lead plus S in V4, S in V3, and S in V3 plus R in AVL times QRS duration. For men, the strength of the relationships were S in V3 (F = 33.8), deepest S wave in any precordial lead plus S V4 (F = 33.7), S in V3 plus R aVL (F = 29.9), S in V4 (F = 29.79), and deepest S in precordial leads (F = 17.9). The R wave in AVL alone did not correlate with LV mass. Criteria using the R wave in lateral precordial leads did not correlate as strongly with LV mass. For women, only S in V4 significantly correlated with LV mass. Overall, the R wave voltage in limb leads (AVL I or II) did not correlate with precordial S wave amplitudes. Univariate and multivariate analysis showed that some but not all QRS voltages correlated with each other. In multivariate analysis, using only single variables and not combination of QRS variables, the only significant relationship between QRS voltage and left ventricular mass was for men the S in V3 (p = 0.04) and for women S in V4 (p = 0.016) and R in V6 (p = 0. 04). Conclusion. The S wave in V3 and V4 correlate most strongly with LV mass while the R wave in limb leads, including AVL, do not correlate. [ABSTRACT FROM AUTHOR]

Sound localization testing is key for comprehensive hearing evaluations, particularly in cases of suspected auditory processing disorders. However, sound localization is not commonly assessed in clinical practice, likely due to the complexity and size of conventional measurement systems, which require semicircular loudspeaker arrays in large and acoustically treated rooms. To address this issue, we investigated the feasibility of testing sound localization in virtual reality (VR). Previous research has shown that virtualization can lead to an increase in localization blur. To measure these effects, we conducted a study with a group of normal-hearing adults, comparing sound localization performance in different augmented reality and VR scenarios. We started with a conventional loudspeaker-based measurement setup and gradually moved to a virtual audiovisual environment, testing sound localization in each scenario using a within-participant design. The loudspeaker-based experiment yielded results comparable to those reported in the literature, and the results of the virtual localization test provided new insights into localization performance in state-of-the-art VR environments. By comparing localization performance between the loudspeaker-based and virtual conditions, we were able to estimate the increase in localization blur induced by virtualization relative to a conventional test setup. Notably, our study provides the first proxy normative cutoff values for sound localization testing in VR. As an outlook, we discuss the potential of a VR-based sound localization test as a suitable, accessible, and portable alternative to conventional setups and how it could serve as a time- and resource-saving prescreening tool to avoid unnecessarily extensive and complex laboratory testing. [ABSTRACT FROM AUTHOR]

Background and Purpose. Myofascial pain syndrome (MPS) is a chronic or acute form of musculoskeletal pain that affects nearly three-quarters of the world's population. It is characterized by muscle pain and stiffness, with palpable nodules and hyperirritability areas called myofascial trigger points (MTPs). The temporal muscle is frequently involved in MPS, and four MTPs in the temporal muscle have been described in the literature, but no anatomical description of the MTPs has been reported. The present study described the entry points of deep temporal nerves in the temporal muscle belly and related these points to the MTPs described in the literature. Method. Temporal muscles of 14 adult cadavers were studied. The muscle bellies were divided into six areas, three superior (1.2 and 3) and three inferior areas (4, 5, and 6) lower, according to a Cartesian plane to analyze and describe the entry points of the branches of the deep temporal nerves into the muscle. The branching distribution was analyzed using Poisson log-linear tests with Bonferroni post hoc tests for comparison between groups (sextants) (p < 0.05). Results. Deep temporal nerve entry points were found in the temporal muscle in all areas. Most of the branches were observed in areas 2 and 5, which coincide with the muscle fibers responsible for mandible elevation and related to the previously described MTPs. Fewer branches were found in areas 1 and 6, where contraction produces mandible retraction. Conclusion. There is an anatomical correlation between the branching pattern of the deep temporal nerve and temporal muscle trigger points. Adequate knowledge of the innervation of the temporal muscle may help elucidate the pathophysiology of myofascial syndromes and provide a rational basis for interventional or conservative approaches and help surgeons avoid iatrogenic lesions to the deep temporal nerve lesion. [ABSTRACT FROM AUTHOR]

