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The laboratory experiment presented here describes the use of a calcium ion-selective electrode (Ca-ISE) to determine the concentration of zinc in a supplement tablet. This approach was developed to show students how to expand the range of applications of Ca-ISE to enable the determination of metal ions other than Ca[superscript 2+]. To determine the concentration of Zn[superscript 2+], students dissolved the sample in a Ca-EDTA buffer solution and used EDTA as titrant. We discuss with students the importance of a fixed pH and ionic strength for the accurate analytical quantification. Students also used colorimetric titration of the same sample with murexide as an indicator to determine the concentration of Zn[superscript 2+]. They used statistical tools to confirm that the two approaches provide similar results. Students concluded that both titrations overestimate the amount of zinc in a tablet by 3-5% in comparison with the known value reported by the manufacturer and discussed factors that affect the accuracy of Zn[superscript 2+] determination.

While University students increasingly participate in work-integrated learning (WIL), their dignity is often violated during WIL. The current literature is limited in so far as it typically focuses on student perspectives within healthcare contexts and does not use the concept of 'dignity'. Instead, this study explored student and supervisor perspectives on student dignity during WIL across healthcare and non-healthcare disciplines. Research questions included: What are: (1) types of student dignity experiences and patterns by groups; (2) factors contributing to experiences; (3) consequences of experiences? Sixty-five semi-structured interviews were conducted using narrative interviewing techniques with 30 supervisors and 46 students from healthcare (medicine, nursing and counselling) and non-healthcare (business, law and education) disciplines. Data were analyzed using framework analysis. Nine common narrative types were identified within 344 stories: verbal abuse, right for learning opportunities, care, inclusion, reasonable expectations, right for appropriate feedback, equality, trust, and right to be informed. Factors contributing to dignity experiences and consequences were often at the individual level (e.g. student/supervisor characteristics). We found some salient differences in perceptions of experiences between students and supervisors, but few differences between healthcare and non-healthcare disciplines. This study extends WIL research based on student perspectives in healthcare, and provides practice and further research guidance to enhance student dignity during WIL.

Cognitive apprenticeship theory emphasizes the process of making expert thinking "visible" to students and fostering the cognitive and meta-cognitive processes required for expertise. The purpose of this review was to evaluate the use of cognitive apprenticeship theory with the primary aim of understanding how and to what extent the theory has been applied to the design, implementation, and analysis of education in the health sciences. The initial search yielded 149 articles, with 45 excluded because they contained the term "cognitive apprenticeship" only in reference list. The remaining 104 articles were categorized using a theory talk coding scheme. An in depth qualitative synthesis and review was conducted for the 26 articles falling into the "major theory talk" category. Application of cognitive apprenticeship theory tended to focus on the methods dimension (e.g., coaching, mentoring, scaffolding), with some consideration for the content and sociology dimensions. Cognitive apprenticeship was applied in various disciplines (e.g., nursing, medicine, veterinary) and educational settings (e.g., clinical, simulations, online). Health sciences education researchers often used cognitive apprenticeship to inform instructional design and instrument development. Major recommendations from the literature included consideration for contextual influences, providing faculty development, and expanding application of the theory to improve instructional design and student outcomes. This body of research provides critical insight into cognitive apprenticeship theory and extends our understanding of how to develop expert thinking in health sciences students. New research directions should apply the theory into additional aspects of health sciences educational research, such as classroom learning and interprofessional education.

Museums promote co-learning through the construction of a social community, one that involves personal, physical, and sociocultural contexts. As researchers and museum educators, we report some of our contextual reflections and recommendations that emerged from our collaborative learning experience of conducting research in a medical science museum. Guided by an established 6P model of museum learning ("place," "purpose," "person," "people," "process," and "product"), we articulate our experiences and propose an additional P ("partnership") with eight steps--beginning with relationship building and culminating in dissemination to varied audiences. Using examples from our research of children and young adolescents' experience of a science and health-related museum program entitled "Surviving the Zombie Apocalypse," we identify principles, factors, and processes that contributed to the success of our museum-based research. By presenting the lessons we learned, we aim to help guide future research endeavors of others considering interdisciplinary museum research.

Background: In Europe, the health situation is primarily influenced by non-communicable diseases. Comparable information on key indicators for the European region can highlight potential areas for improvement in prevention and care. Method: Based on EHIS 3, age-standardised prevalences of three disease groups and two indicators of self-assessed health among those affected were presented for Germany (n = 22,708) and the average of 29 European countries (n = 301,960). Results: The disease prevalence estimates in Germany were higher compared to the European average: diabetes 8.4 % vs. 7.4 %, cardiovascular diseases 6.8 % vs. 5.7 %, chronic respiratory diseases 11.4 % vs. 7.9 %. Likewise, the proportion with self-assessed very good or good general health among those affected was also higher in Germany (diabetes 35.8 % vs. 30.7 %, cardiovascular diseases 25.3 % vs. 18.9 %, chronic respiratory diseases 44.7 % vs. 41.9 %). For limitations in everyday activities, higher proportions were found in Germany for diabetes (65.6 % vs. 60.6 %) and chronic respiratory diseases (64.5 % vs. 57.6 %). Germany showed similar gender-, age- and education-specific differences for disease prevalence, but in part less pronounced differences for the indicators of self-assessed health than the European average. Conclusions: Further analysis of the differences for the indicators considered between Germany and the European average and the possible underlying factors, such as differences in prevention, diagnosis, disease severity and care, is required. The educational inequalities observed across Europe suggest considerable potential for promoting health equity.

Abstract Many studies have explored different loading and rehabilitation strategies, yet rehabilitation intensity and its impact on the local strain environment and bone healing have largely not been investigated. This study combined implantable strain sensors and subject-specific finite element models in a 2 mm rodent segmental bone defect model. After injury animals were underwent high or low intensity rehabilitation. High intensity rehabilitation increased local strains within the regenerative niche by an average of 44% compared to the low intensity rehabilitation. Finite element modeling demonstrated that resistance rehabilitation significantly increased compressive strain by a factor of 2.0 at week 2 and 4.45 after 4 weeks of rehabilitation. Animals that underwent resistance running had the greatest bone volume and improved functional recovery with regenerated femurs that matched intact failure torque and torsional stiffness values. These results demonstrate the potential for early resistance rehabilitation to improve bone healing.

Abstract This study explores the health-related quality of life (HRQoL) experienced by patients with Long COVD-19 using data from British Columbia’s post-COVID-19 Recovery Clinics. A retrospective cohort of 3463 patients was analyzed to assess HRQoL through the EQ-5D-5L questionnaire which includes five dimensions (mobility, self-care, usual activities, physical health, and mental health) administered to patients; responses were analyzed using the Visual Analogue Score (VAS). Notably, 95% of participants reported HRQoL scores below 90, with 50% scoring under 60, indicating significant impacts on their well-being. The analysis revealed that HRQoL is significantly influenced by various social determinants of health (SDoH), including age, sex, employment status, and ethnicity, each showing distinct correlations with HRQoL dimensions and overall VAS scores. Specifically, older age was associated with decreased mobility and increased pain/discomfort but less anxiety and depression, highlighting varying impacts across the age spectrum. The study highlights the multifaceted impacts of Long COVID on the lives of patients and underscores the necessity of targeted strategies to improve HRQoL among diverse groups, considering specific SDoH. Such a comprehensive approach could lead to more equitable health outcomes and support the development of tailored public health policies aimed at the recovery and rehabilitation of Long COVID sufferers.

Abstract Drug Information Centres (DICs) are providing clinicians with evidence-based support for rational drug treatment. However, knowledge gaps in the literature may hinder DICs from offering optimal guidance. This study examined the extent and nature of these knowledge gaps and their impact on clinical pharmacological advice, using real-world query data from a Swedish regional DIC. Data from 2022 at the Sahlgrenska University Hospital were analysed, focusing on queries outside off-label prescriptions and pharmaceutical aspects. A qualitative text content analysis identified phrases indicating a lack of evidence. Responses were categorized by the presence of these signalling phrases and the presence or absence of knowledge gaps. Among 209 responses, the majority were patient-specific (79%), posed by physicians (95%), and often related to adverse effects (37%). The analysis revealed that 23% of the responses had scientific knowledge gaps, and in 18% of the responses, no clinical pharmacological advice could be provided. Knowledge gaps were particularly associated with queries on adverse effects, long-term medication safety, specific patient cases and comorbidities, drug comparisons, or patient populations with limited literature coverage. This analysis highlights the potential of DICs to identify unmet clinical needs in drug treatment and to promote research for evidence-based, patient-centred drug treatment.

