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Context: Hip muscle strength and hop performance limb symmetries after anterior cruciate ligament reconstruction (ACLR) are not well studied. This study aimed to determine the differences in hip abductors' (ABD) and external rotators' (ER) muscle strength measures between limbs, and the relationship between hip ABD and ER muscle strengths and hop performance limb symmetry indices (LSIs) 2 years after ACLR. Design: Cross-sectional study. Methods: Forty (level I/II) men athletes 2 years after unilateral ACLR completed 4 single-legged hop tests and involved hip ABD and ER strength testing (maximum voluntary isometric contraction [MVIC]; isokinetic peak torque [PKTQ] at 60°, 180°, and 300°/s; and isotonic peak velocity at 75% of their MVICs). Muscle strength measures were normalized to body mass, and hop performances were reported as LSIs. Paired t test was used to determine strength differences between limbs, and the Pearson correlation coefficient was used to assess the relationship between involved hip muscle strength measures and hop performance LSIs. Results: Hip ER-MVIC (involved: 60.26 [12.01], uninvolved: 63.68 [13.17] N·m/kg) and ER eccentric PKTQ at 60°/s (involved: 32.59 [9.28]; uninvolved: 35.73 [10.50] N·m/kg) were significantly different between limbs (P ≤.018). Single-hop LSI correlated with hip ER-PKTQ at 180°/s (r =.354) and 300°/s (r =.324, P ≤.041), while triple-hop LSI correlated with hip ER-MVIC (r =.320), concentric ER-PKTQ at 180°/s (r =.355), eccentric ER-PKTQ at 60°/s (r =.314), and hip ABD-PKTQ at 60°/s (r =.364) and 300°/s (r =.336, P ≤.049). Conclusions: Men athletes demonstrated symmetrical hop performance and hip muscle strengths, except for ER hip's MVIC and isokinetic eccentric peak torque at 60°/s 2 years after ACLR. Hop performance LSIs had a few, yet positive moderate relationships with involved hip ABDs and ER strength measures. This may indicate that hip ABD and ER muscle strength measures contribute to athletes' hop performances 2 years after ACLR. Post-ACLR rehabilitation programs might incorporate hip muscle strengthening training to improve athletes' functional performances. [ABSTRACT FROM AUTHOR]

Objective: While thrombosis and pregnancy loss are the best‐known clinical features of antiphospholipid syndrome (APS), many patients also exhibit "extra‐criteria" manifestations, such as thrombocytopenia. The mechanisms that drive APS thrombocytopenia are not completely understood, and no clinical biomarkers are available for predicting antiphospholipid antibody (aPL)–mediated thrombocytopenia. Calprotectin is a heterodimer of S100A8 and S100A9 that is abundant in the neutrophil cytoplasm and released upon proinflammatory neutrophil activation. Here, we sought to evaluate the presence, clinical associations, and potential mechanistic roles of circulating calprotectin in a cohort of primary APS and aPL‐positive patients. Methods: Levels of circulating calprotectin were determined in plasma by the QUANTA Flash chemiluminescent assay. A viability dye‐based platelet assay was used to assess the potential impact of calprotectin on aPL‐mediated thrombocytopenia. Results: Circulating calprotectin was measured in 112 patients with primary APS and 30 aPL‐positive (without APS criteria manifestations or lupus) patients as compared to patients with lupus (without APS), patients with unprovoked venous thrombosis (without aPL), and healthy controls. Levels of calprotectin were higher in patients with primary APS and aPL‐positive patients compared to healthy controls. After adjustment for age and sex, calprotectin level correlated positively with absolute neutrophil count (r = 0.41, P < 0.001), positively with C‐reactive protein level (r = 0.34, P = 0.002), and negatively with platelet count (r = −0.24, P = 0.004). Mechanistically, we found that calprotectin provoked aPL‐mediated thrombocytopenia by engaging platelet surface toll‐like receptor 4 and activating the NLRP3‐inflammasome, thereby reducing platelet viability in a caspase‐1‐dependent manner. Conclusion: These data suggest that calprotectin has the potential to be a functional biomarker and a new therapeutic target for APS thrombocytopenia. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on whether laparoscopic experience should be a prerequisite for robotic training. Further, there is limited information on skill transference between laparoscopic and robotic techniques. This study focused on the general surgery residents' learning curve and skill transference within the two minimally invasive platforms. Methods: General surgery residents were observed during the performance of laparoscopic and robotic inguinal hernia repairs. The recorded data included objective measures (operative time, resident participation indicated by percent active time on console or laparoscopy relative to total case time, number of handoffs between the resident and attending), and subjective evaluations (preceptor and trainee assessments of operative performance) while controlling for case complexity, patient comorbidities, and residents' prior operative experience. Wilcoxon two-sample tests and Pearson Correlation coefficients were used for analysis. Results: Twenty laparoscopic and forty-four robotic cases were observed. Mean operative times were 90 min for robotic and 95 min for laparoscopic cases (P = 0.4590). Residents' active participation time was 66% on the robotic platform and 37% for laparoscopic (P = < 0.0001). On average, hand-offs occurred 9.7 times during robotic cases and 6.3 times during laparoscopic cases (P = 0.0131). The mean number of cases per resident was 5.86 robotic and 1.67 laparoscopic (P = 0.0312). For robotic cases, there was a strong correlation between percent active resident participation and their prior robotic experience (r = 0.78) while there was a weaker correlation with prior laparoscopic experience (r = 0.47). On the other hand, prior robotic experience had minimal correlation with the percent active resident participation in laparoscopic cases (r = 0.12) and a weak correlation with prior laparoscopic experience (r = 0.37). Conclusion: The robotic platform may be a more effective teaching tool with a higher degree of entrustability indicated by the higher mean resident participation. We observed a greater degree of skill transference from laparoscopy to the robot, indicated by a higher degree of correlation between the resident's prior laparoscopic experience and the percent console time in robotic cases. There was minimal correlation between residents' prior robotic experience and their participation in laparoscopic cases. Our findings suggest that the learning curve for the robot may be shorter as prior robotic experience had a much stronger association with future robotic performance compared to the association observed in laparoscopy. [ABSTRACT FROM AUTHOR]

Introduction: Surgery is currently the only effective treatment for retroperitoneal tumors that do not involve any specific organ. The use of robots for removing both benign and malignant retroperitoneal tumors is considered safe and feasible. However, there is insufficient evidence to determine whether robotic retroperitoneal tumor resection (RMBRs) is superior to open retroperitoneal malignant resection (OMBRs). This study compares the short-term outcomes of robotic excision of benign and malignant retroperitoneal tumors with open excision of the same-sized tumors. Methods: The study compared demographics and outcomes of patients who underwent robotic resection (n = 54) vs open resection (n = 54) of retroperitoneal tumors between March 2018 and December 2022. A 1:1 matching analysis was conducted to ensure a fair comparison. Results: The study found that RBMRs resulted in reduced operative time (OT), estimated blood loss (EBM), and postoperative hospital stay (PSH) when compared to OBMRs. Additionally, RBMRs reduced EBL, PHS, and OT for patients with malignant tumor involvement in major vessels. No significant differences were found in tumor size, blood transfusion rate, and morbidity rate between the RBMRs and OBMRs groups. Conclusion: When comparing RMBRs to OMBRs, it was observed that RMBR was associated with lower (EBL), shorter postoperative hospital stays (PHS), and reduced operative time (OT) in a specific group of patients with both benign and malignant tumors. [ABSTRACT FROM AUTHOR]

