Search

Nitrous oxide (N2O) is a greenhouse gas and stratospheric ozone-depleting substance with large and growing anthropogenic emissions. Previous studies identified the influx of N2O-depleted air from the stratosphere to partly cause the seasonality in tropospheric N2O (aN2O), but other contributions remain unclear. Here, we combine surface fluxes from eight land and four ocean models from phase 2 of the Nitrogen/N2O Model Intercomparison Project with tropospheric transport modeling to simulate aN2O at eight remote air sampling sites for modern and pre-industrial periods. Models show general agreement on the seasonal phasing of zonal-average N2O fluxes for most sites, but seasonal peak-to-peak amplitudes differ several-fold across models. The modeled seasonal amplitude of surface aN2O ranges from 0.25 to 0.80 ppb (interquartile ranges 21%–52% of median) for land, 0.14–0.25 ppb (17%–68%) for ocean, and 0.28–0.77 ppb (23%–52%) for combined flux contributions. The observed seasonal amplitude ranges from 0.34 to 1.08 ppb for these sites. The stratospheric contributions to aN2O, inferred by the difference between the surface-troposphere model and observations, show 16%–126% larger amplitudes and minima delayed by ∼1 month compared to Northern Hemisphere site observations. Land fluxes and their seasonal amplitude have increased since the pre-industrial era and are projected to grow further under anthropogenic activities. Our results demonstrate the increasing importance of land fluxes for aN2O seasonality. Considering the large model spread, in situ aN2O observations and atmospheric transport-chemistry models will provide opportunities for constraining terrestrial and oceanic biosphere models, critical for projecting carbon-nitrogen cycles under ongoing global warming.

European countries, in accordance with their higher education policy, regulate in various ways the need for additional professional education of higher education teachers. In the Republic of Croatia, despite the recognized need to improve the process of teaching and learning at the higher education level, efforts and activities in this direction are left to the universities. The main aim of the present study was to examine how the participants of the short course training program on approaches to teaching in higher education in Croatia perceived their own teaching and learning competencies before and after attending the program. University teachers from five higher education institutions in the Republic of Croatia participated in the research. The participants assessed agreement with the statements related to various teaching competencies, important for university teachers, on a 5-point Likert-type scale. The results obtained through research quantitative and qualitative methods indicate that the participants of the short course training program on approaches to teaching in higher education evaluate their own teaching competencies better at the end than at the beginning of the program. The obtained results indicate the importance of formal training and improvement of teaching competencies of university teachers and can serve as an assessment of the expediency of the short course training program on approaches to teaching in higher education at the national level and as a basis for comparison with programs implemented at other European universities.

A principal's conflict management strategies are indispensable in the attainment of the school's goals and objectives. Accordingly, this study was conducted to determine the conflict management styles used by principals in selected campuses of a private educational system which were assessed by 129 teacher-respondents using the adapted ROCI-II Form B. Majority of the teacher-respondents are 20-30 years old, college graduates, have rendered less than five (5) years in the institution, and without administrative load. Individual causes of conflicts were the most common conflicts experienced in the system. Regardless of age, educational attainment, or workload, the teacher-respondents' assessment on the principal's conflict management styles showed that the principals often used the different styles with Collaborating as the most used conflict management style. Results of the study showed that there is no significant difference in the assessment of the teacher-respondents on the principals' use of the Competing and Compromising style when grouped according to age. Also, irrespective of workload, the teacher-respondents have the same assessment on the principals' use of the different conflict management styles. However, the responses of the teacher-respondents on the principal's use of conflict management styles vary when grouped according to educational attainment and length of service. Though different conflict management styles were generally assessed as often used by principals, there is still a high frequency of occurrence of individual and managerial causes of conflicts experienced by both teachers and principals. To address this, a program for the enhancement of relevant skills in conflict management to manage conflicts at different levels or situations was submitted as an output of this study.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.To assess long-term risk of local tumor regrowth, we report updated organ preservation rate and oncologic outcomes of the OPRA trial (ClinicalTrials.gov identifier: NCT02008656). Patients with stage II/III rectal cancer were randomly assigned to receive induction chemotherapy followed by chemoradiation (INCT-CRT) or chemoradiation followed by consolidation chemotherapy (CRT-CNCT). Patients who achieved a complete or near-complete response after finishing treatment were offered watch-and-wait (WW). Total mesorectal excision (TME) was recommended for those who achieved an incomplete response. The primary end point was disease-free survival (DFS). The secondary end point was TME-free survival. In total, 324 patients were randomly assigned (INCT-CRT, n = 158; CRT-CNCT, n = 166). Median follow-up was 5.1 years. The 5-year DFS rates were 71% (95% CI, 64 to 79) and 69% (95% CI, 62 to 77) for INCT-CRT and CRT-CNCT, respectively (P = .68). TME-free survival was 39% (95% CI, 32 to 48) in the INCT-CRT group and 54% (95% CI, 46 to 62) in the CRT-CNCT group (P = .012). Of 81 patients with regrowth, 94% occurred within 2 years and 99% occurred within 3 years. DFS was similar for patients who underwent TME after restaging (64% [95% CI, 53 to 78]) and patients in WW who underwent TME after regrowth (64% [95% CI, 53 to 78]; P = .94). Updated analysis continues to show long-term organ preservation in half of the patients with rectal cancer treated with total neoadjuvant therapy. In patients who enter WW, most cases of tumor regrowth occur in the first 2 years.

