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Probiotics are typically marketed as foods and dietary supplements, categories for products intended to maintain health in generally healthy populations and which, unlike drugs, cannot claim to treat or cure disease. This review addresses the existing evidence that probiotics are beneficial to healthy people. Our approach was to perform a descriptive review of efficacy evidence that probiotics can prevent urinary, vaginal, gastrointestinal, and respiratory infections, and improve risk factors associated with cardiovascular health or reduce antibiotic use. Other endpoints such as mental, dental, or immune health were not specifically addressed. We concluded that there is sufficient evidence of efficacy and safety for clinicians and consumers to consider using specific probiotics for some indications - such as the use of probiotics to support gut function during antibiotic use or to reduce the risk of respiratory tract infections - for certain people. However, we did not find a sufficiently high level of evidence to support unconditional, population-wide recommendations for other preventive endpoints we reviewed for healthy people. Although evidence for some indications is suggestive of the preventive benefits of probiotics, additional research is needed.

Ecological and evolutionary theories have proposed that species traits should be important in mediating species responses to contemporary climate change; yet, empirical evidence has so far provided mixed evidence for the role of behavioral, life history, or ecological characteristics in facilitating or hindering species range shifts. As such, the utility of trait-based approaches to predict species redistribution under climate change has been called into question. We develop the perspective, supported by evidence, that trait variation, if used carefully can have high potential utility, but that past analyses have in many cases failed to identify an explanatory value for traits by not fully embracing the complexity of species range shifts. First, we discuss the relevant theory linking species traits to range shift processes at the leading (expansion) and trailing (contraction) edges of species distributions and highlight the need to clarify the mechanistic basis of trait-based approaches. Second, we provide a brief overview of range shift-trait studies and identify new opportunities for trait integration that consider range-specific processes and intraspecific variability. Third, we explore the circumstances under which environmental and biotic context dependencies are likely to affect our ability to identify the contribution of species traits to range shift processes. Finally, we propose that revealing the role of traits in shaping species redistribution may likely require accounting for methodological variation arising from the range shift estimation process as well as addressing existing functional, geographical, and phylogenetic biases. We provide a series of considerations for more effectively integrating traits as well as extrinsic and methodological factors into species redistribution research. Together, these analytical approaches promise stronger mechanistic and predictive understanding that can help society mitigate and adapt to the effects of climate change on biodiversity.

IntroductionPragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare.MethodsCommunity-dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site-specific recruitment strategies to enroll health system patients.ResultsElectronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American.DiscussionHealth systems can successfully enroll diverse dyads in a pragmatic clinical trial.

Abstract Background The R-Scale-PF was proposed to evaluate the health-related quality of life (HRQoL) in patients with idiopathic pulmonary fibrosis (IPF). We generated a German version of the R-Scale-PF (GR-Scale), representing the first translation of the questionnaire into another language and assessed HRQoL longitudinally in various interstitial lung diseases (ILDs) using the R-Scale-PF scoring system at a specialized ILD centre. Methods We have translated the questionnaire in accordance with the WHO translation guidelines and applied it to 80 ILD patients of our department, with follow-ups after 3–6 months, assessing its internal consistency, floor and ceiling effects, concurrent validity, known-groups validity, and its responsiveness to changes over time. Results At baseline, all 80 patients completed the GR-Scale. In 70 patients (87.5%), follow-up data could be obtained after 4.43 ± 1.2 months. The GR-Scale demonstrated acceptable internal consistency (Cronbach’s α 0.749) and slight floor effects. Concurrent validity analysis showed weak but significant correlations with forced vital capacity (FVC; r=-0.282 p = 0.011) and diffusion capacity for carbon monoxide (DLco; r=-0.254 p = 0.025). In the follow-up analysis, moderate correlations were found with FVC (r=-0.41 p