Background: Video-assisted thoracoscopic surgery (VATS) often induces significant postoperative pain, potentially leading to chronic pain and decreased quality of life. This study aimed to evaluate the acetaminophen/ibuprofen combination effectiveness in reducing analgesic requirements and pain intensity in patients undergoing VATS. Study design: This is a double-blinded randomized controlled trial. Methods: Adult patients scheduled for elective VATS for lung resection were randomized to receive either intravenous acetaminophen and ibuprofen (intervention group) or 100 mL normal saline (control group). Treatments were administered post-anesthesia induction and every 6 h for three cycles. The primary outcome was total analgesic consumption at 24 h postoperatively. Secondary outcomes were cumulative analgesic consumption at 2 and 48 h; analgesic-related side effects at 2, 24, and 48 h; quality of recovery at 24 h and 48 h postoperatively; pain intensity at rest and during coughing; and rescue analgesics use. Chronic postsurgical pain (CPSP) was assessed through telephone interviews 3 months postoperatively. Results: The study included 96 participants. The intervention group showed significantly lower analgesic consumption at 24 h and 48 h postoperatively (24 h: median difference: − 100 µg equivalent intravenous fentanyl [95% confidence interval (CI) − 200 to − 5 μg], P = 0.037; 48 h: median difference: − 140 μg [95% CI − 320 to − 20 μg], P = 0.035). Compared to the controls, the intervention group exhibited a significantly lower quality of recovery 24 h post-surgery, with no significant difference at 48 h. All pain scores except for coughing at 48 h post-surgery were significantly lower in the intervention group compared to the controls. No significant differences were observed between the groups in postoperative nausea and vomiting occurrence, hospital stay length, and CPSP. Conclusion: Perioperative administration of acetaminophen/ibuprofen significantly decreased analgesic needs in patients undergoing VATS, providing an effective postoperative pain management strategy, and potentially minimizing the need for stronger analgesics. [ABSTRACT FROM AUTHOR]

In response to calls by researchers to integrate two or more tested models in the research of important information systems issues and given the urgent need to curb the devastating effects of cyberharassment (CH), we have proposed and used an integrated individual-level research model to better understand the factors that affect CH. The proposed model combines widely researched and theory-based models: the Norm Activation Model (NAM) and the Theory of Planned Behaviour (TPB). A survey instrument was used to collect data from 231 university students. Of the seven paths investigated, six are statistically significant thereby establishing the fact that personal norms and attitude influence the intention to engage in CH, which influences the actual practice. The determinants of CH intention are Awareness of Consequences (AC); Ascription of Responsibility (AR), Attitude (ATT), and Perceived Behaviour Control (PBC); with Personal Norms (PN) mediating the effects of AC and AR on Behaviour Intention (BI). The study contributions include (a) combining two theory-based models to inform the understanding of aspects of CH; (b) highlighting the role of norm activation in intention to engage in CH, and (c) ATT is a crucial TPB factor in explaining CH intention. The implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Palmoplantar pustulosis (PPP) and pompholyx are chronic diseases characterized by pustules and vesicles on the palms and soles. These disorders often have similar clinicopathological features, which lead to diagnostic difficulties. We aimed to investigate the expression patterns of keratins and involucrin in PPP and pompholyx using immunohistochemical staining. Methods: Skin biopsies from patients with PPP (n = 40) and pompholyx (n = 22) were immunohistochemically analyzed for Keratin 5, 9, 14, and involucrin expression. Results: K5 expression was higher in PPP than in pompholyx, with diffusely positive expression in the basal, spinous, and granular layers. K14 expression did not differ between groups. K9 expression was observed near the pompholyx vesicle (P = 0.014) and stratum spinosum (P < 0.001) but was almost absent around PPP pustules. Involucrin expression was diffused around the PPP pustules and partially around the pompholyx vesicles, but without statistical significance (P = 0.123). Involucrin expression was elevated in the basal layer of the PPP compared with that in the pompholyx (P = 0.023). Conclusion: PPP and pompholyx exhibited distinctive differentiation in the expression of K5, K9, and involucrin. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Patients undergoing radical nephrectomy (RN) are often admitted with protocolized bloodwork for several days following their operation, yet the clinical value of serial hemoglobin (Hgb) measurements has not been established. This can lead to unnecessary costs and can prolong patient stay, despite the absence of an intervention based on these lab values. This study sought to examine perioperative Hgb values and identify those patients at high risk of bleeding requiring intervention, as well as those patients who are unlikely to require further monitoring. METHODS: Patient and perioperative factors were retrospectively examined for a cohort of 259 radical nephrectomy patients from 2015-2021 in Atlantic Canada. Postoperative Hgb values and transfusion rates were recorded. A multivariate logistic regression analysis was performed to identify variables associated with requiring a blood transfusion. RESULTS: Overall, 31 (12%) patients required a blood transfusion in the postoperative period. Median estimated blood loss (EBL) was 150 (interquartile range [IQR] 100-300) ml, with a median Hgb change of 15 (IQR 9-22) g/L from preoperative to postoperative day 1 (POD1). In patients with a Hgb loss of =15 g/L (n=131), transfusion was only required in four patients (3.1%). Among those with a POD1 Hgb >100 g/L (n=199), only four (2%) required transfusion. These patients were identified as having complications based on hemodynamic instability. On multivariate regression analysis, factors found to be associated with higher transfusion risk were age and intraoperative EBL, while higher preoperative Hgb was found to be associated with a lower transfusion risk. CONCLUSIONS: In patients who have a reassuring POD1 Hgb value, with a drop of <15 g/L or an absolute value of >100 g/L, consideration can be made towards discontinuing routine Hgb testing in the absence of a clinical indication. Age, blood loss, and preoperative Hgb are factors that may affect a patient's overall risk of transfusion. [ABSTRACT FROM AUTHOR]

Early interventions may promote reductions in mothers' anxiety-depression (AD) symptoms and improvements in their offspring. This longitudinal randomized research was conducted to assess the effects of interdisciplinary online therapeutic groups (GIO) in at-risk mothers and babies during the COVID-19 pandemic in a disadvantaged neighborhood in Barcelona (Spain). A total of 135 babies were born from March 2020 to June 2021 in a primary healthcare center of Barcelona (Spain). Pregnant woman and new mothers were screened for AD symptomatology through EPDS and STAI questionnaires. Seventy-two of them met high-risk criteria for AD and were included in the study. They were randomly assigned into the two groups of the study: 40 participants were assigned to GIO, the therapeutic group (TG), while 32 of them were assigned to the control group (CG) and received treatment as usual. The course of the mothers' symptomatology was assessed, as well as the baby's development at 6 months old in a blind pediatric follow-up. No differences were found in AD between both groups before the intervention. However, we obtained a significant decrease in AD symptomatology (EPDS p <.001; STAI state p =.015 and STAI trait p <.001at 6 months of life) after the intervention in the TG compared to the CG. Pediatric follow-up at 6 months demonstrated significant differences between groups in babies' development assessment (manipulation p =.003; language p <.001; sociability p <.001). The GIO helped to ensure healthy development of the baby and reduction of the mothers' depressive-anxiety symptomatology. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to explore public health nurses' experiences with mental health promotion for adolescent immigrants in lower secondary and high school, aiming to enhance knowledge and insights for effective mental health promotion. Methodological Design and Justification: A qualitative design employing a hermeneutic approach was chosen. Thirteen public health nurses were selected using purposive criterion sampling and snowballing. Thematic analysis was applied, adhering to COREQ guidelines for transparency. Ethical Issues and Approval: The research was approved by the Norwegian Centre for Research Data. The guidelines of the National Committee for Research Ethics in the Social Sciences and the Humanities were followed. Research Methods, Instruments, and/or Interventions: Data were collected through three focus‐group interviews (n = 13), using semi‐structured interview guides to explore the experiences of public health nurses in promoting mental health among adolescent immigrants. Outcome Measures: This study identified three key themes: (i) Striving to understand adolescent immigrants' mental health aspects, including both positive and negative aspects; (ii) Different strategies for promoting mental health, viewing adolescents as both recipients and contributors to their well‐being; and (iii) Barriers to public health nurses' promotion of mental health, including language, cultural, and knowledge‐related obstacles and trust issues. Results: Public health nurses noted that language barriers and trust issues often delayed adolescent immigrants from seeking help for mental health concerns. Cultural competence and empathy were deemed crucial. To meet these needs, public health nurses must build rapport with parents, collaborate with professionals, implement follow‐up programmes, and advocate for policy changes. Study Limitations: Limitations of this qualitative study include potential bias from the authors' background and non‐generalizability of results to other contexts. Conclusions: In conclusion, public health nurses' experiences reveal the need for enhanced cultural competence, language proficiency, and trust‐building to better serve adolescent immigrants. Collaborative efforts, follow‐up programmes, and policy advocacy are essential to improve mental health promotion in school settings. [ABSTRACT FROM AUTHOR]

