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Despite ongoing efforts to improve database accessibility, aggregated database vendors concede that they do not have complete control over document accessibility. Instead, they point to the responsibility of journal publishers to deliver articles in an accessible format. This may increase the likelihood that users with disabilities will encounter articles that are not compatible with a screen reader. To better understand the extent of the problem, a document accessibility audit was conducted of randomly selected articles from EBSCO's Library & Information Source database. Full-text articles from 12 library science journals were evaluated against two measures of screen reader compatibility: HTML format (the optimal format for screen readers) and PDF accessibility conformance. Findings showed inconsistencies in HTML format availability for articles in the selected journals. Additionally, the entire sample of PDF articles failed to meet the minimum standard of PDF Universal Accessibility of containing a tagged structure. However, all PDF articles passed accessibility permissions tests, so could be made accessible retroactively by a third party. [ABSTRACT FROM AUTHOR]

Technology in libraries has played an essential role in serving today's communities. This study provides an overview of the integrated library systems/software (ILSs) used in libraries in South Sulawesi, Indonesia. It aims to highlight the strengths and possibilities of ILSs and briefly explain their advantages and disadvantages along with the cost of implementation. The data was gathered from questionnaires sent via an online survey and from direct interviews with certain academic libraries over the period of 2019 to 2020. Fifty-three of 67 libraries that fulfilled the study have implemented an ILS. To deeply understand the application, a direct interview with some libraries was conducted to learn the advantages and disadvantages. The result of the study showed that the most used ILSs are SLiMS and INLISlite and other programs like Apollo, Athenium Light, Simpus, Spektra, Jibas, KOHA, and Openlibrary. The budget spent is an average of300 USD. While the ILSs have helped these libraries improve services, IT expertise and adequate resources are needed, especially when the systems present problems. An easy-to-use system that costs less will potentially be used in this area of research. This study will be particularly helpful for any library in Indonesia. These findings may also be generalized to libraries in other countries facing economic and technological similarities. [ABSTRACT FROM AUTHOR]

To study library guides, as published on Springshare's LibGuides platform, new approaches are needed to expand the scope of the research, ensure comprehensiveness of data collection, and reduce bias for content analysis. Computational methods can be utilized to conduct a nuanced and thorough evaluation that critically assesses the resources promoted in library guides. Web-based library guides are curated by librarians to provide easy access to high-quality information and resources in a variety of formats to support the research needs of their users. Recent scholarship considers library guides as valuable resources and as de facto publications, highlighting the need for critical study. In this article, the authors present a novel model for comprehensively gathering data about a specific genre of books from individual LibGuide pages and applying computational methods to explore the resultant data. Beginning with a pre-selected list of 159 books, we programmatically queried the titles using the LibGuides Community search engine. After cleaning and filtering the resultant data, we compiled a list of 20,484 book references (of which 6,212 are unique) on 1,529 LibGuide pages. By testing against inclusion and exclusion criteria to ensure relevancy, we identified a total of 281 titles relevant to our topic. To gain insights for future study, citation analysis metrics are presented to reveal patterns of frequency, co-occurrence, and bibliographic coupling of books promoted in LibGuides. This proof-of-concept could be adopted for a variety of applications, including assessment of collections, public services, critical librarianship, and other complex questions to enable a richer and more thorough understanding of the information landscape of LibGuides. [ABSTRACT FROM AUTHOR]

This paper discusses how the William G. Squires Library conducted a usability study on their LibGuides to identify student design preferences. The results of the study support previous research concerning best practices for LibGuide creation. This paper offers insight into how librarian-centric design hinders student success and provides suggestions for how to best develop a student-centric template design that offers consistency and increased user proficiency across all guides. [ABSTRACT FROM AUTHOR]

Universities and scientific educational institutions today need targeted information services to ensure that their user communities have the information they need. This study aims to design, develop, implement, and evaluate a mobile application for academic library services at Tarbiat Modares University (Tehran, Iran). A four-stage process was utilized to accomplish this aim. In the first phase, relevant literature was reviewed to obtain appropriate data requirements for the app. A questionnaire was designed and administered to survey expert librarians on the most suitable data requirements. The second phase involved the design of the user interface and user experience with the assistance of experts, followed by the evaluation of the experience. The third phase involved the development of the app in the Android Studio environment using the Java programming language, based on the requirements identified in the first and second phases. The app was then made available to the user community. Finally, the app was evaluated in the fourth phase using a questionnaire tool. The researchers found this approach to application development to be both economical and effective in the context of a developing country. [ABSTRACT FROM AUTHOR]

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: The global aging population has raised concerns about the fair distribution of elderly care resources. China, as the largest developing country, has made efforts to address population aging challenges. However, equitable distribution of elderly care resources remains a concern. This study analyzed the spatial layout and accessibility of elderly care service facilities (ECSFs) in Xiamen City to improve resource allocation and enhance the elderly care system in China. The findings provide valuable insights for other developing countries and regions seeking to improve their own elderly care resource allocation. Methods: Xiamen City was chosen as the research area due to its unique geographical location and advanced information technology infrastructure. The study examined the spatial distribution, accessibility, and equity of ECSFs. Using Python, point of interest (POI) data were collected and evaluated using the kernel density method and two‐step floating catchment area method. Spatial autocorrelation analysis identified areas of aggregation and dispersion in ECSF accessibility. Results: Xiamen currently has 660 ECSFs, including nursing homes, adult day care centers, home care agencies, and rural elderly care homes. The analysis revealed spatial disparities, with ECSFs clustering primarily in the central area of Xiamen Island. Significant differences in accessibility were found among the four types of ECSFs. Spatial autocorrelation analysis identified cold and hot spot areas, indicating variations in accessibility across regions. Conclusion: Xiamen City has made progress in allocating elderly care resources and constructing service facilities. However, equity in resource allocation remains a concern. Areas with limited accessibility were identified, leading to unequal access to elderly care resources and timely physical care. To address these challenges, decision‐making departments should consider increasing facilities, improving transportation, enhancing macro planning, and improving facility service quality and accessibility. These measures will optimize ECSF accessibility and promote equitable distribution of elderly care resources. [ABSTRACT FROM AUTHOR]

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

Background: Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease (IBD). It is characterized by diffuse inflammatory process of the bowel mucosa with a relapsing course. The precise evaluation of UC severity is pivotal in the therapeutic decision-making. Modified Mayo score is consistently used for the evaluation of the disease activity which depends on the patient's symptoms as well as the colonoscopic findings. The aim of this study is to assess the role of the CT enterography (CTE) scoring system in the evaluation of the disease severity in ulcerative colitis. From October 2022 to July 2023, 66 patients with known ulcerative colitis patients at time of disease activity were referred from the inflammatory bowel disease unit for radiological assessment by CTE. CT images were analyzed to determine the anatomical location of the affected bowel segments, mucosal thickening and hyperenhancement as well as the extra-enteric involvement. Correlation with the modified Mayo score was established. Results: Our results showed a statistical significant correlation between modified Mayo score and CTE with a P value of 0.000. The correlation coefficient is r = 0.964. The cut-off value of the optimal CTE score to predict mild and moderate UC was 7.5 with 0.996 area under the ROC curve, 92%sensitivity and 100% specificity. The cut-off value of the optimal CTE score to predict moderate and severe UC was 10.5 with 0.983 area under the ROC curve, 90.6% sensitivity and 100% specificity. Conclusions: CTE is a reliable diagnostic method in the systematic assessment of the disease severity of active ulcerative colitis. CTE score shows a strong proportionate correlation with modified Mayo score. The aggravation of the course of the disease increased the CTE score. CTE scoring system can help plan the therapeutic strategy and predict prognosis. [ABSTRACT FROM AUTHOR]

Objective: Cognitive decline is often considered an inevitable aspect of aging; however, recent research has identified a subset of older adults known as "superagers" who maintain cognitive abilities comparable to those of younger individuals. Investigating the neurobiological characteristics associated with superior cognitive function in superagers is essential for understanding "successful aging." Evidence suggests that the gut microbiome plays a key role in brain function, forming a bidirectional communication network known as the microbiome-gut-brain axis. Alterations in the gut microbiome have been linked to cognitive aging markers such as oxidative stress and inflammation. This study aims to investigate the unique patterns of the gut microbiome in superagers and to develop machine learning-based predictive models to differentiate superagers from typical agers. Methods: We recruited 161 cognitively unimpaired, community-dwelling volunteers aged 60 years or from dementia prevention centers in Seoul, South Korea. After applying inclusion and exclusion criteria, 115 participants were included in the study. Following the removal of microbiome data outliers, 102 participants, comprising 57 superagers and 45 typical agers, were finally analyzed. Superagers were defined based on memory performance at or above average normative values of middle-aged adults. Gut microbiome data were collected from stool samples, and microbial DNA was extracted and sequenced. Relative abundances of bacterial genera were used as features for model development. We employed the LightGBM algorithm to build predictive models and utilized SHAP analysis for feature importance and interpretability. Results: The predictive model achieved an AUC of 0.832 and accuracy of 0.764 in the training dataset, and an AUC of 0.861 and accuracy of 0.762 in the test dataset. Significant microbiome features for distinguishing superagers included Alistipes, PAC001137_g, PAC001138_g, Leuconostoc, and PAC001115_g. SHAP analysis revealed that higher abundances of certain genera, such as PAC001138_g and PAC001115_g, positively influenced the likelihood of being classified as superagers. Conclusion: Our findings demonstrate the machine learning-based predictive models using gut-microbiome features can differentiate superagers from typical agers with a reasonable performance. [ABSTRACT FROM AUTHOR]

