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This study explores eight key themes: Self-control, personalized learning, smartphone habits, future-time perspective, information overload, digital literacy, meaningful learning, and metacognitive awareness. The primary objective is to investigate the correlations among these factors. Virtual presence serves as a moderating variable, influencing the connections between smartphone habits and digital literacy, as well as between self-control and digital literacy. Additionally, it moderates the relationship between self-control and information overload. The study collected data from 597 engineering students, utilizing a quantitative research approach and employing a questionnaire as the research instrument. Statistical analysis was conducted using a partial least squares structural equation model, implemented with SmartPLS version 4. The study's hypotheses showed a significant impact on each variable, with only the relationships between information overload and meaningful learning, and smartphone habit and metacognitive awareness showing no significant effects, as indicated by the findings.

Research shows that videoconferencing tools can be used for delivering high-quality instruction in real-time to a large number of students simultaneously during and even in the aftermath of the pandemic. However, there is a lack of data on how favourable it is among students, particularly in the Philippine setting, in the field of Physical Education (PE). In this regard, this study aimed at inspecting exogenous factors linked to students' acceptance of a video-conferencing platform in learning knowledge- and skill-based concepts in Physical Education through the adaptation of the Technology Acceptance Model. After performing the Partial Least Square-Structural Equation Modelling from a purposively selected sample of 250 teacher education students, the results showed that perceived ease of use (PEOU) positively affected perceived usefulness (PU). It was also found that PEOU and PU impacted behavioural intention. Lastly, behavioural intention (BI) positively leverages actual use of the Zoom platform. It can be inferred that students can benefit greatly from using the video-conferencing platform to learn various PE concepts. Moreover, another surprising discovery was that students could use the platform to efficiently learn, thus capitalising on the university's educational system, even in the New Normal.

Introduction: The roles of nurse managers are crucial to the success of healthcare organizations, requiring specific skills and competencies. Accordingly, nurse managers are expected to possess leadership and management skills. Therefore, it is essential to investigate the relationship between leadership and managerial competencies among hospital nurse managers. This study seeks to determine the impact of three different leadership competencies, namely administrative skill, interpersonal skill, and conceptual skill, on the managerial competencies of nurse managers at Kuala Lumpur Hospital. Methods: This cross-sectional quantitative study adopted Northouse’s (2019) leadership competencies questionnaires and Mind Tool’s (2018) management skills assessment tool. A total of 247 participants, all of whom were nurse managers at the Kuala Lumpur Hospital, Malaysia, were recruited for this study. Multiple regression analysis was used to test the hypothesis. Results: The findings revealed that nurse managers at Kuala Lumpur Hospital possessed high levels of all three leadership skills and managerial competencies. However, the only significant predictor of managerial competencies among the respondents is the conceptual skill of leadership (beta = 0.820, p < 0.01). Conclusions: This study emphasizes conceptual skills (cognitive abilities, analytical reasoning, and decision-making) in predicting managerial competencies among nurse managers. Developing these skills is critical for effective leadership and smooth healthcare organization operations. Keywords: administrative skill, conceptual skill, interpersonal skill, leadership competencies, mental health

This research focuses on female managers and aims to explore the factors influencing work-life balance among female managers in Chinese higher education institutions (HEIs), while also ranking the importance of these factors within HEIs. The research is divided into five main sections and employs a two-round Delphi research method, utilizing expert discussions and opinions to thoroughly analyze the work-life balance challenges faced by female managers. The findings of the research reveal six primary dimensions that influence the work-life balance of female managers in Chinese HEIs. These factors, ranked in order of importance, are as follows: (1) family factors, (2) work-related factors, (3) cultural and social norms, (4) health factors, (5) self-management and personal skills, and (6) support and satisfaction. In conclusion, this research offers valuable recommendations for understanding and improving the work-life balance of female managers in Chinese HEIs, providing essential guidance for both these institutions and female managers in achieving a balanced development in their professional and personal lives.

Abstract Post‐traumatic epilepsy (PTE) is a life‐long complication of traumatic brain injury (TBI). The development of PTE is associated with neurological morbidity and increases the risk of mortality. An aim of EpiBioS4Rx (Epilepsy Bioinformatics Study for Antiepileptogenic Therapy) was to test potential therapies to prevent the development of PTE in the lateral fluid percussion injury (LFPI) rat model of TBI, in which rats were subjected to injury at the left parietal cortex. Sodium selenate has been reported to be antiepileptogenic post‐TBI in rodent models by activating protein phosphatase 2A and reducing phosphorylated tau (p‐tau) protein. We aimed to characterize the pharmacokinetics (PK) and brain uptake of sodium selenate using naïve control and LFPI rats. Rats received either a single bolus dose or a single bolus dose followed by a 7‐day subcutaneous minipump infusion of sodium selenate. Sodium selenate and selenium concentrations in plasma and brain were analyzed and used for PK estimation and brain exposure assessment. Selenium concentrations rapidly increased after sodium selenate administration, demonstrating biotransformation from sodium selenate to selenium. Sodium selenate and selenium PK parameters were estimated using non‐compartmental analysis. Sodium selenate clearance (CL/F) and volume of distribution (Vd/F) varied by dose and route of administration, suggesting differences in bioavailability and nonlinear pharmacokinetics at the doses tested. Brain‐to‐plasma partition coefficients (AUCbrain/AUCplasma) for sodium selenate and selenium were found to be 0.7–1.3 and 0.1–0.3 following single‐dose injection, respectively, indicating active transport of sodium selenate across the blood–brain barrier (BBB).