The risk of injury in archery is supposedly low. However, relations between pain, shooting phases and types of bow have not been studied. Understanding the biomechanical mechanisms of archery-related injuries. Online survey for archers from all types of bow. Variables were analyzed using contingency tables and chi-squared tests. 396 surveys were completed. 36.9% of the archers had practiced archery for more than 10 years, 23.3% between 5 and 10 years. Olympic recurve bow was the most commonly used (38.2%), followed by traditional (23.3%) and compound (22.0%). 57.3% of the archers suffered some kind of injury during archery practice. Drawing shoulder (28.2%) and neck/back injuries (19.9%) were the most prevalent, preventing 50.3% of those who suffered them from continuing archery practice. There was a moderate association between drawing arm injuries and symptomatology in the drawing phase, especially in the shoulder region (0.55), elbow (0.20), and hand (0.13), and to a lesser extent in the neck/back (0.28). Our results show that injury chronicity is frequent on archery. Correlations between types of bow, phases of the shoot and areas of pain could be a starting point for future studies on the repercussions of different types of injuries in archery practice. [ABSTRACT FROM AUTHOR]

Background Dermoscopy is known to increase the diagnostic accuracy of pigmented skin lesions (PSLs) when used by trained professionals. The effect of dermoscopy training on the diagnostic ability of dermal therapists (DTs) has not been studied so far. Objectives This study aimed to investigate whether DTs, in comparison with general practitioners (GPs), benefited from a training programme including dermoscopy, in both their ability to differentiate between different forms of PSL and to assign the correct therapeutic strategy. Methods In total, 24 DTs and 96 GPs attended a training programme on PSLs. Diagnostic skills as well as therapeutic strategy were assessed, prior to the training (pretest) and after the training (post-test) using clinical images alone, as well as after the addition of dermatoscopic images (integrated post-test). Bayesian hypothesis testing was used to determine statistical significance of differences between pretest, post-test and integrated post-test scores. Results Both the DTs and the GPs demonstrated benefit from the training: at the integrated post-test, the median proportion of correctly diagnosed PSLs was 73% (range 30–90) for GPs and 63% (range 27–80) for DTs. A statistically significant difference between pretest results and integrated test results was seen, with a Bayes factor > 100. At 12 percentage points higher, the GPs outperformed DTs in the accuracy of detecting PSLs. Conclusions The study shows that a training programme focusing on PSLs while including dermoscopy positively impacts detection of PSLs by DTs and GPs. This training programme could form an integral part of the training of DTs in screening procedures, although additional research is needed. [ABSTRACT FROM AUTHOR]

Objective To evaluate the association between sonographic features of placenta previa and vaginal bleeding (VB). Study Design Retrospective cohort study of women with placenta previa identified on ultrasound between 16 0/7 and 27 6/7 weeks gestation. Placental distance past the cervical os (DPO), placental thickness, edge angle, and cervical length (CL) were measured. The primary outcome was any VB and the secondary outcome was VB requiring delivery. Median values of the sonographic features were compared for each of the outcomes using the Mann–Whitney U test. Receiver operating characteristic curves were used to compare the predictive value of sonographic variables markers and to determine optimal cut points for each measurement. Logistic regression was used to estimate the association between each measure and the outcomes while controlling for confounders. Results Of 149 women with placenta previa, 37% had VB and 15% had VB requiring delivery. Women with VB requiring delivery had significantly more episodes of VB than those who did not require delivery for VB (1.5, interquartile range [IQR] [1–3] vs 1.0 [1–5]; p = 0.001). In univariate analysis, women with VB had decreased CL (3.9 vs. 4.2 cm; p < 0.01) compared with those without. Women with VB requiring delivery had increased DPO (2.6 cm IQR [1.7–3.3] vs. 1.5 cm [1.1–2.4], p = 0.01) compared with those without. After adjusting for confounders, only CL < 4 cm remained independently associated with increased risk of VB (adjusted odds ratio: 2.27, 95% confidence interval [1.12–4.58], p = 0.01). None of the measures were predictive of either outcome (area under the curve < 0.65). Conclusion Decreased CL may be associated with risk of VB in placenta previa. Key Points Placenta previa is associated with VB. Sonographic markers of placenta previa are associated with VB. CL is associated with VB in placenta previa, whereas placental DPO is associated with higher rates of bleeding leading to delivery. [ABSTRACT FROM AUTHOR]

The link between pain severity, depressive symptomatology and catastrophizing among women with endometriosis is still under-investigated. The aim of this study was to (i) evaluate differences in depressive symptomatology between women with and without endometriosis; (ii) investigate if pain severity is associated with depressive symptoms; and (iii) test if catastrophizing moderates the link between these two variables. A total of 172 women with a diagnosis of endometriosis and 62 healthy controls volunteered for this cross-sectional study. Depressive symptomatology, pain severity, and catastrophizing were assessed. Compared to healthy controls, women with endometriosis were more likely to score above the cutoff for depressive symptomatology, with 60.5% of the latter being classified as having a subthreshold depression or minor depression and 15.7% as having moderate or severe major depression. Pain severity was significantly associated with depressive symptoms even after controlling for several covariates. Finally, the moderation model suggested that among patients with endometriosis, the relationship between pain severity and depressive symptomatology depended on the level of catastrophizing, with this association being stronger for high levels of the moderator. Mental health practitioners working with women with endometriosis may consider those who report high levels of pain severity and of catastrophizing at high risk of depression and are advised to promote adaptive coping strategies among patients to foster a better adaptation to this chronic disease [ABSTRACT FROM AUTHOR]

Introduction: Hypothermia is a well‐recognised finding in trauma patients, which can occur even in warmer climates. It is an independent predictor of increased morbidity and mortality. It is associated with pre‐hospital intubation, although the reasons for this are likely to be multifactorial. Core temperature drop after induction of anaesthesia is a well‐known phenomenon in the context of elective surgery, and the mechanisms of this are well established. Methods: We conducted a prospective observational study to examine the behaviour of core temperature in patients undergoing pre‐hospital anaesthesia for traumatic injuries. Results: Between 2017 and 2021 data were collected on 48 patients. The data from 40 of these were included in the final analysis. Discussion: Our data do not show a decrease in the core temperatures of patients who receive pre‐hospital anaesthesia, unlike patients who are anaesthetised without pre‐warming, in operating theatres. The lack of a change could relate to patient, anaesthetic or environmental factors. [ABSTRACT FROM AUTHOR]