Abstract: Over recent decades, our understanding of climate change has accelerated greatly, but unfortunately, observable impacts have increased in tandem. Both mitigation and adaptation have not progressed at the level or scale warranted by our collective knowledge on climate change. More effective approaches to engage people on current and future anthropogenic climate change effects are urgently needed. Here, we show how species whose distributions are shifting in response to climate change, that is, ‘species‐on‐the‐move’, present an opportunity to engage people with climate change by linking to human values, and our deep connections with the places in which we live, in a locally relevant yet globally coherent narrative. Species‐on‐the‐move can impact ecosystem structure and function, food security, human health, livelihoods, culture and even the climate itself through feedback to the climate system, presenting a wide variety of potential pathways for people to understand that climate change affects them personally as individuals. Citizen science focussed on documenting changes in biodiversity is one approach to foster a deeper engagement on climate change. However, other possible avenues, which may offer potential to engage people currently unconnected with nature, include arts, games or collaborations with rural agriculture (e.g. new occurrences of pest species) or fisheries organisations (e.g. shifting stocks) or healthcare providers (e.g. changing distributions of disease vectors). Through the importance we place on the aspects of life impacted by the redistribution of species around us, species‐on‐the‐move offer emotional pathways to connect with people on the complex issue of climate change in profound ways that have the potential to engender interest and action on climate change. Read the free Plain Language Summary for this article on the Journal blog.

Ambient energy harvesting has great potential to contribute to sustainable development and address growing environmental challenges. Converting waste energy from energy-intensive processes and systems (e.g. combustion engines and furnaces) is crucial to reducing their environmental impact and achieving net-zero emissions. Compact energy harvesters will also be key to powering the exponentially growing smart devices ecosystem that is part of the Internet of Things, thus enabling futuristic applications that can improve our quality of life (e.g. smart homes, smart cities, smart manufacturing, and smart healthcare). To achieve these goals, innovative materials are needed to efficiently convert ambient energy into electricity through various physical mechanisms, such as the photovoltaic effect, thermoelectricity, piezoelectricity, triboelectricity, and radiofrequency wireless power transfer. By bringing together the perspectives of experts in various types of energy harvesting materials, this Roadmap provides extensive insights into recent advances and present challenges in the field. Additionally, the Roadmap analyses the key performance metrics of these technologies in relation to their ultimate energy conversion limits. Building on these insights, the Roadmap outlines promising directions for future research to fully harness the potential of energy harvesting materials for green energy anytime, anywhere.

Abstract Background 3D reconstruction of Wilms’ tumor provides several advantages but are not systematically performed because manual segmentation is extremely time-consuming. The objective of our study was to develop an artificial intelligence tool to automate the segmentation of tumors and kidneys in children. Methods A manual segmentation was carried out by two experts on 14 CT scans. Then, the segmentation of Wilms’ tumor and neoplastic kidney was automatically performed using the CNN U-Net and the same CNN U-Net trained according to the OV2ASSION method. The time saving for the expert was estimated depending on the number of sections automatically segmented. Results When segmentations were performed manually by two experts, the inter-individual variability resulted in a Dice index of 0.95 for tumor and 0.87 for kidney. Fully automatic segmentation with the CNN U-Net yielded a poor Dice index of 0.69 for Wilms’ tumor and 0.27 for kidney. With the OV2ASSION method, the Dice index varied depending on the number of manually segmented sections. For the segmentation of the Wilms’ tumor and neoplastic kidney, it varied respectively from 0.97 to 0.94 for a gap of 1 (2 out of 3 sections performed manually) to 0.94 and 0.86 for a gap of 10 (1 section out of 6 performed manually). Conclusion Fully automated segmentation remains a challenge in the field of medical image processing. Although it is possible to use already developed neural networks, such as U-Net, we found that the results obtained were not satisfactory for segmentation of neoplastic kidneys or Wilms’ tumors in children. We developed an innovative CNN U-Net training method that makes it possible to segment the kidney and its tumor with the same precision as an expert while reducing their intervention time by 80%.

Sports are characterized by unique rules, environments, and tasks, but also share fundamental similarities with each other sport. Such between-sports parallels can be vital for optimizing talent transfer processes. This study aimed to explore similarities between sports to provide an objective basis for clustering sports into families by means of machine learning. An online survey was conducted, garnering responses from 1,247 coaches across 36 countries and 34 sports. The survey gauged the importance (0 = not important 10 = important) of 18 characteristics related to the sport and the athlete performing in that sport. These traits formed the basis for the categorization of a sport by means of machine learning, particularly unsupervised clustering, and the LIME feature explainer. Analysis grouped 34 sports into five clusters based on shared features. A similarity matrix illustrated the degree of overlap among sports. The application of unsupervised clustering emphasized the lack of a single overarching attribute across sports, marking a shift away from traditional clustering approaches that rely on a limited set of characteristics for talent transfer. The results highlight the importance of identifying common sports for talent transfer, which could prove advantageous in guiding athletes towards new sporting directions.

