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Eric P Borrelli,1 Peter Saad,2 Nathan E Barnes,2 Doina Dumitru,3 Julia D Lucaci4 1Health Economics & Outcomes Research (HEOR), Becton, Dickinson and Company, San Diego, CA, USA; 2Medical Affairs, Becton, Dickinson and Company, Durham, NC, USA; 3Medical Affairs, Becton, Dickinson and Company, San Diego, CA, USA; 4Health Economics & Outcomes Research (HEOR), Becton, Dickinson and Company, Franklin Lakes, NJ, USACorrespondence: Eric P Borrelli, Health Economics & Outcomes Research (HEOR), Becton, Dickinson and Company, 3750 Torrey View Ct, San Diego, CA, 92130, USA, Email Eric.Borrelli@bd.comPurpose: To model the potential clinical and economic impact of blister-packaging medications for chronic conditions on medication adherence and healthcare costs in a commercially insured population.Methods: A health economic model was developed to evaluate the potential impact of blister-packaging chronic medications for a commercially insured population. The chronic medication classes assessed were renin-angiotensin-system (RAS) antagonists, statins, non-insulin oral antidiabetics, and direct oral anticoagulants (DOACs). The model was designed to reflect the perspective of a hypothetical commercially insured health plan with 100,000 members, over a one-year time horizon. Literature-based or best available epidemiologic references were used to inform the number of patients utilizing each medication class, the impact of blister-packaging on the number of patients who become adherent, as well as the impact of medication adherence in a commercially insured population on healthcare costs for each medication class assessed. Impact on costs was measured in total net healthcare costs, as well as being stratified by medical costs and medication costs.Results: Following the blister-packaging intervention, there were an additional 591 patients adherent to RAS antagonists, 1196 patients adherent to statins, 169 patients adherent to oral antidiabetics, and 25 patients adherent to DOACs. While pharmacy costs increased, these costs were more than offset by the reduction in medical costs. Overall, the increase in patients adherent to therapy due to blister-packaging led to a reduction in total healthcare costs of $879,312 for RAS antagonists (-$0.73 per-member per-month (PMPM)), $343,322 for statins (-$0.29 PMPM), $78,917 for oral antidiabetics (-$0.07 PMPM), and $120,793 for DOACs (-$0.10 PMPM).Conclusion: Blister-packaging chronic medications in a commercially insured population has the potential to reduce healthcare costs. Future research is needed to confirm these findings in real-world settings and to fully understand the clinical and economic implications of blister-packaging chronic medications.Plain Language Summary: Patients not taking their medications as prescribed is common in the United States, leading to disease progression, increased healthcare visits, and increased healthcare costs. Blister-packaging medications is an intervention shown to increase medication adherence, or patients taking their medication as prescribed, and has been around for several decades. While there is research and literature available that shows the impact that blister-packaging medications has on improving adherence, and there is literature available that shows patients taking their medications as prescribed reduces healthcare costs, there is minimal literature available that directly ties these two concepts together. As a result, we modeled from a hypothetical commercial insurance health plan perspective what the impact would be of blister-packaging chronic medications on healthcare costs using the best available peer-reviewed literature and epidemiologic data. This analysis found that for a commercially insured health plan with 100,000 members, 591 additional patients would become adherent to their renin-angiotensin-system (RAS) antagonists blood pressure medications, 1196 additional patients would become adherent to their statins, 169 additional patients would become adherent to their oral antidiabetics, and 25 additional patients would become adherent to their direct oral anticoagulants (DOACs). Additionally, this would lead to a reduction in healthcare costs for the health plan of $879,312 for RAS antagonists (-$0.73 per-member per-month (PMPM)), $343,322 for statins (-$0.29 PMPM), $78,917 for oral antidiabetics (-$0.07 PMPM), and $120,793 for DOACs (-$0.10 PMPM).Keywords: medication adherence, medical cost offsets, healthcare costs, total cost of care, medication adherence packaging, blister-packaging, blister-packing, self-insured