This qualitative study explores the role of identity in changing from a traditional, organisation-based career to a protean career path. Biographical narrative interviews were conducted with 12 prime-aged U.K. participants. Data were analysed using narrative and thematic analysis. Findings highlight the anchoring role of identity in transitioning to a career driven by values, and demonstrating adaptability in an unpredictable work environment. Findings are used to propose a definition of identity relevant to protean career changers, and to suggest that clear identity should be considered the core characteristic necessary for thriving in transitions to protean career paths. Career practitioners are advised to prioritise identity exploration with clients seeking to transition from an organisation-based career to pursue a self-directed, values-driven career path. [ABSTRACT FROM AUTHOR]

Objective: The relationships between carotid intima-media thickness (C-IMT) and β cell function and insulin resistance in patients with type 2 diabetes (T2D) have not been fully elucidated. This study is to investigate whether impaired glucose metabolism is etiologically associated with C-IMT in patients with T2D. Methods: The study group consisted of 490 (284 men, 206 women) participants. Venous blood specimens were obtained from all subjects for biochemical profiles after an >8-h overnight fast. C-IMT was measured as the distance between the luminal-intimal leading edge (I-line) and the medial-adventitial leading edge (M-line) on the far wall. Insulin resistance was estimated with the homeostasis model assessment of insulin resistance (HOMA-IR). The acute insulin response to arginine was calculated as the mean of the three plasma insulin levels obtained within 2, 4, and 6 min after the arginine bolus minus the pre-stimulus plasma insulin levels. Results: There was a graded increase in C-IMT values according to tertiles of HOMA-IR in men; the values of C-IMT were significantly decreased across the tertiles of acute insulin and C-peptide responses in women. Multivariate analysis revealed that HOMA-IR and age were positively associated with C-IMT among men participants, and acute insulin response and current smoking were the independent determinants of C-IMT in women. Conclusion: Early insulin response stimulated by arginine is independently associated with C-IMT in women T2D individuals, whereas insulin resistance is positively correlated with C-IMT in men T2D subjects. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in incidence and mortality and evaluate overall survival (OS) of oral cancer in Singapore between 1968 and 2017. Methods: All diagnosed oral cancers by anatomical sites and population size were extracted from the Singapore Cancer Registry and the Department of Statistics Singapore. The trend of age‐standardized incidence rate (ASIR) and mortality rate (ASMR) (per 100 000 person‐years) of the lip, oral cavity and salivary gland cancers were evaluated by Prais‐Winsten regressions for each ethnicity and gender. Kaplan–Meier curves were performed to evaluate the OS by anatomical sites in each age group by ethnicity and sex. Results: Overall, 49, 3494 and 1066 people were diagnosed, and 28, 2310 and 476 died from lip, oral cavity and salivary gland cancers, respectively. The oral cavity cancer ASIR and ASMR reduced from 3.07 (1968–1972) to 2.01(2008–2012) and from 2.06 (1978–1982) to 1.21 (2013–2017) per 100 000 person‐years, respectively, with both highest in Indians throughout the whole period. Male:Female ratio ranged from 3.43 (1973–1977) to 1.75 (2013–2017) and from 3.41 (1978–1982) to 2.40 (2013–2017) for ASIR and ASMR, respectively. However, both salivary gland cancer ASIR and ASMR increased from 0.50 (1968–1972) to 0.80 (2008–2012) and from 0.18 (1968–1982) to 0.42 (1988–1992) per 100 000 person‐years, respectively, with both higher in males since 1993. Oral cavity cancer ASIR decreased for males aged ≥60, and Indian females ≥25, but increased among Chinese females aged ≥60. Oral cavity cancer ASMR decreased among Chinese aged 25–59, and among Malay males and Indian females. Salivary gland cancer ASIR increased among Chinese males aged ≥60 and Malay males aged 25–59; while ASMR increased among Chinese males aged ≥60. The median OS for oral cavity, lip and salivary gland cancers were 3.0, 9.3 and 18.1 years, respectively, with females surviving longer than males. Conclusions: Singapore has experienced a decline in the incidence and mortality of lip, oral cancer, an increase in in the incidence and mortality of salivary gland cancer, with an increase in the median overall survival rate. Monitoring the magnitude of oral cancer burden and the demographic, and temporal variations is necessary for tailoring health planning and setting priorities for future clinical care and research. [ABSTRACT FROM AUTHOR]

The development of efficient and reliable online assessments has become increasingly important in the digital era. We developed a 10-min online word reading assessment of global English based on the existing paper-and-pencil version of our English silent word reading test. The test includes two parts, namely, random word recognition and contextual word reading. A total of 889 participants (437 children and 392 adults; 62.7% female) took part in the study. They were from various regions including mainland China, Hong Kong SAR, Macau SAR, Poland, the United States, and the Philippines. Reliability and validity analyses on various demographics samples (by age and country/region of origin) demonstrated that the WordSword Test is highly reliable and valid (e.g., the correlation of this test with other English reading measures were above.80). Education level was positively correlated with test performance, while the correlations between age and test performance were not consistent. Ninety-seven children participants also took the paper-and-pencil version of the WordSword Test. The correlation between performances on the online and paper-and-pencil versions of the test was.879, one year apart. With more children and adults taking the WordSword Test, we ultimately hope to establish norms by area, grade level, and age. [ABSTRACT FROM AUTHOR]

Based on previous work, we developed the comic "A healthy liver will always deliver!" to raise awareness about Non-Alcoholic Fatty Liver Disease (NAFLD) and promote healthy lifestyles. An online pre-post questionnaire design demonstrated an increase in health-threat beliefs regarding NAFLD among the general public, as well as response efficacy and self-efficacy beliefs, normative and control beliefs regarding the maintenance of preventive strategies involving healthy diets and active lifestyles, after interaction with the comic's narrative. This effect was more evident in women. Furthermore, although we could not perform all the ideal controls during the COVID-19 pandemic, and the online strategy attracted mostly university education-level subjects, the comic seemed relatable and engaging. However, more work will have to be performed to ensure its usefulness in terms of acquired knowledge and behavior changes, especially in at-risk segments of the population. [ABSTRACT FROM AUTHOR]

To determine the effect of self-evaluation of foetal movement and position tracking on prenatal attachment and distress. The study was a randomised controlled study. The study included women who came to the Kahramanmaraş Maternity and Children's Hospital for prenatal examination. The data were collected using a questionnaire form, the prenatal attachment inventory (PAI), and the Tilburg pregnancy distress scale (TPDS). The pregnant women in the intervention group were trained to count the foetal movements and track the position of the foetus. Data were evaluated using paired samples t-test, independent samples t-test, chi-square test, Pearson correlation analysis, and linear regression analysis. This trial was registered at ClinicalTrials.gov under the process NCT05313113. Although the mean PAI pre-test scores were similar in the intervention and control groups (t = −0.811; p = 0.420), a significant difference was observed in the mean post-test scores between the two groups (t = 6.404; p < 0.001). The mean TPDS pre-test scores were similar in both groups (t = 0.933; p = 0.453), but a significant difference was observed in the mean post-test scores (t = −3.345; p < 0.001). Thus, self-evaluation of foetal movement and foetal position tracking increased the prenatal attachment. [ABSTRACT FROM AUTHOR]