Background. The latest Movement Disorder Society (MDS) diagnostic criteria require a good and sustained response to medication to get a diagnosis of Parkinson's disease, PD. Objective. The aim of this study was to evaluate levodopa response in a group of patients with probable PD, diagnosed by movement disorder specialists. Methods. An acute levodopa challenge test (LDCT) was performed after pausing the dopaminergic medication for 6 half-times. The motor part of the Unified Parkinson's Disease Rating Scale was performed in the OFF-state and after LDCT (ON). A good effect was defined as >30% improvement. A video-protocol was used to secure standardized motor examination with blinded assessments of the UPDRS-III OFF and ON. An age-matched group of control subjects (CS) was included but did not go through LDCT. All participants were evaluated with Montreal Cognitive Assessment (MoCA) and Beck's Depression Inventory (BDI). Results. In the statistical analysis, 37 patients were included. Twenty-one patients showed an improvement ≤30%, while 16 patients showed an improvement >30%. LDCT showed an overall mean improvement of 27.3% of motor UPDRS. In 43.2%, there was a discrepancy between the effect seen with the LDCT and the patients' self-perceived medicine evaluation. Patients with PD had a significantly lower MoCA score and more depressive symptoms compared to CS. Conclusions. We showed an acute effect of levodopa using LDCT that was around 30% improvement. While it lends support to the use of this limit in the MDS diagnostic criteria, an acute effect of less than 30% should be considered acceptable in some patients. Our study highlights a discrepancy in the objective measure of medicine effect on motor symptoms and the patient's subjective evaluation. [ABSTRACT FROM AUTHOR]

Background. Korean university students (KUS) face numerous challenges that can jeopardize their well-being, including academic stress, peer pressure, irregular sleep patterns, unhealthy eating habits, lack of physical exercise, and difficulties in time management, resulting in unhealthy habits and fluctuations in lifestyle. Consequently, there is a growing need for interventions tailored to this population. Aim. This study explored the effects of a Lifestyle Redesign (LR) intervention on Korean university students' well-being including occupational participation, satisfaction, perceived stress levels, and quality of life. Method. A quasi-experimental study with 33 KUS (17 intervention, 16 control) assessed the effects of a 10-week LR intervention on well-being of the students. Pre- and postintervention changes were measured using Canadian Occupational Performance Measure (COPM), Stress Response Inventory (SRI), and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF). The intervention, delivered by trained OTs, comprised of individual and group sessions. Results. Statistically significant improvement was observed in occupational performance. While statistical significance was not consistently achieved in the rest of other areas, the LR group displayed positive trends. The LR group exhibited higher COPM satisfaction scores, lower SRI scores (indicating reduced stress), and elevated WHOQOL-BREF scores compared to the control group. Conclusion. This study contributes to the understanding of the importance of addressing lifestyle changes and habits in the well-being of university students, especially in the context of academic stress and peer pressure. Future research with larger, more diverse samples and extended intervention periods may offer further insights into the benefits of LR programs in university settings. [ABSTRACT FROM AUTHOR]

Background and Purpose. Leisure, as an occupation, played a crucial role in promoting individuals' health and well-being. However, the specific impact of leisure as an intervention for individuals with substance use disorder remains unclear. This pilot study was aimed at investigating the effect of a leisure intervention on occupational performance and occupational balance in individuals with substance use disorder. Methods. The sample for this quasiexperimental pretest–posttest with a two-month follow-up design comprised nine individuals aged between 18 and 55 years, selected using a convenience sampling method. The intervention consisted of a 2-month group leisure participation program, conducted twice a week, followed by a 2-month follow-up period. Primary outcome measures included occupational performance and occupational balance, and secondary outcome measures were leisure participation, quality of life, and drug craving. Outcome measures were assessed three times: preintervention, postintervention, and after the follow-up period. The outcome measures included the Canadian Occupational Performance Measure (COPM), Occupational Balance Questionnaire-11 (OBQ11), Nottingham Leisure Questionnaire (NLQ), 36-Item Short-Form Health Survey (SF-36), and Desire to Drug Questionnaire (DDQ). Data analysis was performed using the Friedman test and Wilcoxon signed-rank test as a post hoc procedure, with a significance level set at 5%. Results. The findings showed significant improvements in participants' occupational performance in postintervention and follow-up assessments (p < 0.01 , r = 0.59) and better occupational balance from pre- to postintervention (p < 0.01 , r = 0.59) and after the follow-up period (p < 0.01 , r = 0.60). Furthermore, significant enhancements were observed in leisure participation, quality of life, and a reduction in drug craving. Conclusion. The findings indicate that leisure intervention positively impacted both occupational performance and occupational balance, suggesting its potential as a beneficial therapeutic approach for individuals with substance use disorder. Additional research is warranted to delve deeper into and validate the effectiveness of leisure intervention within this specific population. [ABSTRACT FROM AUTHOR]