Background: Needs-based care is a central concern of healthcare policy. A European comparison of the utilisation of medical services can help to assess national data and identify the need for action. Methods: This article describes indicators on the utilisation of outpatient and inpatient services, medical examinations and the use of medicines from the third wave of the European Health Interview Survey (EHIS 3) and compares the results from Germany with the European averages. Results: Age-standardised, the utilisation of medical services in Germany was above the European average without exception, whereby demographic and social differences were similar. Almost all services were utilised more frequently by women and in older age groups. Exceptions are inpatient services and colonoscopy, where there was no difference between the sexes, and more frequent use of psychiatric and psychotherapeutic services and non-prescription medication among younger adults. Specialist medical and dental services were used more frequently in the high education group, psychiatric and psychotherapeutic services as well as inpatient services and prescription medication in the low education group. Conclusions: The European comparison requires a differentiated categorisation of the findings. While the high utilisation in Germany for some evidence-based services (e.g. colonoscopy, dentistry) indicates good access to care, the high inpatient utilisation, for example, is also the subject of critical discussion.

Abstract The present preliminary study aimed to provide a targeted lipidomic analysis of Hashimoto (HT) and non-HT patients with well-controlled hypothyroidism as well as in healthy adults, and is the first to demonstrate the association of several components of the human lipidome with hypothyroidism in relation to the total plasma selenium content. All the patients and age-, sex-, and BMI-matched healthy controls met the very strict qualification criteria. Se levels were analyzed by ICP-MS, and lipidome studies were conducted using TQ-LC/MS. The 40 acylcarnitines, 90 glycerophospholipids, and 15 sphingomyelins were identified and quantified. PCaaC26:0 and PCaaC40:1 were negatively correlated with Se concentrations. Other lipids that were negatively correlated with Se concentrations but did not present significant differences between the three groups in the Kruskal–Wallis ANOVA test were PCaaC32:0, PCaeC30:0, PCaeC36:5, SMC18:0, and SM C18:1. In the multiple linear regression analyses, Se levels showed negative relationship, whereas different phosphatidylcholines: PCaaC24:0, PCaaC26:0, PCaeC30:1, PCaeC34:0, PCaeC36:4, PCaeC42:0 were positively associated with the presence of (H). Different lipidome components were identified in healthy and hypothyroid patients regardless of the cause of that condition. Studies on larger populations are needed to determine cause-and-effect relations and the potential mechanisms underlying these associations.

Abstract Although corticosteroids are an important treatment for inflammatory bowel disease (IBD) patients, many subjects develop dependence, leading to serious long-term side effects. We applied causal inference analyses to investigate the length of steroid use on reoperations in IBD patients. We identified subjects in the UK Biobank general practice dataset with at least one major GI surgery and followed them for at least 5 years to evaluate subsequent operations. We defined steroid dependence as at least 12 weeks of use (vs. acute steroid use) prior to baseline surgery. Of the 363 subjects included in our analyses, 163 (45%) were prescribed steroids on or before baseline surgery, and of these (N = 125 of 163, 77%) were dependent. Additional analyses for time-dependent data on prescriptions found a link between prescription length and reoperation. Among UC subjects with acute use, the odds of reoperation were significantly lower (OR: 0.32, 95% CI: 0.0–0.73). Steroid dependence resulted in a delay of reoperation (median 1.2 vs. 2.3 years, P = 0.01). Our findings indicate that long-term steroid use tends to increase the need for reoperation, whereas short-term use may reduce it.

Abstract Healthcare workers are increasingly utilising cutting-edge technology, including mobile apps, to enhance patient health care and ensure efficient professional performance. The aim of this study was to design, develop and evaluate an educational mobile app dedicated towards being employed by nursing students and practicing nurses to support the clinical assessment of a patient’s health condition in nursing care. In order to develop the mobile app, the Analysis, Design, Development, Implementation and Evaluation (ADDIE) model was employed. Between 2022 and 2023, a “Diagnostic Nurse” mobile app was developed in the “Android Application Package (APK).” The app’s usability was tested in the laboratory by 20 participants. Three methods were employed in the study, that is, an eye-tracking technique, a qualitative evaluation and a quantitative evaluation. According to the System Usability Scale (SUS), the app test score for the nursing student group was assessed as 83.3 ± 8.9, and for the practicing nursing group, this was 84 ± 12.7. These results indicate that the mobile app’s is highly usable. The app received high ratings in the “user-friendliness”, “ease-of-use”, and “user satisfaction” categories. The “DiagNurse” app makes it easier to learn how to conduct a clinical assessment of a patient’s condition in nursing care, resulting in better information acquisition, assessment accuracy and speed. Given the low cost of the app development and the ADDIE model on which it is based, the app may be beneficial to nursing students, practicing nurses and other health-care professionals and students.

Abstract Primates, the most colorful mammalian radiation, have previously served as an interesting model to test the functions and evolutionary drivers of variation in eye color. We assess the contribution of photo-regulatory and communicative functions to the external eye appearance of nine macaque species representing all the branches of their radiation. Macaques’ well described social structure and wide geographical distribution make them interesting to explore. We find that (1) the posterior option of the anterior eyeball is more pigmented closer to the equator, suggesting photoprotective functions. We also find that (2) the temporal side of the eyeball is more heavily pigmented than the nasal side. This suggests that eyeball pigmentation in macaques is distributed to reduce damage to the corneal limbus. The inclusion of a translocated population of M. fuscata in our analyses also suggests that external eye appearance may change quickly, perhaps owing to phenotypic plasticity. We find no evidence that communicative functions drive variation in external eye appearance in macaques. These results suggest that the amount of light in a species’ environment drives variation in eye coloration across macaque species. Furthermore, the geographical distribution of macaques hints at important factors that have yet to be accounted for, such as the reflectivity of the terrain a given species inhabits.

Abstract Chitinase-like proteins have multiple biological functions that promote tumor growth, angiogenesis and metastasis. Expression of CHI3L2, which is similar in structure to CHI3L1, is detected in glioma cells and tumor-associated macrophages (TAMs) in glioma and breast cancer. However, its exact role remains unclear. We analyzed the expression of CHI3L2 in 74 invasive ductal breast carcinoma (IDC) tumors, breast cancer and macrophages cell cultures using immunohistochemistry, immunofluorescence, Western blot and PCR methods. Clinicopathologic data were included in the analysis. The results obtained show that CHI3L2 expression decreases with increasing degree of tumor grade and negative status of estrogen (ER) and progesterone receptors (PR). Furthermore, CHI3L2 is significantly and positively correlated with phosphorylation of STAT-3 and ERK1/2 signaling pathways, but negatively correlated with macrophage infiltration. CHI3L2 is expressed both in the cytoplasm of cancer cells and in macrophages and may regulate STAT-3 and ERK1/2 phosphorylation in breast cancer cell lines. Analysis of the clinicopathologic data revealed that CHI3L2 levels had no effect on patient survival. CHI3L2 expression may be specific for cancer cells in IDC and involved in cross-talk with the tumor microenvironment. Our study has shown that IDC cancer cells express the CHI3L2 protein, possibly indicating a novel function of this protein.

Abstract Reconstructing hydrological conditions of past warm periods, such as the Eocene ‘hot house’ provides empirical data to compare to state of the art climate models. However, reconstructing these changes in deep time is challenging, for example, given the complex interplay between evapotranspiration, precipitation and runoff. As a proxy for past changes in these hydrological systems, the dynamics of fresh water input into marginal seas can be used to identify the spatiotemporal distribution of riverine runoff. Elemental barium (Ba) and radiogenic strontium (87Sr) are, depending on the amount of runoff and the background geology of the catchment area, typically enriched in river waters in comparison to seawater and can thus be utilized to determine changes in riverine fresh water discharge. Here, we use barium to calcium ratios (Ba/Ca) and radiogenic strontium isotopes (87Sr/86Sr) measured in fossil bivalve shells to reconstruct patterns of fresh water input into the paleo North Sea during the early to middle Eocene. Our reconstruction shows the potential of Ba/Ca and 87Sr/86Sr to serve as proxies for riverine runoff and highlights the spatiotemporal complexity of Eocene hydrological conditions in western Europe. In particular, our results enable changes in riverine input along geological to perennial time scales for different coastal regions to be determined, revealing a steady influx of fresh water, but with distinct spatiotemporal differences.

