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Introduction: In this multicenter clinical study, we aimed to investigate the efficacy and safety of the transhepatic arterial administration of granulocyte-colony stimulating factor (G–CSF)–mobilized autologous peripheral blood (PB)-CD34+ cells compared with standard therapy in patients with decompensated cirrhosis type C. Methods: Patients were randomly assigned (2:1) to the CD34+ cell transplant (CD34+ cell) or standard-of-care (SOC) group and followed up for 52 weeks. The primary endpoints were the non-progression rate of Child-Pugh (CP) scores at 24 weeks post-enrollment and the safety of the protocol treatment. Results: Fourteen patients (CD34+ cell group: 10; SOC group: 4) were enrolled. CP scores at 24 weeks had a non-progression rate of 90% in the CD34+ cell group and 100% in the SOC group, with no significant difference between groups. Importantly, 4 out of 10 patients in the CD34+ cell group exhibited an improvement from decompensated to compensated cirrhosis, whereas all patients in the SOC group remained in decompensated cirrhosis. With regard to secondary endpoints, a trend toward increased serum albumin levels in the CD34+ cell group was noted. Serious adverse events (SAEs) occurred in three patients in the CD34+ cell group and in one patient in the SOC group. No causal relationship was observed between all SAEs and G-CSF, leukapheresis, or cell transplantation in the CD34+ cell group. No patients died and no hepatocellular carcinoma occurred within the study period. Conclusions: PB-CD34+ cell infusion therapy may have the potential to circumvent the decompensated stage of cirrhosis, thus avoiding the need for liver transplantation.

Abstract Introduction Given the increase in the primary care nursing workforce and the need to further grow nursing roles in the community understanding how this is included in undergraduate education is important. This study aimed to explore the inclusion of primary care in the undergraduate nursing education curriculum of four countries. Method A mixed‐method design was employed to obtain a broader context of primary care nursing in nursing education and teaching approaches relating to primary care nursing. Subsequently, Australia, Canada, Spain, and Ireland were selected for this study because primary healthcare systems are established as a part of their healthcare system. Results In total, 136 nursing faculties (40 in Australia, 35 in Canada, 46 in Spain, and 15 in Ireland) were invited to participate in this study. Of these, 27 responses were obtained (19.8% response rate). Following the survey phase, in‐depth interviews were conducted with 13 participants. The results indicated that the highest number was coded within the theme of “Understanding of PHC in the curriculum” (n = 108). The second highest number (n = 87) was within the theme of “Interpretation differences of PHC in curriculum,” and the third highest (n = 31) was coded within “Policy impact on health by national government and others.” Conclusion The results emphasized the ambiguity of primary care within the undergraduate nursing curriculum and that interpretation and implementation into the curriculum largely depended on the school's intentions.

Abstract Background Nasotracheal intubation (NTI) is necessary during surgeries requiring clear access to the surgical field and in patients with respiratory issues. This study investigates the pre-NTI nasal disinfection efficacy of different cotton swab sizes, hypothesizing that smaller swabs could minimize bleeding while maintaining disinfection efficacy. Methods Patients classified as American Society of Anesthesiologists-physical status (ASA-PS) class 1 or 2 scheduled for general anesthesia with NTI were randomly assigned to either a large cotton swabs (LCS) or fine cotton swabs (FCS) group in this randomized controlled trial (RCT).” After anesthesia, a fine cotton swab was inserted into the inferior nasal meatus in both groups to collect bacteria (sample A). Next, the nasal cavity was disinfected with LCS or FCS according to the patient group. Bacteria were collected by inserting a fine cotton swab into the inferior nasal meatus (sample B). After surgery, bacteria were collected from the endotracheal tube tip using a fine cotton swab in both groups (sample C). The samples were cultured for 24 hours, and the colonies from samples A–C were counted. The changes in bacteria count between samples A and B and samples A and C were determined. Nasal bleeding from cotton swab insertion was assessed as a secondary outcome. Student’s t-tests, a chi-square independence test, and Mann–Whitney U tests were used for the statistical analysis. The statistical significance level was set at p