It is frequently observed in practice that the Wald statistic gives a poor assessment of the statistical significance of a variance component. This paper provides detailed analytic insight into the phenomenon by way of two simple models, which point to an atypical geometry as the source of the aberration. The latter can in principle be checked numerically to cover situations of arbitrary complexity, such as those arising from elaborate forms of blocking in an experimental context, or models for longitudinal or clustered data. The salient point, echoing Dickey (2020) , is that a suitable likelihood-ratio test should always be used for the assessment of variance components. [ABSTRACT FROM AUTHOR]

Summary: Effect sizes from previously reported trials are often used to determine the meaningful change in weight in childhood obesity prevention interventions because information on clinically meaningful differences is lacking. Estimates from previous trials may be influenced by statistical significance; therefore, it is important that they have a low risk of type 1 error. A systematic review and meta‐analysis were conducted to report on the design of child obesity prevention randomized controlled trials and effectiveness according to risk of type 1 error. Eighty‐four randomized controlled trials were identified. A large range of assumptions were applied in the sample size calculations. The most common primary outcome was BMI, with detectable effect size differences used in sample size calculations ranging from 0.25 kg/m2 (followed up at 2 years) to 1.1 kg/m2 (at 9 months) and BMI z‐score ranging from 0.1 (at 4 years) to 0.67 (at 3 years). There was no consistent relationship between low risk of type 1 error and reports of higher or lower effectiveness. Further clarity of the size of a meaningful difference in weight in childhood obesity prevention trials is required to support evaluation design and decision‐making for intervention and policy. Type 1 error risk does not appear to impact effect sizes in a consistent direction. [ABSTRACT FROM AUTHOR]

Summary: This paper reviews the effectiveness of four types of front‐of‐pack nutrition labels (FoPLs) in influencing calorie purchases. The four FoPL types are poised for unified implementation across European countries. Further, this study extends its analysis to evaluate the impacts of the voluntary adoption of these FoPLs within 27 EU nations. Nutri‐Score displays higher potential for yielding positive health and economic outcomes, compared with other FoPLs. Across EU countries, Nutri‐Score is projected to avert nearly two million cases of non‐communicable diseases, in total, between 2023 and 2050. Keyhole demonstrates effects of a similar magnitude but with no statistical significance. Nutri‐Repere shows smaller impacts, while Nutri‐Couleurs has non‐significant effects. Nutri‐Score is projected to significantly lower annual healthcare spending by 0.05%, whereas the other labels have negligible impacts. By reducing cases of disease, FoPLs have the potential to improve employment and work productivity. Nutri‐Score surpasses the other labels with an estimated annual gain of 10.6 full‐time equivalent workers per 100,000 individuals of working age across EU countries. In all, mandatory implementation of any of the four labels would lead to greater effects than those obtained with a voluntary implementation, providing evidence to inform legislation proposal for an EU‐wide nutrition labelling system. [ABSTRACT FROM AUTHOR]

Background: Even though monitoring and control enactment are key aspects of self‐regulated learning (SRL), Adaptive learning technologies (ALTs) may reduce the need for learners to monitor and control their learning. Personalized dashboards are effective in supporting learners' monitoring and can potentially support control behaviour. Allowing learners to enact control over their learning process, seems to hold potential for increasing their motivation. Objectives: Therefore, this study's aim was to investigate the relation between control enactment and motivation. We examined how learners enacted control while learning with an ALT with personalized dashboards and examined the relation between learners' enactment of control and their motivation. Methods: Seventy‐eight primary school learners (Grade 5) participated. During the lesson, learners worked on mathematics in the ALT and concurrently were shown personalized visualizations that supported monitoring and enacting control over their learning process. Learners could enact control to change problems' difficulty to easy, medium, or hard. Motivation was measured before and after learning. Results: The SEM analyses showed that how learners enacted control was related to their motivation. Choosing difficult problems was related to more enjoyment and competence while choosing easy problems related to more pressure and tension. Learners who complied with the suggested difficulty level experienced less choice, but also less pressure/tension and more enjoyment and competence. Conclusions: These results provide avenues to account for broader learner characteristics like SRL and motivation to optimize learning. This way, hybrid systems in which control enactment is a shared responsibility of the system and learner, can be improved to support SRL development. Lay Description: What is currently known: Monitor and control enactment are key aspects of self‐regulated learning (SRL).Adaptive learning technologies may reduce the need for learners to monitor and control their learning.Personalized dashboards support learners' monitoring behaviour and can potentially also support control enactment.Enactment of control could positively affect learners' motivation. What does this paper add: There is a large variation in how learners enact control and whether they comply with the scaffold.Learners who chose more difficult problems experienced more enjoyment, while learners choosing easy problems, experienced more pressure.Learners complied with the scaffold, experienced less choice, but also less pressure and more enjoyment.This study provides avenues to account for broader learner characteristics like SRL and motivation to optimize learning. Practical implications: Support control enactment by actively involve learners in choice during the learning process.Offer monitor and enactment in conjunction, as learners can only make well‐founded choices if they can monitor their learning process.Intrinsically and extrinsically motivated learners showed different choice patterns and learning experience.It is important to have an understanding and monitoring of learners' motivation. [ABSTRACT FROM AUTHOR]

Even after adopting various measures, recent years have witnessed a surge in environment‐related issues such as pollution and climate change. These issues have been considered anthropogenic, and it is a well‐received notion that changing human behaviour is crucial for sustainable development. Promoting pro‐environmental behaviour (PEB) requires understanding of associations among relevant factors; the present study aimed to explore the same among a few less‐explored constructs, which, along with other factors, may significantly explain pro‐environmental behaviour. The study examined the direct relationship of PEB with ecological intelligence (EI) and self‐transcendent values. Also, it explored the mediating effects of implementation‐intentions and the moderating effect of the "new ecological paradigm" (NEP) on PEB. The data were obtained from 400 adult participants using a set of standardized questionnaires. The results showed significant direct and indirect associations among EI, self‐transcendent values, implementation‐intentions, the NEP and PEB. Implementation‐intentions significantly mediated the relationship of EI and values with PEB, and the mediation was moderated by the NEP. Individuals low on EI but endorsing the NEP showed implementation‐intentions similar to those with high EI. Knowledge of the interplay among these factors can be utilized to design interventions for promoting PEB. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

The aim of the study is to examine the relationship between spiritual well-being, prenatal stress and attachment level of Turkish women conceiving spontaneously or with assisted reproductive techniques (ART). The comparative descriptive study type was conducted between November 2021 and June 2022 with 202 pregnant women, including 87 women conceiving with ART and 115 women conceiving spontaneously, who applied for routine prenatal care checkup in a state hospital in the west of Turkey. Both groups have a high level of spiritual well-being. Pregnant women in the ART group experience higher prenatal distress (9.6% for spontaneous, 12.6% for ART, p = 0.487) and low level of attachment (69.72 ± 7.98 for spontaneous, 66.24 ± 8.88 for ART, p = 0.006) compared to the other group. Additionally, as insufficient partner involvement in the prenatal process increases in pregnant women in both groups, prenatal attachment decreases. It is extremely important that midwives and nurses evaluate the spiritual well-being of pregnant women and provide holistic care in line with their spiritual needs. [ABSTRACT FROM AUTHOR]