Introdução: O Serviço de Controle de Infecção Hospitalar (SCIH) é responsável por executar ações visando prevenir infecções hospitalares (IRAS). Objetivo: Estimar a economia gerada com a redução de infecções cirúrgicas (ISC), especificamente em procedimentos ortopédicos, e responder à pergunta: “Quanto um hospital ganha com os investimentos feitos em SCIH?”. Método: Coorte de cirurgias ortopédicas realizadas entre janeiro de 2019 e setembro de 2023 (Artroplastia de joelho, Artroplastia de quadril, Redução aberta de fratura). Os impactos da ISC em pacientes submetidos a estes procedimentos, em termos de risco de óbito e tempo de internação, foram estimados com base em dados coletados entre 2019 e 2022. Já o custo de cada infecção foi obtido de trabalhos da literatura, variando de R$ 38.062 e R$ 68.495. Principais intervenções do SCIH, implementadas a partir de abril de 2022: ATB no cimento ortopédico; Swab de aureus para vigilância; antibióticos de espectro estendido (cefuroxima com gentamicina) para profilaxia para pacientes com maior risco de ISC pós-operatória; repique intraoperatório quando necessário; auditaria de procedimentos cirúrgicos utilizando a equipe de controle de prevenção de infecções; boas p´raticas em sala curúrgica. Resultados: Avaliados de janeiro de 2019 a dezembro de 2022, 4.258 pacientes foram submetidos a cirurgias ortopédicas: AQ (11%), AJ (9%), redução aberta de fratura (80%). Destes, 2.439 eram mulheres (57%), 1.819 homens (43%), idade média e mediana de 51 anos, dp de 21 anos. Mortalidade de 1,6%, e taxa de ISC 5,6%. A ISC elevou o risco de mortalidade em mais de duas vezes RR 2,5, valor de p 0,014. A ISC foi associada à hospitalização prolongada; o tempo médio de permanência duplicou com infecção (18,2 dias) em comparação com sem infecção (9 dias), valor de p: 0,001. Comparando os riscos de infecção de 2019-2022 (5,6%) com 2023 (1,4%) após o investimento em controle de infecção, demonstrou-se uma redução do risco. Risco relativo (0,25) valor de p < 0,001. Conclusão: As ISC em cirurgias ortopédicas representam riscos duplos, aumentando readmissões e prejudicando o desempenho hospitalar. Investir na redução de ISC melhora o cuidado ao paciente, a segurança e proporciona retornos financeiros significativos. Este estudo destaca o retorno sobre o investimento (ROI) da prevenção de infecções, especialmente direcionado às infecções cirúrgicas ortopédicas. Prevenir ISC pode resultar em economias mensais de R$142.706,10 a R$256.797,91.