Introduction. Anethum graveolens (AG), commonly known as dill, is a plant from the Apiaceae family that has been traditionally used as a skin softener and purifying agent in Persian medicine. In a previous study conducted on male rats, dill was found to have anti-inflammatory effects. The current study aimed to examine the efficacy of topical application of Anethum graveolens oil on pruritus severity, skin dryness, sleep quality, and quality of life in patients undergoing hemodialysis. Methods. In the current clinical trial, the participants were randomly assigned to one of these groups: topical AG preparation, sesame oil, or a control group receiving no treatment. The study was double-blind and placebo-controlled. The topical treatment was applied twice a day for one month to areas of the skin affected by pruritus. The outcome measures included the severity of skin dryness, the Pittsburgh Sleep Quality Index, Duo's Uremic Pruritus Severity Scale, and the Itchy QoL questionnaire. Results. This study involved 106 hemodialysis patients, and after intervention for one month, the medication group had a significantly lower mean score of sleep quality (3.24 ± 2.41) than the placebo (4.54 ± 3.11) and control (5.05 ± 3.21) groups (P = 0.032). The mean change in pruritus severity was significantly greater in the medication group (−17.28 ± 8.938) than the placebo (−5.91 ± 5.398) and control (−3.43 ± 3.228) groups (P < 0.001). Moreover, a significant difference was observed in the mean changes in quality of life between the medication, placebo, and control groups, with values of −14.88 ± 7.89, −5.34 ± 4.50, and −1.92 ± 2.86, respectively (P < 0.001). Furthermore, both the medication and placebo groups showed improvement in skin dryness compared to the control group having the values of −1.65 ± 0.91, −1.11 ± 0.79, and −0.38 ± 0.54, respectively (P < 0.001). Conclusion. Topical Anethum graveolens preparation significantly improved the sleep quality and quality of life and reduced skin pruritus and dryness in hemodialysis patients. It could be considered as a simple therapeutic modality to control pruritus in hemodialysis patients. This trial is registered with IRCT2017022032671N1. [ABSTRACT FROM AUTHOR]

This study investigated the correlation between PD-L1 expression, metastasis, and survival in colorectal cancer (CRC) patients. PD-L1 expression was not significantly associated with overall survival, disease-free survival, or mortality rate. However, a significant difference was observed between PD-L1 positive and negative patients regarding the presence of metastasis, which was higher in the PD-L1 positive group. These findings suggest that PD-L1 expression may impact metastasis in CRC patients but not overall survival. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify factors affecting the noise management performance of adult intensive care unit (ICU) nurses in Korea. The ICU environment is exposed to various types of noises due to the use of medical devices for the treatment of critically ill patients. The noise has an adverse effect on nurses' health and their nursing performance, which might potentially threaten patient safety. A cross-sectional study was conducted with a total of 148 nurses working in adult ICUs from two university hospitals in Korea. Data were collected using self-administered questionnaires, which included various aspects such as noise knowledge, response to noise, patient safety culture, and noise management performance. Multiple regression analysis revealed that teamwork (β = 0.33, p = 0.004), patient safety policy, and procedure (β = 0.25, p = 0.037), which were subscales of patient safety culture, as well as frequency of noise experience (β = 0.16, p = 0.030) were significant factors affecting adult ICU nurses' performance of noise management. This study provides a significant basis for promoting adult ICU nurses' performance in noise management. A structured policy and procedure for noise management should be established for reducing noise in adult ICUs. In terms of nursing education, it is necessary to consider and develop team-based training programs to promote noise management performance in the ICU. Nurse managers and nursing organizations should consider how to create conditions in which nurses can recognize the importance of noise reduction and perform well in noise management. [ABSTRACT FROM AUTHOR]