Background: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is typically resistant to pharmacological interventions; however, achieving seizure freedom is possible through surgery. Our objective was to focus on the pregnancy and seizure outcomes during pregnancy of women with TLE-HS, and aim to identify predictors of seizure control. Methods: The West China Registry of Pregnancy of Women with Epilepsy (WCPR_EPi) was a monocentric prospective cohort study of women with epilepsy (WWE). We screened women with TLE-HS in this database. Their clinical profile, anti-seizure medication (ASM) use, and pregnancy outcomes were extracted from the records of the registry (2010–2023). Results: Out of 2320 WWE followed up, 47 pregnancies in women with TLE-HS were identified and analyzed. Seizure exacerbation occurred in 40.4% of pregnancies, and seizure freedom was present in 34.0% of these during pregnancy. Factors associated with seizure exacerbation during pregnancy was ASM non-adherence (odds ratio [OR] =7.00, 95% confidence interval [CI] 1.43–34.07, P=0.016). The surgery group showed a significantly higher seizure freedom rate (OR = 6.87, 95% CI 1.02–46.23, P=0.016) and lower rate of induced labor (0.0% vs 26.5%, P=0.047) compared to the medically-treated group alone. Caesarean section was chosen in 77.1% of cases due to seizure concerns, with comparable in epilepsy-related (n=20) and obstetric causes (n=24). No major congenital malformations were reported. Conclusions: Surgical treatment before pregnancy appears to offer a higher chance of seizure freedom compared to medication alone. Most of women with TLE-HS can deliver healthy offspring regardless of suboptimal seizure control and unwarranted concerns. [ABSTRACT FROM AUTHOR]

Pseudoxanthoma elasticum (PXE) is a rare metabolic disease with autosomal recessive inheritance. The manifestation in PXE is represented by retinal complications, pseudoxanthomas of the skin folding areas, and arterial calcification. The retinal complications are caused by the calcification of Bruch's membrane beneath retinal pigment epithelial cells (RPE) that can lead to retinal macular degeneration. The exact mechanism for the retinal pathophysiology is not known, and patients have variable symptoms and findings. Two induced pluripotent stem cell (hiPSC) lines from a patient carrying the common homozygous mutation c.3421C > T, p.Arg1141X in the ATP‐binding cassette transporter gene (ABCC6; OMIM264800) were established and fully characterized. Then, RPE cells were differentiated, and molecular and functional characterization was conducted as a comparison to healthy controls. Data demonstrated that PXE‐specific high‐quality hiPSC lines can be established from a skin biopsy regardless of the skin‐related disease phenotype and disease‐specific RPE differentiation is feasible. The molecular and functional assessment of the PXE‐specific RPE indicated increased pigmentation and reduced epithelial barrier functions as well as phagocytosis activity as compared to healthy controls. Although preliminary data, this indicates possible RPE‐dependent factors that might explain the individual vulnerability of the retinas for macular degeneration in PXE. Future validation of the novel findings with additional PXE patients will be important. [ABSTRACT FROM AUTHOR]

Objective. The metabolic effects of metabolic syndrome (MetS) on musculoskeletal metabolism are controversial. This study explored the effect of MetS on bone mineral density (BMD) and muscle quality index (MQI). Methods. Data from the NHANES database from 2011 to 2014 were extracted, and nonpregnant participants aged 45–59 years were included. The included data were first weighted by complex sampling, and then, the effect of MetS on BMD and MQI was analyzed using multifactorial linear regression. We then performed a stratified analysis by gender and BMI classification. Moreover, a mediation analysis of MetS on BMD was conducted, with MQI as a mediating variable. A propensity score matching analysis method with a complex sampling design was additionally performed to verify the stability of the results. Results. A total of 1943 participants were eventually included. After adjusting for covariates, the results of linear regression show that MetS is associated with elevated pelvic BMD (beta = 0.03; 95% CI = 0.01, 0.06; P = 0.02) and reduced MQI, especially arm MQI (beta = −1.02; 95% CI = −1.27, −0.77; P < 0.0001). MetS is more associated with BMD in women, MQI in normal or heavyweight, and BMD in lightweight, according to stratified analysis. MQI explains the indirect effect of MetS on BMD (beta = 0.007; 95% CI = 0.003, 0.010). Conclusion. This study provides evidence that MetS elevates BMD and reduces MQI, and further, that there is a mediating effect of MQI on elevated BMD. [ABSTRACT FROM AUTHOR]

Background: Respiratory disease is a predominantly observed problem in neonates. Moreover, the application of flexible bronchoscopy in newborns is gradually increasing. This study aimed to investigate the value of bronchoscopy in neonates respiratory abnormalities and evaluate the safety of bronchoscopy application. Methods: Clinical data and outcomes of 56 neonates who underwent flexible bronchoscopy were retrospectively analyzed. Correlations among indications for bronchoscopy, findings, and clinical diseases were assessed. Results: A total of 56 neonates had a minimum weight of 1200 g at the time of bronchoscopy, while the minimum gestational age at birth was 26 + 1 weeks. A total of 22 cases (39.3%) had two or more clinical indications; the five most common indications were respiratory distress in 24 (42.9%), stridor in 22 (39.3%), pulmonary atelectasis in 10 (17.6%), feeding difficulty in 10 (17.6%), and difficult weaning from mechanical ventilation in 6 (10.7%) cases. A total of 13 types of abnormalities were detected in the respiratory tract. The most common abnormalities were laryngomalacia in 29 (59.2%), tracheobroncomalacia in 8 (16.3%), and vocal cord paralysis in 6 (12.2%) cases. Bronchoalveolar lavage was performed in 39 cases. Eight cases were diagnosed by bronchoscopy and then treated with surgery in the Thoracic Surgery/Otolaryngology Department; all of them were cured and discharged from the hospital after surgery. No serious complications, such as pneumothorax or shock, occurred in any of the children, of whom none died. Conclusions: Flexible bronchoscopy could play an important role in diagnosing and identifying respiratory disorders in neonates and be safely used with few serious complications. [ABSTRACT FROM AUTHOR]

Background: Distal femur fractures account for 6% of femur fractures. The treatment of distal femur fractures is challenging. Historically, nonoperative management has been the mainstay of management, which has evolved to operative management. There is no single implant used for all types of distal femur fractures. The implant evolves with time. The introduction of a distal femur locking plate (DF LCP) has had a great impact on the treatment. In developing countries like Ethiopia, there is scarcity of studies on functional outcome of operative treatment. So, this study aimed to assess the functional outcome of distal femur fractures treatment using distal femur locking plate. Methods: This prospective cohort study was carried out among adult patients with distal femur fractures treated using distal femur locking plate at Tibebe Ghion Specialized Hospital from august 2022 to July 2023. A total of 60 patients with AO Type A and Type C fracture were included. All patients were followed for 6 months. Functional outcomes were assessed using Neer's scoring system. Data was entered and analyzed using SPSS 27. Frequency, mean and cross tabulation were used to summarize descriptive statistics. Multinomial logistic regression was used to test the associations. Results: In our study out of 60 patients ,48.3% (29) had excellent functional outcomes, 30% (18) had good functional outcomes, 10% (6) had fair functional outcomes and 11.7% (7) had unsatisfactory functional outcomes according to Neer's scoring system. Patients with closed distal femur fractures had 5 times higher probability of excellent functional outcome than those patients with open distal femur fractures (AOR (2.49(5.8 ,1.07)). Patients who had regular follow up had 7 times higher probability of excellent functional outcome than those who had no regular follow up (AOR 7.16(1.11,46.22)). The average union period was 4.63 months, with only 2 patients experiencing delayed union. Conclusion: Closed fracture and regular follow up were determining factors for better functional outcomes. Closed fractures preserve the biological environment, which facilitates early fracture healing. The regular follow up helped patients to assess their rehabilitation status and pick any complication early. [ABSTRACT FROM AUTHOR]

Introduction. Despite all the improvements in surgical and anesthetic techniques, this procedure is still associated with pulmonary and cardiovascular complications in the postoperative period, and early rehabilitation, done through the use of cycloergometer, can minimize such complications, besides reducing the length of hospital stay. Objective. Therefore, the aim of the study was to assess the impact of cardiovascular exercise on lung function, respiratory muscle strength, and functional capacity in elderly patients after heart bypass surgery. Methods. To this purpose, a randomized and controlled clinical trial was conducted. Research participants were randomized to the cycle ergometer group (CEG) or to the control group (CG). The CG was managed based on the institution's protocol. The CEG also carried out all the activities of the control group, but there was the inclusion of cycle ergometry through a device built by the researchers. Pulmonary function (vital capacity (VC) and peak expiratory flow (PEF)), ventilatory muscle strength (maximum inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), and functional capacity (six‐minute walk test) were evaluated before surgery, at ICU, and hospital discharge. Results. During the research period, 122 patients were evaluated, 61 in each group. The MIP of the cycle ergometry group was higher at discharge from the ICU 95% CI 8 (5.46 to 10.54) and at hospital discharge 95% CI 14 (16.89 to 11.11). MEP was higher in the cycle ergometry group at discharge from the ICU with 95% CI 6 (8.18 to 3.82) and at hospital discharge with 95% CI 9 (11.69 a 6.31). Vital capacity at ICU discharge with 95% CI 6 (7.98 to 4.02) and at hospital discharge with 95% CI 7 (8.98 to 5.02), as well as peak flow at ICU discharge with 95% CI 43 (75.27 to 10.73), showed relevance, being higher in the group that used the cycle ergometer. The CEG showed improvement in functional capacity at the time of hospital discharge with a 95% CI 56 (30.37 to 81.63). Conclusion. We conclude that application of cycloergometry after CABG decreases the loss of pulmonary function, muscle strength, and functional capacity. This trial is registered with RBR-39yrht6. [ABSTRACT FROM AUTHOR]