Introdução: Iniciativas baseadas em valor estão se tornando cada vez mais importantes como modelos estratégicos de gestão em saúde. A redução das taxas de infecção associada à assistência à saúde (IRAS), especialmente nas infecções de sítio cirúrgico (ISCs), tem sido atribuída ao desenvolvimento de programas de prevenção de infecções (PPI). Objetivo: Avaliar custo/benefício de investimentos contínuos na prevenção de ISCs, estimando o impacto destas infecções na lucratividade hospitalar. Método: Estudo de coorte retrospectivo de centro único, conduzido entre janeiro de 2019 e setembro de 2023, envolvendo pacientes submetidos a artroplastia, cirurgias de intestino delgado, colecistectomia, herniorrafia e redução de fraturas abertas. A definição de ISC seguiu os critérios estabelecidos pelo CDC/ANVISA. O custo de cada infecção foi obtido na literatura. O estudo comparou a incidência de ISC entre 2019-2022 versus 2023. O hospital implementou um Escritório de Valor em Saúde em 2022 para acelerar a disseminação do atendimento em saúde baseado em valor, com foco no PPI, incluindo medidas para prevenir ISCs: máxima aderência à profilaxia antimicrobiana, feedback sobre a taxa de ISC para a equipe cirúrgica com análise de causa raiz, auditoria de procedimentos cirúrgicos, reforço das boas práticas na sala de cirurgia e melhoria do centro de materiais e esterilização. Resultados: Durante o período basal (Jan/2019 - Dez/2022), foram incluídos 9.235 pacientes, sendo 59% mulheres e uma idade média de 51 anos. 368 foram diagnosticados com ISC, com taxa de mortalidade de 1,4%. Quando ocorre uma ISC, o tempo de internação é significativamente maior (p = 0,001) e o risco de morte dobra (RR = 2,1; p = 0,033). Houve redução de 64% nas taxas de ISC, de 4% em 2019-2022 para 1,4% em 2023. Isso se traduz em 63 infecções prevenidas e 2 mortes a menos. O estudo atribui esse sucesso às medidas preventivas implementadas, pois não houve diferença significativa em termos de duração da cirurgia (p = 0,411) e idade dos pacientes em cada grupo (p = 0,843). Além disso, a redução na taxa de ISC levou a estadias hospitalares mais curtas e economia mensal entre R$ 260.800 e R$ 469.327. Conclusão: As ISCs não apenas contribuem para readmissões, mas também impactam no desempenho do hospital. Investir em intervenções destinadas a reduzir infecções é essencial para melhorar o cuidado e a segurança do paciente. Este estudo destaca o retorno financeiro significativo associado ao investimento na prevenção de infecções.

As doses de P a serem aplicadas na cultura do milho comumente são elevadas em decorrência do baixo aproveitamento do nutriente devido a sua adsorção ao solo. O objetivo deste trabalho foi avaliar o uso das bactérias solubilizadoras de fosfato Bacillus megaterium e Bacillus subtilis, e do fungo micorrízico Rhizophagus intraradices, bem como a interação entre eles, e a possibilidade de redução da adubação fosfatada na cultura do milho. O delineamento experimental foi em blocos casualizados, em um fatorial 4x3, sendo o fator A composto por diferentes microrganismos solubilizadores de P (micorrizas e BiomaPhos®) e o fator B composto por diferentes doses de P (100, 75 e 50% da dose recomendada). A redução das doses de P, sem o uso de inoculantes, resultou em menor área foliar e teor de clorofila, porém não foi observado efeito significativo na altura das plantas. Nos componentes de rendimento número de grãos por espiga, peso de mil grãos e produtividade, a inoculação compensou a redução das doses. A aplicação de 50% da dose de P juntamente com a inoculação das bactérias foi o tratamento com maior margem bruta, sendo viável para a redução da adubação mineral.

Introduction The main risk factors of necrotising enterocolitis (NEC) are prematurity and low birth weight. The aim of our study was to identify risk factors for NEC in patients with duct-dependent congenital heart disease (CHD).Study design Newborns with duct-dependent CHD and NEC were matched 1:1 to those without NEC. Matched criteria were gestational age, birth weight, antenatal versus postnatal diagnosis and type of CHD.Results Twenty-three infants were included in each group. In the NEC group, mortality, length of intensive care unit stay and length of hospital stay were significantly higher (p=0.035; p

BACKGROUND: Randomized trials are the gold standard for generating clinical practice evidence, but follow-up and outcome ascertainment are resource-intensive. Electronic health record (EHR) data from routine care can be a cost-effective means of follow-up, but concordance with trial-ascertained outcomes is less well-studied. METHODS: We linked EHR and trial data for participants of the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial comparing intensive and standard blood pressure targets. Among participants with available EHR data concurrent to trial-ascertained outcomes, we calculated sensitivity, specificity, positive predictive value, and negative predictive value for EHR-recorded cardiovascular disease (CVD) events, using the gold standard of SPRINT-adjudicated outcomes (myocardial infarction (MI)/acute coronary syndrome (ACS), heart failure, stroke, and composite CVD events). We additionally compared the incidence of non-CVD adverse events (hyponatremia, hypernatremia, hypokalemia, hyperkalemia, bradycardia, and hypotension) in trial versus EHR data. RESULTS: 2468 SPRINT participants were included (mean age 68 (SD 9) years; 26% female). EHR data demonstrated ≥80% sensitivity and specificity, and ≥ 99% negative predictive value for MI/ACS, heart failure, stroke, and composite CVD events. Positive predictive value ranged from 26% (95% CI; 16%, 38%) for heart failure to 52% (95% CI; 37%, 67%) for MI/ACS. EHR data uniformly identified more non-CVD adverse events and higher incidence rates compared with trial ascertainment. CONCLUSIONS: These results support a role for EHR data collection in clinical trials, particularly for capturing laboratory-based adverse events. EHR data may be an efficient source for CVD outcome ascertainment, though there is clear benefit from adjudication to avoid false positives.