Abstract The standard treatment duration for acute cholangitis (AC) involves a 4–7-day antimicrobial treatment post-biliary drainage; however, recent studies have suggested that a ≤ 2–3 days is sufficient. However, clinical practice frequently depends on body temperature as a criterion for discontinuing antimicrobial treatment. Therefore, in this study, we assessed whether patients with AC can achieve successful outcomes with a ≤ 7-day antimicrobial treatment, even with a fever, assuming the infection source is effectively controlled. We conducted a single-center retrospective study involving patients with AC, defined following the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a ≤ 7-day antimicrobial treatment. Patients were categorized into the febrile and afebrile groups based on their body temperature within 24 h before completing antimicrobial treatment. The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 post-biliary drainage without recurrence or death by day 30. The secondary outcome was a 3-month recurrence rate. Logistic regression with inverse probability of treatment weighting was used. Overall, 408 patients were selected, among whom 40 (9.8%) were febrile. The two groups showed no significant differences in the clinical cure and 3-month recurrence rates. Notably, the subgroups limited to patients with a ≤ 3-day antibiotic treatment duration also showed no differences in these outcomes. Therefore, our results suggest that discontinuing antibiotics within the initially planned treatment period was sufficient for successful drainage cases of AC, regardless of the patient's fever status during the 24 h leading up to termination.

Abstract We study the performance scaling of three quantum algorithms for combinatorial optimization: measurement-feedback coherent Ising machines (MFB-CIM), discrete adiabatic quantum computation (DAQC), and the Dürr–Høyer algorithm for quantum minimum finding (DH-QMF) that is based on Grover’s search. We use MaxCut problems as a reference for comparison, and time-to-solution (TTS) as a practical measure of performance for these optimization algorithms. For each algorithm, we analyze its performance in solving two types of MaxCut problems: weighted graph instances with randomly generated edge weights attaining 21 equidistant values from −1 to 1; and randomly generated Sherrington–Kirkpatrick (SK) spin glass instances. We empirically find a significant performance advantage for the studied MFB-CIM in comparison to the other two algorithms. We empirically observe a sub-exponential scaling for the median TTS for the MFB-CIM, in comparison to the almost exponential scaling for DAQC and the proven $$\widetilde{{{{\mathcal{O}}}}}\left(\sqrt{{2}^{n}}\right)$$ O ̃ 2 n scaling for DH-QMF. We conclude that the MFB-CIM outperforms DAQC and DH-QMF in solving MaxCut problems.

Abstract Background Remimazolam is a recently developed, ultrashort-acting benzodiazepine that is used as a general anesthetic. Some cases of remimazolam anaphylaxis have been reported, but its characteristics are not fully understood. We present an interesting case report and review of the literature to better understand remimazolam anaphylaxis. Case presentation A 75-year-old man scheduled for robot-assisted gastrectomy was administered remimazolam for the induction of general anesthesia. After intubation, low end-expiratory CO2, high airway pressure and concurrent circulatory collapse were observed. Bronchoscopy revealed marked tracheal and bronchial edema, which we diagnosed as anaphylaxis. The patient suffered cardiac arrest after bronchoscopy but recovered immediately with intravenous adrenaline administration and chest compressions. We performed skin prick tests for the drugs used during induction except for remimazolam, considering the high risk of systemic adverse reactions to remimazolam. We diagnosed remimazolam anaphylaxis because the skin prick test results for the other drugs used during anesthesia were negative, and these drugs could have been used without allergic reactions during the subsequent surgery. Furthermore, this patient had experienced severe anaphylactic-like reactions when he underwent cardiac surgery a year earlier, in which midazolam had been used, but it was not thought to be the allergen at that time. Based on these findings, cross-reactivity to remimazolam and midazolam was suspected. However, the patient had previously received another benzodiazepine, brotizolam, to which he was not allergic, suggesting that cross-reactivity of remimazolam may vary among benzodiazepines. In this article, we reviewed the 11 cases of remimazolam anaphylaxis that have been described in the literature. Conclusions Remimazolam is an ultrashort-acting sedative; however, it can cause life-threatening anaphylaxis. In addition, its cross-reactivity with other benzodiazepines is not fully understood. To increase the safety of this drug, further research and more experience in its use are needed.