Background: According to a report from the WHO, an estimated 1.13 billion people worldwide have hypertension. Medication therapy management (MTM) service is a clinical service based on the theoretical and methodological framework of pharmaceutical care practice, which aims to ensure the best therapeutic outcomes for the patient by identifying, preventing, and resolving drug therapy problems (DTPs). Purpose: The goal of this study was to determine the impact of MTM on hypertension management in Ethiopia. Methods: A pre-post interventional study design was used. Descriptive statistics, linear regression, and logistic regressions were employed to present and analyze data. Results: The final analysis included 279 patients out of 304, with a 7.8% attrition rate. The prevalence of drug therapy problems (DTPs) reduced from 63.4% at baseline to 31.5% during the post-intervention phase. Polypharmacy (AOR = 2.46; 95% CI: 1.27-4.77) and complications (AOR = 0.52; 95% CI: 0.27-0.99) were substantially associated with DTPs at the start of the study. The MTM resulted in a significant reduction in mean systolic blood pressure (SBP) (AOR = 5.31, 95% CI (3.50-7.11), P <.001), as well as a significant increase (P <.001) in the number of study patients who reached a target BP. At the end of the MTM intervention, non-adherence was linked with DTP (AOR = 2.40; 95% CI: 1.33-4.334) and living outside Addis Ababa (AOR = 1.73; 95% CI: 1.38-1.88). On average, treatment satisfaction was 86.55% (+SD) 10.34. Conclusion: To resolve DTPs and improve clinical outcomes, the MTM service was critical. The majority of patients were found to be compliant with a high treatment satisfaction score. [ABSTRACT FROM AUTHOR]

Introduction. Hormonal contraceptives (HCs) are used for birth control, menstrual disturbances, and premenopausal syndrome. Most women stop using hormonal contraceptives due to changes in their mood. The evidence regarding the association of hormonal contraception with depression shows mixed results. Therefore, we aim to establish the association between the use of hormonal contraception and depressive symptoms. Methods. A cross‐sectional study was conducted on 326 women of the reproductive age group (15–49 years) attending the family planning unit of the obstetrics and gynecology department of a medical college in Saudi Arabia. Their sociodemographic and medical details along with the current use of any contraceptives (hormonal, nonhormonal, or not using any) with duration were collected. Beck depression inventory‐II (BDI‐II) was applied to the women to assess for depression along with its severity, and a BDI score of >16 was taken to denote clinical depression. Women were stratified by type of contraceptive used, and its association with depression category was assessed. Results. A total of 326 consenting eligible women in the age group of 15–49 years were enrolled in the study of which 165 (50.6%) were currently using a hormonal contraceptive and 49 (15.0%) were using a nonhormonal contraceptive and the rest 112 (34.4%) were not using any contraceptives. There was no significant difference in the mean BDI scores (p = 0.79) and degrees of depression (p = 0.06) between the HC users and HC nonusers. However, individual symptoms of depression such as sadness (p = 0.01), reduced libido (p = 0.0002), feelings of pessimism (p = 0.02), and failure (p = 0.003) were found to be significantly higher in the HC users than non‐HC users. Conclusion. We conclude that there was no significant difference in mean depression scores between groups. However, a few individual symptoms of depression were high in HC users suggesting depression as a potential side effect of hormonal contraceptive use. [ABSTRACT FROM AUTHOR]

Background: Currently, many natural gums are extensively utilized as suspending agents in the formulation of pharmaceutical suspensions. They are easily available, nontoxic, biodegradable, and cost‐effective to be used as pharmaceutical excipients. Objective: The present study was aimed at physicochemical characterization and evaluation of the suspending capacity of Boswellia papyrifera gum (BPG) in comparison with sodium carboxy methyl cellulose (SCMC) and tragacanth gum (TG). Methods: The extracted and powdered BPG was subjected to physicochemical properties such as micromeritics, solubility, swelling power, ash value, moisture content, conductivity, pH, and apparent viscosity using standard methods. Metronidazole benzoate suspensions were formulated using various concentrations of BPG, SCMC, and TG (1%–5% w/v). The apparent viscosity, flow rate, sedimentation volume, redispersibility number, pH, and drug content were studied as assessment parameters. Results: The micromeritic studies revealed that BPG exhibited good flow properties. There was also a significant increase in solubility and swelling power of the gum as a function of temperature. The gum had 2.78% ash value and 4.32% moisture content. Conductivity and apparent viscosity of the gum were found to be increased with concentration (p < 0.05). However, the apparent viscosity of BPG was decreased with shear rate (p < 0.05), rendering a pseudoplastic flow property of the gum, which is an ideal characteristic of suspending agents. The suspending capacity of the BPG was found to be comparable to SCMC, but higher than TG. Thus, it can be concluded that BPG could be used as the best alternative to natural and synthetic suspending agents. [ABSTRACT FROM AUTHOR]

Background. Many individuals with serious mental illness live in supported accommodation. Decisions regarding type of supported accommodation required and level of support to meet individual's needs are crucial for continuing rehabilitation and recovery following admission to hospital. This study aimed to identify personal and contextual predictive factors for (1) discharge from hospital to different levels of supported accommodation and (2) self‐directed support needs of individuals with serious mental illness once they are in supported accommodation in Scotland. Method. Linked data from the Scottish Morbidity Record‐Scottish Mental Health and Inpatient Day Case Section and the Scottish Government Social Care Survey were analysed using multinomial regression and multivariable logistic regression to identify personal and contextual factors associated with accommodation destination at the time of discharge and four self‐directed support needs: personal care; domestic care; healthcare; and social, educational, and recreational. Results. Personal factors (age and having a diagnosis of schizophrenia, schizotypal, or delusional disorder) were associated with individuals moving to supported accommodation with higher levels of support. One contextual factor, compulsory detention when admitted to hospital, decreased the likelihood of moving to any type of supported accommodation. The personal and contextual factors associated with identified self‐directed support needs varied by need. Support provided by the local authority was associated with all self‐directed support needs, with having a diagnosis of schizophrenia, schizotypal, or delusional disorder associated with identifying domestic care, healthcare, and social, educational, and recreational needs, while living in the most deprived areas was associated with identifying healthcare needs. Advancing age and being compulsorily detained decreased the likelihood of identifying social, educational, and recreational needs. Conclusion. The study highlights that older men with a diagnosis of schizophrenia, schizotypal, or delusional disorder require higher levels of support upon discharge from hospital. When living in supported accommodation, having this diagnosis increases the likelihood of identifying support with looking after the home, looking after their health, and social and recreational activities; however, being older decreases the likelihood of identifying support with social and recreational activities. [ABSTRACT FROM AUTHOR]

Background: 3-Hydroxybutyrate, also called β-hydroxybutyrate, is a significant constituent of ketone bodies. Previous observational and experimental studies have suggested that ketogenic diet, especially 3-hydroxybutyrate, may have a protective effect against cardiovascular disease. However, the relationship between ketone bodies, especially 3-hydroxybutyrate, and aortic dissection remains uncertain. Materials and methods: Publicly accessible data from genome-wide association study (GWAS) was utilized to obtain information on ketone bodies, including 3-hydroxybutyrate, acetoacetate and acetone as exposure respectively, while GWAS data on aortic dissection was used as outcome. Subsequently, two-sample Mendelian randomization (MR) analysis was conducted to examine the potential relationship between ketone bodies and aortic dissection. Then, reverse and multivariate Mendelian randomization analyses were performed. Additionally, sensitivity tests were conducted to assess the robustness of MR study. Results: The inverse-variance weighted (IVW) method of Mendelian randomization analysis of gene prediction observed a negative correlation between 3-hydroxybutyrate and risk of aortic dissection (OR 0.147, 95% CI 0.053–0.410). Furthermore, consistent findings were obtained through the implementation of the weighted median, simple mode, Mendelian randomization-Egger (MR-Egger), and weighted mode methods. After adjusting acetoacetate (OR 0.143, 95% CI 0.023-0.900) or acetone (OR 0.100, 95% CI 0.025–0.398), MR analysis of gene prediction still observed a negative correlation between 3-hydroxybutyrate and risk of aortic dissection. No indications of heterogeneity or pleiotropy among the SNPs were detected. Conclusion: The findings from the MR analysis demonstrated that genetically predicted 3-hydroxybutyrate exhibits a protective effect against aortic dissection. [ABSTRACT FROM AUTHOR]