In the United States (US), biosafety and biosecurity oversight of research on viruses is being reappraised. Safety in virology research is paramount and oversight frameworks should be reviewed periodically. Changes should be made with care, however, to avoid impeding science that is essential for rapidly reducing and responding to pandemic threats as well as addressing more common challenges caused by infectious diseases. Decades of research uniquely positioned the US to be able to respond to the COVID-19 crisis with astounding speed, delivering life-saving vaccines within a year of identifying the virus. We should embolden and empower this strength, which is a vital part of protecting the health, economy, and security of US citizens. Herein, we offer our perspectives on priorities for revised rules governing virology research in the US.

The current third-line (and beyond) treatment options for RAS-mutant metastatic colorectal cancer have yielded limited efficacy. At the time of study start, the combination of sotorasib, a KRAS (Kirsten rat sarcoma viral oncogene homolog)-G12C inhibitor, and panitumumab, an epidermal growth factor receptor (EGFR) inhibitor, was hypothesized to overcome treatment-induced resistance. This phase 1b substudy of the CodeBreaK 101 master protocol evaluated sotorasib plus panitumumab in patients with chemotherapy-refractory KRASG12C-mutated metastatic colorectal cancer. Here, we report the results in a dose-exploration cohort and a dose-expansion cohort. Patients received sotorasib (960 mg, once daily) plus panitumumab (6 mg kg-1, once every 2 weeks). The primary endpoints were safety and tolerability. Secondary endpoints included efficacy and pharmacokinetics. Exploratory biomarkers at baseline were assessed. Forty-eight patients (dose-exploration cohort, n = 8; dose-expansion cohort, n = 40) were treated. Treatment-related adverse events of any grade and grade ≥3 occurred in 45 (94%) and 13 (27%) patients, respectively. In the dose-expansion cohort, the confirmed objective response rate was 30.0% (95% confidence interval (CI) 16.6%, 46.5%). Median progression-free survival was 5.7 months (95% CI 4.2, 7.7 months). Median overall survival was 15.2 months (95% CI 12.5 months, not estimable). Prevalent genomic coalterations included APC (84%), TP53 (74%), SMAD4 (33%), PIK3CA (28%) and EGFR (26%). Sotorasib-panitumumab demonstrated acceptable safety with promising efficacy in chemotherapy-refractory KRASG12C-mutated metastatic colorectal cancer. ClinicalTrials.gov identifier: NCT04185883 .