Background. Nurses demonstrate high burnout prevalence. Moreover, destructive leadership, as well as job demands and resources, are associated with burnout. However, these associations, particularly in the context of nursing, warrant further investigation. Objective. To explore the associations of destructive leadership, as well as job demands and resources, with burnout in registered nurses. Design. A cross-sectional survey. Participants. 2115 registered nurses in Finland. Methods. The self-administered questionnaire survey was distributed nationwide to 106,000 members of the Finnish trade union for health and social care professionals via an online newsletter in February 2023. Nurses' burnout was measured with the Burnout Assessment Tool (BAT). The data were analysed through descriptive statistics and linear regression analysis. Results. Destructive leadership and job demands were positively associated with burnout (β = 0.39 and 0.32, respectively; both p < 0.001), whereas job resources and burnout were negatively associated (β = −0.41, p < 0.001). The associations of destructive leadership and job demands with burnout became less positive when job resources were added to the regression model (β = 0.21 and 0.14, respectively; both p < 0.001). Conclusions. Job resources led to the greatest reduction in burnout among registered nurses. Moreover, job resources reduced burnout by diminishing the negative effects of destructive leadership and job demands. Providing a sufficient amount of job resources might reduce burnout and diminish the negative effects of destructive leadership and job demands among nurses. These relationships warrant examination in other cultural settings. [ABSTRACT FROM AUTHOR]

India is a land of unity in diversity and it is not only true about its sociocultural but also holds residential areas too. Rural and urban areas associated with different sociostructural characteristics may contribute variation in behavioural adaptation. We studied the impact of rural-urban differences on the acceptance level and meaning of life among breast cancer patients in India. The present analytical descriptive cross-sectional study was conducted under superspecialty hospital, West Bengal, India. We compared the acceptance capability and meaning in life in breast cancer patients from rural areas (N = 122) and urban areas (N = 99). Patient-reported data concerning selected psychological (acceptance ability and the meaning of life), sociodemographic, and biological factors were collected by using validated tools. To identify the impact of sociocultural variation, descriptive statistics were calculated as the mean ± standard deviation of the score of validated tools based on acceptance and meaning of life. Patients from urban areas perceived meaning of life significantly worse than rural individuals (33.1 ± 2.44 vs. 24.2 ± 1.02). Education (p = < 0.01), family per capita income (p = 0 < 0.01), and family structure (p = 0.004) factors were evaluated for being predictors of acceptance levels, whereas the educational level (p = < 0.01) has significantly interacted with the meaning of life among both areas' patients. Disease acceptance levels were found to be significantly higher in urban area's patients than rural ones (38.6 ± 1.9 vs. 32.7 ± 1.92). The current study demonstrates that the patients of rural background and low education are more likely than their respective counterparts to have a lower level of acceptance capability and meaning of life. [ABSTRACT FROM AUTHOR]

Purpose. This post hoc analysis assessed the importance of proper paliperidone palmitate (PP) dose preparation prior to administration and evaluated injection site reactions after dorsogluteal injection of PP once-every-6-months (PP6M) and once-every-3-months (PP3M) formulations from a double-blind (DB) noninferiority study. Design and Methods. Clinically stable patients receiving moderate/high doses of PP once-monthly (PP1M) (156 mg/mL; 234 mg/1.5 mL) or PP3M (546 mg/1.75 mL; 819 mg/2.63 mL) were randomly assigned 2:1 to corresponding dorsogluteal injections of PP6M (1092 mg/3.5 mL; 1560 mg/5 mL) or PP3M (546 mg/1.75 mL; 819 mg/2.63 mL) during a 12-month DB phase. Patients receiving PP6M injections received alternating matching placebo injections every 3 months between active doses to maintain blinding. Prior to administration, each PP formulation was prepared per specific instructions to ensure complete resuspension of the medication. Findings. Of 895 PP6M injections, one of two incomplete injections was possibly related to insufficient shaking before administration; neither resulted in an adverse reaction. After dorsogluteal administration, 59 of 478 patients who received PP6M (12.3%) and 11 of 224 patients who received PP3M (4.9%) reported an injection site–related treatment-emergent adverse event (TEAE), with pain being the most commonly reported (7.7% and 4.0%, respectively). Patient-reported pain decreased from baseline to end point in both groups. During the DB phase, injection site-related TEAEs associated with PP6M injections up to 5 mL and PP3M injections up to 2.63 mL were mild to moderate in severity; none were reported as serious, resulted in treatment discontinuation, or required dermatological consultation. Practice Implications. These results inform provider and patient expectations of PP6M administration and reinforce the importance of proper PP dose preparation and administration; future work could assess safety data from real-world clinical practice. This trial is registered with NCT03345342. [ABSTRACT FROM AUTHOR]