Background: Presenteeism has become a significant issue related to health. However, the effect of fatigue and organizational identification on the relationship between emotional labor and presenteeism among Chinese nurses remains unclear. This study aims to explore the correlation of Chinese nurses' emotional labor, fatigue and organizational identification with presenteeism, and to analyze the mediating effect of fatigue and the moderating effect of organizational identification on the relationship between emotional labor and presenteeism. Methods: A cross-sectional study was performed from June to October 2022 in Changchun City, Jilin Province, China. In total, 1,630 nurses were asked to complete a range of self-administered questionnaires, including the Emotional Labor Scale, the Fatigue Scale, the Organizational Identification Scale and the Stanford Presenteeism Scale. Besides, the PROCESS macro and multiple linear regression were used for moderated mediation analysis. Results: Emotional labor (r = 0.108, P < 0.001) and fatigue (r = 0.475, P < 0.001) were positively correlated with presenteeism, while organizational identification (r = -0.261, P < 0.001) was negatively correlated with presenteeism. The effect of emotional labor on presenteeism was partially mediated by fatigue (Effect = 0.014, 95% CI = [0.007, 0.021]). Additionally, the relationship between emotional labor and fatigue was moderated by organizational identification (P = 0.018 for the interaction term). Conclusions: Fatigue and organizational identification have mediating and moderating effects on the relationship between emotional labor and presenteeism, respectively. Targeted support measures should be taken to improve the presenteeism of nurses. Nursing managers can relieve the psychological pressure and fatigue of nurses by establishing emotional release channels, and improve the presenteeism of nurses through enhancing organizational identification. [ABSTRACT FROM AUTHOR]

Background: The handover process is a vital part of patient safety continuity, particularly conducted between nurses at the end of shifts. Nurses often face challenges in handover due to a lack of self-efficacy and inadequate communication skills. The clinical supervision model, by providing emotional, educational, and organizational support, aids in skill acquisition and instills confidence. Objective: This study was conducted to investigate the effect of the clinical supervision model on nurses' self-efficacy and communication skills in the handover process within medical and surgical wards. Method: This experimental two-group (pre-and post-test) study was conducted in 2024 at selected hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. Convenience sampling was used, and participants were randomly assigned to either the intervention or control group. Data were collected using the ISBAR communication checklist, communication clarity, the Sherer General Self-Efficacy Scale (GSES), the Visual Analog Scale (VAS) for handover self-efficacy, and the Manchester Clinical Supervision Scale (MCSS). The clinical supervision model and routine supervision were implemented in six sessions for the intervention and control groups, respectively. Data were analyzed using SPSS version 16, employing independent t-tests, covariance analysis, paired t-tests, chi-square tests, and repeated measures ANOVA with a significance level of p < 0.05. Results: No significant differences were observed between the intervention and control groups in terms of baseline characteristics. Inter-group analysis indicated that there were no significant differences in the scores of self-efficacy, ISBAR, and communication clarity between the control and intervention groups before the intervention (P > 0.05). According to the intra-group analysis, the ISBAR and communication clarity scores in the intervention group significantly increased over time (p < 0.001), whereas no such increase was observed in the control group. The intervention group showed a significant increase in general self-efficacy (p < 0.001) compared to the control group. Although both groups showed a significant improvement in handover self-efficacy, the mean scores of the intervention group were higher than those of the control group (p < 0.001). The mean score of the Manchester Clinical Supervision Scale in the intervention group was 128.98, indicating the high effectiveness of implementing the clinical supervision model. Conclusion: The findings indicated that the use of the clinical supervision model improves self-efficacy and communication skills in the handover process of nurses in medical and surgical wards. Therefore, it is recommended to use this model in handover training to enhance the quality of care and improve patient safety. [ABSTRACT FROM AUTHOR]

Background: Inadequate postoperative analgesia greatly affects the recovery of patients, can poses a substantial health and economic burden. Patient-controlled analgesia is the most commonly used method for postoperative pain relief. However, the situation of inadequate analgesia still exists. Artificial intelligent Patient-controlled analgesia (Ai-PCA) system can make it easier for medical staff to understand the pain level of patients in order to deal with it in time. So far, several studies have investigated anesthesiologists' knowledge and management of Ai-PCA. Objective: This study aimed to assess the degree of anesthesiologists' knowledge, attitude and their practice (KAP) towards Ai-PCA in east China's Jiangsu Province. Methods: This cross-sectional study was conducted among 396 anesthesiologists working in tertiary hospitals. The data were collected using a pretested, structured and self-administered KAP questionnaire. The data were analyzed using Independent t-test, analysis of variance, Pearson's correlation and multiple linear regression tests. Results: Five hundred twelve questionnaires were collected, 396 anesthesiologists (190 Male, and 206 Female) were included in our study for statistical analysis. The score of knowledge, attitude, practice was 5.49 ((SD = 1.65; range:0–8), 37.45 (SD = 4.46; range:9–45), and 26.41 (SD = 9.61; range:9–45), respectively. Among the participants, 309 (78%) and 264 (66.7%) had good knowledge and positive attitudes toward Ai-PCA, respectively. However, only 81 (20.5%) of the participants exhibited good practice regarding Ai-PCA. Participation in Ai-PCA training showed a significant correlation with knowledge, attitude and practice scores. Besides, age, years of experience and professional titles of anesthesiologists were correlated with knowledge scores. The title of the anesthesiologist was associated with attitude scores. And the marital status of anesthesiologists was correlated with practice scores. Conclusion: Our findings revealed the score of practice regarding Ai-PCA are very poor among anesthesiologists in east China's Jiangsu Province. The utilization of Ai-PCA was found to be impacted by whether the individual had received training. This calls for a comprehensive approach should be conducted for raising the level of knowledge, attitude, and practice of anesthesiologist on using Ai-PCA and more Ai-PCA training to be included in the daily learning. Trial registration: Chinese Clinical Trial Registry (www.chictr.org.cn; 27/10/2023; ChiCTR2300077070). [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference. Methods: This prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18–80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved. Results: Seventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed. Conclusion: The combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups. [ABSTRACT FROM AUTHOR]

Background: The development of clinical guidelines aimed at GPs is a key strategy to improving the management of chronic kidney disease (CKD). In 2019, the first CKD guideline aimed specifically at GPs practicing in Germany was published by the German College of General Practitioners and Family Physicians (DEGAM.) Aims: The aim of this study is to identify the barriers and enablers for the implementation of this guideline. The results of this project, together with quantitative evaluation against quality indicators for CKD in primary care will inform an update to the guideline. Methods: We performed 17 semi-structured interviews with GPs practicing in Berlin and Brandenburg. Transcripts were analysed using qualitative content analysis as described by Mayring. Results: We found that the perception of low clinical priority of CKD compared to other chronic diseases, opportunity cost of using guidelines, as well as poor patient understanding were significant barriers. GPs expressed that improved graphic design or integration of guideline recommendations in clinical decision support systems were enabling factors. Clinical problems concerning CKD were mostly solved by recourse to informal communication with specialists. GPs reported that they rarely consulted CKD guidelines as an aide to clinical decision making. Conclusion: The most significant barrier to use was that guidelines were not used as step-by-step decision aide in consultations with patients. Our analysis suggests that informal contact between primary and secondary care is significant conduit for evidence-based information on CKD in German primary care. Implementation projects should support the development of these relationships. [ABSTRACT FROM AUTHOR]