Purpose: The aim of this study is to measure the concurrent validity of the Athletic Skills Track (AST) by examining whether its outcome score correlates with the holistic judgments of experts about the quality of movement. Method: Video recordings of children performing the AST were shown to physical education teachers who independently gave a holistic rating of the movement quality of each child. Results: Both intra- and interrater reliability of the teachers' ratings were moderate to good. The holistic judgments on movement quality were significantly correlated with AST time, showing that higher ratings were associated with less time required to complete the track. Next, hierarchical stepwise regression indicated that in addition to the holistic rating, also age, but not gender, explained part of the variance in AST time. Conclusion: The findings show that the AST has good concurrent validity and provides a fast, indirect indication for quality of movement.

Background: GPs are particularly vulnerable to job burnout. Tailored prevention and intervention strategies are needed. Aim: To investigate organisational, interpersonal, and individual factors contributing to exhaustion and disengagement at work among GPs. Design & setting: We conducted a cross-sectional study in a sample of Belgian GPs. Method: A total of 358 doctors (73% females, 301 with complete data) completed an online anonymous questionnaire assessing job burnout, psychosocial characteristics of the work environment, perceived social support in the private domain, emotional competence, and self-compassion. Results: GPs reported moderate levels of exhaustion and disengagement. Regression models showed that included factors jointly explained 69% of the variance in exhaustion and 63% in disengagement. Exhaustion was significantly predicted by female sex (β effect size = −0.1), high perceived emotional demands (β = 0.19), as well as low self-compassion (β = −0.14) and low emotional competence (β = 0.09). Disengagement was significantly predicted by low seniority (β = −0.12) and limited opportunities for development (β = −0.16). Both exhaustion and disengagement were predicted by low perceived quality of work (β = −0.19 and −0.14, respectively), meaning of work (β = −0.17 and −0.31, respectively), and role clarity (β = 0.09 and 0.12, respectively), as well as high perceived work–life conflict (β = 0.46 and 0.21, respectively). Moreover, GPs working in a multidisciplinary group reported lower levels of exhaustion and disengagement than those working in a monodisciplinary group or a solo practice, and this difference was associated with factors such as work–life conflict. Conclusion: Organisational, interpersonal, and intrapersonal factors interact to predict a substantial part of burnout in general practice. The most significant risk factors were perceived work–life conflict and poor meaning of work. Policymakers should work to support more sustainable practices based on the specific needs and constraints reported by GPs.

Background: Abdominal radiographs remain useful in newborns. Given the high radiation sensitivity of this population, it is necessary to optimize acquisition techniques to minimize radiation exposure. Objective: Evaluate the effects of three additional filtrations on radiation dose and image quality in abdominal X-rays of newborns using an anthropomorphic phantom. Material and method: Abdominal radiographs of an anthropomorphic newborn phantom were performed using acquisition parameters ranging from 55 to 70 kV and from 0.4 to 2.5 mAs, without and with three different additional filtrations: 0.1 mm copper (Cu) + 1 mm aluminum (Al), 0.2 mm copper + 1 mm aluminum, and 2 mm aluminum. For each X-ray the dose area product (DAP) was measured, the signal-to-noise ratio (SNR) was calculated, and image quality (IQ) was evaluated by two blinded radiologists using the absolute visual grading analysis (VGA) method. Results: Adding an additional filtration resulted in a significant reduction in DAP, with a decrease of 42% using 2 mm Al filtration, 65% with 0.1 mm Cu + 1 mm Al filtration, and 78% with 0.2 mm Cu + 1 mm Al filtration (p < 0.01). The addition of 2 mm aluminum filtration does not significantly decrease the SNR (p = 0.31), CNR (p = 0.52) or the IQ (p = 0.12 and 0.401 for reader 1 and 2, respectively). However, adding copper-containing filtration leads to a significant decrease in, SNR, CNR and IQ. Conclusion: Adding a 2 mm Al additional filtration for abdominal radiographs in newborns can significantly reduce the radiation dose without causing a significant decrease in image quality.