Retaining a devoted and skilled workforce has become of paramount importance in China’s dynamic and competitive education sector. The consequences of employee turnover bear weight, especially for institutions striving for global excellence, impacting both institutional continuity and the quality of education. This study explores the factors influencing employee turnover intention within Chinese academic institutions and prioritizes these factors based on their significance. A two-round Delphi method was employed to solicit and synthesize expert opinions through iterative rounds. Nineteen experts from private education institutions in Fuzhou, China, were selected using a combination of purposeful and snowball sampling. In the first round, experts listed the factors contributing to employee turnover intentions, which were then analyzed using thematic analysis. In the second round, the experts ranked these dimensions from most to least important. The study identifies five pivotal factors affecting turnover intentions, listed in order of importance: (1) compensation, benefits, and employee recognition; (2) career development and advancement opportunities; (3) professional growth, training, and job security; (4) leadership, management support, and organizational culture; and (5) work-life balance and work environment. This research proffers actionable recommendations to discern and counteract contributors to employee turnover. The insights furnish invaluable guidance for Chinese educational institutions, underscoring the necessity of employee contentment and laying the groundwork for a sustained and driven workforce.

The purpose of this research is to examine the determinants that impact employee job satisfaction in the manufacturing industry of Malaysia in the midst of technological progress and economic changes that have been further complicated by the COVID-19 pandemic. The study utilizes the Delphi method to ascertain and rank workplace factors that influence job satisfaction. By employing a qualitative Delphi approach, the study amasses expert consensus in order to investigate the complex dimensions of job satisfaction within the manufacturing sector. The study solicits input from industry experts via two rounds of surveys in order to evaluate the significance of a variety of working environment factors. The analysis is guided by theoretical frameworks, including Maslow’s Hierarchy of Needs and Herzberg’s Two-Factor Theory. In descending order of importance, industry experts agreed that compensation and benefits are the most significant determinant of employee job satisfaction, followed by support for work-life balance, rewards and recognition, organizational support, and opportunities for career growth and development. This research contributes to the body of knowledge on job satisfaction by utilizing the Delphi method, which is an innovative approach in this particular domain, to obtain expert consensus regarding the factors that influence job satisfaction in the manufacturing industry. This approach overcomes the constraints of quantitative methodologies by offering comprehensive analyses of the qualitative dimensions of employee satisfaction. In addition, the study provides policymakers and industry stakeholders with actionable suggestions, underscoring the importance of implementing comprehensive approaches to improve job satisfaction.

Attrition is the biggest pain point in the contact-center industry across nations. Hence, it is important to study how to retain contact center employees. This study aimed to identify the key factors influencing long-term retention among contact center employees in Malaysia. The Delphi method was implemented using purposive sampling. A total of 24 experts were selected from the contact center industry, who had been working in the field for more than five years in managerial positions. A two-round Delphi method was conducted where, in the first round, experts were requested to list the factors contributing to long-term retention among contact center employees in Malaysia. Thematic analysis was employed in the first round to identify the dimensions by grouping themes. In the second round, experts were requested to rank the dimensions from the most important to the least important. Based on the findings, the most important factors identified were supportive management, followed by work-life balance, compensation and benefits, working environment, career development, reward and recognition, training and development, and health support. Recommendation was provided to the contact center operation in Malaysia based on this finding on the initiative that can be worked on to retain the contact center employee in Malaysia.

Considering the concerning increase in overweight and obesity rates among Filipino youth, this study seeks to evaluate the effectiveness of a housework-based exercise program. This program capitalizes on the inherent familiarity of traditional household chores, transforming them into structured exercise routines designed to improve the physical fitness levels of overweight and obese Filipino adolescents. A one-group pretest-posttest design was employed. The intervention transformed traditional household chores into structured exercise routines. Fitness parameters, including Body Mass Index (BMI), cardiovascular endurance, flexibility, and muscular strength & endurance, were assessed before and after the intervention. Statistical analysis was conducted using SPSS software version 29, with Q-Q plots used to confirm the normality of the data. Paired sample t-tests evaluated pre- and post-intervention changes, while independent sample –t-tests determined gender differences. Findings showed that males experienced a greater reduction in BMI (+13.37%, p < .001, effect size = 1.393), while females showed more improvement in cardiovascular endurance (+8.82%, p < .001, effect size = 2.354) and flexibility (left: −46.12%, p < .001, right: −8.31%, p < .001). Both sexes achieved similar gains in muscular strength and endurance (push-up: −35.33%, p < .001, plank: −30.77%, p < .001). This research supports the value of everyday activities beyond structured exercise programs, highlighting the potential of a culturally sensitive approach that utilizes familiar household chores. The program promotes physical activity in a way that resonates with Filipino adolescents and their families, offering a promising, cost-effective intervention to address childhood obesity within the Filipino community.

This research focuses on female managers and aims to explore the factors influencing work–life balance among female managers in Chinese higher education institutions (HEIs), while also ranking the importance of these factors within HEIs. The research is divided into five main sections and employs a two-round Delphi research method, utilizing expert discussions and opinions to thoroughly analyze the work–life balance challenges faced by female managers. The findings of the research reveal six primary dimensions that influence the work–life balance of female managers in Chinese HEIs. These factors, ranked in order of importance, are as follows: (1) family factors, (2) work-related factors, (3) cultural and social norms, (4) health factors, (5) self-management and personal skills, and (6) support and satisfaction. In conclusion, this research offers valuable recommendations for understanding and improving the work–life balance of female managers in Chinese HEIs, providing essential guidance for both these institutions and female managers in achieving a balanced development in their professional and personal lives.