Background. Missed nursing care, which has been explored in various acute care settings, results in adverse patient outcomes and job dissatisfaction in nurses. However, little is known about missed care in the operating room. Objective. This study tested a hypothesised model to identify relationships between nurses' age, years of experience in the operating room, job satisfaction, and intention to leave which have direct and indirect effects on the frequency of missed care. The frequency of missed care was hypothesised to be mediated by nurses reported perioperative competence and the reasons for missed care. Design. A cross-sectional design using an online survey of Australian perioperative nurses was undertaken in 2022. Methods. All Australian College of Perioperative Nurses members were invited to participate. Missed nursing care was measured using the MISSCARE Survey-OR. Age, years of experience, and intention to leave were single-item measures. Satisfaction was a three-item scale. Competence was measured by the 18-item Perceived Perioperative Competence Scale-Short Form. Structural equation modelling was used to test our hypothesised model. Results. Of the 5,500 nurses invited, 853 (15.5%) responded, but only 602 (10.9%) participant responses were usable for inclusion in the model. The model demonstrates that participants' age directly predicted the frequency of missed care, nurse role satisfaction, perceived perioperative competence, and reasons for missed care. The reasons for missed care and perceived perioperative competence were mediators that were negatively associated with the frequency of missed care. Conclusions. While the final model explained 22.6% of the frequency of missed care, other variables not identified in this study may influence this outcome. [ABSTRACT FROM AUTHOR]

Aim. To examine death anxiety and its related factors among candidates to become advanced nurse practitioners. Background. Nurses are required to care for dying patients and frequently face death-related issues in clinical practice. Yet, as human beings, it is natural for nurses to feel anxious about their own mortality, which can be incited by witnessing the death of another person. It is evident that a nurse's death anxiety level may influence how they care for their patients. However, studies to date focus primarily on the death anxiety of patients. Little is known about such experiences among registered nurses, especially those training to be advanced nurse practitioners. Design. This is a quantitative cross-sectional study. Methods. Participants were postgraduate students pursuing their advanced nurse practitioner degree at Nam Dinh University of Nursing, Vietnam. The enrolment criteria included full-time student status and a willingness to participate in the study. Data were collected from 297 participants who completed a self-administered questionnaire during February or March 2022. Death anxiety was measured using Templer's Death Anxiety Scale. Results. Most advanced nurse practitioner candidates demonstrated a moderate level of death anxiety (109/297; 39.1%). Nearly three in ten (74/297; 26.5%) reported a high level of death anxiety. No statistically significant associations between nurses' life satisfaction, age, and death anxiety were found. Death anxiety levels did not differ by gender, work position, workplace, or frequency of caring for dying patients (p > 0.05). Conclusions. There is an identified need to support nurses, especially future nurse clinical leaders, to manage their death anxiety. Professional training programs should offer nurses the opportunity to develop skills necessary to cope with their negative attitude toward death. Further research is recommended to confirm the apparent associations between death anxiety and demographic and psychosocial factors. Those relationships should be examined with appropriate consideration of the contextual and cultural environment in which the study is performed. [ABSTRACT FROM AUTHOR]