Biodiversity monitoring is an almost inconceivable challenge at the scale of the entire Earth. The current (and soon to be flown) generation of spaceborne and airborne optical sensors (i.e., imaging spectrometers) can collect detailed information at unprecedented spatial, temporal, and spectral resolutions. These new data streams are preceded by a revolution in modeling and analytics that can utilize the richness of these datasets to measure a wide range of plant traits, community composition, and ecosystem functions. At the heart of this framework for monitoring plant biodiversity is the idea of remotely identifying species by making use of the 'spectral species' concept. In theory, the spectral species concept can be defined as a species characterized by a unique spectral signature and thus remotely detectable within pixel units of a spectral image. In reality, depending on spatial resolution, pixels may contain several species which renders species-specific assignment of spectral information more challenging. The aim of this paper is to review the spectral species concept and relate it to underlying ecological principles, while also discussing the complexities, challenges and opportunities to apply this concept given current and future scientific advances in remote sensing.

Abstract Cancer cells integrate multiple biosynthetic demands to drive unrestricted proliferation. How these cellular processes crosstalk to fuel cancer cell growth is still not fully understood. Here, we uncover the mechanisms by which the transcription factor Carbohydrate responsive element binding protein (ChREBP) functions as an oncogene during hepatocellular carcinoma (HCC) development. Mechanistically, ChREBP triggers the expression of the PI3K regulatory subunit p85α, to sustain the activity of the pro-oncogenic PI3K/AKT signaling pathway in HCC. In parallel, increased ChREBP activity reroutes glucose and glutamine metabolic fluxes into fatty acid and nucleic acid synthesis to support PI3K/AKT-mediated HCC growth. Thus, HCC cells have a ChREBP-driven circuitry that ensures balanced coordination between PI3K/AKT signaling and appropriate cell anabolism to support HCC development. Finally, pharmacological inhibition of ChREBP by SBI-993 significantly suppresses in vivo HCC tumor growth. Overall, we show that targeting ChREBP with specific inhibitors provides an attractive therapeutic window for HCC treatment.

Introduction: Infectious diseases, particularly among pediatric populations, represent a significant global health problems. Rational antibiotic use is paramount for achieving optimal patient outcomes, but prescribing antibiotics in pediatric settings is a multifaceted task influenced by various factors, including prescriber's knowledge and experience. Aim: This study, conducted at Pediatric Department at Bouaké University Hospital (Côte d'Ivoire) (CHU), aimed to investigate the relationship between prescriber's experience and the appropriateness of antibiotic prescriptions for pediatric patients. Material and Methods: The academic study lasted from June 1, 2019, to July 31, 2019, within the pediatric department of the Bouaké University Hospital. It included all children age 0 to 15 years, who were receiving antibiotic therapy for at least 48 hours. Evaluation of antibiotic therapy relied on criteria from authoritative references in infectious diseases. Antibiotic therapy was deemed appropriate if it was clinically justified for treating the specific infectious disease. Prescribers' experience-related variables, including years in medical practice, specialization level, and other pertinent factors, were integrated into the analysis to gain insights into their influence on the appropriateness and compliance of antibiotic prescriptions. Data analysis was executed using EPI INFO 2007 version 7.1.3.3 software, employing statistical tests such as Pearson's chi-square and Fisher's exact test. Results: The study unveiled that the incidence of antibiotic prescription among hospitalized children over the two-month period was 31.28%. Most prescribers had approximately 2 years of experience, with an average overall experience of 3.25 years. Male prescribers slightly outnumbered their female counterparts, and specialist physicians constituted the majority of prescribers (70.94%). Compliance was markedly higher among older children (46.76%) in comparison to infants (2.34%). Beta-lactam antibiotics were the most frequently prescribed class, accounting for 62.72% of antibiotic prescriptions. Non-compliance, particularly concerning dosage, was prevalent, contributing to 33.05% of cases, with betalactams being a prominent contributor. Conclusion: Although the influence of prescriber experience on antibiotic appropriateness remained inconclusive, the significance of rational antibiotic use remains pivotal. These findings underscore the necessity for continual efforts to optimize antibiotic therapy in pediatric care, endorsing evidence-based prescribing practices to safeguard the efficacy of antibiotics for future generations.