Allopregnanolone (ALLO) is a neurosteroid that modulates synaptic and extrasynaptic GABAA receptors. We hypothesize that ALLO may be useful as first-line treatment of status epilepticus (SE). Our objectives were to (1) characterize ALLO pharmacokinetics-pharmacodynamics PK-PD after intravenous (IV) and intramuscular (IM) administration and (2) compare IV and IM ALLO safety and tolerability. Three healthy dogs and two with a history of epilepsy were used. Single ALLO IV doses ranging from 1-6 mg/kg were infused over 5 minutes or injected IM. Blood samples, vital signs, and sedation assessment were collected up to 8 hours postdose. Intracranial EEG (iEEG) was continuously recorded in one dog. IV ALLO exhibited dose-proportional increases in exposure, which were associated with an increase in absolute power spectral density in all iEEG frequency bands. This relationship was best described by an indirect link PK-PD model where concentration-response was described by a sigmoidal maximum response (Emax) equation. Adverse events included site injection pain with higher IM volumes and ataxia and sedation associated with higher doses. IM administration exhibited incomplete absorption and volume-dependent bioavailability. Robust iEEG changes after IM administration were not observed. Based on PK-PD simulations, a 2 mg/kg dose infused over 5 minutes is predicted to achieve plasma concentrations above the EC50, but below those associated with heavy sedation. This study demonstrates that ALLO is safe and well tolerated when administered at 1-4 mg/kg IV and up to 2 mg/kg IM. The rapid onset of effect after IV infusion suggests that ALLO may be useful in the early treatment of SE. SIGNIFICANCE STATEMENT: The characterization of the pharmacokinetics and pharmacodynamics of allopregnanolone is essential in order to design clinical studies evaluating its effectiveness as an early treatment for status epilepticus in dogs and people. This study has proposed a target dose/therapeutic range for a clinical trial in canine status epilepticus.

Naomi Goldenberg’s model of religion as a “vestigial state” is an excellent interrogation of how religion interacts with the state. To Goldenberg, religions traditionally functioned in the same manner as nation-states before being conquered and delineated as semi-autonomous institutions under the larger secular apparatus. However, I argue in this paper that Goldenberg’s “vestigial state” fails to account for the dynamism that religions have in their relationships to the state. I propose seeing religions as “alternative authorities”, which can be subordinate, cooperative, or hostile to the secular state. These perspectives as an alternative authority are seen best in the evolution of American fundamentalism and Christian nationalism, whose adherents have historically distinguished themselves from the state while simultaneously engaging in the effort to reshape it. In looking at how these movements develop, we understand that religions are constantly evolving in how to achieve and maintain power.

BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p

The purpose of the present study was to conduct a process evaluation of intervention delivery for a randomized controlled trial (RCT) conducted during the COVID-19 pandemic (NCT 03915548). The RCT tested the effects of a telephone-delivered behavioral intervention on changes in breast cancer survivors’ satisfaction with social roles and activities, as compared to an attention control condition. This process evaluation examined (a) fidelity monitoring scores; (b) participants’ perceived benefit ratings for gaining confidence, reducing distress, adjusting habits and routines, setting goals, and increasing exercise; and (c) field notes, email communications, and transcripts of coach supervision and debriefing sessions. The behavioral and attention control conditions were delivered with a high degree of fidelity (global quality rating score for the BA/PS condition was M = 4.6 (SD = 0.6) and M = 4.9 (SD = 0.3) for the attention control condition, where “5” is the highest rating). The behavioral intervention participants perceived greater benefits than the control participants pertaining to goal setting, t(248) = 5.73, p = t(248) = 2.94, p = 0.0036, and increasing exercise, t(248) = 4.66, p =

Background and Study Aim. Studies on exercise as punishment (EAP) have focused on students and coaches, but less attention has been given to the perspectives of physical education (PE) teachers. This study examined the factors that influence Filipino PE teachers' intentions to use EAP. Specifically, the study examined the role of socio-demographic characteristics, attitudes, and subjective norms in predicting intentions to use EAP in PE classes. Material and Methods. A cross-sectional study was conducted to collect data from 397 PE teachers from all 16 regions of the Philippines. A researcher-made questionnaire was used to collect data on the participants' socio-demographic characteristics, attitudes, subjective norms, and intention to use EAP in their classes. Descriptive statistics and regression analysis were used to analyze the data. Results. The results showed that attitude was the strongest predictor, followed by gender (male), subjective norms, and age (over 45 years). This analysis suggests that the intention to use EAP is more prevalent among males and those over 45 years. It also shows that attitudes significantly predict these intentions. This suggests that teachers who perceive exercise as a tool for improving physical fitness and enforcing adherence to rules in a physical education setting are more likely to have such intentions. In addition, respondents with higher social pressure in employing exercise as a disciplinary measure in PE classes showed greater intentions to use EAP. Conclusions. The intention to use EAP is more prevalent among male PE teachers, those who are older, and those with positive attitudes towards exercise. Additionally, teachers who feel more social pressure to use exercise as a disciplinary measure are also more likely to intend to use EAP. These findings can be used to inform the development of PE teacher training programs and policies that promote the use of positive reinforcement and other non-punitive methods of discipline in PE classes.

This study presents a comprehensive bibliometric analysis of the literature on psychological capital (PsyCap) within higher education institutions (HEIs). Its main objective is to offer an encompassing perspective on this field's current state and potential developments. To achieve this, the study examines present research trends and predicts future directions using a bibliometric approach. A total of 412 journal articles were gathered from the Web of Science database. The analysis identifies influential publications, outlines the knowledge structure, and forecasts future trends through bibliographic coupling and co-word analyses. The bibliographic coupling revealed five distinct clusters, while the co-word analysis identified four clusters. Despite the growing significance of PsyCap research in HEIs, there remains a need for greater academic efforts to comprehend the research landscape fully. This paper provides valuable insights into the expanding area of PsyCap research within HEIs. In conclusion, the study sheds light on the extensive research conducted on PsyCap in the context of HEIs and offers insights into its potential for further growth.