INTRODUCTION: Activating RAS gene mutations occur in approximately 55% of patients with metastatic colorectal cancer (mCRC) and are associated with poorer clinical outcomes due to epidermal growth factor receptor (EGFR) blockade resistance. Combined EGFR and mitogen-activated protein kinase (MEK) inhibition may extend response to EGFR inhibition and overcome acquired resistance. This phase Ib/II dose escalation trial evaluated the safety and activity of dual inhibition with binimetinib (MEK1/2 inhibitor) and panitumumab (EGFR inhibitor [EGFRi]) in patients with RAS mutant or BRAF wild type (WT)/RAS WT mCRC. METHODS: Phase Ib dose escalation started with binimetinib 45 mg twice daily plus panitumumab 6 mg/kg administered every 2 weeks. In the phase II study, patients with measurable mCRC were enrolled into 4 groups based on previous anti-EGFR monoclonal antibody therapy and RAS mutational status. RESULTS: No patients in the phase Ib portion (n = 10) had a response; 70% of patients had stable disease. In the phase II portion (n = 43), overall response rate (ORR, confirmed) was 2.3% with one partial response in the RAS WT group, DCR was 30.2%, and median progression-free survival was 1.8 months (95%CI, 1.6-3.3). All patients experienced ≥1 adverse event, with the most common being diarrhea (71.7%), vomiting (52.8%), nausea (50.9%), fatigue (49.1%), dermatitis acneiform (43.4%), and rash (41.5%). Most patients required treatment interruption or dose reduction due to difficulties tolerating treatment. CONCLUSIONS: The combination of binimetinib and panitumumab had substantial toxicity and limited clinical activity for patients with mutant or WT RAS mCRC, independent of EGFRi treatment history (Trial registration: NCT01927341).

Abstract Background Health literacy(HL) is defined as the degree to which individuals have the capacity to obtain process and understand basic health information and services required for making appropriate health decisions. Effective interventions to improve older people’s HL have become increasingly important. The purpose of this study is to conduct a review of interventions aimed at enhancing the HL of older people. Methodology Relevant information was gathered from various databases including PubMed, Scopus, Cochrane Library, Science Direct, and Web of Science. Additionally, a manual search of related journals and Google Scholar, a search of the reference lists of selected articles, and a search of unpublished sources were also conducted up to 30 August 2024. Reporting quality assessment was performed using CONSORT: 2010, JBI Critical Appraisal Checklist for Quasi-Experimental Studies, and “Quality Assessment Criteria for Survey Research Reports”. Results A total of 21 articles were included in this study. The interventions conducted in high-income countries were found to be more effective compared to those conducted in middle and low-income countries. Furthermore, interventions carried out at the community level were more effective than those performed in nursing homes. Educational interventions were more effective than lifestyle modification interventions, and interventions carried out in a single dimension were more effective than multidimensional interventions. Additionally, interventions that utilized technology were found to be more effective. Conclusion Based on the findings, community-based interventions that encompass a one-dimensional approach, incorporating the use of technology and considering the duration of the intervention, are more recommended.

Corporate Social Responsibility (CSR) plays a vital role in fostering an empowered and sustainable society, particularly concerning environmental conservation efforts. This study explores the implementation of CSR communication through a multicultural lens by PT Kilang Pertamina Internasional Refinery Unit II Sungai Pakning, focusing on its "Permata Hijau Pesisir Gambut" program aimed at preserving the environment and protecting coastal areas. Employing a qualitative descriptive method, data were gathered through in-depth interviews, literature reviews, and document analysis. The Miles and Huberman data analysis model was utilized, which encompasses data collection, presentation, and simultaneous conclusion drawing, supported by source triangulation to ensure data validity. The findings indicate that PT Kilang Pertamina Internasional Refinery Unit II effectively adopts the triple bottom line approach of "planet, people, and profit" to attain sustainable development. By integrating multicultural principles, the CSR program aligns with community needs and cultural contexts along the peatland coast. A symmetrical CSR communication model was implemented, incorporating socialization, training, and direct assistance in collaboration with local groups, such as the Harapan Bersama Group, to establish the Mangrove Education Center Ecotourism. This approach exemplifies the effectiveness of culturally adaptive CSR strategies in promoting environmental sustainability. Keywords: CSR Communication, Multicultural, Sustainable Environment, Pertamina Abstrak Tanggung jawab sosial perusahaan (CSR) memainkan peran penting dalam membangun masyarakat yang berdaya dan berkelanjutan, terutama dalam upaya konservasi lingkungan. Penelitian ini mengeksplorasi pelaksanaan komunikasi CSR melalui pendekatan multikultural oleh PT Kilang Pertamina Internasional Refinery Unit II Sungai Pakning, dengan fokus pada program "Permata Hijau Pesisir Gambut" yang bertujuan untuk melestarikan lingkungan dan melindungi daerah pesisir. Menggunakan metode deskriptif kualitatif, data dikumpulkan melalui wawancara mendalam, tinjauan pustaka, dan analisis dokumen. Model analisis data Miles dan Huberman digunakan, yang mencakup pengumpulan data, presentasi, dan penarikan kesimpulan secara bersamaan, didukung oleh triangulasi sumber untuk memastikan validitas data. Temuan menunjukkan bahwa PT Kilang Pertamina Internasional Refinery Unit II berhasil mengadopsi pendekatan triple bottom line "planet, people, dan profit" untuk mencapai pembangunan berkelanjutan. Dengan mengintegrasikan prinsip-prinsip multikultural, program CSR ini selaras dengan kebutuhan komunitas dan konteks budaya di sepanjang pesisir lahan gambut. Model komunikasi CSR yang simetris diterapkan, mencakup sosialisasi, pelatihan, dan bantuan langsung bekerja sama dengan kelompok lokal, seperti Harapan Bersama Group, untuk mendirikan Ecotourism Pusat Pendidikan Mangrove. Pendekatan ini menunjukkan efektivitas strategi CSR yang adaptif secara budaya dalam mempromosikan keberlanjutan lingkungan. Kata Kunci: Komunikasi CSR, Lingkungan Berkelanjutan, Pertamina