Background: Primary care providers are well placed to improve disaster preparedness in communities. Their close position to their clients and understanding of theirhealth needs can be utilized to increase disaster preparedeness for vulnerable populations. However, there is still a lack of clarity about their roles and services in this area. The aim of this review was to explore the services provided by primary care providers in the context of disaster preparedness activities for vulnerable populations. Methods: Scoping review was performed with PubMed, Scopus and MEDLINE databases. Results: A total of 2193 articles were identified from the database screening and 22 full-text articles yielded for the final analysis. After thematic analysis was conducted, six themes were emerged. Conclusion: To utilise and maximise theprofessional roles of primary care providers effectively, there is a need to strengthen the expertise and involvement of providers in disaster risk management mechanisms and planning. In addition, there is a need for scientific research to explore the existing capabilities of primary care providers and to facilitate their existing ability to coordinate with disaster management agencies.

Early diagnosis and continuous monitoring of patients with eye diseases are critical in computer-aided detection (CAD) techniques. Semantic segmentation, a key component in computer vision, enables pixel-level classification and provides detailed information about objects within images. In this study, we present three U-Net models designed for multi-class semantic segmentation, leveraging the U-Net architecture with transfer learning. To generate ground truth for the HRF dataset, we combine two U-Net models, namely MSU-Net and BU-Net, to predict probability maps for the optic disc and cup regions. Binary masks are then derived from these probability maps to extract the optic disc and cup regions from retinal images. The dataset used in this study includes pre-existing blood vessels and manually annotated peripapillary atrophy zones (alpha and beta) provided by expert ophthalmologists. This comprehensive dataset, integrating existing blood vessels and expert-marked peripapillary atrophy zones, fulfills the study's objectives. The effectiveness of the proposed approach is validated by training nine pre-trained models on the HRF dataset comprising 45 retinal images, successfully segmenting the optic disc, cup, blood vessels, and peripapillary atrophy zones (alpha and beta). The results demonstrate 87.7 % pixel accuracy, 87 % Intersection over Union (IoU), 86.9 % F1 Score, 85 % mean IoU (mIoU), and 15 % model loss, significantly contributing to the early diagnosis and monitoring of glaucoma and optic nerve disorders.

The addition reaction of C60 with silylene 1, a silicon analog of carbene, yielded the corresponding bis-adduct 3. The structure of 3 was determined by single-crystal X-ray structure analysis, representing the first example of a crystal structure of a silirane (silacyclopropane) derivative of fullerenes. Electrochemical measurements confirmed that the redox potentials of 3 are shifted cathodically compared to those of the parent mono-adduct 2. Density functional theory (DFT) calculations provided the basis for the electronic properties of compound 3.

2[C9H18N3][C8F4O4], monoclinic, I2/a (no. 15), a = 10.2282(4) Å, b = 11.9366(5) Å, c = 24.5548(12) Å, β = 98.948(4)°, V = 2961.4(2) Å3, Z = 4, Rgt(F) = 0.0456, wRref(F2) = 0.1217, T = 178 K.

This study was conducted in University of Duhok's nursery of horticulture department, college of Agriculture Engineering Sciences, in Kurdistan region of Iraq, during growing season (2022–2023). One-year-old almond seedlings were getting from college nursery. and sprayed two times: first spray was on 1st April and second spray was on 1st May. Randomized complete block design (RCBD) as factorial experiment was used, including three factors (Full green fertilizer (0, 4, 8) gm. L- 1, GA3 (0, 50, 100) mg. L- 1, and NAA (0, 750, 1250) mg. L- 1 (3*3*3*3), with three seedlings for each experiment unit. Statistical analysis was performed by SAS program Results were compared according to Duncan's multiple range tests at 5%. Results showed that full green significantly increased (stem length (90.11cm), shoot number (9.22), leave area (47.48 cm2), shoot dry weight (5.58gm)) at 8 mg/L-1, GA3 significantly affected on (stem length (89.11cm), leave area (47.08cm2), shoot fresh weight (9.05gm), shoot dry weight (5.92gm) , root fresh weight (6.50gm), and root dry weight (3.85gm)) at 100mg/L-1 ,and NAA increased stem length (90.85cm) and shoot fresh weight (8.73gm) at 1250mg/L-1, while shoot number (9.59) and leave area (46.12cm2) at 750mg/L-1 NAA.