Although chronic orofacial pain (COFP) is common among older adults, the role of psychological factors in pain outcomes among this population has received limited attention. This study examined the role of anxiety and pain catastrophizing, two corelates of pain in other populations, in pain intensity and interference among 166 older adults with COFP (79% female, Mage = 68.84, SD = 5.56). Participants completed an online survey including measures of anxiety, pain catastrophizing, and pain intensity/interference. We applied mediation analyses to test indirect associations between anxiety and pain outcomes via pain catastrophizing. Results indicated that anxiety was positively associated with pain intensity and pain interference (bs =.70–1.12, ps <.05). There was also an indirect association between anxiety and pain interference through pain catastrophizing (b =.35, 95% CI [.0383,.7954]), indicating pain catastrophizing partially accounts for this relationship. Assessing and addressing anxiety and pain catastrophizing has the potential to improve treatment outcomes in this population. [ABSTRACT FROM AUTHOR]

Background: Medical insurance stands as a pivotal component within the overarching framework of public service systems. The intricate interplay between the extent of healthcare coverage and the overall well-being of the populace remains a pivotal research question within the academic sphere. Methods: Drawing from the comprehensive dataset of the Chinese Household Livelihood Survey, this article employs a rigorous data model to delve into the profound implications of medical coverage on population health. Results: The descriptive analysis revealed that areas with broader medical coverage tend to exhibit higher levels of overall population health. This initial observation provided a foundation for further quantitative exploration using multiple regression analysis. The regression analysis demonstrated a statistically significant positive relationship between medical coverage and population health. This finding is particularly noteworthy as it suggests that expanding access to healthcare services has tangible benefits for improving the overall health of a population. Conclusion: From the lens of familial sustenance, this article delves into the intricate health implications of medical coverage, thereby introducing a novel theoretical lens to the evolving discourse surrounding medical insurance healthcare systems and their impact on public health. This approach aims to enrich the current understanding of this complex relationship and contribute to the scholarly dialogue. [ABSTRACT FROM AUTHOR]

Aim. To identify the barriers and enablers to the implementation of a national policy to increase and develop the advanced nurse practitioner (ANP) workforce in Ireland. Background. The Department of Health (Ireland) introduced a policy to increase the number of ANPs to 2% of the nursing workforce. Evaluation provides information to inform successful policy implementation and development of ANP roles in healthcare services. Methods. Qualitative descriptive design. Twenty candidate ANPs participated in four focus groups. Nine key stakeholders were also interviewed. Results. Analysis identified four barriers: lack of infrastructural resources; delay in releasing and arranging replacements for candidate ANPs; role resistance from administration, allied healthcare professionals and other nurses; and lack of organisational readiness. The five enablers were: supportive physicians; Nursing and Midwifery Practice Development Units; supportive directors of nursing; role awareness and clarity; and educational preparation. Conclusions. This evaluation identifies barriers and enablers to the implementation of a national policy to increase the critical mass of advanced practitioners within the healthcare services. Evaluation at the implementation phase informed the roll-out of future advanced practice initiatives. Implications for Nursing Management. To support advanced practice development, leadership, infrastructure, and resource planning are needed to harness known enablers and address identified barriers to the implementation and sustainability of these posts. [ABSTRACT FROM AUTHOR]

We present astrolink , an efficient and versatile clustering algorithm designed to hierarchically classify astrophysically relevant structures from both synthetic and observational data sets. We build upon clustar-nd , a hierarchical galaxy/(sub)halo finder, so that astrolink now generates a 2D representation of the implicit clustering structure as well as ensuring that clusters are statistically distinct from the noisy density fluctuations implicit within the n -dimensional input data. This redesign replaces the three cluster extraction parameters from clustar-nd with a single parameter, S – the lower statistical significance threshold of clusters, which can be automatically and reliably estimated via a dynamical model-fitting process. We demonstrate the robustness of this approach compared to astrolink 's predecessors by applying each algorithm to a suite of simulated galaxies defined over various feature spaces. We find that astrolink delivers a more powerful clustering performance while being |$\sim 27~{{\ \rm per \, cent}}$| faster and using less memory than clustar-nd. With these improvements, astrolink is ideally suited to extracting a meaningful set of hierarchical and arbitrarily shaped astrophysical clusters from both synthetic and observational data sets – lending itself as a great tool for morphological decomposition within the context of hierarchical structure formation. [ABSTRACT FROM AUTHOR]

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

Background: Patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with radiation-based therapy suffer from short- and long-term toxicities that affect quality of life (QOL). Transoral robotic surgery (TORS) has an established role in the management of early OPSCC but adjuvant treatment is often indicated postoperatively due to the high incidence of nodal metastasis associated with advanced human papillomavirus (HPV)-related OPSCC. To overcome the need for adjuvant radiation therapy (RT), neoadjuvant chemotherapy followed by TORS and neck dissection (ND) is proposed. This study aimed to assess if QOL in HPV-associated OPSCC receiving neoadjuvant chemotherapy followed by TORS and ND returns to baseline within 12 months of completing treatment. Methods: A 12 month longitudinal study was carried out at McGill University Health Centre in Montreal, Canada, among a convenience sample of patients with American Joint Committee on Cancer Seventh Edition stage III and IVa HPV-related OPSCC who were treated with neoadjuvant chemotherapy followed by TORS and ND. QOL data were obtained pretreatment and at 1, 3, 6, and 12 months following treatment completion using the European Organisation for Research and Treatment of Cancer Core and Head and Neck extension modules. Paired t tests and mixed models for repeated measures analysis were used to assess changes in QOL from baseline to 12 months postoperatively and over time, respectively. Results: Nineteen of 23 patients (median age 58 years) who received the study treatment fulfilled the eligibility criteria. OPSCC subsites were palatine tonsil (n = 12) and base of tongue (n = 7). All 19 patients were treated per protocol and none required adjuvant RT as per pathology review and protocol requirements at a postoperative multidisciplinary team tumor board discussion. No significant differences were found when comparing 12 month QOL follow-up scores to pretreatment scores in measures that would likely be affected by RT [eg, swallowing (P =.7), social eating (P =.8), xerostomia (P =.9)]. Conclusion: In HPV-related OPSCC, neoadjuvant chemotherapy followed by TORS and ND as definitive treatment is associated with excellent QOL outcomes. Postoperative QOL scores returned to baseline by 3 months and were maintained for all measures, indicating a return to normal function. [ABSTRACT FROM AUTHOR]

Background: The role of mechanical power on pulmonary outcomes after thoracic surgery with one-lung ventilation was unclear. We investigated the association between mechanical power and postoperative pulmonary complications in patients undergoing thoracoscopic lung resection surgery. Methods: In this single-center, prospective observational study, 622 patients scheduled for thoracoscopic lung resection surgery were included. Volume control mode with lung protective ventilation strategies were implemented in all participants. The primary endpoint was a composite of postoperative pulmonary complications during hospital stay. Multivariable logistic regression models were used to evaluate the association between mechanical power and outcomes. Results: The incidence of pulmonary complications after surgery during hospital stay was 24.6% (150 of 609 patients). The multivariable analysis showed that there was no link between mechanical power and postoperative pulmonary complications. Conclusions: In patients undergoing thoracoscopic lung resection with standardized lung-protective ventilation, no association was found between mechanical power and postoperative pulmonary complications. Trial registration: Trial registration number: ChiCTR2200058528, date of registration: April 10, 2022. [ABSTRACT FROM AUTHOR]