Background: 18KHT01 is a novel synergistic composition of Quercus acutissima, Camellia sinensis, Geranium thunbergii, and a small portion of Citrus limon. Our previous report demonstrated that the 18KHT01 exhibits potent antiobesity effects, with synergistic antioxidant, antiadipogenic, and antiobesity activities in diet‐induced obese mice. This study explores the toxicity profile and quality control parameters of the 18KHT01 formulation. Methods: Broad‐spectrum acute and subacute oral toxicity studies were performed using male and female ICR mice. In order to simultaneous analysis of the 18KHT01 formulation, an ultraperformance liquid chromatography coupled with a diode array detector (UPLC‐DAD) method was developed and validated using six marker compounds. Results: Acute oral toxicity evaluation of 18KHT01, administered at single high doses of 2, 2.5, 3, and 5 g/kg, identified 2 g/kg as the no‐observed adverse effect level (NOAEL). The LD50 (50% lethal dose) and LD100 (100% lethal dose) of 18KHT01 for male ICR mice were 3.99 and 7.77 g/kg, and those for the female mice were 2.94 and 4.70 g/kg, respectively. In addition, a 30‐day repeated dose oral subacute toxicity evaluation indicated that 18KHT01 is safe below 500 mg/kg/day for long‐term administration in ICR mice of either sex. UPLC‐DAD method validation revealed that each calibration curve for the marker compounds showed good linearity, as well as the validation parameters such as precision, specificity, and accuracy met the acceptance criteria. Conclusion: The present study evidenced the toxicological profile of 18KHT01 polyherbal formulation in mice as well as developed a simple, rapid, and accurate chromatographic method for quality control. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to investigate the risk factors associated with central serous chorioretinopathy (CSC) and analyze the relationship between vascular endothelial growth factor (VEGF), high‐sensitivity C‐reactive protein (hs‐CRP), erythrocyte sedimentation rate (ESR), and CSC. Methods. A total of 109 patients diagnosed with CSC (CSC group) at our ophthalmology clinic from February 2017 to February 2021 were included, with 103 volunteers from our hospital's health examination center serving as the control group. Additionally, the new multimodal imaging classification of 109 CSC patients was further divided into simple CSC (57 cases) and complex CSC (52 cases). Demographic data, underlying diseases, medical history, and medication history were collected. Levels of VEGF, hs‐CRP, and ESR were measured, and multifactorial logistic regression analysis was performed to identify factors influencing CSC. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic value of VEGF, hs‐CRP, and ESR in CSC. Results. The CSC group showed a higher proportion of males, smoking history, alcohol consumption, comorbid obstructive sleep apnea, hypothyroidism, renal disease, Helicobacter pylori infection, steroid use, and shift work compared to the control group (P < 0.05). VEGF, hs‐CRP, and ESR levels were significantly higher in the CSC group than in the control group (P < 0.05). The levels of VEGF, hs‐CRP, and ESR in the complex CSC group were higher than those in the simple CSC group (P < 0.05). Male gender, shift work, Helicobacter pylori infection, hypothyroidism, elevated VEGF, hs‐CRP, and ESR were identified as risk factors for CSC (P < 0.05). The combined diagnostic value of VEGF, hs‐CRP, and ESR (area under the ROC curve: 0.886) was higher than that of individual markers (0.722, 0.728, and 0.703, respectively) (P < 0.05). Conclusion. Male gender, shift work, Helicobacter pylori infection, hypothyroidism, and elevated levels of VEGF, hs‐CRP, and ESR are risk factors for CSC. The combined use of VEGF, hs‐CRP, and ESR demonstrates higher diagnostic efficiency in identifying CSC. [ABSTRACT FROM AUTHOR]

Objective: To explore the distribution of thrombin–antithrombin complex (TAT), plasmin-α2-antiplasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) in healthy older Chinese adults, and establish the reference intervals (RIs). Methods: The Biotech Shine i2900 chemiluminescence immune assay was used to measure the plasma concentrations of TAT, PIC, TM, and t-PAIC in 1628 adults ≥ 60 years. The RIs were established using the 2.5th and 97.5th percentiles of the distribution. Results: TAT levels were lower in males than females across all ages. Differences between the ages of 60–79 and ≥ 80 in both sex groups were statistically significant, with an upward trend with age. PIC levels showed no difference between the sexes but increased with age in both groups. TM levels did not differ between the sex groups, with slight fluctuation with age. The level in females aged 60–69 was slightly higher than that in the other groups; the difference was statistically significant. T-PAIC levels were not significantly different between the sex groups, with less fluctuation with sex and age. The level in males ≥ 80 years old was slightly lower than that in the other groups; the difference was statistically significant. The RIs for all markers in healthy older Chinese adults were determined and statistically reported by age and sex. For TAT, the RIs for males aged 60–79 and ≥ 80 are 0.51–2.30 ng/mL and 0.88–3.72 ng/mL, respectively, whereas for females aged 60–79 and ≥ 80, the RIs are 0.68–2.82 ng/mL and 1.02–3.67 ng/mL, respectively. For PIC, the RIs for the age groups 60–69, 70–79, and ≥ 80 are 0.10–0.89 µg/mL, 0.12–1.00 µg/mL, and 0.21–1.04 µg/mL, respectively. The RI of TM for females aged 60–69 is 3.32–13.22 TU/mL, whereas it is 2.96–13.26 TU/mL for the other groups. The RI of t-PAIC for males aged ≥ 80 is 1.63–10.68 ng/mL, whereas it is 2.33–11.34 ng/mL for the other groups. Conclusions: Discrepancies exist in thrombus markers among different sex and age groups. The RIs of TAT, PIC, TM and t-PAIC for healthy older Chinese adults were successfully established. [ABSTRACT FROM AUTHOR]

Background: Telemedicine represents an important strategy to facilitate access to medication abortion (MAB) procedures, reduces distance barriers and expands coverage to underserved communities. The aim is evaluating the self-managed MAB (provided through telemedicine as the sole intervention or in comparison to in-person care) in pregnant people at up to 12 weeks of pregnancy. Methods: A literature search was conducted using electronic databases: MEDLINE, Embase, Cochrane (Central Register of Controlled Trials and Database of Systematic Reviews), LILACS, SciELO, and Google Scholar. The search was based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework, and was not restricted to any years of publication, and studies could be published in English or Spanish. Study screening and selection, risk of bias assessment, and data extraction were performed by peer reviewers. Risk of bias was evaluated with RoB 2.0 and ROBIS-I. A narrative and descriptive synthesis of the results was conducted. Meta-analyses with random-effects models were performed using Review Manager version 5.4 to calculate pooled risk differences, along with their individual 95% confidence intervals. The rate of evidence certainty was based on GRADE recommendations. Results: 21 articles published between 2011 and 2022 met the inclusion criteria. Among them, 20 were observational studies, and 1 was a randomized clinical trial. Regarding the risk of bias, 5 studies had a serious risk, 15 had a moderate risk, and 1 had an undetermined risk. In terms of the type of intervention, 7 compared telemedicine to standard care. The meta-analysis of effectiveness revealed no statistically significant differences between the two modalities of care (RD = 0.01; 95%CI 0.00, 0.02). Our meta-analyses show that there were no significant differences in the occurrence of adverse events or in patient satisfaction when comparing the two methods of healthcare delivery. Conclusion: Telemedicine is an effective and viable alternative for MAB, similar to standard care. The occurrence of complications was low in both forms of healthcare delivery. Telemedicine services are an opportunity to expand access to safe abortion services. Plain English summary: Globally, unsafe abortion causes 47,000 deaths and 5 million sexual and reproductive dysfunctions in young pregnant people due to complications of the procedure. This practice is related to barriers to accessing safe abortion services secondary to health system limitations and inequities in the distribution of resources. Telemedicine has proven to be an efficient care alternative to reduce distancing gaps, decrease waiting time and rationalize the costs derived from the procedure. Consequently, several health systems in the world use this model with differences in treatment schemes, weeks of gestation, pregnancy confirmation methods and measurement of reported outcomes. For this reason, evaluating the effectiveness and safety of self-managed medication abortion (MAB) by telemedicine is a support for decision makers who consider implementing or expanding remote care services. This systematic review integrated studies that evaluated MAB only by Telemedicine or in comparison with standard care on pregnant people with 12 weeks gestation or less. Available studies until January 2023 were chosen. Screening and selection of studies, data extraction, and risk of bias assessment were performed by expert reviewers. Aspects such as the effectiveness, safety, and satisfaction of the procedure, among other outcomes, were reviewed. A narrative and descriptive synthesis was carried out, as well as several meta-analyses of the differences in risks between Telemedicine and in-person care. The meta-analysis of studies comparing telemedicine care with standard services reveals that the type of care provided does not affect the effectiveness and safety of MAB, nor does it affect user satisfaction, follow-up, or medication adherence. [ABSTRACT FROM AUTHOR]

Background: Information on the influences of daily eating frequency (DEF) and nighttime fasting duration (NFD) on biological aging is minimal. Our study investigated the potential associations of DEF and NFD with accelerated aging. Methods: Out of 24212 participants in NHANES 2003–2010 and 2015–2018, 4 predicted age metrics [homeostatic dysregulation (HD), Klemera–Doubal method (KDM), phenoAge (PA), and allostatic load (AL)] were computed based on 12 blood chemistry parameters. Utilizing 24-h dietary recall, DEF was measured by the frequency of eating occurrences, while NFD was determined by assessing the timing of the initial and final meals throughout the day. Weighted multivariate linear regression models and restricted cubic spline (RCS) were utilized to examine the associations. Results: Compared to DEF of ≤ 3.0 times, subjects with DEF ≥ 4.6 times demonstrated lower KDM residual [β: -0.57, 95% confidence-interval (CI): (-0.97, -0.17)] and PA residual [β: -0.47, 95% CI: (-0.69, -0.25)]. In comparison to NFD between 10.1 and 12.0 h, individuals with NFD ≤ 10.0 h were at higher HD [β: 0.03, 95% CI: (0.01, 0.04)], KDM residual [β: 0.34, 95% CI: (0.05, 0.63)], and PA residual [β: 0.38, 95% CI: (0.18, 0.57)]. Likewise, those with NFD ≥ 14.1 h also had higher HD [β: 0.02, 95% CI: (0.01, 0.04)] and KDM residual [β: 0.33, 95% CI: (0.03, 0.62)]. The results were confirmed by the dose–response relationships of DEF and NFD with predicted age metrics. Lactate dehydrogenase (LDH) and globulin (Glo) were acknowledged as implicated in and mediating the relationships. Conclusions: DEF below 3.0 times and NFD less than 10.0 or more than 14.1 h were independently associated with higher predicted age metrics. [ABSTRACT FROM AUTHOR]

Background: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. Methods: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19–30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. Results: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. Conclusions: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks. [ABSTRACT FROM AUTHOR]