Eric P Borrelli,1 Peter Saad,2 Nathan E Barnes,2 Heather Nelkin,3 Doina Dumitru,3 Julia D Lucaci4 1Health Economics & Outcomes Research; Becton, Dickinson and Company, San Diego, CA, USA; 2Medical Affairs; Becton, Dickinson and Company, Durham, NC, USA; 3Medical Affairs; Becton, Dickinson and Company, San Diego, CA, USA; 4Health Economics & Outcomes Research; Becton, Dickinson and Company, Franklin Lakes, NJ, USACorrespondence: Eric P Borrelli, Becton, Dickinson and Company, 3750 Torrey View Ct, San Diego, CA, 92130, USA, Email Eric.Borrelli@bd.comBackground: The opioid epidemic has severely impacted the US over the last 15 years. Buprenorphine is a partial opioid agonist indicated for the treatment of opioid use disorder (OUD) and is recognized as an effective treatment when taken as prescribed. However, adherence rates have been low in real-world settings. Blister-packaging has been shown to promote medication adherence across a variety of disease states, although it has never been studied in OUD.Methods: An economic analysis was conducted to assess the impact of increased adherence of blister-packaged buprenorphine on health care resource utilization (HCRU) and health care costs for 10,000 patients initiating therapy for OUD. The model analyzed a commercially insured population within the US over a one-year time horizon. Medication adherence was defined in the model as proportion of days covered (PDC) of at least 80%. Literature-based references were used to inform both the impact of blister-packaging on the number of patients who became adherent as well as the impact of medication adherence on HCRU and health care costs. Model input uncertainty was assessed in one-way sensitivity analyses.Results: With the implementation of blister-packaging buprenorphine, adherence rates increased from 37.1% of patients in the pre-intervention period to 45.3%, resulting in an additional 818 patients becoming adherent post-intervention. The increase in adherence led to a reduction of medical costs of $12,138,757 (-$1,214 per-patient (PP)). Specifically, inpatient costs decreased by $7,127,073 (-$713 PP) while outpatient costs decreased by $5,013,319 (-$501 PP). Pharmacy costs increased by $3,432,705 ($343 PP). Despite the increase in pharmacy costs, total health care costs saw a reduction of $8,559,684 (-$856 PP).Conclusion: Blister-packaging buprenorphine for treatment of OUD has potential to improve medication adherence and health outcomes while reducing HCRU and health care costs. Future studies are necessary to assess the real-world application and impact of blister-packaging buprenorphine for OUD across various patient populations and health care settings.Plain Language Summary: The opioid epidemic has taken its toll in the United States for the last several decades. Several medications are available in the treatment of opioid use disorder (OUD), including buprenorphine. Buprenorphine has shown to be an effective treatment when taken as prescribed, however, in real-world settings, the occurrence of patients taking buprenorphine as prescribed is low. Blister-packaging medications has been shown to help promote medication adherence across a variety of disease states, although it has never been studied in OUD. As a result, we attempted to model the potential impact that blister-packaging buprenorphine for 10,000 commercially insured patients initiating treatment for OUD would have on health care resource utilization and health care costs using the best available peer-reviewed literature. This analysis saw adherence rates increased from 37.1% of patients in the pre-blister-packaging period to 45.3% post-blister-packaging period, resulting in an additional 818 patients becoming adherent. The increase in adherence led to reductions of medical costs of $12,138,757 (-$1214 per-patient (PP)). Specifically, inpatient costs decreased by $7,127,073 (-$713 PP) while outpatient costs decreased by $5,013,319 (-$501 PP). Pharmacy costs increased by $3,432,705 ($343 PP). Despite the increase in pharmacy costs, total health care costs saw a reduction of $8,559,684 (-$856 PP). Future studies are necessary to assess the real-world application and impact of blister-packaging buprenorphine for OUD across various patient populations and health care settings.Keywords: blister-packaging, blister-packing, medication adherence, buprenorphine, health care costs, medication adherence packaging, opioid use disorder

Today, environmental protection has become a global concern, with every country obliged to implement laws and actions to protect the environment and promote sustainable development. One of the solutions to this problem is the implementation of environmental protection measures in small and medium-sized enterprises (SMEs). Following the analysis of the level of knowledge, we observed that the transition to the green economy through the adoption of sustainable tourism requires an innovative process, which may be the result of the introduction of new actions, strategies, and technologies. In order to implement sustainable practices in organizations, it is essential to have entrepreneurs who are dedicated to finding the best options and ways to implement ideas that comply with the three principles of sustainable development. In January-March 2024, a survey was conducted among tourism entrepreneurs (accommodation and catering establishments, associations) in Bukovina region on the implementation of green economy principles for creating sustainable businesses.