Abstract Background Student-run free clinics are critical for medical education and medical care of underserved populations. This paper explores the feasibility of establishing ethical preventative health services at student-run free clinics such as the Rochester Education and Advocacy for Community Health (REACH) Clinic, affiliated with the Mayo Clinic Alix School of Medicine. Our analysis discusses the challenges and ethical considerations of providing preventative healthcare in student-run clinics. This paper also provides recommendations for implementing preventative care at REACH and other student-run clinics. Methods A literature search was conducted by an experienced librarian across four databases using keywords “student-run clinics” and “preventative healthcare.” Additionally, contributing authors identified and gathered data about community service organizations that provide preventative healthcare services to residents of Rochester, MN and surrounding areas. Results The literature search yielded 50 articles, 20 of which were included in the narrative review. Vaccinations and cancer screenings were the two preventative care initiatives most commonly undertaken by student-run clinics. The benefits of student-run clinic initiatives for both patients and students were an emerging theme. Clinics often achieved high vaccination and screening rates, and integration of preventative care topics into medical curricula was valued by students. However, the limitations of student-run clinics also emerged as a theme, particularly limitations to resources and comprehensive follow-up. 15 community health organizations in/around Rochester, MN were identified; of these, five provide preventative healthcare services. Conclusion Student-run clinics like REACH play a key role in delivering preventative care to underserved populations, bridging critical gaps in our healthcare system, and benefiting patients and students alike. However, the ethical principles of beneficence and non-maleficence should be considered when student-run clinics decide what services to offer. Preventative care has been successfully implemented at other student-run clinics but requires careful arrangement of adequate follow-up care, especially when it comes to cancer screening. Vaccinations are a low-cost, high-impact initiative that can be feasibly implemented at most student-run clinics.

Abstract Background While high-grade serous ovarian cancer (HGSC) has proven largely resistant to immunotherapy, sporadic incidents of partial and complete response have been observed in clinical trials and case reports. These observations suggest that a molecular basis for effective immunity may exist within a subpopulation of HGSC. Herein, we developed an algorithm, CONSTRU (Computing Prognostic Marker Dependencies by Successive Testing of Gene-Stratified Subgroups), to facilitate the discovery and characterization of molecular backgrounds of HGSC that confer resistance or susceptibility to protective anti-tumor immunity. Methods We used CONSTRU to identify genes from tumor expression profiles that influence the prognostic power of an established immune cytolytic activity signature (CYTscore). From the identified genes, we developed a stratification signature (STRATsig) that partitioned patient populations into tertiles that varied markedly by CYTscore prognostic power. The tertile groups were then analyzed for distinguishing biological, clinical and immunological properties using integrative bioinformatics approaches. Results Patient survival and molecular measures of immune suppression, evasion and dysfunction varied significantly across STRATsig tertiles in validation cohorts. Tumors comprising STRATsig tertile 1 (S-T1) showed no immune-survival benefit and displayed a hyper-immune suppressed state marked by activation of TGF-β, Wnt/β-catenin and adenosine-mediated immunosuppressive pathways, with concurrent T cell dysfunction, reduced potential for antigen presentation, and enrichment of cancer-associated fibroblasts. By contrast, S-T3 tumors exhibited diminished immunosuppressive signaling, heightened antigen presentation machinery, lowered T cell dysfunction, and a significant CYTscore-survival benefit that correlated with mutational burden in a manner consistent with anti-tumor immunoediting. These tumors also showed elevated activity of DNA damage/repair, cell cycle/proliferation and oxidative phosphorylation, and displayed greater proportions of Th1 CD4 + T cells. In these patients, but not those of S-T1 or S-T2, validated predictors of immunotherapy response were prognostic of longer patient survival. Further analyses showed that STRATsig tertile properties were not explained by known HGSC molecular or clinical subtypes or singular immune mechanisms. Conclusions STRATsig is a composite of parallel immunoregulatory pathways that mirrors tumor immunogenic potential. Approximately one-third of HGSC cases classify as S-T3 and display a hypo-immunosuppressed and antigenic molecular composition that favors immunologic tumor control. These patients may show heightened responsiveness to current immunotherapies.

Abstract Background There are three possible SARS-CoV-2 post-pandemic scenarios: (i) ongoing severity, (ii) influenza-like severity, and (iii) a transition to an endemic disease with lesser morbidity similar to that of other human coronaviruses. Methods To assess a possible evolution of the pandemic under the three scenarios, we use data from the US National Covid Cohort Collaborative, CDC COVID-NET, and CDC Fluview and from the WastewaterSCAN Dashboard. We include influenza disease and treatment response as benchmark. The US National Covid Cohort Collaborative allows the quantification of viral-specific morbidity using electronic health records from 424,165 SARS-CoV-2 cases, 53,846 influenza cases, and 199,971 uninfected control subjects from 2021–2022. Evolution of hospitalization rates is estimated from the correlation between national SARS-CoV-2 and influenza hospitalization data and viral gene copies in wastewater. Results Our findings reveal that medically attended SARS-CoV-2 infections exhibit similar morbidity to influenza [indicative of scenario (ii)], but SARS-CoV-2 hospitalization rates are one order of magnitude lower than influenza when considering virus concentration in wastewater [indicative of scenario (iii)]. Moreover, SARS-CoV-2 displays a more favorable response to antiviral therapy. Conclusions Our analysis confirms a rapid decline in SARS-CoV-2 morbidity as it transitions to an endemic state.

Abstract One of the most intriguing properties of magnonic systems is their reconfigurability, where an external magnetic field alters the static magnetic configuration to influence magnetization dynamics. In this paper, we present an alternative approach to tunable magnonic systems. We studied theoretically and numerically a magnonic crystal induced within a uniform magnetic layer by a periodic magnetic field pattern created by the sequence of superconducting strips. We showed that the spin-wave spectrum can be tuned by the inhomogeneous stray field of the superconductor in response to a small uniform external magnetic field. Additionally, we demonstrated that modifying the width of superconducting strips and separation between them leads to the changes in the internal field which are unprecedented in conventional magnonic structures. The paper presents the results of semi-analytical calculations for realistic structures, which are verified by finite-element method computations.

Abstract It is well known that hearing in noisy situations is more challenging than in quiet environments. This holds true for adults and especially for children. This study employed a child-appropriate dual-task paradigm to investigate listening effort in children aged six to ten years and young adults. The primary task involved word recognition, while the secondary task evaluated digit recall. Additionally, subjective perception of listening effort was assessed using a child-appropriate questionnaire. This study incorporated plausible sound reproduction and examined classroom scenarios including multi-talker babble noise with two signal-to-noise ratios (0 dB and −3 dB) in an anechoic and an acoustically simulated classroom environment. Forty-four primary school children aged six to ten (17 first- to second-graders and 18 third- to fourth-graders) and 25 young adults participated in this study. The results revealed differences in listening effort between the noise conditions in third- to fourth-graders and supported using the dual-task paradigm for that age group. For all three age groups, a greater subjective perception of listening effort in noise was found. Furthermore, a correlation between the subjective perception of listening effort and behavioural listening effort based on the experimental results was found for third- to fourth-graders and adults.