This comprehensive bibliometric study analyzes 1820 journal articles from the Web of Science database to explore Equity, Diversity, and Inclusion (EDI) leadership in higher education institutions (HEIs). Utilizing co-citation and co-word analysis, the study identifies distinct thematic clusters. The co-citation analysis reveals five key themes: Race, Diversity, and Inclusion (RDI), Diversity, Leadership, and Self-Efficacy (DLSE), Gender Dynamics and Leadership Challenges, Women's Representation in Academic Medicine Leadership, and Transformational Leadership in HEIs. Meanwhile, the co-word analysis highlights three critical areas: Transformative Collaborative Resilience in HEIs, Advancing Gender Equality in Academic Medicine and STEM, and Inclusive Educational Leadership in HEIs. These themes collectively provide a deep understanding of the EDI leadership field's intellectual structure, suggesting significant areas for future research and practical application. The study emphasizes the necessity for HEIs to engage comprehensively in EDI leadership research, shedding light on the importance of transformative collaborative resilience, gender equality in STEM, and inclusive leadership. This research offers valuable insights for developing effective EDI leadership policies and practices, highlighting the interconnectedness of these themes in fostering a more equitable, diverse, and inclusive environment in higher education and beyond.

Fosphenytoin (FOS) and its active form, phenytoin (PHT), levetiracetam (LEV), and valproic acid (VPA) are commonly used second-line treatments of status epilepticus. However, limited information is available regarding LEV and VPA concentrations following high intravenous doses, particularly in young children. The Established Status Epilepticus Treatment Trial, a blinded, comparative effectiveness study of FOS, LEV, and VPA for benzodiazepine-refractory status epilepticus provided an opportunity to investigate early drug concentrations. Patients aged ≥2 years who continued to seizure despite receiving adequate doses of benzodiazepines were randomly assigned to FOS, LEV, or VPA infused over 10 minutes. A sparse blood-sampling approach was used, with up to 2 samples collected per patient within 2 hours following drug administration. The objective of this work was to report early drug exposure of PHT, LEV, and VPA and plasma protein binding of PHT and VPA. Twenty-seven children with median (interquartile range) age of 4 (2.5-6.5) years were enrolled. The total plasma concentrations ranged from 69 to 151.3 μg/mL for LEV, 11.3 to 26.7 μg/mL for PHT and 126 to 223 μg/mL for VPA. Free fraction ranged from 4% to 19% for PHT and 17% to 51% for VPA. This is the first report in young children of LEV concentrations with convulsive status epilepticus as well as VPA concentrations after a 40 mg/kg dose. Several challenges limited patient enrollment and blood sampling. Additional studies with a larger sample size are required to evaluate the exposure-response relationships in this emergent condition.

ObjectiveTo quantify the association between early neurologic recovery, practice pattern variation, and endotracheal intubation during established status epilepticus, we performed a secondary analysis within the cohort of patients enrolled in the Established Status Epilepticus Treatment Trial (ESETT).MethodsWe evaluated factors associated with the endpoint of endotracheal intubation occurring within 120 minutes of ESETT study drug initiation. We defined a blocked, stepwise multivariate regression, examining 4 phases during status epilepticus management: (1) baseline characteristics, (2) acute treatment, (3) 20-minute neurologic recovery, and (4) 60-minute recovery, including seizure cessation and improving responsiveness.ResultsOf 478 patients, 117 (24.5%) were intubated within 120 minutes. Among high-enrolling sites, intubation rates ranged from 4% to 32% at pediatric sites and 19% to 39% at adult sites. Baseline characteristics, including seizure precipitant, benzodiazepine dosing, and admission vital signs, provided limited discrimination for predicting intubation (area under the curve [AUC] 0.63). However, treatment at sites with an intubation rate in the highest (vs lowest) quartile strongly predicted endotracheal intubation independently of other treatment variables (adjusted odds ratio [aOR] 8.12, 95% confidence interval [CI] 3.08-21.4, model AUC 0.70). Site-specific variation was the factor most strongly associated with endotracheal intubation after adjustment for 20-minute (aOR 23.4, 95% CI 6.99-78.3, model AUC 0.88) and 60-minute (aOR 14.7, 95% CI 3.20-67.5, model AUC 0.98) neurologic recovery.ConclusionsEndotracheal intubation after established status epilepticus is strongly associated with site-specific practice pattern variation, independently of baseline characteristics, and early neurologic recovery and should not alone serve as a clinical trial endpoint in established status epilepticus.Trial registration informationClinicalTrials.gov Identifier: NCT01960075.

The liver maintains a balance between immune tolerance and activation in its role as a filtration system. Chronic inflammation disrupts this immune microenvironment, thereby allowing for the rise and progression of cancer. Hepatocellular carcinoma (HCC) is a liver tumor generally diagnosed in the setting of chronic liver disease. When diagnosed early, the primary treatment is surgical resection, liver transplantation, or liver directed therapies. Unfortunately, patients with HCC often present at an advanced stage or with poor liver function, thereby limiting options. To further complicate matters, most systemic therapies are relatively limited and ineffective among patients with advanced disease. Recently, the IMbrave150 trial demonstrated that the combination of atezolizumab and bevacizumab was associated with better survival compared to sorafenib among patients with advanced HCC. As such, atezolizumab and bevacizumab is now recommended first-line therapy for these patients. Tumor cells work to create an immunotolerant environment by preventing the activation of stimulatory immunoreceptors and upregulating expression of proteins that bind inhibitory immunoreceptors. ICIs work to block these interactions and bolster the anti-tumor function of the immune system. We herein provide an overview of the use of ICIs in the treatment of HCC.