The Otago Exercise Program (OEP) is a strength and balance rehabilitation program designed to prevent falls in older people living in the community.The aim of this study was to investigate the effects of the Otago exercise program on balance, muscle strength and risk prevention in community-dwelling elderly people.Method: The sample included 10 elderly people from “Sf. Cuv. Parascheva” from Iasi, aged over 65 years old, both men and women, who fall into the increased and moderate risk of falling as measured by the Berg Scale. The intervention consisted mainly of strength and balance training.Results: At the final test regarding the Berg scale, an improvement in the balance of the participants was found (none of the participants was placed at high risk of falling) but also an improvement in the muscle strength in the lower limbs, the scores recorded exceeding 2-3 points from the initial moment of the evaluation when testing with the 30 Seconds Sit To Stand Test tool.Conclusion: The Otago Exercise program is effective for increasing lower limb strength, increasing balance, thereby reducing risk of fall in older people living in a residential care setting.

The aim of the study was to identify an effective exercise protocol addressed to elderly patients diagnosed with knee osteoarthritis so that by applying it can be obtained a significant decrease in pain, improvement in knee flexion, muscle strength and functional capacity. The importance of the topic is due to the fact that osteoarthritis of the knee leads to difficulties in carrying out daily activities and to the lack of physical activity as a result of pain.The study was conducted on 10 patients aged between 73 and 81, clinically diagnosed with chronic knee osteoarthritis. The recovery protocol was applied for 8 weeks with a frequencyof 5 session per week, for ~30-40 minutes, once a day in individual trainings.Conclusions highlight that physiotherapy reduces pain and improves function, muscle strength, range of motion, joint stability and aerobic condition. The regular practice of exercises performed by patients with osteoarthritis of the knee, in an intervention program through adequate guidance, can helppreventing the loss of muscle strength and the restriction of daily activities.

Introduction: Rhabdomyolysis is a complicated medical condition characterized by the rapid breakdown of damaged or injured skeletal muscles. This syndrome can be caused by various factors, with the most common being trauma, prolonged immobilization, sepsis, and the use of drugs and alcohol. Purpose: the case study aims to highlight the importance of the correct diagnosis of the rhabdomyolysis syndrome and the implementation of an effective treatment plan to avoid repercussions on the patient, which can put his life in danger. Material and method: The case study took place over a period of six months, at the subject's home, where the examinations, recovery programs and diet plan were implemented. The subject is a 23-year-old student who practices three sports, including bodybuilding, from which the rhabdomyolysis syndrome was triggered after an intense leg workout. Assessment tools used: Schober Test, Chest amplitude measurement, Apley's scratch Test, and Fingertip-to-floor Test. Results: There is a significant difference between the first treatment session and the last one, the degree of independence has increased, the mobility of the upper and lower limbs is much improved, the pains are reduced, and the endurance to the effort is also increased. Conclusion: As a general conclusion, I can say that the effects of rhabdomyolysis can be treated and reduced with a personalized program of physical therapy and alternative therapies.

Background/Objectives: Immunoglobulin A (IgA) vasculitis (IgAV), classically known as Henoch–Schönlein purpura (HSP), is a type of nonthrombocytopenic small-vessel vasculitis. HSP is the most frequent kind of systemic vasculitis in children, characterized by purpura, arthritis or arthralgia, gastrointestinal pain, and kidney dysfunction. The aim of our research was to investigate and observe the clinical characteristics of children diagnosed with HSP and to explore the correlation between infectious diseases and HSP. Furthermore, this retrospective study considered other factors, such as demographic characteristics (sex, area/environment, and age), and their effect on the pediatric population diagnosed with HSP. Methods: To answer this question, we conducted a five-year hospital-based retrospective study that included 144 hospitalized children who were diagnosed with HSP during hospitalization. Measurements of immunological panels (IgA, IgM, IgG, and IgE), C3, C4, C-reactive protein, fibrinogen, and hematite sedimentation rate (VSH) determined using blood samples revealed that there is a strong correlation between the elements of the immunological panel and the HSP manifestations. Results: Additionally, elevated IgG and normal IgA serum levels in pediatric HSP patients are strongly associated with infectious diseases. Conclusions: Notably, patients with infectious diseases exhibited high IgG and normal IgA serum levels post-treatment and a higher risk of relapses.