Objective To estimate real world vaccine effectiveness against symptomatic disease and hospital admission with the delta and omicron variants of the SARS-CoV-2 virus in pregnant individuals, and to estimate the protection conferred by previous infection and maternal vaccination in their infants.Design Test negative case-control study.Setting Community and hospital testing for covid-19, in England, 26 April 2021 to 9 January 2022 (delta variant period) and 29 November 2021 to 31 March 2022 (omicron variant period). Testing data were linked to Hospital Episode Statistics and Maternal Services Data Set (for data on pregnant individuals and infants), National Immunisation Management System (for covid-19 vaccinations), and Secondary Uses Service (for hospital admissions).Participants 35 206 negative and 16 693 positive eligible test results in the delta variant period from pregnant individuals with symptoms of infection, aged 16-55 years, whose pregnancy ended in 2021, and 5974 negative and 4715 positive eligible test results in the omicron variant period. For infants born in 2021, 23 053 negative and 2924 positive eligible test results in the delta variant period and 13 908 negative and 5669 positive test results from infants in the omicron period.Main outcome measures Vaccine effectiveness against symptomatic disease and hospital admission with the delta and omicron variants of the SARS-CoV-2 virus in pregnant women. Also, effectiveness of maternal vaccination and the protection conferred by previous infection in mothers in preventing symptomatic disease and hospital admission in their infants in the first six months of life. Symptomatic SARS-CoV-2 infection was confirmed by a positive polymerase chain reaction test result.Results Vaccine effectiveness against symptomatic disease (delta and omicron infection) and against hospital admission (delta infection only) in pregnant individuals was high, as seen in the general population. A booster dose of vaccine gave sustained protection, with no evidence of waning up to 15 weeks after vaccination. Vaccine effectiveness against symptomatic disease peaked at 98.4% (95% confidence interval (CI) 88.4% to 99.8%) and 80.1% (73.8% to 84.9%) against the delta and omicron variants, respectively, after the booster dose of vaccine. Vaccine effectiveness after a two dose primary schedule against hospital admission with delta infection peaked at 92.7% (95% CI 79.9% to 97.4%) in pregnant individuals. Maternal vaccination during and after pregnancy also provided sustained protection from symptomatic disease and hospital admission after delta and omicron infection in infants aged up to six months, with the highest protection seen when maternal vaccination occurred during later pregnancy. The effectiveness of two maternal doses when the last dose was given in the third trimester was 86.5% (95% CI 81.9% to 90.0%) and 56.6% (46.7% to 64.6%) against symptomatic disease with delta and omicron infection, respectively, in infants, and effectiveness against hospital admission was 94.7% (78.2% to 98.7%) and 78.7% (58.2% to 89.1%), respectively. Previous infection with wild-type, alpha, and delta variants of the SARS-CoV-2 virus in pregnant individuals was more protective against mild and severe delta infection than omicron infection in their infants.Conclusions The results of this study indicated that maternal vaccination prevented mild and severe disease in pregnant individuals and their infants for up to six months after birth. The findings support the promotion of both primary and booster vaccination for pregnant individuals to protect themselves and their infants.

Introduction Type 2 diabetes mellitus (T2DM) is an increasing health concern, and diabetic kidney disease (DKD) affects 30–40% of patients with diabetes. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective medications used in the treatment of T2DM, which not only improve glycemic control but also slow the progression of diabetic kidney disease (DKD), reducing the risk of renal and cardiovascular complications. They work by decreasing glomerular hyperfiltration and alleviating inflammation in the kidneys. Clinical studies have demonstrated significant therapeutic benefits, including a reduction in albuminuria and improvement in renal function. In the future, the development of new drug classes, such as Nrf2 activators and RAS inhibitors, which are currently under clinical investigation, may further advance the treatment of DKD, offering a more personalized approach to therapy. This article reviews the current knowledge on SGLT2i and their impact on the progression of DKD, the future prospects for therapies in managing diabetes and its complications. Aim of the Study: The aim of this study was to gather and analyze available scientific publications regarding the effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on slowing the progression of chronic kidney disease (CKD) in patients with T2DM and to determine the future of therapy based on new reports and research into emerging drug classes. Materials and Methods: We conducted a review and analysis of the literature available in the PubMed database, using keywords such as SGLT2 inhibitors, gliflozins, chronic kidney disease, type 2 diabetes.

Abstract Alcohol consumption in Tanzania exceeds the global average. While sociodemographic difference in alcohol consumption in Tanzania have been studied, the relationship between psycho-cognitive phenomena and alcohol consumption has garnered little attention. Our study examines how depressive symptoms and cognitive performance affect alcohol consumption, considering sociodemographic variations. We interviewed 2299 Tanzanian adults, with an average age of 53 years, to assess their alcohol consumption, depressive symptoms, cognitive performance, and sociodemographic characteristics using a zero-inflated negative binomial regression model. The logistic portion of our model revealed that the likelihood alcohol consumption increased by 8.4% (95% confidence interval [CI] 3.6%, 13.1%, p

Introduction: Interest in the relationship between physical activity and skin health has grown significantly in recent years. Both scientific literature and media platforms highlight the influence of exercise on skin vitality, with social media often emphasizing its aesthetic benefits. Scientific studies, however, focus on mechanisms like improved circulation, enhanced collagen production, and reduced inflammation. This review aims to analyze the impact of physical activity on skin health, examining its benefits and potential drawbacks while providing a comprehensive understanding of the biological processes involved. Aim of the study: The study seeks to review scientific literature to evaluate the effects of physical exercise on skin health and condition. Materials and methods: The authors conducted a review of scientific literature using databases such as PubMed, ScienceDirect, UpToDate, and Google Scholar. Articles from 2003 to 2024 were analyzed with keywords including physical activity and skin health, exercise and dermatology, skin metabolism, and exercise benefits for the skin. Only studies relevant to the relationship between physical activity and skin health were included. Results and conclusions: Physical activity significantly benefits skin health by boosting collagen production, improving circulation, and reducing cortisol levels, resulting in a radiant and youthful complexion. However, risks such as barrier damage, increased sebum production, and infections must be managed. Personalized skincare routines emphasizing cleansing, hydration, and protection against environmental factors are essential for individuals engaging in regular exercise.

Introduction We codesigned an intervention with a low-resourced community with the aim to investigate the effects of time-restricted eating (TRE) on changes in body weight and associated cardiometabolic outcomes in South African women living with overweight/obesity and HIV who have initiated dolutegravir (DTG)-based antiretroviral therapy (ART).Methods and analysis Women with overweight or obesity (body mass index ≥25 kg/m², no upper limit), aged 20–45 years, living with HIV and in a low-resourced community, and receiving DTG-based ART for less than 2 years will be recruited from a community healthcare centre in Khayelitsha, Cape Town (n=152). Participants will be randomised 1:1 to the TRE group (n=76) or standard of care control group (n=76) for 12 months. The TRE group will be required to restrict their eating window to ~8–10 hours/day and will receive nutritional information sessions at baseline and at 3, 6, 9 and 12 months. The primary outcome of body weight will be assessed at baseline and monthly. Cardiometabolic measures will be reported as secondary outcomes. At baseline, 6- and 12 months, an oral glucose tolerance test (to estimate insulin sensitivity and beta-cell function), questionnaires (sociodemographic, food insecurity, quality of life, social support and sleep quality) and a quantified food frequency questionnaire (total energy and macronutrient composition) will be completed. Every 3 months, appetite ratings, bioelectrical impedance (fat mass and fat-free mass), fasting venous bloods (glucose, insulin, gut hormones and systemic inflammation) and process evaluation (qualitative interviews) will be completed. Monthly monitoring will also include anthropometry and blood pressure.Ethics and dissemination The study is conducted in accordance with the Declaration of Helsinki and has been approved by the Human Research Ethics Committee of the University of Cape Town (628/2021). Verbal and written consent is required from study participants. Results of this study will be published in peer-reviewed journals and presented at conferences.Trial registration number PACTR202302484999720.