Infantile spasms (IS) is a devastating epilepsy syndrome that typically begins in the first year of life. Symptoms consist of stereotypical spasms, developmental delay, and electroencephalogram (EEG) that may demonstrate Hypsarhythmia. Current therapeutic approaches are not always effective, and there is no reliable way to predict which patient will respond to therapy. Given this disorder's complexity and the potential impact of a disease-modifying approach, Citizens United for Research in Epilepsy (CURE) employed a "team science" approach to advance the understanding of IS pathology and explore therapeutic modalities that might lead to the development of new ways to potentially prevent spasms and Hypsarhythmia. This approach was a first-of-its-kind collaborative initiative in epilepsy. The IS initiative funded 8 investigative teams over the course of 1-3 years. Projects included the following: discovery on the basic biology of IS, discovery of novel therapeutic targets, cross-validation of targets, discovery of biomarkers, and prognosis and treatment of IS. The combined efforts of a strong investigative team led to numerous advances in understanding the neural pathways underlying IS, testing of small molecules in preclinical models of IS and generated preliminary data on potential biomarkers. Thus far, the initiative has resulted in over 19 publications and subsequent funding for several investigators. Investigators reported that the IS initiative generally affected their research positively due to its collaborative and iterative nature. It also provided a unique opportunity to mentor junior investigators with an interest in translational research. Learnings included the need for a dedicated project manager and more transparent and real-time communication with investigators. The CURE IS initiative represents a unique approach to fund scientific discoveries on epilepsy. It brought together an interdisciplinary group of investigators-who otherwise would not have collaborated-to find transformative therapies for IS. Learnings from this initiative are being utilized for subsequent initiatives at CURE.

ObjectiveThis study was undertaken to describe patterns of benzodiazepine use as first-line treatment of status epilepticus (SE) and test the association of benzodiazepine doses with response to second-line agents in patients enrolled in the Established Status Epilepticus Treatment Trial (ESETT).MethodsPatients refractory to an adequate dose of benzodiazepines for the treatment of SE were enrolled in ESETT. Choice of benzodiazepine, doses given prior to administration of second-line agent, route of administration, setting, and patient weight were characterized. These were compared with guideline-recommended dosing. Logistic regression was used to determine the association of the first dose of benzodiazepine and the cumulative benzodiazepine dose with the response to second-line agent.ResultsFour hundred sixty patients were administered 1170 doses of benzodiazepines (669 lorazepam, 398 midazolam, 103 diazepam). Lorazepam was most frequently administered intravenously in the emergency department, midazolam intramuscularly or intravenously by the emergency medical services personnel, and diazepam rectally prior to ambulance arrival. The first dose of the first benzodiazepine (N = 460) was lower than guideline recommendations in 76% of midazolam administrations and 81% of lorazepam administrations. Among all administrations, >85% of midazolam and >76% of lorazepam administrations were lower than recommended. Higher first or cumulative benzodiazepine doses were not associated with better outcomes or clinical seizure cessation in response to second-line medications in these benzodiazepine-refractory seizures.SignificanceBenzodiazepines as first-line treatment of SE, particularly midazolam and lorazepam, are frequently underdosed throughout the United States. This broad and generalizable cohort confirms prior single site reports that underdosing is both pervasive and difficult to remediate. (ESETT ClinicalTrials.gov identifier: NCT01960075.).

The purpose of this study is to conduct a bibliometric analysis of Service Quality (SERVQUAL) research in private higher education institutions (HEIs). This analysis aims to provide a comprehensive evaluation of SERVQUAL's current state and future potential in private HEIs. This study collected 205 journal articles from the Web of Science database using a bibliometric approach. Then, co-citation and co-word analyses were conducted to determine the most influential publications, analyze the knowledge structure, and forecast future trends. This review offers valuable insight into the expanding field of SERVQUAL research, despite its limitations, as the analysis revealed five clusters in co-citation and co-word analysis, respectively. This study contributes to the existing body of knowledge by offering a comprehensive understanding of SERVQUAL in the context of private HEIs. Additionally, it provides insight into potential future developments in this field.

Digital tourism has witnessed substantial evolution, shaping the trajectory of tourism research. Employing bibliometric analysis on 1,079 articles from the Web of Science database, this study identifies predominant themes and research trends in digital tourism. Key findings revealed three main co-citation clusters: ‘Smart tourism destinations and smart tourists', ‘Evolution and impact of E-tourism on travel behavior’, and ‘Personalized smart tourism experience’. Additionally, co-word analysis showcased prominent themes such as ‘AR-Integrated E-Tourism’, ‘Co-creation of smart tourism destinations in China post-COVID-19′, and ‘AI-driven personalized destination recommender systems in tourism’. The study highlights gaps in digital tourism research, advocating for socio-cultural preservation alongside tech advancements. Co-citation analysis suggests new travel theory directions, while AR's role in sustainable tourism is spotlighted. Practically, AI and Big Data emerge as pivotal in personalized experiences, with co-word analysis aiding industry foresight and emphasizing AI-driven, sustainable strategies. Limitations include reliance on a single database, suggesting future studies to integrate multiple sources and qualitative insights. The study's findings offer a roadmap for academics and practitioners, emphasizing potential avenues in digital tourism, especially in the context of sustainable and responsible practices.