This study was conducted during growing season (2022), in the nursery of the Horticulture Department, College of Agricultural Engineering Science, University of Duhok, Kurdistan region, Iraq, in summel district, situated at western of Duhok city (8 km from Duhok city center). The study consisted the effect of spray with different concentrations of IBA (0, 1000 and 1500mgl-1), GA3 (0, 750 and 1500mg L-1 ) and Nutri green (0 ,4 and 8mL.l) on some vegetative growth characteristics of almond (Prunus Amygdalus) seedling. The superior results indicated the following: seedling spray with IBA concentrations significantly gave the best increase length of shoots, leaf area, increase number of shoots, height of seedling, also seedling spray with GA3 concentrations effect significantly gave the best result of increase length of shoots, leaf area, decrease number of shoots, increase height of seedling, whereas seedling spray with Nutri green concentrations significantly gave the best result only of increase number of shoots.

Abstract Background The practical sessions during skills laboratory simulation or clinical simulation are cores of nursing education. For this, different modalities have been devised to facilitate psychomotor skills learning. One of the commonly used educational material or instructional method to supplement skills learning across various disciplines is video-based teaching method. The opportunities of traditional two-dimensional video might be limitless and maximized with 360º virtual reality (VR) video, which offers immersive experience. This study incorporates 360º VR video into skills laboratory training as an alternative approach to face-to-face procedure demonstration. Methods An open-label, parallel (1:1), randomized controlled trial study was conducted among third-year undergraduate nursing students at Hiroshima University, Japan. The nursing students were block-randomized into 360º VR video and face-to-face demonstration group. After a 3-hour theoretical class of patient management on ventilator and closed-suction principles of mechanically ventilated patients in an Intensive Care Unit focused class, the 360º VR group watched the 360º VR video of closed tracheal suction (including oral) using the head-mounted display of Meta Quest 2 individually, while the face-to-face group attended the instructor’s demonstration. A week after the skills laboratory, the students’ psychomotor skills, knowledge, satisfaction, confidence were evaluated; the 360º VR video group’s perception was explored; Wilcoxon rank-sum test was used to compare the two groups. Results A total of 57 students were analyzed; 27 students in the 360º VR video group and 30 students in face-to-face group. There were no statistically significant differences between both groups in skills, knowledge, and confidence. However, the face-to-face group had higher satisfaction level than the 360º VR group; this difference was statistically significant. In the 360º VR video group, 62% agreed that VR makes learning more interesting; more than half of students (62.5%) experienced VR sickness symptoms, and “feeling of drunk” is the highest. The students appreciated the ready to use, immersiveness, and realism; however, symptoms and discomfort, burdensomeness, and production limitations were improvements recommended. Conclusion Although face-to-face demonstration is the established method of teaching psychomotor skills to nursing students, the use of 360º VR video could achieve similar learning effect as an alternative approach.

ABSTRACTIntimate partner violence (IPV) is a complex and pervasive public health problem disproportionately affecting Indigenous and Black women. During the COVID-19 pandemic, IPV became more complicated for advocates because social distancing, quarantine, and isolation measures further endangered women experiencing IPV. This manuscript is based on an ongoing community-engaged study in an upper Midwestern state. Our primary goal for this study is to generate urgently needed knowledge on the impact of the COVID-19 pandemic on Indigenous and Black women’s help-seeking behaviours following IPV by systematically documenting barriers women faced during the pandemic. Engaging women in a large study that seeks to garner information about their experiences of violence is complex and challenging and requires significant planning, especially for ensuring participants’ safety. In this write-up, we detail the safety planning protocol developed for the purposes of recruiting and engaging women in rural and urban areas in an upper Midwestern state in the United States. Our goal is to provide scholars conducting research in the area of violence with practical considerations for safely conducting a study of this nature.