This study explored controlled substance (CS) diversion surveillance practices within hospital pharmacies across the United States. A survey with questions based on published CS diversion risk points was conducted in May 2024. A total of 66 participants from 31 states responded, with 54.5% from single facilities and the remaining from health systems. Most respondents were pharmacy directors, managers, or those in dedicated drug diversion roles. Over 70% have dedicated surveillance teams and use drug diversion software. Results highlight variation in practices, with larger institutions generally showing better compliance. Compliance in procurement and receiving was high for access measures; however, auditing of processes was lower. The lowest procurement compliance was in monitoring periodic automatic replacement (PAR) levels and validating orders with wholesalers. Storage practices showed high compliance in deploying cameras, but low compliance in monitoring them. Dispensing practices had high compliance for restricting CS in automated dispensing cabinets, but low incidence of witness verification during stocking. Waste and disposal practices were well-followed, but training on detecting potential signs of medication tampering was less common. The survey highlights that while strategies to prevent CS diversion exist, their implementation varies. Enhancing monitoring, auditing, and training is essential to strengthen diversion prevention efforts in hospital pharmacies.

Rad And Gem-Like GTP-Binding Protein 2 (Rem2), a member of the RGK family of Ras-like GTPases, is implicated in Huntington’s disease and Long QT Syndrome and is highly expressed in the brain and endocrine cells. We examine the evolutionary history of Rem2 identified in various mammalian species, focusing on the role of purifying selection and coevolution in shaping its sequence and protein structural constraints. Our analysis of Rem2 sequences across 175 mammalian species found evidence for strong purifying selection in 70% of non-invariant codon sites which is characteristic of essential proteins that play critical roles in biological processes and is consistent with Rem2’s role in the regulation of neuronal development and function. We inferred epistatic effects in 50 pairs of codon sites in Rem2, some of which are predicted to have deleterious effects on human health. Additionally, we reconstructed the ancestral evolutionary history of mammalian Rem2 using protein structure prediction of extinct and extant sequences which revealed the dynamics of how substitutions that change the gene sequence of Rem2 can impact protein structure in variable regions while maintaining core functional mechanisms. By understanding the selective pressures, protein- and gene - interactions that have shaped the sequence and structure of the Rem2 protein, we gain a stronger understanding of its biological and functional constraints.

Small heat shock proteins (sHSPs) emerged early in evolution and occur in all domains of life and nearly in all species, including humans. Mutations in four sHSPs (HspB1, HspB3, HspB5, HspB8) are associated with neuromuscular disorders. The aim of this study is to investigate the evolutionary forces shaping these sHSPs during vertebrate evolution. We performed comparative evolutionary analyses on a set of orthologous sHSP sequences, based on the ratio of non-synonymous: synonymous substitution rates for each codon. We found that these sHSPs had been historically exposed to different degrees of purifying selection, decreasing in this order: HspB8 > HspB1, HspB5 > HspB3. Within each sHSP, regions with different degrees of purifying selection can be discerned, resulting in characteristic selective pressure profiles. The conserved α-crystallin domains were exposed to the most stringent purifying selection compared to the flanking regions, supporting a 'dimorphic pattern' of evolution. Thus, during vertebrate evolution the different sequence partitions were exposed to different and measurable degrees of selective pressures. Among the disease-associated mutations, most are missense mutations primarily in HspB1 and to a lesser extent in the other sHSPs. Our data provide an explanation for this disparate incidence. Contrary to the expectation, most missense mutations cause dominant disease phenotypes. Theoretical considerations support a connection between the historic exposure of these sHSP genes to a high degree of purifying selection and the unusual prevalence of genetic dominance of the associated disease phenotypes. Our study puts the genetics of inheritable sHSP-borne diseases into the context of vertebrate evolution.