BackgroundWhile parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC.MethodsPatients from the US HIPEC Collaborative (2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS).ResultsA total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p

BackgroundPostoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is unknown.MethodsThe US HIPEC Collaborative (2000-2017) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. The analysis was stratified by noninvasive appendiceal neoplasm versus invasive appendiceal/colorectal adenocarcinoma. The POCs were grouped into infectious, cardiopulmonary, thromboembolic, and intestinal dysmotility. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS).ResultsOf the 1304 patients, 33% had noninvasive appendiceal neoplasm (n = 426), and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the noninvasive appendiceal cohort, POCs were identified in 55% of the patients (n = 233). The 3-year OS and RFS did not differ between the patients who experienced a complication and those who did not (OS, 94% vs 94%, p = 0.26; RFS, 68% vs 60%, p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased 3-year OS (59% vs 74%; p

BackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis can be performed in two ways: Open or closed abdominal technique.AimTo evaluate the impact of HIPEC method on post-operative and long-term survival outcomes.MethodsPatients undergoing CRS with HIPEC from 2000-2017 were identified in the United States HIPEC collaborative database. Post-operative, recurrence, and overall survival outcomes were compared between those who received open vs closed HIPEC.ResultsOf the 1812 patients undergoing curative-intent CRS and HIPEC, 372 (21%) patients underwent open HIPEC and 1440 (79%) underwent closed HIPEC. There was no difference in re-operation or severe complications between the two groups. Closed HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d mortalities. On multi-variable analysis, closed HIPEC technique was not a significant predictor for overall survival (hazards ratio: 0.75, 95% confidence interval: 0.51-1.10, P = 0.14) or recurrence-free survival (hazards ratio: 1.39, 95% confidence interval: 1.00-1.93, P = 0.05) in the entire cohort. These findings remained consistent in the appendiceal and the colorectal subgroups.ConclusionIn this multi-institutional analysis, the HIPEC method was not independently associated with relevant post-operative or long-term outcomes. HIPEC technique may be left to the discretion of the operating surgeon.

The Established Status Epilepticus Treatment Trial was a blinded, comparative-effectiveness study of fosphenytoin, levetiracetam, and valproic acid in benzodiazepine-refractory status epilepticus. The primary outcome was clinical seizure cessation and increased responsiveness without additional anticonvulsant medications. Weight-based dosing was capped at 75 kg. Hence, patients weighing >75 kg received a lower mg/kg dose. Logistic regression models were developed in 235 adults to determine the association of weight (≤ or >75 kg, ≤ or >90 kg), sex, treatment, and weight-normalized dose with the primary outcome and solely seizure cessation. The primary outcome was achieved in 45.1% and 42.5% of those ≤75 kg and >75 kg, respectively. Using univariate analyses, the likelihood of success for those >75 kg (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.54-1.51) or >90 kg (OR = 0.85, 95% CI = 0.42-1.66) was not statistically different compared with those ≤75 kg or ≤90 kg, respectively. Similarly, other predictors were not significantly associated with primary outcome or clinical seizure cessation. Our findings suggest that doses, capped at 75 kg, likely resulted in concentrations greater than those needed for outcome. Studies that include drug concentrations and heavier individuals are needed to confirm these findings.

BackgroundBenzodiazepine-refractory, or established, status epilepticus is thought to be of similar pathophysiology in children and adults, but differences in underlying aetiology and pharmacodynamics might differentially affect response to therapy. In the Established Status Epilepticus Treatment Trial (ESETT) we compared the efficacy and safety of levetiracetam, fosphenytoin, and valproate in established status epilepticus, and here we describe our results after extending enrolment in children to compare outcomes in three age groups.MethodsIn this multicentre, double-blind, response-adaptive, randomised controlled trial, we recruited patients from 58 hospital emergency departments across the USA. Patients were eligible for inclusion if they were aged 2 years or older, had been treated for a generalised convulsive seizure of longer than 5 min duration with adequate doses of benzodiazepines, and continued to have persistent or recurrent convulsions in the emergency department for at least 5 min and no more than 30 min after the last dose of benzodiazepine. Patients were randomly assigned in a response-adaptive manner, using Bayesian methods and stratified by age group (65 years), to levetiracetam, fosphenytoin, or valproate. All patients, investigators, study staff, and pharmacists were masked to treatment allocation. The primary outcome was absence of clinically apparent seizures with improved consciousness and without additional antiseizure medication at 1 h from start of drug infusion. The primary safety outcome was life-threatening hypotension or cardiac arrhythmia. The efficacy and safety outcomes were analysed by intention to treat. This study is registered in ClinicalTrials.gov, NCT01960075.FindingsBetween Nov 3, 2015, and Dec 29, 2018, we enrolled 478 patients and 462 unique patients were included: 225 children (aged 65 years). 175 (38%) patients were randomly assigned to levetiracetam, 142 (31%) to fosphenyltoin, and 145 (31%) were to valproate. Baseline characteristics were balanced across treatments within age groups. The primary efficacy outcome was met in those treated with levetiracetam for 52% (95% credible interval 41-62) of children, 44% (33-55) of adults, and 37% (19-59) of older adults; with fosphenytoin in 49% (38-61) of children, 46% (34-59) of adults, and 35% (17-59) of older adults; and with valproate in 52% (41-63) of children, 46% (34-58) of adults, and 47% (25-70) of older adults. No differences were detected in efficacy or primary safety outcome by drug within each age group. With the exception of endotracheal intubation in children, secondary safety outcomes did not significantly differ by drug within each age group.InterpretationChildren, adults, and older adults with established status epilepticus respond similarly to levetiracetam, fosphenytoin, and valproate, with treatment success in approximately half of patients. Any of the three drugs can be considered as a potential first-choice, second-line drug for benzodiazepine-refractory status epilepticus.FundingNational Institute of Neurological Disorders and Stroke, National Institutes of Health.