Aim: To construct evidence-based sensitive quality indicators for patients' rapid rehabilitation care after combined pancreaticoduodenectomy (PD) and to provide a reference for clinical nursing professionals to scientifically evaluate the quality of patients' rehabilitation post-PD. Background: Since PD is associated with higher surgical risk and anastomotic complications, it leads to higher complication rates and longer postoperative recovery cycles. This reiterates the need for rapid recovery of patients after PD; however, the evaluation of sensitive nursing care indicators regarding rapid recovery post-PD has not yet been established to date. Methods: Based on the Donabedian structure-process-result theory model, we used available literature, semi-structured interviews, the Delphi method, and hierarchical analysis to establish a sensitive indicator system for patients' rapid rehabilitation after PD and evaluate the importance of such indicators. Results: There were two rounds of expert correspondence, and the effective recovery rate of the questionnaires of these rounds was 100%. The expert authority coefficients, as well as the Kendall coordination coefficients of the expert opinions, were 0.859 and 0.872 as well as 0.423 and 0.431, with statistically significant differences (p < 0.05), respectively. Consequently, we developed a sensitive quality index system for patients' rapid rehabilitation care after combined PD, including 3 first-level, 12 s-level, and 23 third-level indexes, respectively. Conclusion: The constructed sensitive quality index system developed for patients' rapid rehabilitation nursing care after combined PD is standardized, practical, and aligned with the specialty characteristics. Furthermore, this might help greatly in improving the quality and safety of patients' rapid rehabilitation nursing care after combined PD, standardizing nursing management skills, and enhancing nursing quality. [ABSTRACT FROM AUTHOR]

Background: Work-family enrichment refers to the extent to which experiences in one role improve the quality of life in another role, and the bidirectionality indicates that benefits derived from work can be applied to family and vice versa. Parent nurses, that is, female nurses who are raising preschool children, play a major role at work and in the family. Thus, work-family enrichment is significant for them. The Work-Family Enrichment Scale cannot be generalized to parent nurses. This study was aimed at developing and psychometrically validating a draft Work-Family Enrichment Scale for Parent Nurses. Methods: A questionnaire survey was conducted among 1,090 parent nurses who were randomly sampled from hospitals with more than 200 beds in Japan. The survey evaluated (1) a draft Work-Family Enrichment Scale for Parent Nurses, (2) the Japanese version of the Work-Family Enrichment Scale, and (3) the Positive Spillover Scale. The scales were psychometrically evaluated for internal consistency, construct validity, and criterion-related validity. Results: Data from 503 participants (age, mean ± standard deviation [range] 35.5 ± 4.96 [23–47] years) were analyzed. Results of exploratory factor analysis, the work to family enrichment direction yielded five factors for 23 items: "emotional fulfillment," "efficiency," "ability to lead," "displaying industriousness," and "self-growth." Cronbach's alpha coefficients ranged from 0.862 to 0.914. In the family-to-work enrichment direction, there were five factors for 28 items: "help-seeking," "receptiveness," "expansion of one's horizon," "efficiency," and "emotional fulfillment." Cronbach's alpha coefficients ranged from 0.790 to 0.907. Additionally, the correlation coefficients reporting criterion-related validity were 0.685 and 0.619 with regard to the Japanese version of the Work-Family Enrichment Scale and 0.596 and 0.534 with the Positive Spillover Scale for the Work-to-Family Enrichment Scale and the Family-to-Work Enrichment Scale for Parent Nurses, respectively. Conclusions: The Work-Family Enrichment Scale for Parent Nurses has adequate reliability and validity and can be used as an effective measure to assess the positive aspects of work and family roles among female parent nurses. [ABSTRACT FROM AUTHOR]

Introduction: Angiography is associated with anxiety, stress, and changes in patients' vital signs. The role of the liaison nurse is to bridge gaps and solve problems between departments, thereby preventing the occurrence of undesired complications during patient transfers. Proper preparation of patients by the liaison nurse may lead to an improvement in the hemodynamic status of patients. The present study was conducted to investigate the effect of liaison nurse on hemodynamic status during transfer process to angiography. Method: This randomized controlled trial was conducted from December 2019 to March 2020 on 62 patients who were candidates for elective angiography at Imam Reza Hospital in Mashhad. Participants were selected using a convenience sampling method and then randomly assigned to either the control or intervention group using a lottery system. In the intervention group, patients benefited from the presence of a liaison nurse from the moment the transfer order was issued by the doctor. Tools used included a demographic information questionnaire and a hemodynamic signs checklist. Data were analyzed using SPSS 25 with independent T-tests, paired T-tests, Wilcoxon, Mann-Whitney test, chi-squared, and Fisher's exact test. Result: Following the intervention, the mean systolic blood pressure, heart rate, and respiratory rate in the intervention group were found to be significantly lower than those in the control group (p < 0.05). In contrast, the mean body temperature, diastolic blood pressure and the percentage of arterial blood oxygen saturation did not exhibit a statistically significant difference between the two groups (p > 0.05). Conclusion: The liaison nurse role emerges as a valuable strategy for enhancing patients' hemodynamic stability, and its implementation can have a positive impact on patient outcomes in hospital settings. [ABSTRACT FROM AUTHOR]

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

Background: Toxic leadership is abusive, destructive, and detrimental to nurses, can decrease nurse morale, increase stress levels, diminish organizational performance, and cause employee emotional exhaustion. Emotional exhaustion, a key component of burnout, has been linked to decreased job performance and increased likelihood of engaging in deviant behaviors at work. Organizational cynicism, as a negative attitude or distrust towards the organization and its leadership, may exacerbate the relationship between toxic leadership and workplace deviance. This study aims to explore how toxic leadership, workplace deviance, emotional exhaustion, and organizational cynicism are interrelated in the nursing profession. Method: A multicenter descriptive, cross-sectional research design was conducted at three university hospitals affiliated with three Egyptian governorates: Zagazig, El-Fayoum, and Alexandria. Two hundred forty-three nurses completed the Personal and Job-related Data Questionnaire, Toxic Leadership Scale, Emotional Exhaustion Scale, Workplace Deviance Scale, and Organizational Cynicism Scale. Mediation analysis using SPSS PROCESS revealed that emotional exhaustion indirectly influences the relationship between toxic leadership and workplace deviance, while hierarchical multiple regression showed that organizational cynicism moderates this relationship, with linear regression confirming the predictive impact of these variables on workplace deviance. Results: Toxic leadership exhibits a substantial positive influence on workplace deviance (B = 16.132, p < 0.001), as does emotional exhaustion (B = 8.760, p < 0.001) and organizational cynicism (B = 5.376, p = 0.036). Furthermore, the interaction terms of toxic leadership, organizational cynicism, and emotional exhaustion are significant (B = -3.012, p = 0.036). The negative coefficient of the interaction term implies a mitigating impact, indicating that the combined presence of high toxic leadership, high emotional exhaustion, and high organizational cynicism may counterintuitively reduce workplace deviance (t = -2.110). Conclusion: These results suggest that while toxic leadership, emotional exhaustion, and organizational cynicism each independently increase workplace deviance, their combined presence may unexpectedly reduce deviant behaviors. Implication for nursing: These results highlight the significance of tackling toxic leadership practices and cultivating a positive organizational culture to enhance a healthier work environment and reduce instances of workplace deviance. Healthcare settings should prioritize interventions to improve leadership practices, enhance employee well-being, and cultivate a supportive organizational climate. [ABSTRACT FROM AUTHOR]

Aim: Explore the mediating role of cognitive emotion regulation strategies used by nursing students between academic anxiety and procrastination. Design: A descriptive correlational design was used. Setting: This study was carried out in the faculty of nursing at the University of Alexandria. Sample: The participants in this study were all students enrolled in emergency nursing during the second semester of the academic year 2021–2022 and a convenience sampling of 654 nursing students. The Sobel test was used as a statistical method to determine the significance of a mediation effect by assessing whether the relationship between perceived academic anxiety and procrastination was significantly reduced when cognitive emotion regulation was included, using coefficients and standard errors from regression models to calculate the test statistic. Tools: Academic Anxiety Scale, Academic Procrastination Scale, and Cognitive Emotion Regulation Questionnaire were used to collect data. Results: The study found that 46.5% of students reported high anxiety levels, with 40.1% perceiving moderate anxiety and only 11.3% experiencing low anxiety. Moreover, 80.4% of nursing students showed moderate academic procrastination. There is a positive correlation between procrastination and academic anxiety, with Adaptive and maladaptive coping strategies mediating this relationship, according to the Sobel test. Conclusion: Based on the results, it can be concluded that there is a complex causal and effect relationship between academic anxiety and procrastination. Nursing students may resort to academic procrastination as a means of coping. Therefore, reducing anxiety, correcting maladaptive behaviors, and enhancing adaptive cognitive and emotional regulation strategies could effectively reduce academic procrastination. [ABSTRACT FROM AUTHOR]