Innovation has the potential to increase the competitiveness and efficiency of economies. Environmental innovation helps companies improve the use of valuable resources and generate sustainable solutions that reduce the negative impact of the economy on the environment. In this paper, we provide a background on eco-innovation and methods to measure it. The purpose of this study is to underline the importance of eco-innovation for business reputation and to identify the main discrepancies between the post-socialist countries in terms of eco-innovation. Despite significant differences between countries and economic sectors, there are not enough companies implementing eco-innovation on the scale that is needed. Of all the post-socialist countries, the Czech Republic is the best practical example for eco-innovation activities. Despite the opportunities that environmental innovation presents to companies, more efforts are required to close the implementation gap

Lumbar pain is one of the most common pathologies encountered among the population. With advancing age, the predisposition to this type of pain increases, which can lead to a decrease in the quality of life.The present study was carried out on a group of 10 patients aged between 70 and 83 years, clinically diagnosed with lumbar discopathy.The recovery program consisted of specific physical therapy exercises associated with massage and medium frequency currents.The obtained results highlight the fact that the pain level decreased significantly following the functional rehabilitation protocol, and the mobility of the lumbar spine improved.The conclusions of the study emphasize the importance of physiotherapy programs in association with massage and medium frequency currents, in terms of improving the symptoms specific to lumbar discopathy in the elderly patient.

Nowadays, one of the major concerns of the specialists in the field of health is represented by finding optimal solutions to prevent falls among the elderly.The study was carried out on a group of 10 elderly people from a retirement home in Iasi, who were given a customized physiotherapy program, after being functionally evaluated using Tinetti walking test, Tinetti balance test and Romberg test.The research results highlight an improvement in balance and muscle control following specific physiotherapy programs.The conclusions of the current study highlight the fact that physiotherapy programs can reduce the risk of falls in the elderly by improving balance and walking abilities.

This study analyses the three-point bending behavior of Nylon 12 (PA12) specimens produced using two additive manufacturing technologies (i.e., fused filament fabrication and selective laser sintering). A Nylon 12 commercially available filament (from Fiberlab S.A.) was selected to employ the fused filament fabrication method (FFF) with a Prusa 3D desktop printer, whereas Nylon 12 sintering powder (from Formlabs Inc.) was chosen for selective laser sintering (SLS) using a benchtop industrial SLS platform, Formlabs Fuse 1, with a powder refresh ratio of 30%. The bending strength and flexural elasticity moduli were determined by following ISO 178:2019 standard specifications to assess the effect of two different technologies on the mechanical behavior of three-point bending specimens produced in three distinct build orientations (i.e., 0°, 45°, and 90°) relative to the printing platform. One-way ANOVA analysis, Tukey’s HSD, and Games-Howell tests are considered to assess the statistical variability of experimental data and compare the mean values of bending strength and flexural moduli. The testing results for the three orientations under question show notable differences and interesting similarities either in terms of strength or elasticity response for a significance p-level of 0.05.

The independent emergence late in 2020 of the B.1.1.7, B.1.351, and P.1 lineages of SARS-CoV-2 prompted renewed concerns about the evolutionary capacity of this virus to overcome public health interventions and rising population immunity. Here, by examining patterns of synonymous and non-synonymous mutations that have accumulated in SARS-CoV-2 genomes since the pandemic began, we find that the emergence of these three "501Y lineages" coincided with a major global shift in the selective forces acting on various SARS-CoV-2 genes. Following their emergence, the adaptive evolution of 501Y lineage viruses has involved repeated selectively favored convergent mutations at 35 genome sites, mutations we refer to as the 501Y meta-signature. The ongoing convergence of viruses in many other lineages on this meta-signature suggests that it includes multiple mutation combinations capable of promoting the persistence of diverse SARS-CoV-2 lineages in the face of mounting host immune recognition.