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000-2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

The citrus mealybug, Planococcus citri, is an insect pest of greenhouse-grown horticultural crops. Citrus mealybug causes plant damage when feeding on plant leaves, stems, flowers, and fruits, resulting in a substantial economic loss. Insecticides are applied to manage citrus mealybug populations in greenhouse production systems. Anecdotal information suggests that mixing entomopathogenic fungal-based insecticides with insect growth regulators may be effective for managing citrus mealybug populations under greenhouse conditions. Consequently, we conducted two experiments in a research greenhouse at Kansas State University (Manhattan, KS, USA) in 2023. The experiments were designed to determine the efficacy of three commercially available entomopathogenic fungal-based insecticides [Beauveria bassiana Strain GHA (BotaniGard®), B. bassiana strain PPRI 5339 (Velifer™) and Isaria fumosorosea Apopka Strain 97 (Ancora®)] when mixed with three insect growth regulators [azadirachtin (Azatin® O), novaluron (Pedestal®), and pyriproxyfen (Distance®)] on citrus mealybug feeding on coleus, Solenostemon scutellarioides, plants. The entomopathogenic fungal-based insecticides alone or when mixed with the insect growth regulators were not effective in managing citrus mealybug populations, with

Convulsive status epilepticus (SE) is a relatively common emergency condition affecting individuals of all ages. The primary goal of treatment is prompt termination of seizures. Where first-line treatment with benzodiazepine has failed to achieve this, a condition known as established SE (ESE), there is uncertainty about which agent to use next. The Established Status Epilepticus Treatment Trial (ESETT) is a 3-arm (valproate (VPA), fosphenytoin (FOS), levetiracetam (LEV)), phase III, double-blind randomized comparative effectiveness study in patients aged 2 years and above with established convulsive SE. Enrollment was completed in January 2019, and the results are expected later this year. We discuss lessons learnt during the conduct of the study in relation to the following: ethical considerations; trial design and practical implementation in emergency settings, including pediatric and adult populations; quality assurance; and outcome determination where treating emergency clinicians may lack specialist expertise. We consider that the ESETT is already informing both clinical practice and future trial design. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".

BackgroundThe choice of drugs for patients with status epilepticus that is refractory to treatment with benzodiazepines has not been thoroughly studied.MethodsIn a randomized, blinded, adaptive trial, we compared the efficacy and safety of three intravenous anticonvulsive agents - levetiracetam, fosphenytoin, and valproate - in children and adults with convulsive status epilepticus that was unresponsive to treatment with benzodiazepines. The primary outcome was absence of clinically evident seizures and improvement in the level of consciousness by 60 minutes after the start of drug infusion, without additional anticonvulsant medication. The posterior probabilities that each drug was the most or least effective were calculated. Safety outcomes included life-threatening hypotension or cardiac arrhythmia, endotracheal intubation, seizure recurrence, and death.ResultsA total of 384 patients were enrolled and randomly assigned to receive levetiracetam (145 patients), fosphenytoin (118), or valproate (121). Reenrollment of patients with a second episode of status epilepticus accounted for 16 additional instances of randomization. In accordance with a prespecified stopping rule for futility of finding one drug to be superior or inferior, a planned interim analysis led to the trial being stopped. Of the enrolled patients, 10% were determined to have had psychogenic seizures. The primary outcome of cessation of status epilepticus and improvement in the level of consciousness at 60 minutes occurred in 68 patients assigned to levetiracetam (47%; 95% credible interval, 39 to 55), 53 patients assigned to fosphenytoin (45%; 95% credible interval, 36 to 54), and 56 patients assigned to valproate (46%; 95% credible interval, 38 to 55). The posterior probability that each drug was the most effective was 0.41, 0.24, and 0.35, respectively. Numerically more episodes of hypotension and intubation occurred in the fosphenytoin group and more deaths occurred in the levetiracetam group than in the other groups, but these differences were not significant.ConclusionsIn the context of benzodiazepine-refractory convulsive status epilepticus, the anticonvulsant drugs levetiracetam, fosphenytoin, and valproate each led to seizure cessation and improved alertness by 60 minutes in approximately half the patients, and the three drugs were associated with similar incidences of adverse events. (Funded by the National Institute of Neurological Disorders and Stroke; ESETT ClinicalTrials.gov number, NCT01960075.).

Background and Study Aim. There is a void in the literature comparing the fitness effects of housework-based exercise (HBE) and conventional exercise (CE), including studies that adapt housework into an exercise program. This study examines the effectiveness of HBE and CE on adolescent learners' health-related fitness (HRF) and compares the effectiveness of the two exercises. Material and Methods. This study uses a parallel-group, randomized controlled trial with 120 adolescent learners; 60 are in the HBE group, and 60 are in the CE group. The participants in the HBE group exercised using housework activities, while the participants in the CE group exercised by doing push and pull, squats, lunges, leaps and jumps, planks, etc. The participants in both groups trained for at least an hour every weekday for 12 weeks under the supervision of qualified fitness instructors. Results. The findings show that HBE improves the fitness levels of adolescent learners, albeit it has no significant improvement in their BMI. Furthermore, HBE significantly improves the cardiorespiratory fitness of females more than males. Finally, CE outperforms the HBE in producing more significant and favorable fitness effects. Conclusions. When planned, implemented, and monitored carefully as an exercise program, doing housework is just as good as doing traditional exercise for keeping or improving adolescent learners’ fitness. Furthermore, the findings indicate that HBE may be more appropriate for females because it involves household-related tasks that they traditionally perform.However, CE produces more positive and significant fitness effects. Thus, teachers can use HBE in the remote exercise activities of their learners along with CE.