Introduction Cognitive–behavioural therapy (CBT) is an effective treatment for chronic primary pain (CPP), but effect sizes are small to moderate. Process orientation, personalisation, and data-driven clinical decision-making might address the heterogeneity among persons with CPP and are thus promising pathways to enhance the effectiveness of CBT for CPP. This study protocol describes one approach to personalise CBT for CPP using network analysis.Methods and analysis A single-case experimental design with multiple baselines will be combined with ecological momentary assessment (EMA). Feasibility and acceptance of the study procedure will be demonstrated on a sample of n=12 adults with CPP in an outpatient clinic. In phase A, participants complete 21 days of EMA, followed by the standard diagnostic phase of routine clinical care (phase B). Person-specific, process-based networks are estimated based on EMA data. Treatment targets are selected using mean ratings, strength and out-strength centrality. After a second, randomised baseline (phase A'), participants will receive 1 out of 10 CBT interventions, selected by an algorithm matching targets to interventions, in up to 10 sessions (phase C). Finally, another EMA phase of 21 days will be completed to estimate a post-therapy network. Tau-U and Hedges’ g are used to indicate individual treatment effects. Additionally, conventional pain disability measures (Pain Disability Index and the adapted Quebec Back Pain Disability Scale) are assessed prior, post, and 3 months after phase C.Ethics and dissemination Ethical considerations were made with regard to the assessment-induced burden on the participants. This proof-of-concept study may guide future studies aiming at personalisation of CBT for CPP as it outlines methodological decisions that need to be considered step by step. The project was approved by the local ethics committee of the psychology department of University Kaiserslautern-Landau (#LEK-457). Participants gave their written informed consent prior to any data assessment and app installation. The results of the project will be published, presented at congresses, and relevant data will be made openly accessible via the Open Science Framework (OSF).Trial registration number NCT06179784.

Defensive behavior changes based on threat intensity, proximity, and context of exposure, and learning about danger-predicting stimuli is critical for survival. However, most Pavlovian fear conditioning paradigms focus only on freezing behavior, obscuring the contributions of associative and non-associative mechanisms to dynamic defensive responses. To thoroughly investigate defensive ethograms, we subjected male and female adult C57BL/6 J mice to a Pavlovian conditioning paradigm that paired footshock with a serial compound stimulus (SCS) consisting of distinct tone and white noise (WN) stimulus periods. To investigate how associative and non-associative mechanisms affect defensive responses, we compared this paired SCS-footshock group with four control groups that were conditioned with either pseudorandom unpaired presentations of SCS and footshock, shock only, or reversed SCS presentations with inverted tone-WN order, with paired or unpaired presentations. On day 2 of conditioning, the paired group exhibited robust freezing during the tone period with switching to explosive jumping and darting behaviors during the WN period. Comparatively, the unpaired and both reverse SCS groups expressed less tone-induced freezing and rarely showed jumping or darting during WN. Following the second day of conditioning, we observed how defensive behavior changed over two extinction sessions. During extinction, the tone-induced freezing decreased in the paired group, and mice rapidly shifted from escape jumping during WN to a combination of freezing and darting. The unpaired, unpaired reverse, and shock-only groups displayed defensive tail rattling and darting during the SCS, with minimal freezing and jumping. Interestingly, the paired reverse group did not jump to WN, and tone-evoked freezing was resistant to extinction. These findings demonstrate that non-associative factors promote some defensive responsiveness, but associative factors are required for robust cue-induced freezing and high-intensity flight expression.

Más de una cuarta parte de la población mundial tiene menos de 15 años. Los niños ocupan un lugar especial en nuestras sociedades en todo el mundo. Los entornos limpios son esenciales para garantizar un futuro en el que puedan crecer, aprender y prosperar con todo su potencial. La salud ambiental de los niños estudia cómo las exposiciones ambientales en los primeros años de vida influyen en la salud y el desarrollo en la infancia y a lo largo de toda la vida humana. Este artículo analiza por qué el medio ambiente es importante para la salud de los niños y ofrece una breve descripción de la disciplina de la salud ambiental de los niños y cómo se aplica. También proporciona algunas acciones que el sector de la salud puede tomar para proteger a los niños de los peligros ambientales.

Background Skin aging is a complex biological phenomenon influenced by intrinsic and extrinsic factors. Photoaging can be prevented by applying phytochemicals that have sun-protective properties. This study aimed to evaluate the effect of saffron serum to restore collagen density and autophagy processes and reduce inflammatory gene expression in UVB-exposed Wistar rats. Methods An experimental laboratory study was conducted involving 20 male Wistar rats that were divided into 4 groups: control, UVB, UVB + base serum, UVB + saffron serum exposed to UVB radiation for 5 weeks with a total dose of 3100 mJ/cm2. The skin was extracted then underwent Masson Trichrome staining and real-time PCR to obtain collagen density and gene expression. Results The gene expression of MMP1, IL6, TNFá, LC3, and p62 was significantly increased in the UVB group compared to the control group. Topical administration of saffron serum significantly increased collagen density (p=0.001). Induction by UVB significantly increased LC3 (p=0.020) and p62 (p=0.030) gene expression, indicating an inhibition of autophagy. The saffron serum might modulate autophagy by increasing LC3, but not significant (p=0.495) and significantly decreasing p62 gene expression (p=0.001). As for MMP1, IL6, and TNFá, no significant decrease in gene expression was found in the UVB + saffron serum group compared to the UVB group. Conclusion Saffron serum increases collagen density and modulates autophagy in the skin of UVB-exposed Wistar rats. Inflammatory markers were increased after UVB induction, but no differences were found after saffron serum topical administration.

Introducción. Los nódulos tiroideos son una patología común, aunque la tasa de malignidad es baja. El diagnóstico de malignidad en estos nódulos generalmente requiere métodos invasivos como la punción por aspiración con aguja fina (PAAF), los cuales pueden ser costosos y presentar limitaciones. La elastografía tiroidea, una técnica no invasiva que evalúa la elasticidad del tejido, ha emergido como una alternativa prometedora. Metodología. Este estudio revisa la literatura sobre la sensibilidad y especificidad de la elastografía para la detección de malignidad en nódulos tiroideos, comparándola con métodos convencionales, a través de una búsqueda sistemática de estudios publicados desde 2020. De un total de 592 artículos revisados, se seleccionaron 27 estudios que cumplían los criterios de inclusión. Resultados. Estos indican que la elastografía tiene una sensibilidad superior al 50% y una especificidad superior al 49%, con estudios como el de Rajabzadeh et al. (2023) alcanzando un 100% en ambos parámetros con un valor de kPa específico. La mayoría de los estudios utilizaron histología postquirúrgica como el estándar de referencia. Aunque se observó una alta variabilidad en los métodos, el uso predominante de elastografía cuantitativa (Shear Wave) y la creciente evidencia de su efectividad destacan su potencial en la evaluación de nódulos tiroideos. Conclusiones y recomendaciones. Se recomienda seguir investigando y estandarizando los protocolos para mejorar la precisión y aplicabilidad de esta técnica, con el fin de reducir procedimientos invasivos innecesarios y mejorar la detección temprana de cáncer tiroideo.

Introducción: la preservación de la extremidad como premisa en el tratamiento de los tumores óseos ha requerido el empleo de reconstrucciones cada vez más complejas. En Venezuela, el uso de injertos es determinante en un porcentaje elevado de patologías tumorales óseas. Métodos: El tipo de estudio es observacional, descriptivo, comparativo de tipo retrospectivo y multicéntrico.Resultados: la edad sobresaliente fue entre 31-60 años (35,5%); el sexo predominante fue masculino con veintisiete (27) casos 60%; en la categoría de injerto el Autólogo obtuvo treinta y siete (37) casos 69,8%; el subtipo más relevante de injerto óseo fue el Peroné no Vascularizado con veinte (20) casos obteniendo 37,7%; el tipo de injerto por patología resulto el Encondroma con siete (7) injerto de Peroné no Vascularizado, dos (2) casos injerto de Cresta Ilíaca, uno (1) caso de cortico-esponjoso y esponjoso; el Quiste Óseo Aneurismático requirió uso de doble injerto Autólogo de Peroné no Vascularizado y Cresta Iliaca en dos (2) casos; la complicación relevante fue el dolor del sitio donador con diez (10) casos.Conclusiones: la presente investigación responde al objetivo general planteado, En el Centro Médico Docente la Trinidad y en el Instituto Venezolano de los Seguros Sociales (Antiguo Hospital Padre Machado), ubicados en la República Bolivariana de Venezuela, Caracas, años 2013-2023; se obtuvo información útil respecto a la categoría de injerto óseo y su relación con los diferentes tumores músculo-esqueléticos.