This study aimed to identify retinal vessel whitening outside the standard Early Treatment Diabetic Retinopathy Study (ETDRS) fields and to correlate the findings with vision and severity of diabetic retinopathy. Patients with diabetes mellitus who were seen in the retinal clinic to assess diabetic retinopathy status were included. Retinal vessel whitening was identified using ultra-widefield imaging. Four hundred and forty-five eyes of 260 patients were included. Thirty-five eyes in 24 patients (7.9%) were noted to have peripheral retinal vessel whitening. Thirty-one eyes with peripheral retinal vessel whitening did not have vessel whitening within the standard 7 ETDRS fields (p

The recent progress with ruxolitinib treatment might improve quality-of-life as well as overall survival in patients with primary myelofibrosis (PMF). Therefore, the optimal timing of allogeneic hematopoietic cell transplantation (HCT) remains to be elucidated in the ruxolitinib era. We constructed a Markov model to simulate the 5-year clinical course of transplant candidates with PMF, and compared outcomes between immediate HCT and delayed HCT after ruxolitinib failure. Since older age was associated with an increased risk of mortality, we analyzed patients aged < 60 and ≥ 60 separately in subgroup analyses. The expected life years was consistently longer in delayed HCT after ruxolitinib failure regardless of patient age. Regarding quality-adjusted life years (QALYs), a baseline analysis showed that immediate HCT was inferior to delayed HCT after ruxolitinib failure (2.19 versus 2.26). In patients aged < 60, immediate HCT was equivalent to delayed HCT after ruxolitinib failure (2.31 versus 2.31). On the other hand, in patients aged ≥ 60, immediate HCT was inferior to delayed HCT after ruxolitinib failure (1.98 versus 2.21). A one-way sensitivity analysis showed that the utility of being alive without chronic graft-versus-host disease after immediate HCT was the most influential parameter for QALYs, and that a value higher than 0.836 could reverse the superiority of delayed HCT after ruxolitinib failure. As a result, delayed HCT after ruxolitinib failure is expected to be superior to immediate HCT, especially in patients aged ≥ 60, and is also a promising strategy even in those aged < 60.

Abstract The COVID-19 pandemic highlighted the urgent need to strengthen public health systems. In response, the United Nations Disaster Risk Reduction (UNDRR) Public Health System Resilience Scorecard (Scorecard) was applied in workshops across multiple countries. The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience. We conducted a workshop from 14 to 16 March 2023, at the UNDRR Global Education and Training Institute in Incheon, Republic of Korea. A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies. These were drawn from 70 strategies identified from 13 distinct workshops in eight countries. After two surveys, 23 strategies were finalized. Ten received ratings of “High” or “Very High” from 89% of participants. These related to the inclusion of public health risks in emergency plans, integrating multidisciplinary teams into public health, enabling local transport mechanisms, and improving the ability to manage an influx of patients. The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience. By leveraging this methodology, our study demonstrated how resilience strategies could inform disaster risk reduction funding, policies, and actions.

This case study examines how preservice teachers make meaning of "American culture" while being cognizant of personal bonding between a Japanese ex-inmate and the community he connected with in prison--whom he refers to affectionately as his Chicano homies--in the college course "Culture and Languages of the United States." The study explores a more transformative pedagogical approach and aims to raise awareness of the preservice teachers regarding: how a knowledge of self in a sociopolitical sense enables their teaching to be more accessible and relevant to their students, and using counternarratives to widen the teachers' worldviews to create more inclusive teaching practices and rebuild equity and justice in education. This study examines how preschool teacher candidates at a Japanese university discussed Chicanx culture and how it was relevant to them reflecting and questioning the practice of equating the term with "American culture."