Abstract When used in real‐world conditions, substantial interindividual variations in direct oral anticoagulant (DOAC) plasma concentrations are observed for a given dose, leading to a risk of over‐ or under‐exposure and clinically significant adverse events. Physiologically‐based pharmacokinetic (PBPK) models could help physicians to tailor DOAC prescriptions in vulnerable patient populations, such as those in the hospital setting. The present study aims to validate prospectively PBPK models for rivaroxaban and apixaban in a large cohort of elderly, polymorbid, and hospitalized patients. In using a model of geriatric population integrating appropriate physiological parameters into models first optimized with healthy volunteer data, observed plasma concentration collected in hospitalized patients on apixaban (n = 100) and rivaroxaban (n = 100) were adequately predicted (ratio predicted/observed area under the concentration curve for a dosing interval [AUCtau] = 0.97 [0.96–0.99] geometric mean, 90% confidence interval, ratio predicted/observed AUCtau = 1.03 [1.02–1.05]) for apixaban and rivaroxaban, respectively. Validation of the present PBPK models for rivaroxaban and apixaban in in‐patients represent an additional step toward the feasibility of bedside use.

BACKGROUND: Adjudication of inpatient AKI in the Systolic Blood Pressure Intervention Trial (SPRINT) was based on billing codes and admission and discharge notes. The purpose of this study was to evaluate the effect of intensive versus standard BP control on creatinine-based inpatient and outpatient AKI, and whether AKI was associated with cardiovascular disease (CVD) and mortality. METHODS: We linked electronic health record (EHR) data from 47 clinic sites with trial data to enable creatinine-based adjudication of AKI. Cox regression was used to evaluate the effect of intensive BP control on the incidence of AKI, and the relationship between incident AKI and CVD and all-cause mortality. RESULTS: A total of 3644 participants had linked EHR data. A greater number of inpatient AKI events were identified using EHR data (187 on intensive versus 155 on standard treatment) as compared with serious adverse event (SAE) adjudication in the trial (95 on intensive versus 61 on standard treatment). Intensive treatment increased risk for SPRINT-adjudicated inpatient AKI (HR, 1.51; 95% CI, 1.09 to 2.08) and for creatinine-based outpatient AKI (HR, 1.40; 95% CI, 1.15 to 1.70), but not for creatinine-based inpatient AKI (HR, 1.20; 95% CI, 0.97 to 1.48). Irrespective of the definition (SAE or creatinine based), AKI was associated with increased risk for all-cause mortality, but only creatinine-based inpatient AKI was associated with increased risk for CVD. CONCLUSIONS: Creatinine-based ascertainment of AKI, enabled by EHR data, may be more sensitive and less biased than traditional SAE adjudication. Identifying ways to prevent AKI may reduce mortality further in the setting of intensive BP control.

This study's purpose was to explore the relationship between emotional intelligence (EI) and motor competence (MC) in 540 children, adolescents, and young adults. Using the Schutte Self-Report Emotional Intelligence Scale (SSEIT), participants were divided in three groups of high, average, and low EI. The short form of Bruininks-Oseretsky Test for Motor Proficiency -- 2 (BOTMP-2SF) evaluated MC. Within each age and sex group, associations between MC and a) EI as a global construct and b) the four subdomains of EI were overall significant (with p < 0.01 for 85 out of 90 correlations) and very strong (with 66 correlations > 0.60). A 3 (EI groups) x 3 (age groups) x 2 (sex) ANOVA on standardized overall MC scores revealed that in all age groups, participants with higher EI outperformed their peers with average and low EI with respect to MC (p < 0.001). Additionally, boys scored higher on MC tests compared to girls (p < 0.001). A third-order interaction effect (p < 0.001) revealed that boys' superiority in MC generally decreased from childhood to adulthood, especially in the low EI group. The outcomes of this study show a robust relationship between EI and MC from childhood through early adulthood, suggesting a novel MC correlate throughout the lifespan.