BackgroundCerebral venous thrombosis (CVT) is a rare but serious subtype of stroke. Several studies have reported an increased incidence of CVT after either COVID-19 (CoV19) infection or vaccination; however, data on clinical characteristics, the radiological profiles, and the outcomes of these patients with CVT as the only severe symptom of a CoV19 infection or vaccination compared to patients with non-CoV19-related CVT are still scarce.MethodsWe performed a retrospective monocentric study over 10 years (January 2013–December 2022) that included consecutive patients with a confirmed diagnosis of CVT based on imaging of the cerebral venous system. Patients were categorized as CoV19 CVT (either due to infection or post-vaccination) or non-CoV19 CVT and compared regarding demographics, risk factors, clinical characteristics, and imaging findings as well as outcome (at discharge, at 6 months, and last follow-up). Furthermore, sub-analyses were performed to compare CoV19-infection-related-CVT and CoV19-vaccination-related-CVT patients.ResultsOverall, 122 patients with suspected CVT were identified. After excluding patients with missing data (n = 20) or missing imaging of the cerebral venous system (n = 31), 71 patients with confirmed CVT remained for the final analyses. Of those, 11 patients had CoV19 CVT (infection n = 3, vaccination n = 8), and 60 patients had non-CoV19-CVT. There were no differences regarding median age (CoV19: 40 [IQR: 22–70] vs. non-CoV19: 41 [IQR:27–64]) or percentage of female sex among both groups. A lower rate of CVT risk factors was observed in the CoV19 group but without significant differences. No patient with CoV19 CVT displayed impaired consciousness on presentation, and only 30% had focal neurological deficits compared to 51.7% in the control group. The rate of CVT-related intracranial hemorrhage and venous infarcts were 27.3% and 9.1%, respectively, in the CoV19 group and 30% and 16.7%, respectively, in the non-CoV19 group. The mortality rate at discharge was 9.1% in the CoV19-CVT group vs. 3.3% in the non-CoV19-CVT group, without differences in functional outcomes during the follow-up period. Sub-analyses comparing CoV19-infection-related CVT vs. CoV19-vaccination-related CVT patients revealed no significant differences in clinical, imaging, or treatment characteristics.ConclusionIn this monocentric study, there was no signal for a worse severity of CoV19 CVT compared to non-CoV19 CVT regarding clinical characteristics, imaging profile, or outcomes in patients with CVT only. Larger observational data with sophisticated workups of CVT patients are needed to confirm our results.

BackgroundThe mental health system in Greece faces challenges to complete its transition to a community-oriented model, having significant concerns for child and adolescent care due to lower coverage and service gaps. This component of the mental health system has not been comprehensively evaluated.MethodsWe conducted a review of the mental health care system for children and adolescents in Greece. For a field assessment, we directly collected data from mental health services to map availability and distribution. We analyzed the needs of human resources using professional register data and the national census.ResultsThe National Health Care Service (ESY, Εθνικό Σύστημα Υγείας) is the public health system in Greece, characterized by public governance but significant private participation. Although ESY aims for universal care, gaps in population coverage and high user fees create barriers to access. Embedded within ESY, the mental health system is shifting towards a community-oriented structure since the psychiatric reform. For children and adolescents, there is a developing framework for regionalization and community services, including day centers, inpatient facilities, outpatient departments, and school-based psychoeducational facilities. However, services lack coordination in a stepped care model. Patient pathways are not established and primary care rarely involves child mental health, leading to direct access to specialists. Services operate in isolation due to the absence of online registers. There is no systematic performance monitoring, yet some assessments indicate that professional practices may lack evidence-based guidelines. Our mapping highlighted a scarcity of public structures, with an unbalanced regional distribution and many underserved areas. Child and adolescent psychiatrists are predominantly affiliated with the private sector, leading to professional gaps in the public system.ConclusionsOur assessment identifies an established framework for a community-oriented, universally accessible mental health system, yet several barriers impede its full realization. These include an inconsistent primary healthcare system, a shortage of specialists in the public sector, imbalanced service distribution, lack of coordination among providers, underfunding, and absence of quality monitoring. We propose interventions to promote child and adolescent mental health in primary care, coordinate patient pathways, establish standards of care, and monitor performance.

BackgroundThe development of a medical device requires strict adherence to regulatory processes. Prehabilitation in this context is a new area in surgery that trains, coaches, and advises patients in mental well-being, nutrition, and physical activity. As staff is permanently drained from clinical care, remote and digital solutions with real-time assessments of data, including patient-related outcome reporting, may simplify preparation before major surgeries. ObjectiveThis study aimed to evaluate the usability engineering process for the Prehab App, a newly developed medical device, in order to identify and adapt any design and usability flaws found. MethodsWe hypothesized that formative and summative usability testing would achieve 80% interrater and intrarater reliability and consistency and that the safety-relevant scenarios would uncover undetected risks of the medical device (stand-alone software class IIa). In total, 8 experts and 8 laypersons (patients and potential patients) were asked to evaluate paper-based mockups, followed by an evaluation of the minimal viable product (MVP) of the Prehab App at least more than 8 weeks later after instruction and training. The experts had to face 5 and the laypersons 6 usability scenarios. Their evaluations were measured with the Mobile App Rating Scale (MARS) and trustworthiness checklists (range 0-64, with higher scores indicating trustworthiness), and the usability scenarios were evaluated with the After Scenario Questionnaire (ASQ) and a judgment by an observer. The time taken for the scenarios was also recorded. ResultsMARS achieved constant scores of more than 4 out of 5 points for both experts and laypersons. The mean trustworthiness score was 51.3 (SD 2.7) for the experts and 50.8 (SD 2.1) for the laypersons (P=.68) in task I. The interrater correlation, shown by the Fleiss-Kappa value, was 0.87 (range 0.85-0.89) for all raters (N=16), 0.86 (range 0.82-0.91) for the experts (n=8, 50%), and 0.88 (range 0.84-0.93) for the laypersons (n=8, 50%), reflecting almost perfect agreement between the raters. This indicated the high quality of the usability. The usability scenarios were performed with ease, except for the onboarding part, when the wearable was required to be connected; this took a considerable amount of time and was recognized as a challenge to good usability. ConclusionsThe formative and summative evaluation of the Prehab App design resulted in good-to-acceptable results of the design and usability of the critical and safety-relevant areas of the medical device and stand-alone software. Usability testing improves medical devices early in the design and development process, reduces errors, and mitigates risks, and in this study, it delivered a profound ethical and medical justification for a randomized controlled trial (RCT) of the Prehab App in a remote setting as a next step in the development process. Trial RegistrationGerman Registry for Clinical Trials (DRKS00026985); https://drks.de/search/en/trial/DRKS00026985

Introduction Idiopathic intracranial hypertension (IIH) is a condition characterized by signs and symptoms of elevated intracranial pressure (ICP). Although the role of venous sinus stenosis in the pathophysiology of IIH is controversial, venous angioplasty with stenting has been proven to decrease cerebral venous pressure and intracranial pressure. This study aims to identify and quantify the clinical improvement obtained by patients with IIH, refractory to prior pharmacological treatment, undergoing endovascular venous angioplasty in a neuroendovascular reference service.

Bow Hunter syndrome manifests when the vertebral artery is compressed following head rotation. Symptomatic compression with vertebral artery stenosis due to cervical osteophytes is a rare cause and occurs due to a progressive degenerative process. In most cases, compression originates anteromedially from the uncinate process and is asymptomatic due to the competence of the contralateral vertebral artery. In the described patient, compression presented superomedially due to osteophytes in the superior articular facet of the C5 vertebra, and the contralateral vertebral artery was obstructed. Careful evaluation with imaging, mainly preoperative 3D angiotomography, is necessary to determine the most beneficial approach for decompression. The treatment of choice for symptomatic compression induced by cervical spondylosis is decompression surgery.

Introduction: Recent research highlights a link between early dietary habits, especially breastfeeding, and reduced obesity risk in adulthood. Breastfeeding provides essential nutrients and compounds that may shape an infant’s metabolism. This article reviews current findings to guide parents in supporting lifelong healthy development. Material and Methods: This review examined 30 studies focusing on the relationship between breastfeeding and the risk of developing obesity. Relevant studies were identified through searches on PubMed and Google Scholar. Literature Analysis: The reviewed literature suggests a possible link between breastfeeding and a decreased likelihood of obesity in adulthood, although comprehensive, systematic research on this relationship is still scarce. Findings indicate that bioactive elements in breast milk and breastfeeding behaviors may play a role in early metabolic and appetite regulation, which could influence weight control later in life. Observational studies and case reports show varying impacts, often dependent on factors like the duration and exclusivity of breastfeeding, as well as broader environmental influences. Conclusions: Breastfeeding offers significant long-term health benefits, including reduced risks of obesity, type 2 diabetes, and cardiovascular diseases. Studies show that longer breastfeeding duration is associated with healthier weight trajectories, improved metabolic outcomes, and lower BMI and HDL levels later in life. Exclusive breastfeeding for six months or more provides substantial protection against obesity in childhood and adulthood. Early formula introduction is linked to higher BMI trajectories and increased metabolic risks. These findings emphasize the importance of promoting breastfeeding as a key public health strategy to support long-term health and disease prevention.