People are currently facing high unemployment rates, and one of the main causes is financial literacy. Financial literacy is critically important for people as it enables them to effectively manage their money and decide whether to invest or save. Furthermore, everyone must be educated from an early age about financial issues because they will be taught about how to save, invest, budget, and borrow. The purpose of this article is to investigate the scientific literature on financial education and employment. To this end, we conducted a bibliometric analysis of financial literacy and the relationship between financial literacy and employment. The research methodology included a bibliometric analysis conducted with the VOSviewer software. The results highlight low rates of financial literacy in terms of knowledge, behaviour and attitude. The main determinants of poor financial literacy include poor financial education in schools, disinterest of people in the subject, limited accessibility to financial resources, and insufficient involvement of people in financial issues. Policy makers must take into account this unfavourable situation with respect to the state of financial literacy and implement actions to address it.

Drug dispensing in retail pharmacies typically involves several manual tasks that often lead to inefficiencies and errors. This is the first published quality improvement study in Latin America, specifically in Brazil, investigating the operational impacts of implementing a robotic dispensing system in a retail pharmacy. Through observational techniques, we measured the time required for the following pharmacy workflows before and after implementing the robotic dispensing system: customer service, receiving stock, stocking inventory, separation, invoicing, and packaging of online orders for delivery. Time savings were observed across all workflows within the pharmacy, notably in receiving stock and online order separation, which experienced 70% and 75% reductions in total time, respectively. Furthermore, customer service, stocking, invoicing, and packaging of online orders, also saw total time reductions from 36% to 53% after implementation of the robotic dispensing system. This study demonstrates an improvement in the pharmacy’s operational efficiency post-implementation of the robotic dispensing system. These findings highlight the potential for such automated systems to streamline pharmacy operations, improve staff time efficiency, and enhance service delivery.

As the earliest indirect sign of an acute coronary occlusion arriving against non-operative collateral heart vessels, the unabating ST segment elevation accounts for the acute coronary syndrome asking for mandatory and immediate reperfusion therapy. The geography of the ST segment elevations usually enables one to identify the culprit artery and to guess its likely occlusion site, as pivotal pieces of the necessary vital risk forecasting, along with somehow expected occurring arrhythmias. Aside from the classical ST segment elevation myocardial infarction (STEMI) pattern, a handful of distinctive non-ST elevation appearances of the acute coronary occlusion also need imperative reperfusion therapy, thus qualifying themselves as STEMI equivalents. The early forthcoming of ST elevation during an acute transmural ischaemic episode, as well as the wide availability of the electrocardiogram, make it an invaluable diagnostic tool. Yet many confounding factors are able to limit the diagnostic sensibility of ST elevation (as for example its customary absence in the conventional leads in some cases of circumflex artery occlusion, or the casual mutual cancellation of the transmural ST vectors from opposite ventricular walls), the accuracy of the electrocardiographic localisation of the occlusion site (due to coronary anatomic variants, concomitant new or old coronary lesions elsewhere, previous coronary artery bypass grafts), as well as its specificity for transmural ischaemia (by virtue of a well-known manifold of non-ischaemic causes). While the STEMI patient must be offered undelayed reperfusion therapy, the non-ischaemic ST elevation one should be kept away from the haemorrhagic risk of a useless invasive procedure.

Abstract Brain-Derived Neurotrophic Factor (BDNF) is an essential mediator of brain assembly, development, and maturation. BDNF has been implicated in a variety of brain disorders such as neurodevelopmental disorders (e.g., autism spectrum disorder), neuropsychiatric disorders (e.g., anxiety, depression, PTSD, and schizophrenia), and various neurodegenerative disorders (e.g., Parkinson’s, Alzheimer’s, etc.). To better understand the role of BDNF in disease, we sought to define the evolution of BDNF within Mammalia. We conducted sequence alignment and phylogenetic reconstruction of BDNF across a diverse selection of >160 mammalian species spanning ~177 million years of evolution. The selective evolutionary change was examined via several independent computational models of codon evolution including FEL (pervasive diversifying selection), MEME (episodic selection), and BGM (structural coevolution of sites within a single molecule). We report strict purifying selection in the main functional domain of BDNF (NGF domain, essentially comprising the mature BDNF protein). Additionally, we discover six sites in our homologous alignment which are under episodic selection in early regulatory regions (i.e. the prodomain) and 23 pairs of coevolving sites that are distributed across the entirety of BDNF. Coevolving BDNF sites exhibited complex spatial relationships and geometric features including triangular relations, acyclic graph networks, double-linked sites, and triple-linked sites, although the most notable pattern to emerge was that changes in the mature region of BDNF tended to coevolve along with sites in the prodomain. Thus, we propose that the discovery of both local and distal sites of coevolution likely reflects ‘evolutionary fine-tuning’ of BDNF’s underlying regulation and function in mammals. This tracks with the observation that BDNF’s mature domain (which encodes mature BDNF protein) is largely conserved, while the prodomain (which is linked to regulation and its own unique functionality) exhibits more pervasive and diversifying evolutionary selection. That said, the fact that negative purifying selection also occurs in BDNF’s prodomain also highlights that this region also contains critical sites of sensitivity which also partially explains its disease relevance (via Val66Met and other prodomain variants). Taken together, these computational evolutionary analyses provide important context as to the origins and sensitivity of genetic changes within BDNF that may help to deconvolute the role of BDNF polymorphisms in human brain disorders.