Background: In China, Internet-Based Sharing Nursing Service (IBSNS) is a new mode of nursing service delivery that has been in practice for over five years, which enables nurses to provide care at clients' home. However, the acceptance and associated factors of IBSNS among caregivers of elderly with chronic diseases who are the major clients of the service were unclear. Aim: To explore the acceptance of IBSNS and its associated factors among Chinese caregivers of elderly patient with chronic diseases based on the modified Technology Acceptance Model (mTAM). Methods: A cross-sectional study was conducted from February 2023 to March 2023. Caregivers of hospitalized elderly with chronic diseases were recruited using convenience sampling method from three hospitals in Beijing, China. Data were obtained from self-reports of participants. Structural equation modeling was used to analyze data. Results: A total of 65.1% of the caregivers had neutral to weakly positive behavioral intention of IBSNS use. The mTAM model was supported with good model fit. Perceived ease of use was positively associated with perceived usefulness. Both perceived usefulness and perceived security were positively associated with attitude, consequently, attitude was associated with behavioral intention. Conclusions: Improving the ease of use, security, and usefulness may be helpful to increase the positive attitude towards IBSNS and behavioral intention of using IBSNS, which provides valuable insights that can help healthcare providers improve the integration of technology in patient care, ultimately leading to better health outcomes and more efficient healthcare systems. [ABSTRACT FROM AUTHOR]

Background/aim: In the current study, we aimed to assess the association of carbohydrate quality index (CQI) with the risk of non-alcoholic fatty liver disease (NAFLD) in Iranian adults. Methods: This case-control study was conducted on 225 newly diagnosed NAFLD patients and 450 controls, aged 20–60 years. A food frequency questionnaire was used to calculate the CQI and its components, including fiber intake, glycemic index, whole grains: total grains ratio, and solid carbohydrates: total carbohydrates ratio. Multivariable logistic regression was used to estimate the odds ratio (OR) of NAFLD across the tertile of CQI and its components. Results: The participant's mean ± SD of body mass index and age were 26.8 ± 4.3 kg/m2 and 38.1 ± 8.8 years, respectively. The median (interquartile) CQI score in participants of the case and control groups was 20 (15–25) and 23 (18–28), respectively. In the multivariable-adjusted model, the risk of NAFLD decreased significantly across the tertiles of the CQI [(OR: 0.20; %95CI: 0.11–0.39), Ptrend <0.001)]. Also, the odds of NAFLD decreased across tertiles of solid carbohydrates to total carbohydrates ratio [(OR: 0.39; 95%CI: 0.22–0.69), Ptrend <0.001)]. However, a high dietary glycemic index (GI) was associated with increased odds of NAFLD [(OR:7.47; 95%CI: 3.89–14.33, Ptrend<0.001)]. There was no significant relationship between other CQI components, including fiber intake and whole grain/total grains and the risk of NAFLD. Conclusions: Our results revealed that a diet with a high quality of carbohydrates, characterized by higher intakes of solid carbohydrates, whole grain, and low GI carbohydrates, can be related to a reduced risk of NAFLD. [ABSTRACT FROM AUTHOR]

Background: Individuals develop crucial survival knowledge in the juvenile phase, including understanding medicinal plants. The family context or contact with resources can influence this dynamic knowledge. By investigating the influence of these factors on young people's understanding of medicinal plants, we aimed to enhance our understanding of the knowledge-building process. Methods: The study was conducted in three communities in the State of Alagoas, Brazil: Lagoa do Junco, Serrote do Amparo, and Brivaldo de Medeiros. Semi-structured interviews were conducted with young people aged between 11 and 19 to assess their knowledge of medicinal plants. We used a generalized linear mixed model (GLMM) with the number of therapeutic targets and known medicinal species (knowledge proxy) as response variables. As predictors, we included the number of individuals per family unit and the gender distribution within the famimunícpily (family context proxy), as well as dependence on the use (contact proxy). Location (city) was added as a fixed effect to the model. We investigated how knowledge of medicinal plants correlates with the practice of collecting these species. Results: We did not identify a relationship between the number of individuals per household, gender distribution within the family, and the frequency of medicinal plant use with knowledge about these species. However, we observed a positive, albeit weak, correlation between knowledge of medicinal species and the number of species collected. Conclusion: These results highlight the importance of investigating how young people acquire knowledge about medicinal plants, emphasizing the complex interactions between humans and nature, and providing a basis for future research. [ABSTRACT FROM AUTHOR]

Background: New daily persistent headache (NDPH) is a continuous, unremitting headache from onset that yields suboptimal results with traditional medicines. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive treatment for other headache disorders, such as migraine, and neuromodulation has not been well-studied in NDPH. The objective of the study was to evaluate the efficacy of rTMS in reducing the frequency and severity of headaches, and associated anxiety and depressive symptoms in NDPH patients. Methods: This was an open label prospective, single arm, interventional pilot study conducted between October 2022 and September 2023. All eligible participants received 10 Hz rTMS (600 pulses, 10 trains), delivered to the left prefrontal cortex for three consecutive days. The post-rTMS headache severity was recorded weekly for four weeks and headache free days/functional disability, PHQ-9, and GAD-7 scores at the end of four weeks and compared with pre-rTMS parameters. The primary outcome was defined by ≥ 50% reduction in headache severity on Visual Analogue Scale (VAS) score, decrease in headache days from the baseline and secondary outcome was ≥ 6 point reduction in HIT-6 score at 4 weeks. Results: Fifty NDPH patients (mean [SD] age, 35.06 [13.91] years; 31 females [62%]) participated in this study. Thirty-five patients (70%) reported ≥ 50% improvement in pain severity (p-value < 0.001), with a mean reduction of 10.84 (4.88) headache days per 28 days from a baseline of 28 headache days (p-value < 0.001). Thirty-eight patients (76%) reported a ≥ 6 point's reduction in HIT score at 4 weeks. Maximum improvement in the above parameters was observed in NDPH patients with chronic migraine. Two patients reported intolerance to the sound of the rTMS. The median (IQR) PHQ-9 and GAD-7 scores reduced from 11.5(3.75,20) to 7(2,15) (p-value < 0.001) and 10(3,14) to 5.5(0,9) (p-value < 0.001) respectively. Conclusion: rTMS was well tolerated and effective in reducing pain severity, headache days and headache related disability, depressive and anxiety symptoms. Trial registration: CTRI/2023/05/053247. [ABSTRACT FROM AUTHOR]

Background and Purpose: The continuous accumulation of M2 macrophages may potentially contribute to the development of kidney fibrosis in chronic kidney disease (CKD). The purpose of this study was to analyze the infiltration of M2 macrophages in uremic patients and to seek new strategies to slow down the progression of renal fibrosis. Methods: We conducted a comprehensive search for expression data pertaining to uremic samples within the Gene Expression Omnibus (GEO) database, encompassing the time frame from 2010 to 2022. Control and uremic differentially expressed genes (DEGs) were identified. Immune cell infiltration was investigated by CIBERSORT and modules associated with M2 macrophage infiltration were identified by weighted gene coexpression network analysis (WGCNA). Consistent genes were identified using the least absolute shrinkage and selection operator (LASSO) and selection and visualization of the most relevant features (SVM‐RFE) methods to search for overlapping genes. Receiver operating characteristic (ROC) curves were examined for the diagnostic value of candidate genes. Quantitative real‐time PCR (qPCR) examined the expression levels of candidate genes obtained from uremic patients in M2 macrophage. Results: A total of 1298 DEGs were identified within the GSE37171 dataset. Significant enrichment of DEGs was observed in 20 biological processes (BP), 19 cellular components (CC), 6 molecular functions (MF), and 70 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. CIBERSORT analysis observed a significant increase in B‐cell memory, dendritic cell activation, M0, M1, M2, and plasma cell numbers in uremic samples. We identified the 10 most interrelated genes. In particular, adenomatous polyposis coli (APC) and zinc finger and BTB structural domain 2 (ZBTB2) were adversely associated with the infiltration of M2 macrophages. Importantly, the expression levels of APC and ZBTB2 were far lower in M2 macrophages from uremic patients than those in healthy individuals. Conclusion: The development of renal fibrosis may be the result of M2 macrophage infiltration promoted by APC and ZBTB2. [ABSTRACT FROM AUTHOR]

Objective. This research aimed to validate the Informal Supporter Readiness Inventory (ISRI) for evaluating the preparedness of informal supporters, in an Australian sample, to provide assistance in the context of intimate partner violence (IPV). Method. The ISRI's four distinct factors were each assessed with separate confirmatory factor analyses (CFA). Reliability was calculated using Cronbach's alpha values, and test‐retest reliability was evaluated using intraclass correlation coefficients. Additionally, the ISRI's validity was assessed through Pearson's correlations with both convergent and divergent measures. Results. The CFAs supported the four distinct factors of the ISRI: normative, individual, situational‐emotion, and situational‐assessment. The measure exhibited good‐to‐excellent internal consistency across these factors and good test‐retest reliability at four weeks. Convergent validity was supported by a strong positive correlation with the Intent to Help Friends Scale, while its weak association with the Generic Job Satisfaction Scale supported divergent validity. Discussion. The ISRI has emerged as a practical instrument with relevance to certain Australian sociocultural dynamics, offering utility in both research and clinical settings. The ISRI supports a network‐oriented approach to IPV survivor support, assisting the alliance between formal and informal support mechanisms. Future research should focus on broadening the ISRI's applicability by assessing its effectiveness across diverse Australian populations. [ABSTRACT FROM AUTHOR]