Introduction and Purpose: Cerebral palsy (CP) is a prevalent neurological disorder in children, characterized by movement, muscle tone, and posture impairments. This article reviews the clinical and therapeutic management of CP, focusing on spasticity, musculoskeletal disorders, and holistic rehabilitation. It examines evidence-based interventions, including onabotulinumtoxinA, intrathecal baclofen pumps, and surgical options for orthopedic deformities. Key rehabilitation techniques such as neurodevelopmental therapies, gait training, and speech therapy are discussed to enhance motor skills and cognitive development. Additionally, the management of associated conditions like epilepsy and intellectual challenges is addressed, emphasizing psychological support for patients and families. The purpose of this article is to provide a comprehensive overview of the current state of knowledge regarding the management of cerebral palsy. Material and Methods: We utilized English databases such as PubMed, Google Scholar, Cochrane, and PubMed Central, selecting articles based on keywords like cerebral palsy, spasticity, physical therapy, and rehabilitation. State of Knowledge: Effective CP management requires a multidisciplinary approach to tackle motor impairments, spasticity, deformities, and psychosocial challenges. Therapeutic interventions, including pharmacological treatments, surgical options, and innovative rehabilitation techniques, are essential for improving mobility and quality of life. Summary: Comprehensive care for children with CP is crucial. Evidence supports combining multiple therapeutic approaches tailored to each child’s needs and involving family preferences to optimize development and well-being.

Introduction Eosinophilic fasciitis (EF) is a rare inflammatory disorder marked by elevated eosinophils in tissues and blood. Patients typically present with symptoms such as skin swelling, pain, and induration, which can be mistaken for other connective tissue diseases. The pathogenesis of EF is not fully understood, though immune and autoimmune mechanisms appear to play significant roles. Diagnosis often involves biopsies, lab analyses, and imaging techniques. Current treatment mainly consists of corticosteroids, but further research is needed to assess various therapeutic strategies. Understanding EF is essential for improving patient outcomes and quality of life. Purpose The purpose of this article is to enhance knowledge of eosinophilic fasciitis by examining its pathogenesis, immune mechanisms, and diagnostic challenges, as well as evaluating current diagnostic criteria and treatments. Given the rarity and complexity of EF, the study also seeks to clarify its differentiation from similar diseases and offer insights into effective therapies for early diagnosis and improved treatment outcomes. Conclusion EF is a rare disease, and its complexity, due to diverse etiologies and variable treatment efficacy, poses significant challenges in clinical practice. In the near future, the publication of new cases and the initiation of clinical trials should contribute to the development of innovative therapeutic strategies and an effective treatment algorithm. Materials and methods: Our review is based on an analysis of material collected in 'Pubmed', 'Google Scholar' and other scientific articles using the keywords: Eosinophilic fasciitis, Shulman, fibrosis, hypergammaglobulinemia, eosinophilia.

Introduction: COVID-19 manifests with symptoms ranging from mild to severe, including respiratory and cardiovascular complications. Severe cases are often marked by a cytokine storm, causing pulmonary damage and multi-organ dysfunction. Current treatments lack a specific antiviral, though several pharmacological options, including immunomodulatory and antiviral drugs, are under investigation. Purpose: The purpose of this article is to provide an evaluation of the efficacy and safety of baricitinib, a JAK inhibitor, combined with standard care for hospitalized adults with COVID-19. By reviewing recent literature, it aims to assess baricitinib's effectiveness in improving patient outcomes. Material and methods: A systematic review of clinical trials and case studies was conducted to analyze baricitinib’s impact on COVID-19 mortality. Data includes treatment-emergent adverse events and patient outcomes in moderate to severe cases. Discussion: Baricitinib has demonstrated potential in managing hyperinflammation in severe COVID-19 by inhibiting multiple proinflammatory cytokines and enhancing immune response. Clinical trials show that baricitinib, particularly in combination with corticosteroids, reduces mortality and serious infections compared to standard care alone. Due to potential adverse events, continuous monitoring of hematological and lipid levels is essential. These findings highlight baricitinib's dual role as an immunomodulatory and antiviral agent, suggesting its importance in treating severe COVID-19. Future research should focus on optimizing treatment regimens and further exploring the long-term implications of baricitinib therapy.

Introduction and purpose: The topic of apple cider vinegar supplementation and insulin resistance is becoming increasingly widespread, especially on the internet, which carries many potential risks. There is a need to understand both how apple cider vinegar reduces insulin resistance and improves metabolic parameters, as well as the potential risks of its use. Material and methods: Medical databases like PubMed, Google Scholar, and Embase were searched for scientific papers on the safety, benefits, mechanisms, and risks of apple cider vinegar in insulin resistance and related conditions. These were analyzed and summarized in a single review. State of knowledge: Apple cider vinegar supplementation contributes to a reduction in insulin resistance, which is reflected in parameters such as decreased postprandial insulin secretion, lower levels of triglycerides (TG) and total cholesterol (TC), reduced fasting glucose, lower HbA1c levels, and supports weight loss, potentially improving insulin sensitivity. In most cases, no adverse effects or serious side effects were observed with doses of 15-30 ml per day. However, potential risks include delayed gastric emptying, exacerbation of gastroesophageal reflux disease (GERD), gastrointestinal disturbances, tooth erosion, although one study suggests that such supplementation may be associated with acute pancreatitis. Conclusions: More research is needed on supplementation, particularly regarding its duration. Another risk is the search for health information online without critically evaluating the content. Weight loss through a proper diet and exercise appears to be key for improving insulin sensitivity, but supplementation may help achieve results in certain patient groups.

Introduction: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the most prevalent cause of dementia. It is caused by the degeneration of brain cells due to the accumulation of intracellular hyperphosphorylated tau - containing neurofibrillary tangles and extracellular plaques of amyloid-beta peptide. While pharmacotherapy remains the main form of treatment (including cholinesterase inhibitors and antagonists to NMDA), various non-pharmacological therapy modalities have gained increasing attention as complementary treatment options, such as music therapy. Purpose of the study: This review examines the role of music therapy as an important complement to baseline therapy for AD patients, focusing on indications, methods, and the prospect of music therapy. Materials and methods: A comprehensive literature review was conducted, analyzing 48 studies from the PubMed database (English-language, up to November 2024) that assess the efficacy, methods, and prospect of music therapy as an adjunctive therapy in Alzheimer’s disease. Conclusions: Music therapy is an established and effective supportive treatment for AD patients. It has demonstrated clinical success over many years as a tool for engaging multiple motor and sensory areas, shaping emotions, and evoking memories. This may be due to activating limbic and paralimbic structures, enhancing neuroplasticity, and modulating neurotransmitter systems. Despite the observable benefits of music therapy, the methodological limitations of existing studies highlight the need for further long-term research to standardize treatment approaches.

Background: Air pollution poses a significant global health risk, affecting a wide range of conditions, including skin aging, atopic dermatitis, cardiovascular diseases, respiratory disorders, and cancer. Recent studies reveal its role in accelerating aging and exacerbating chronic conditions through mechanisms like oxidative stress and systemic inflammation. However, gaps remain in understanding pollutant-specific effects and their cumulative impact on health. Methods: This review synthesizes findings from recent studies examining the effects of air pollution on skin and systemic health. A comprehensive analysis was conducted across multiple health conditions, with a focus on pollutant-specific mechanisms, including oxidative stress, DNA damage, immune dysregulation, and inflammatory responses. Results: Findings highlight strong correlations between exposure to pollutants, such as PM2.5, SO2, NOx, and VOCs, with adverse health outcomes. Pollutants exacerbate conditions like wrinkles, atopic dermatitis, thrombosis, and lung cancer. Interestingly, some pollutants, like ozone, showed mixed effects on specific skin conditions, emphasizing the need for nuanced analysis. Conclusion: Understanding the multifaceted impact of air pollution underscores the urgent need for targeted interventions and policies to mitigate health risks. Further research is essential to develop precise strategies to address the pollutant-specific effects and protect vulnerable populations.