ntrepreneurship is globally accepted as a significant driver of socio-economic development. However, the Covid-19 pandemic affected entrepreneurial activity in each country of the world, and the restrictions imposed by the governments caused strong disruptions for entrepreneurs. The purpose of this paper is to investigate the impact of the Covid-19 pandemic on entrepreneurship. The research methodology included qualitative and quantitative analysis. In addition, macroeconomic indicators issued by the Global Entrepreneurship Monitor related to entrepreneurial activity and business ownership have been used. The results show that the Covid-19 pandemic had a significant impact on entrepreneurship. The crisis affected the activities of SMEs and policymakers attempted to introduce resilience actions to support the entrepreneurial system. The most impacted industries during the Coronavirus pandemic were tourism, airlines, and the automotive field. However, industries related to health, technology, pharmaceutical, and science were the least impacted by the Coronavirus pandemic. Changes caused by the health crisis could also change the current labour market and the management infrastructure of existing companies. Policymakers should create opportunities for existing and future entrepreneurs through new policies related to remote work, reskilling of the workforce, and investments in innovative technologies.

Background/Objectives: Immunoglobulin A (IgA) vasculitis (IgAV), classically known as Henoch–Schönlein purpura (HSP), is a type of nonthrombocytopenic small-vessel vasculitis. HSP is the most frequent kind of systemic vasculitis in children, characterized by purpura, arthritis or arthralgia, gastrointestinal pain, and kidney dysfunction. The aim of our research was to investigate and observe the clinical characteristics of children diagnosed with HSP and to explore the correlation between infectious diseases and HSP. Furthermore, this retrospective study considered other factors, such as demographic characteristics (sex, area/environment, and age), and their effect on the pediatric population diagnosed with HSP. Methods: To answer this question, we conducted a five-year hospital-based retrospective study that included 144 hospitalized children who were diagnosed with HSP during hospitalization. Measurements of immunological panels (IgA, IgM, IgG, and IgE), C3, C4, C-reactive protein, fibrinogen, and hematite sedimentation rate (VSH) determined using blood samples revealed that there is a strong correlation between the elements of the immunological panel and the HSP manifestations. Results: Additionally, elevated IgG and normal IgA serum levels in pediatric HSP patients are strongly associated with infectious diseases. Conclusions: Notably, patients with infectious diseases exhibited high IgG and normal IgA serum levels post-treatment and a higher risk of relapses. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain syndrome is a condition with an increasing incidence in recent years, being known as the most common cause of knee pain in adults and adolescents. Undiagnosed and untreated, this condition can worsen over time. The aggravation leads to an increase in the intensity of the pain and the risk of injury, along with an increase in stress on the other joints of the lower limb. The objective of this study was to evaluate the contribution of shockwave therapy to a functional rehabilitation programme for patients with patellofemoral pain syndrome. Materials and Methods: The study was carried out on a group of 64 subjects (32 males and 32 females), aged between 20 and 39 years. The subjects were divided into two groups: 32 subjects who followed a program of functional rehabilitation based on low- and medium-frequency electrotherapy, ultrasound and laser therapy, along with a physical therapy program lasting approximately 3 weeks, and 32 subjects who followed a functional rehabilitation program based on shockwave therapy and specific physical therapy exercises lasting approximately 3 weeks. Results: Following the protocols applied to the two groups, the pain reported by the patients decreased, while the functional parameters of the knee improved, better results being obtained in the group that performed shock wave therapy together with specific physical therapy programs (Cohen Index 5916, p < 0.001). Conclusions: This study indicates that radial shockwave therapy combined with physiotherapy may provide additional benefits for patellofemoral syndrome, including greater pain reduction and improved joint mobility, compared to traditional treatments. However, further research is needed to confirm these findings and their broader clinical applicability. [ABSTRACT FROM AUTHOR]