Background: Individuals' values, attitudes, and behaviours are significantly influenced by their religious beliefs. The present study examines the demographic factors (gender, age groups, religion, employment status, household income, marital status, self-perceived adulthood, and country of origin) that may influence religious beliefs. Methods: The data was collected from September to December 2022 using an online survey. A cross-sectional design was used to collect data from 885 respondents from five countries: Malaysia, the Philippines, China, Kenya, and Indonesia. The survey included questions on five variables related to religious belief: religious certainty, religious culture, religious importance, religious practice, and belief in God. Respondents were asked to rate their level of agreement or disagreement with statements related to each variable on a Likert scale. T-tests and one-way ANOVA were used to analyze the data and determine any significant differences in religious beliefs between the five countries. Results: The results revealed that female respondents held stronger religious beliefs than male respondents. Furthermore, respondents aged 30-45 rated themselves as having a higher religious culture and practice than respondents aged 18-29. Islam groups ranked highest in religious beliefs, followed by Christian, Roman Catholic, and Hindu groups. Full-time students rated themselves as less religious than full-time employed and other groups, while lower-income groups rated themselves as more religious than middle- and upper-income groups. Single groups rated themselves higher on belief in God than cohabiting and in-relationship groups. Conclusions: In conclusion, this study provides evidence that demographic factors influence religious beliefs among respondents from five different countries. These findings can contribute to a better understanding of how religiosity is shaped by various socio-demographic factors and can inform policies and interventions designed to promote religious tolerance and diversity. More research is required to investigate the complex relationships between demographic factors and religiosity, particularly in different cultural and religious contexts.

Stakeholders have long been concerned about high school drop-out rates and associated achievement gaps between groups, specifically racial, of high school students. While significant improvements have been made to these drop-out rates at the national level, the largest group of drop-out students continues to be those of Hispanic heritage. Research indicates nearly 28% of high school drop-outs make those decisions in the ninth or tenth grade and may do so as a result of already being behind in meeting graduation requirements. Including community service as part of high school graduation rates is the current trend. The purpose of the discussion in this article is to gain an understanding of the history, goals, implementation, and outcomes of student service learning (SSL) relational to curriculum equity. Self-determination theory and critical theory were used in the theoretical framework.

Post‐traumatic epilepsy (PTE) is a life‐long complication of traumatic brain injury (TBI). The development of PTE is associated with neurological morbidity and increases the risk of mortality. An aim of EpiBioS4Rx (Epilepsy Bioinformatics Study for Antiepileptogenic Therapy) was to test potential therapies to prevent the development of PTE in the lateral fluid percussion injury (LFPI) rat model of TBI, in which rats were subjected to injury at the left parietal cortex. Sodium selenate has been reported to be antiepileptogenic post‐TBI in rodent models by activating protein phosphatase 2A and reducing phosphorylated tau (p‐tau) protein. We aimed to characterize the pharmacokinetics (PK) and brain uptake of sodium selenate using naïve control and LFPI rats. Rats received either a single bolus dose or a single bolus dose followed by a 7‐day subcutaneous minipump infusion of sodium selenate. Sodium selenate and selenium concentrations in plasma and brain were analyzed and used for PK estimation and brain exposure assessment. Selenium concentrations rapidly increased after sodium selenate administration, demonstrating biotransformation from sodium selenate to selenium. Sodium selenate and selenium PK parameters were estimated using non‐compartmental analysis. Sodium selenate clearance (CL/F) and volume of distribution (Vd/F) varied by dose and route of administration, suggesting differences in bioavailability and nonlinear pharmacokinetics at the doses tested. Brain‐to‐plasma partition coefficients (AUCbrain/AUCplasma) for sodium selenate and selenium were found to be 0.7–1.3 and 0.1–0.3 following single‐dose injection, respectively, indicating active transport of sodium selenate across the blood–brain barrier (BBB). [ABSTRACT FROM AUTHOR]

Thermal ablation, including microwave ablation, has become increasingly important in the management of many solid tumors, including primary and metastatic tumors of the liver, kidney, and lung. However, its adoption to treat pancreatic lesions has been slowed due to concerns about potential adverse events. The success of radiofrequency ablation (RFA) in inoperable pancreatic cancers paved the way for its use in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms (PCLs). In the last decade, other thermal ablation techniques, like microwave ablation, have emerged as alternatives to RFA. Microwaves, with frequencies ranging from 900 to 2450 MHz, generate heat by rapidly oscillating water molecules. Microwave ablation’s advantage lies in its ability to achieve higher intra-lesion temperatures and uniform heating compared with RFA. Microwave ablation’s application in pancreatic cancer and pancreatic neuroendocrine tumors has demonstrated promise with similar technical success to RFA. Yet, concern for peri-procedure complications, as well as a dearth of studies comparing RFA and microwave ablation, emphasize the need for further research. No studies have evaluated microwave ablation in PCLs. We herein review thermal ablation’s potential to treat pancreatic lesions.

Introduction Millions of patients receive general anaesthesia for surgery annually. Crucial gaps in evidence exist regarding which technique, propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA), yields superior patient experience, safety and outcomes. The aim of this pilot study is to assess the feasibility of conducting a large comparative effectiveness trial assessing patient experiences and outcomes after receiving propofol TIVA or INVA.Methods and analysis This protocol was cocreated by a diverse team, including patient partners with personal experience of TIVA or INVA. The design is a 300-patient, two-centre, randomised, feasibility pilot trial. Patients 18 years of age or older, undergoing elective non-cardiac surgery requiring general anaesthesia with a tracheal tube or laryngeal mask airway will be eligible. Patients will be randomised 1:1 to propofol TIVA or INVA, stratified by centre and procedural complexity. The feasibility endpoints include: (1) proportion of patients approached who agree to participate; (2) proportion of patients who receive their assigned randomised treatment; (3) completeness of outcomes data collection and (4) feasibility of data management procedures. Proportions and 95% CIs will be calculated to assess whether prespecified thresholds are met for the feasibility parameters. If the lower bounds of the 95% CI are above the thresholds of 10% for the proportion of patients agreeing to participate among those approached and 80% for compliance with treatment allocation for each randomised treatment group, this will suggest that our planned pragmatic 12 500-patient comparative effectiveness trial can likely be conducted successfully. Other feasibility outcomes and adverse events will be described.Ethics and dissemination This study is approved by the ethics board at Washington University (IRB# 202205053), serving as the single Institutional Review Board for both participating sites. Recruitment began in September 2022. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media.Trial registration number NCT05346588.