In recent years, concern has grown about the inappropriate application and interpretation of P values, especially the use of P<0.05 to denote "statistical significance" and the practice of P-hacking to produce results below this threshold and selectively reporting these in publications. Such behavior is said to be a major contributor to the large number of false and non-reproducible discoveries found in academic journals. In response, it has been proposed that the threshold for statistical significance be changed from 0.05 to 0.005. The aim of the current study was to use an evolutionary agent-based model comprised of researchers who test hypotheses and strive to increase their publication rates in order to explore the impact of a 0.005 P value threshold on P-hacking and published false positive rates. Three scenarios were examined, one in which researchers tested a single hypothesis, one in which they tested multiple hypotheses using a P<0.05 threshold, and one in which they tested multiple hypotheses using a P<0.005 threshold. Effects sizes were varied across models and output assessed in terms of researcher effort, number of hypotheses tested and number of publications, and the published false positive rate. The results supported the view that a more stringent P value threshold can serve to reduce the rate of published false positive results. Researchers still engaged in P-hacking with the new threshold, but the effort they expended increased substantially and their overall productivity was reduced, resulting in a decline in the published false positive rate. Compared to other proposed interventions to improve the academic publishing system, changing the P value threshold has the advantage of being relatively easy to implement and could be monitored and enforced with minimal effort by journal editors and peer reviewers. [ABSTRACT FROM AUTHOR]

Simple Summary: Endometrial cancer disrupts various internal functions, which may be reflected across several blood markers or biomarkers. The precise ratios of these biomarkers could be useful for endometrial cancer diagnosis, prognosis, and treatment decisions. Our study aimed to observe whether a panel of blood markers (red blood cells, white blood cells, platelets, inflammatory markers) managed to distinguish between two endometrial entities (neoplasia versus hyperplasia). Background: Endometrial cancer is associated with changes in blood cell counts and with high levels of inflammatory markers, thus reflecting the tumor's impact on various biological processes and suggesting their potential as biomarkers for endometrial cancer diagnosis, prognosis, and treatment response. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in peripheral blood sampled preoperatively from patients have been reported to be independently associated with the prognosis of different types of malignancies. Objectives: This study aimed to compare several blood markers—red blood cells, white blood cells, platelet parameters, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, C-reactive protein, and fibrinogen—in patients with benign or malignant endometrial tumors. Material and methods: Our retrospective study included 670 patients (192 diagnosed with endometrial cancer and 478 with endometrial hyperplasia), and we compared the serological parameters discussed above with those sampled the day before surgery. Results: Analysis of complete blood count indices revealed no significant differences in red blood cell or total white blood cell parameters between the endometrial cancer group and the endometrial hyperplasia group. However, a distinct pattern emerged in the white blood cell differential. The endometrial cancer group showed a statistically significant decrease in lymphocyte count compared with the endometrial hyperplasia group. In contrast, the endometrial cancer group showed significantly higher mean platelet counts and increased mean platelet volume compared with controls. Furthermore, the endometrial cancer group demonstrated a marked inflammatory response, as evidenced by significantly elevated levels of C-reactive protein, fibrinogen, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio compared with the endometrial hyperplasia group. Conclusions: The current research revealed statistically significant differences in multiple serological biomarkers between the two groups. These findings support the initial hypothesis regarding the potential utility of these biomarkers in endometrial cancer diagnosis, prognosis, and treatment response, highlighting the existence of biomarkers affordable for analysis under any health system, regardless of the country's level of development. [ABSTRACT FROM AUTHOR]

Simple Summary: We developed an attention-based whole slide image (WSI)-level classification deep learning model employing surgically and endoscopically resected specimens to predict LNM in T1 CRC. Our AI model with H&E-stained WSIs and without annotations showed good performance power with the validation of an independent cohort in a single center. The area under the curve of our model was 0.781–0.824, higher than that of previous artificial intelligence (AI) studies with only WSIs. Our AI model, which showed the highest sensitivity (92.9%), reduced unnecessary additional surgery by 14.2% more than using the current JSCCR guidelines (68.3% vs. 82.5%). This revealed the feasibility of using an AI model with only H&E-stained WSIs to predict LNM in T1 CRC. According to the current guidelines, additional surgery is performed for endoscopically resected specimens of early colorectal cancer (CRC) with a high risk of lymph node metastasis (LNM). However, the rate of LNM is 2.1–25.0% in cases treated endoscopically followed by surgery, indicating a high rate of unnecessary surgeries. Therefore, this study aimed to develop an artificial intelligence (AI) model using H&E-stained whole slide images (WSIs) without handcrafted features employing surgically and endoscopically resected specimens to predict LNM in T1 CRC. To validate with an independent cohort, we developed a model with four versions comprising various combinations of training and test sets using H&E-stained WSIs from endoscopically (400 patients) and surgically resected specimens (881 patients): Version 1, Train and Test: surgical specimens; Version 2, Train and Test: endoscopic and surgically resected specimens; Version 3, Train: endoscopic and surgical specimens and Test: surgical specimens; Version 4, Train: endoscopic and surgical specimens and Test: endoscopic specimens. The area under the curve (AUC) of the receiver operating characteristic curve was used to determine the accuracy of the AI model for predicting LNM with a 5-fold cross-validation in the training set. Our AI model with H&E-stained WSIs and without annotations showed good performance power with the validation of an independent cohort in a single center. The AUC of our model was 0.758–0.830 in the training set and 0.781–0.824 in the test set, higher than that of previous AI studies with only WSI. Moreover, the AI model with Version 4, which showed the highest sensitivity (92.9%), reduced unnecessary additional surgery by 14.2% more than using the current guidelines (68.3% vs. 82.5%). This revealed the feasibility of using an AI model with only H&E-stained WSIs to predict LNM in T1 CRC. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer is a commonly diagnosed cancer in men with varying outcomes following treatment. This study focuses on a specific feature observed in some prostate cancers called a histologically overt stromal response (HOST-response), which involves changes in the tissue surrounding the cancer cells. Our research used data from patients who had undergone surgery for prostate cancer to explore how this stromal response impacted their recovery without the cancer returning. We found that the presence of a HOST-response is linked to a higher chance of the cancer coming back sooner. These findings suggest that monitoring for this feature could help identify patients who might benefit from additional treatments after surgery, which could potentially improve their outcomes. The results of this study could guide future clinical trials aiming to refine treatment strategies for prostate cancer patients exhibiting a HOST-response. Purpose: Given the variable clinical course of prostate cancer and the limitations of current prognostic factors, this study was conducted to investigate the impact of a histologically overt stromal response (HOST-response) to prostate cancer on clinical outcomes after radical prostatectomy. Methods: This retrospective analysis utilized The Cancer Genome Atlas (TCGA) to evaluate data from individuals with a confirmed diagnosis of prostate cancer who underwent radical prostatectomy and had available pathology slides. These slides were assessed for the presence of a HOST-response, similar to desmoplasia. The primary endpoint was progression-free survival (PFS). A multivariable competing risk regression analysis was used to assess whether a significant association existed between HOST-response and PFS, adjusting for known prostate cancer prognostic factors. Results: Among the 348 patients analyzed, 166 (47.70%) demonstrated a HOST-response. After a median follow-up of 37.87 months (IQR: 21.20, 65.50), the presence of a HOST-response was significantly associated with a shorter PFS (SDHR, 2.10; 95% CI, 1.26 to 3.50; p = 0.004), after adjusting for covariates. Conclusions: HOST-response in prostate cancer patients treated with radical prostatectomy is significantly associated with reduced PFS, suggesting a potential benefit from adjuvant therapy and highlighting the need for further investigation in a prospective randomized clinical trial. [ABSTRACT FROM AUTHOR]