Purpose. Postintravitreal injection (IVI) endophthalmitis is a rare but devastating complication. Herein, we report the incidence ,and clinical and microbiological characteristics, as well as the visual outcome, in IVIs endophthalmitis in two medical centers. Methods. All patients undergoing intravitreal injections between 1/2018 and 12/2019 in two large medical centers were analyzed for post-IVI endophthalmitis. Results. Of the total of 51,356 IVIs performed, 23 cases of post-IVI endophthalmitis were diagnosed, yielding an overall incidence of 0.045%. The median interval from IVI to symptoms onset was 2 days (IQR: 1–5). Cultures were positive in 56% of the cases (100% Gram-positive bacteria and 76% coagulase-negative staphylococcus). Parameters associated with higher culture-positive rates included samples taken during vitrectomy, WBC on vitreous smear, the number of IVIs in the 12 months prior to presentation, and the time interval from last IVI to diagnostic sampling. At 6- and 12-month follow-up, the median change in VA (logMAR) was −1.10 (IQR: (−1.32)–(−0.40)) and −1.02 (IQR: (−1.10)–(−0.30)), respectively. Younger age and better BCVA at presentation were associated with better VA outcome, while positive culture result and systemic steroids treatment were each associated with the worse visual outcome. We found no difference in visual outcomes between PPV and TAI as a primary procedure. Conclusion. Post-IVI endophthalmitis is a rare complication, and most patients do not regain their initial VA. Certain parameters (clinical, microbiological, and therapeutic) may help anticipate the outcome and guide decision making regarding diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Onjisaponin B (OB) is the main active ingredient of Radix Polygalae with various bioactivities. However, the protective effect of OB in Parkinson's disease (PD) has not been fully studied. Liposomes are ideal nanocarriers for drugs targeting the brain. In this study, we investigated the therapeutic effect of OB-loaded liposomes (lip OB) on a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine- (MPTP-) induced mouse model of PD and 1-methyl-4-phenylpyridinium- (MPP+-) induced cell model of PD. Our results showed that lip OB significantly ameliorated MPTP-induced motor deficits and dopaminergic neuron loss in vivo and prevented MPP+-triggered cell viability reduction and apoptosis in vitro. Lip OB also improved mitochondrial dysfunction in PD models by driving PINK1/Parkin-mediated mitophagy. Furthermore, silencing PINK1 compromised the beneficial effects of lip OB on MPP+-treated PC12 cells. These findings suggested lip OB mitigates Parkinsonism in vivo and in vitro by enhancing mitochondrial dysfunction through the PINK1/Parkin pathway of mitophagy, which provides a new possibility for treating PD. [ABSTRACT FROM AUTHOR]

Long stimuli have lower detection thresholds or are perceived louder than short stimuli with the same intensity, an effect known as temporal loudness integration (TLI). In electric hearing, TLI for pulse trains with a fixed rate but varying number of pulses, i.e. stimulus duration, has mainly been investigated at clinically used stimulation rates. To study the effect of an overall effective stimulation rate at 100% channel crosstalk, we investigated TLI with (a) a clinically used single-channel stimulation rate of 1,500 pps and (b) a high stimulation rate of 18,000 pps, both for an apical and a basal electrode. Thresholds (THR), a line of equal loudness (BAL), and maximum acceptable levels (MALs) were measured in 10 MED-EL cochlear implant users. Stimulus durations varied from a single pulse to 300 ms long pulse trains. At 18,000 pps, the dynamic range (DR) increased by 7.36 ± 3.16 dB for the 300 ms pulse train. Amplitudes at THR, BAL, and MAL decreased monotonically with increasing stimulus duration. The decline was fitted with high accuracy with a power law function (R 2 = 0.94 ± 0.06). Threshold slopes were − 1.05 ± 0.36 and − 1.66 ± 0.30 dB per doubling of duration for the low and high rate, respectively, and were shallower than for acoustic hearing. The electrode location did not affect the amplitudes or slopes of the TLI curves. THR, BAL, and MAL were always lower for the higher rate and the DR was larger at the higher rate at all measured durations. [ABSTRACT FROM AUTHOR]

Older adults are a vulnerable group and face a series of problems that are preventable by changing their lifestyle, so it is necessary to understand the healthy lifestyle and its related factors in older adults. This study aimed to determine the relationship between healthy lifestyle, self-esteem, and subjective vitality in the older adults of Sirjan. This descriptive-analytical cross-sectional study included 200 older adults referred to community health centers in Sirjan in 2021. Older adults with inclusion criteria were selected by two-stage cluster sampling. Data were collected by demographic information questionnaire, the healthy lifestyle questionnaire for elderly, the Rosenberg self-esteem scale, and the subjective vitality scale. The data were analyzed using SPSS20 and descriptive and inferential statistics (Mann–Whitney U test, Kruskal–Wallis, post hoc tests, and Spearman correlation coefficient). A significance level <0.05 was considered. The study results showed that the mean scores of healthy lifestyle, self-esteem, and subjective vitality were 134.42 ± 13.78, 36.34 ± 4.62, and 21.80 ± 2.85, respectively. We observed a direct and significant relationship between healthy lifestyle, self-esteem, and subjective vitality (p < 0.001). Considering the relationship between healthy lifestyle, self-esteem, and subjective vitality in older adults, managers and planners can help older adults to promote their healthy lifestyles. [ABSTRACT FROM AUTHOR]