Aims: When entering a mountain plateau, people are at risk of developing acute mountain sickness (AMS), for which there are limited prophylactic medicines available. This study aimed at exploring the effectiveness of ibuprofen, acetazolamide, and methazolamide in preventing AMS and at providing valuable insights for the future development of related drugs. Methods: A total of 137 mountaineers were recruited for this study and divided into six groups: a control group, an ibuprofen group, an acetazolamide group, a methazolamide group, an ibuprofen/methazolamide combination group, and a high‐dose ibuprofen/methazolamide combination group. After the assigned drug was taken for three days at a lower elevation (300 m), the participants ascended to a plateau environment at 5050 m. The Lake Louise AMS Score (LLS) system was used to diagnose and evaluate the AMS rates of the mountaineers in each group, and the results were compared through statistical analysis. Results: The results show that all the medications tested herein were effective in preventing AMS, but their level of effectiveness varied. The prevalence of AMS was 50.00% in the control group, 14.29% in the ibuprofen group, 5.56% in the acetazolamide group, 27.27% in the methazolamide group, 44.8% in the ibuprofen and methazolamide group, and 22.50% in the high‐dose ibuprofen and methazolamide group. Acetazolamide demonstrated a significant prophylactic effect on symptoms related to AMS diagnosis, and ibuprofen showed the best efficacy for preventing headache. Conclusion: Acetazolamide remains an effective medicine for preventing AMS. Ibuprofen combined with methazolamide is less effective than ibuprofen alone to prevent AMS. Trial Registration: ClinicalTrials.gov identifier: ChiCTR-TRC-12002219 [ABSTRACT FROM AUTHOR]

Purpose: The implementation of artificial intelligence (AI) in health care is gaining popularity. Many publications describe powerful AI-enabled algorithms. Yet there's only scarce evidence for measurable value in terms of patient outcomes, clinical decision-making or socio-economic impact. Our aim was to investigate the significance of AI in the emergency treatment of wrist trauma patients. Method: Two groups of physicians were confronted with twenty realistic cases of wrist trauma patients and had to find the correct diagnosis and provide a treatment recommendation. One group was assisted by an AI-enabled application which detects and localizes distal radius fractures (DRF) with near-to-perfect precision while the other group had no help. Primary outcome measurement was diagnostic accuracy. Secondary outcome measurements were required time, number of added CT scans and senior consultations, correctness of the treatment, subjective and objective stress levels. Results: The AI-supported group was able to make a diagnosis without support (no additional CT, no senior consultation) in significantly more of the cases than the control group (75% vs. 52%, p = 0.003). The AI-enhanced group detected DRF with superior sensitivity (1.00 vs. 0.96, p = 0.06) and specificity (0.99 vs. 0.93, p = 0.17), used significantly less additional CT scans to reach the correct diagnosis (14% vs. 28%, p = 0.02) and was subjectively significantly less stressed (p = 0.05). Conclusion: The results indicate that physicians can diagnose wrist trauma more accurately and faster when aided by an AI-tool that lessens the need for extra diagnostic procedures. The AI-tool also seems to lower physicians' stress levels while examining cases. We anticipate that these benefits will be amplified in larger studies as skepticism towards the new technology diminishes. [ABSTRACT FROM AUTHOR]

Background: There is a scarcity of evidence regarding the potential relationship between the size and location of necrotic lesions, which must be understood to provide optimal joint-preserving treatment. The purpose of this study was to characterize the distribution patterns of necrotic lesions of varying sizes in early-stage osteonecrosis of femoral head (ONFH) with the use of three-dimensional mapping. Methods: We retrospectively evaluated clinical CT images of the hips that were performed in the Third Hospital of Hebei Medical University from January 2018 to December 2022 and collected all CT images diagnosed with stage I and II ONFH. Three-dimensional structures that included both necrotic lesions and normal areas of the femoral heads were reconstructed and divided into eight regions to record their size and location. CT images for all lesions were superimposed onto a standard template, and three-dimensional mapping was created to determine the presence of concentrated areas of lesions. Results: In a cohort of 143 patients with stage I and II ONFH, a total of 150 hips were reviewed. For lesions with less than 15% of the femoral head volume, necrotic lesions predominantly involve regions I, III, and V, with region I showing concentration. For lesions with volumes ranging from 15 to 30%, necrotic lesions exhibited a wider distribution across regions I, II, III, IV, V, and VII, with significant concentrations in regions I, III, and V. For lesions exceeding 30% of the femoral head volume, the necrotic lesions were extensively distributed across nearly the entire femoral head, with a notable expansion of the concentrated necrotic areas. Conclusions: The distribution of necrotic lesions varies with lesion size, with smaller lesions primarily concentrated in the anterior and medial regions of the femoral head, particularly in the anterosuperior region, while larger lesions expand to the lateral and inferior regions. These findings enhance existing classification systems and provide crucial insights for guiding hip-preserving surgical planning and approaches. [ABSTRACT FROM AUTHOR]

Background: Based on participatory research tools and analysis with a gender focus, we aim to identify the knowledge associated with native plants of the Atlantic Forest in one Quilombola community whose territory is juxtaposed with a protected area, in South Brazil. Methods: Through the perception of the residents of the Quilombola community of São Roque, we classified the availability, harvesting intensity, abundance, and importance of fourteen plants native to the Atlantic Forest found in their territory. These fourteen plants were selected after initial interviews with a free listing of plants done with all adults (44 people), followed by plant collection and identification. A participatory workshop was built with the community to collect data through three activities: four-cell tool, environment matrix, and importance matrix. To identify the gender nuances in the knowledge within this community, all activities were separated into two groups based on the gender of the 22 participants (9 women and 13 men) and the researchers. Results: The species Pau-pra-tudo (Picrasma crenata), Quina (Coutarea hexandra), and Cipó-milome (Aristolochia triangularis) were similarly classified as important by both groups, which indicates the cultural and environmental relevance associated with them regardless of gender. The perceptions of other species were expressed differently between the groups, showing the variance of the ecological knowledge and the relationship between the sociocultural contexts of gender and the knowledge manifested. The final part of the workshop was a lecture given by two community experts about herbal medicines based on forest species found in the territory. Conclusions: Based on the multiple forms of results recorded in the workshop, we discuss the demand for inclusion of the traditional community in land management plans of environmental agencies, highlighting how individual characteristics, such as gender, can fill gaps in data about local biodiversity. [ABSTRACT FROM AUTHOR]

Background. Psoriasis is a common immune‐mediated papulosquamous inflammatory skin disease characterized by well‐demarcated, erythematous silvery scaly plaques. Prevalence rates of psoriasis showed a worldwide variation and have been reported to range between 0.09% and 5.1%. It has been associated with several intrinsic as well as extrinsic factors and has a detrimental effect on health‐related quality of life. Studies on the burden, factors associated with it, and quality of life of psoriasis are limited in the study area. Objectives. To assess the magnitude, factors associated with it, and quality of life of psoriasis patients. Methods. Institution‐based cross‐sectional study was conducted among patients who attend dermatology clinics at Tibebe Ghion comprehensive specialized and Addis Alem primary hospitals from June 8 to September 5, 2022. Systematic random sampling was applied to select study participants until the sample size (318) was fulfilled. A structured interviewer‐administered questionnaire was used to collect data. Collected data were coded and entered into EPI data version 3.1 and then exported to SPSS version 27 for analysis. Descriptive statistics and logistic regression analysis were done. Result. The mean age of study participants was 22.5 with a standard deviation (SD) of 18.2 years. The proportion of psoriasis was 5.3% with a 95% CI (3.1%, 8.4%). Stressful life events (AOR = 3.32, 95% CI (1.12, 9.86)) and alcohol consumption (AOR = 3.73, 95% CI (1.03, 13.51)) were significantly associated with psoriasis. Seven (41.2%) psoriasis patients had a large effect on their quality of life. The mean dermatology quality of life index (DLQI) was 9.82. Conclusion. The proportion of psoriasis in this study was comparable to earlier international and Ethiopian studies, but greater than studies from other African countries. Stressful life events and alcohol consumption were significantly associated with psoriasis. The majority of psoriasis patients had a large negative effect on their quality of life. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a significant decrease in the desire to have children among Chinese women of childbearing age, particularly for the first child. This trend has sparked a growing interest in understanding the underlying factors. Although perceived stress has been speculated as an important factor in decreasing fertility intention, the precise mechanism is unclear. The current study, therefore, aims to investigate the psychological mechanisms linking perceived stress to fertility intentions among women of childbearing age without children, a topic of significant relevance and importance. Methods: Data were sourced from Chinese residents' psychology and behavior investigation (PBICR-2022). A multistage random sampling method was applied to recruit eligible participants. The Mplus8.3 software constructed a chain path model among the variables. Results: The median fertility intention was 30(3–60) on a scale of 0 to 100. The mediation analysis revealed a significant negative influence of perceived stress on fertility intention (β = − 0.076, P < 0.001). Additionally, a more intricate pattern of chain-mediating effect was observed involving perceived stress, anxiety (β = 0.037, P < 0.05), family communication (β = 0.106, P < 0.001), subjective well-being (β = 0.088, P < 0.001) and fertility intention. Conclusions: Perceived stress not only directly suppressed fertility intention but also indirectly affected it through anxiety, family communication, and subjective well-being. Effective family communication and favorable subjective well-being emerged as factors that could augment fertility intentions among women of childbearing age without children. [ABSTRACT FROM AUTHOR]