Simple Summary: Selecting and developing effective therapies for distinct epithelial ovarian cancer subtypes necessitates tumor models that accurately recapitulate the individual characteristics and microenvironmental interactions. Patient-derived tumor models offer a promising approach by preserving the tumor's integrity, providing a platform for personalized treatment strategies. Zebrafish embryos could be a useful tool for quickly testing potential treatments in parallel. In this research article, we aimed to evaluate the model using a real-world case study and compare results with existing in vitro and in vivo models. A patient-derived cell line from a low-grade serous ovarian cancer with a KRAS mutation was engrafted in zebrafish embryos. Xenografts were assigned to a five-day treatment with trametinib and/or luminespib, targeting two complementary pathways that have previously shown efficacy in other cancer models of this cell line. The zebrafish model offers several options to analyze the response of the tumor to drug exposure. Here, we evaluated both cell growth and cell death, which showed a significant positive tumor response upon treatment that was amplified further by combining the drugs. Ovarian cancer (OC) is an umbrella term for cancerous malignancies affecting the ovaries, yet treatment options for all subtypes are predominantly derived from high-grade serous ovarian cancer, the largest subgroup. The concept of "functional precision medicine" involves gaining personalized insights on therapy choice, based on direct exposure of patient tissues to drugs. This especially holds promise for rare subtypes like low-grade serous ovarian cancer (LGSOC). This study aims to establish an in vivo model for LGSOC using zebrafish embryos, comparing treatment responses previously observed in mouse PDX models, cell lines and 3D tumor models. To address this goal, a well-characterized patient-derived LGSOC cell line with the KRAS mutation c.35 G>T (p.(Gly12Val)) was used. Fluorescently labeled tumor cells were injected into the perivitelline space of 2 days' post-fertilization zebrafish embryos. At 1 day post-injection, xenografts were assessed for tumor size, followed by random allocation into treatment groups with trametinib, luminespib and trametinib + luminespib. Subsequently, xenografts were euthanized and analyzed for apoptosis and proliferation by confocal microscopy. Tumor cells formed compact tumor masses (n = 84) in vivo, with clear Ki67 staining, indicating proliferation. Zebrafish xenografts exhibited sensitivity to trametinib and luminespib, individually or combined, within a two-week period, establishing them as a rapid and complementary tool to existing in vitro and in vivo models for evaluating targeted therapies in LGSOC. [ABSTRACT FROM AUTHOR]

Background The duration of the protective effect of tuberculosis preventive therapy (TPT) is controversial. Some studies have found that the protective effect of TPT is lost after cessation of therapy among people with human immunodeficiency virus (HIV) in settings with very high tuberculosis incidence, but others have found long-term protection in low-incidence settings. Methods We estimated the incidence rate (IR) of new tuberculosis disease for up to 12 years after randomization to 4 months of rifampin or 9 months of isoniazid, among 991 Brazilian participants in a TPT trial in the state of Rio de Janeiro, with an incidence of 68.6/100 000 population in 2022. The adjusted hazard ratios (aHRs) of independent variables for incident tuberculosis were calculated. Results The overall tuberculosis IR was 1.7 (95% confidence interval [CI], 1.01– 2.7) per 1000 person-years (PY). The tuberculosis IR was higher among those who did not complete TPT than in those who did (2.9 [95% CI, 1.3–5.6] vs 1.1 [.4–2.3] per 1000 PY; IR ratio, 2.7 [1.0–7.2]). The tuberculosis IR was higher within 28 months after randomization (IR, 3.5 [95% CI, 1.6–6.6] vs 1.1 [.5–2.1] per 1000 PY between 28 and 143 months; IR ratio, 3.1 [1.2–8.2]). Treatment noncompletion was the only variable associated with incident tuberculosis (aHR, 3.2 [95% CI, 1.1–9.7]). Conclusions In a mostly HIV-noninfected population, a complete course of TPT conferred long-term protection against tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Immunotherapy has revolutionized cancer treatment. Recent studies have suggested that the efficacy of immunotherapy can be further enhanced by the influence of gut microbiota. In this study, we aimed to investigate the impact of bacteria on the effectiveness of cancer immunotherapy by combining analysis of clinical samples with validation in animal models. Methods: In order to characterize the diversity and composition of microbiota and its relationship with response to immune checkpoint inhibitors (ICIs), 16S ribosomal RNA (rRNA) and GC–MS sequencing was performed on 71 stool samples from patients with advanced non‐small cell lung cancer (NSCLC) prior to treatment with immune checkpoint blockade (ICB). Furthermore, fecal microbiota transplantation (FMT) was performed from different patients into mice and a subcutaneous tumor model established using the Lewis lung cancer cell line to evaluate the therapeutic effect of PD‐1 on mice with varying gut microbiota. Results: The results demonstrated a significant association between elevated gut microbiota diversity and response to treatment with ICIs, p < 0.05. Faecalibacterium was markedly increased in the gut microbiota of responders (R), accompanied by increased short‐chain fatty acid (SCFA) levels, especially butanoic acid, acetic acid and hexanoic acid, p < 0.05. Additionally, FMT from R and nonresponders (NR) could promote an anticancer effect and reduce the expression of Ki‐67 cells in tumors in mice, p < 0.05. Moreover, R and NR FMT did not alter PD‐L1 expression in the tumor tissues of mice, p > 0.05. The diversity of gut microbiota consistently correlated with an optimistic prognosis in NSCLC patients with immunotherapy, which could be functionally mediated by SCFAs. Conclusion: The findings of the present study indicated that the diversity of gut microbiota and SCFAs is related to the efficacy of immunotherapy. FMT can effectively delay tumor progression, and enhance the effect of immunotherapy, thus providing evidence for improving the efficacy of immunotherapy in NSCLC patients. [ABSTRACT FROM AUTHOR]

Life balance is a new and important concept in occupational therapy. New measurements are needed to assess and evaluate life balance and interventions aimed to achieve this concept. This article describes the test-retest reliability of three life balance measures: the Activity Calculator (AC), Activity Card Sort (ACS-NL(18-64)) and Occupational Balance Questionnaire (OBQ11-NL). Data collection took place among 50 participants with neuromuscular diseases: facioscapulohumeral dystrophy (FSHD, n = 25) or mitochondrial myopathy (MM, n = 25). The AC, the ACS-NL(18–64) and the OBQ11-NL were assessed twice with an interval of one week. Intraclass correlation coefficients (ICC-agreement) were applied to examine test-retest reliability. The ICC of the AC-average total day score was.95 (95% CI.91-.97), whereas the ICC of the weights allocated to each activity was 0.80 (95% CI.77–0.82). The ICC of the ACS-NL(18–64) percentage retained activities was 0.92 (95% CI 0.86 − 0.96) and the ICC of the importance score per activity was-.76 (95% CI. 0.68–0.89). The ICC of the OBQ11-NL total score was.76 (95% CI 0.62–0.86). All three tools showed good to excellent test-retest reliability in a sample of patients with FSHD or MM, which is promising for its use in clinical practice and research. The AC, ACS-NL(18–64) and the OBQ11-NL are promising, reliable measures of life balance in patients with neuromuscular diseases. The development of three new instruments for life balance enlarges the possibility for health professionals to measure life balance in clinical practice and research. [ABSTRACT FROM AUTHOR]