Objective. To identify the authentic leadership dimensions demonstrated by nurse leaders and to analyze the relationship between these dimensions, personality types, and job satisfaction among both leaders and their followers. Methods. A descriptive, cross-sectional study was conducted with 111 nurses using the Instruments Authentic Leadership Questionnaire, Job Satisfaction Survey, and Myers–Briggs Type Indicator®. The statistical methods used included Spearman correlation coefficients, nonparametric Mann–Whitney tests, and generalized estimating equation models with gamma distribution. Results. There was a significant difference between the evaluations of authentic leadership by leaders and followers. There was a significant association between authentic leadership and job satisfaction among followers (p value >0.05), while no correlation was observed between authentic leadership, job satisfaction, and personality type among leaders. Conclusions. The findings indicate a positive correlation between authentic leadership dimensions and job satisfaction among followers. [ABSTRACT FROM AUTHOR]

Aims. To examine the association between job satisfaction and the intention to leave and explore the factors associated with job satisfaction or the intention to leave among foreign-educated nurses in Japan. Design. A cross-sectional design was used, and data were collected through an online survey of nurses who were born and received their basic nursing education outside of Japan but are currently working as registered nurses in Japan. Data were analyzed across two phases: the first explored the related factors with intention to leave and job satisfaction using bivariate analysis and regression through IBM SPSS; the second examined the theoretical framework model using a structural equation model through IBM Amos. Results. Data from 180 participants (effective response rate: 87.4%) were analyzed. Overall, foreign-educated nurses reported moderate job satisfaction level in Japan. The final model showed good fit indices, indicating that higher workplace discrimination, lower Japanese language satisfaction, and not receiving orientation were predictors of foreign-educated nurses' lower job satisfaction. Lower job satisfaction, fewer years of nursing practice in Japan, single status, and higher language satisfaction predicted a higher intention to leave. Conclusion. This study provides incremental evidence of a negative relationship between job satisfaction and intention to leave among foreign-educated nurses in Japan. Workplace discrimination was the main predictor of nurses' job dissatisfaction and indirectly correlated with their intention to leave, as mediated by job satisfaction. Implications. Our study suggests that managers should provide a supportive and equal work environment, including implementing policies to reduce workplace discrimination and providing adequate support programs to enhance foreign-educated nurses' job satisfaction and reduce their turnover intention. [ABSTRACT FROM AUTHOR]

Aims. The aim of this study is to assess the relationship between rivaroxaban plasma concentration quantified by the gold standard and anticoagulant activities measured by routine coagulation assays in Chinese atrial fibrillation (AF) patients. Whether the normal results of these tests were reliable to rule out clinically relevant rivaroxaban levels at various thresholds was also explored. The effect of clinical drug-drug interactions (DDIs) on the exposure and anticoagulant effect of rivaroxaban were further evaluated. Methods. 116 patients receiving rivaroxaban for the management of nonvalvular AF were recruited. Rivaroxaban concentrations and coagulation tests were measured by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) and a blood coagulation analyzer, respectively. Results. The correlation of trough concentration (Ctrough) and prothrombin time (PT) or international normalized ratio (INR) was moderate with Spearman's correlation coefficient of 0.495 and 0.506, respectively. A normal PT/INR was unable to rule out Ctrough levels of >30 ng/mL and >50 ng/mL, but the negative predictive value reached 100% to exclude Ctrough of >100 ng/mL. Ctrough showed a small correlation with activated partial thromboplastin time (aPTT) (Spearman's correlation coefficient: 0.241) and no correlation with thrombin time (TT) (Spearman's correlation coefficient: 0.074). Neither aPTT nor TT accurately predicted Ctrough at any concentration. Peak concentration (Cpeak) did not correlate with any coagulation parameters. The presence of digoxin and febuxostat significantly increased rivaroxaban Ctrough by 2.18 fold and prolonged PT and INR by 44.16% and 43.60%, respectively. Conclusions. Normal routine coagulation assays were insufficient to monitor therapy with rivaroxaban. Poor correlations between rivaroxaban concentration and routine coagulation assays were observed in Chinese AF patients. The use of digoxin/febuxostat alone had no effect on rivaroxaban concentrations; however, combined strong breast cancer resistance protein inhibitor (febuxostat) and P-glycoprotein probe (digoxin) in patients with renal impairment is likely to cause clinically significant DDI with rivaroxaban. More studies are needed to establish routine therapeutic drug monitoring of rivaroxaban in clinical practice. [ABSTRACT FROM AUTHOR]