This study explored controlled substance (CS) diversion surveillance practices within hospital pharmacies across the United States. A survey with questions based on published CS diversion risk points was conducted in May 2024. A total of 66 participants from 31 states responded, with 54.5% from single facilities and the remaining from health systems. Most respondents were pharmacy directors, managers, or those in dedicated drug diversion roles. Over 70% have dedicated surveillance teams and use drug diversion software. Results highlight variation in practices, with larger institutions generally showing better compliance. Compliance in procurement and receiving was high for access measures; however, auditing of processes was lower. The lowest procurement compliance was in monitoring periodic automatic replacement (PAR) levels and validating orders with wholesalers. Storage practices showed high compliance in deploying cameras, but low compliance in monitoring them. Dispensing practices had high compliance for restricting CS in automated dispensing cabinets, but low incidence of witness verification during stocking. Waste and disposal practices were well-followed, but training on detecting potential signs of medication tampering was less common. The survey highlights that while strategies to prevent CS diversion exist, their implementation varies. Enhancing monitoring, auditing, and training is essential to strengthen diversion prevention efforts in hospital pharmacies. [ABSTRACT FROM AUTHOR]

Canine hip dysplasia is characterized by joint instability, subluxation, or even luxation of the femoral head, which causes a deformation of the joint with the early production of coxarthrosis. The main purpose of the paper was to determine the incidence of canine hip dysplasia from October 2019 until June 2021 in the Faculty of Veterinary Medicine in Cluj-Napoca. A total of 173 X-rays on the canine hips were taken between October 2019 and June 2021 in the Radiology Department of the Faculty of Veterinary Medicine from Cluj-Napoca. X-rays were taken with the Roentgen TEMCO Grx machine, then imported into the RadiAnt DICOM™ program, and interpreted according to the FCI grading scheme. A total number of 88 X-rays were excluded due to different causes, thus our study presents 85 X-ray images of the hip from different breeds of dogs. From a total of 85 dogs presented in this study, 38 dogs were graded A, 10 dogs were graded B, 22 dogs were classified with grade C, with grade D were classified 6 dogs and with grade E were diagnosed 9 dogs. Out of 85 dogs examined (49 males and 36 females) more than half (N=48; 56,5%) were free from canine hip dysplasia.

Most companion birds have no distinct sexual dimorphic traits. The aim of this study was to identify the CHD genes from sexual chromosomes of birds (ZW) from various tissue samples. Feathers, oral swabs, blood and various tissues (by necropsy) were collected from four companion bird species (Gallus gallus domesticus, Melopsittacus undulatus, Psittacus erithacus, Ara ararauna). Feathers were processed mechanically using the Tissue Lyser II. DNA isolation was performed using the Isolate II Genomic DNA, Bioline kit. PCR was performed according to Griffiths et al. (1998) using P2/P8 primers. Chicken whose DNA sexing was identified based on phenotypic characters, was confirmed by PCR. Budgerigars whose DNA sexing identified a male and female have been confirmed based on necropsy results. African Grey Parrot whose sex was identified by DNA sexing as female was confirmed based on a genetic sexing previously performed. The Blue and Yellow Macaw, whose sex was determined as male by DNA sexing, was confirmed based on necropsy results. DNA concentration was higher in blood samples than in oral swabs or feathers. Blood collection is considered an invasive procedure in birds. For feather samples, mechanical denaturation before DNA extraction is recommended. Oral swab samples are suitable for isolating and amplifying DNA in birds.