The review highlights that TN has a prevalence of 0.16%–0.3%, predominantly affecting women, with an increased incidence among individuals over 50 years of age. TN etiology includes neurovascular compression, demyelinating conditions like multiple sclerosis, and familial genetic predispositions. Classification systems, such as the 2018 ICHD-3, provide diagnostic criteria and categorize TN into classical, secondary, and idiopathic types. First-line treatments involve antiepileptic medications such as carbamazepine and oxcarbazepine, with second-line options including lamotrigine and baclofen. For refractory cases, microvascular decompression and percutaneous techniques are recommended, with options like gamma knife radiosurgery (GKRS) and botulinum toxin injections showing promise. Despite available treatments, TN’s recurrent nature underscores the need for personalized, multidisciplinary management to address both physiological and mental health impacts.

Introduction: Nowadays, a plant-based diet is gaining increasing popularity. Guidance on adopting this diet can be found in scientific literature, as well as through social media and advertisements promoting a wide range of new products appearing on store shelves. By reviewing scientific sources, we decided to analyze the principles of a plant-based diet, its associated benefits, as well as the potential negative aspects of its implementation, particularly among athletes. Aim of the study: This review aims to analyse the literature concerning the impact of a plant- based diet on accomplishments, endurance, and health, especially for athletes. Materials and methods: The authors conducted an extensive review of available articles on PubMed, ScienceDirect, Cochrane, UpToDate, Google Scholar, and Pubmed databases, using keywords such as vegan, vegetarian, plant-based,, civilization diseases, healthy lifestyle, athletes, strength, accomplishments, endurance. Studies accessed between 2016-2024 were included in this review. Results and conclusions: A plant-based diet is a valuable option for athletes, offering benefits such as improved recovery, reduced oxidative stress, and alignment with sustainable practices. When properly planned to address potential nutrient deficiencies, it can effectively support athletic performance, including strength and endurance, without compromising health. Thus, for athletes seeking ethical, health-conscious, or environmentally sustainable dietary patterns, a plant-based diet is indeed worth considering.

BackgroundOlder adults comprise a substantial proportion of the US population requiring support during disaster events. Previous research demonstrates that older adults are resilient but deficient in disaster preparedness and lacking in community engagement. There is a gap in high-quality research in this area. ObjectiveThis study aims to fill this gap by developing a 4-phase intervention to improve mobility and balance, decrease fall risks (mitigation), increase knowledge of disaster preparedness (preparedness), improve community emergency operation plans (response), and improve self-efficacy in disaster recovery (recovery) for older adults. MethodsThis is a community-based, 10-month study in a large Midwestern urban and suburban location targeting community-dwelling older adults. The 4 phases of interventions address mitigation, preparedness, response, and recovery—aspects improving outcomes from disaster events. In total, 4 to 6 one-hour seminars each month are provided to community-dwelling older adults to improve disaster preparedness and recovery planning. A critical incident packet with resources on essential information such as medications, a communication plan, evacuation resources, and supplies was started and is being reviewed. Preintervention surveys are orally given, with research assistants aiding in any difficulties the participants have. After the surveys, 2 individual 20-minute presentations separated by a short break for snacks and initial completion of their disaster plan preserve the older adult’s attention. Mitigation efforts to improve mobility and safety are offered with 10 visits to the older adults’ residences, adapting physical activity and balance exercises to the individual’s needs. To address response needs, the emergency operations plans for 2 of the major cities are being amended for specific functional needs and access guidelines. Measurements include accelerometers to assess improvement in mobility, fall risk assessments, an abbreviated Federal Emergency Management Association Household Survey, an assessment for disaster engagement with partners tool, a brief pain inventory assessment, and the General Self-Efficacy Scale. We analyze data descriptively and compare pre- and postintervention data for each phase with paired-samples t test and other nonparametric techniques (proportion tests and Wilcoxon signed-rank tests). Overarching objectives prioritized during this intervention include underscoring respect for the experience and resilience found in older adults and engaging them in specialized roles to support their communities during disaster events. ResultsThe intervention was funded in July 2023; enrollment began in November 2023 and is continuing. We will conclude data collection by July 2025. Published study results can be expected in early 2025. ConclusionsWith improved disaster preparedness, mobility, recovery planning, and inclusion as a resource in community disasters, older adults are expected to be safer and be able to age in place. If successful, future studies will focus on outreach and sustainability. This study will serve as a model for older adult disaster preparedness and community involvement. International Registered Report Identifier (IRRID)DERR1-10.2196/58895

Summary: Background: High-intensity interval training (HIIT) has been shown to improve cardiorespiratory fitness (V˙O2 max) but may ameliorate insulin sensitivity only in insulin-resistant humans. It is yet unclear whether these benefits persist after detraining and to which extent duration and effectiveness of metabolic improvements differ between individuals without and with prediabetes or type 2 diabetes (T2D). Understanding these differences is relevant for developing targeted exercise training modes for individuals with different stages of dysglycemia. Methods: Men with (20 T2D) and without T2D (12 insulin-sensitive, IS-NDM; 10 insulin-resistant, IR-NDM) underwent hyperinsulinemic-euglycemic clamps, spiroergometry, ectopic lipid quantification and muscle biopsies at baseline, after 12-week HIIT and after 4-week detraining. Findings: After detraining, the HIIT-stimulated V˙O2 max declined in T2D and IR-NDM, but remained higher compared to baseline in all groups. The HIIT-induced changes in hepatic insulin sensitivity and ectopic lipid content were sustained after detraining in T2D and IR-NDM, whereas improvements of whole-body insulin sensitivity were abolished in T2D. T2D and IR-NDM showed persistent increases in the number of small extracellular vesicles, which carry among others antioxidant proteins. The ratio of reduced-to-oxidized glutathione further decreased after detraining in all groups, whereas changes in proteins involved in mitochondrial turnover were dependent on insulin sensitivity, with some evidence for upregulation of fusion and mitophagy in T2D and IR-NDM and upregulation of fission in IS-NDM. Levels of different lipolytic proteins were reduced in all participants after detraining. Interpretation: HIIT offers sustained improvement of energy metabolism and hepatic insulin sensitivity in insulin-resistant humans, but long-term adherence is required to maintain these benefits. Funding: Funding bodies that contributed to this study are listed in the Acknowledgements section.

Introduction Transition of care from hospital to primary care has been recognised globally as a high-risk scenario for older patients’ safety by the WHO. Indeed, sub-optimal care transitions are associated with increased mortality, morbidity and adverse events.Improving communication through timely and accurate clinical information transfer has been identified as a key component of optimal care transitions. However, timely and accurate clinical information transfer from hospital to primary care varies across countries and institutions. Information transfer practices are heterogeneous, in some places depending on individual initiative and sometimes not occurring at all.To improve current practices, we will conduct a scoping review to identify the current and suggested practices of information transfer between hospital-based physicians or pharmacists and the primary care team of older patients.Methods and analysis This scoping review will be conducted using Arksey and O’Malley’s methodological framework, augmented by Levac et al and the JBI Manual for Evidence Synthesis, and the findings reported according to the PRISMA extension for Scoping Reviews. We will use a search strategy developed with a specialised librarian to search four databases (MEDLINE, Embase, CINAHL and AgeLine) and reference lists of selected studies. All studies adhering to our iteratively created eligibility criteria outlined by the population, concept and context elements will be included. The data extraction table will also be constructed iteratively with the research team, and results will be presented tabularly and qualitatively.Ethics and dissemination Ethics approval was obtained. We plan to disseminate the results as scientific communication (peer-reviewed journal and presentations) and during a deliberative dialogue workshop with key stakeholders in order to generate recommendations to improve current practices in our own clinical setting, potentially to be adapted and scaled up with our collaborators provincially, nationally and internationally.This protocol has been registered on the Open Science Framework: https://osf.io/eg958.