Abstract Background Antibiotic resistant infections cause over 700,000 deaths worldwide annually. As antimicrobial stewardship (AMS) helps minimise the emergence of antibiotic resistance resulting from inappropriate use of antibiotics in healthcare, we developed ePAMS+ (ePrescribing-based Anti-Microbial Stewardship), an ePrescribing and Medicines Administration (EPMA) system decision-support tool complemented by educational, behavioural and organisational elements. Methods We conducted a non-randomised before-and-after feasibility trial, implementing ePAMS+ in two English hospitals using the Cerner Millennium EPMA system. Wards of several specialties were included. Patient participants were blinded to whether ePAMS+ was in use; prescribers were not. A mixed-methods evaluation aimed to establish: acceptability and usability of ePAMS+ and trial processes; feasibility of ePAMS+ implementation and quantitative outcome recording; and a Fidelity Index measuring the extent to which ePAMS+ was delivered as intended. Longitudinal semi-structured interviews of doctors, nurses and pharmacists, alongside non-participant observations, gathered qualitative data; we extracted quantitative prescribing data from the EPMA system. Normal linear modelling of the defined daily dose (DDD) of antibiotic per admission quantified its variability, to inform sample size calculations for a future trial of ePAMS+ effectiveness. Results The research took place during the SARS-CoV-2 pandemic, from April 2021 to November 2022. 60 qualitative interviews were conducted (33 before ePAMS+ implementation, 27 after). 1,958 admissions (1,358 before ePAMS+ implementation; 600 after) included 24,884 antibiotic orders. Qualitative interviews confirmed that some aspects of ePAMS+ , its implementation and training were acceptable, while other features (e.g. enabling combinations of antibiotics to be prescribed) required further development. ePAMS+ uptake was low (28 antibiotic review records from 600 admissions; 0.047 records per admission), preventing full development of a Fidelity Index. Normal linear modelling of antibiotic DDD per admission showed a residual variance of 1.086 (log-transformed scale). Unavailability of indication data prevented measurement of some outcomes (e.g. number of antibiotic courses per indication). Conclusions This feasibility trial encountered unforeseen circumstances due to contextual factors and a global pandemic, highlighting the need for careful adaptation of complex intervention implementations to the local setting. We identified key refinements to ePAMS+ to support its wider adoption in clinical practice, requiring further piloting before a confirmatory effectiveness trial. Trial registration ISRCTN Registry ISRCTN13429325, 24 March 2022.

Abstract Examining a large number of specific college majors and their association with mental health literacy (MHL) is an important step towards identifying at-risk groups at the college level. Though prior research has investigated MHL across student demographics such as gender, age, ethnicity, and level of education, the present study was the first to compare the MHL of undergraduate students across 19 different college majors. A total of 617 demographically and ethnically diverse undergraduate students (62.1% female; 69.3% non-white; mean age = 22.2 years; mean year in college = 2.8) reported their demographics, college experience, and college major, and completed an MHL measure that assessed knowledge of more than 20 psychological disorders and the application of that knowledge to real life scenarios. After controlling for gender, data were analyzed using ANOVA and post hoc comparisons to determine if differences in mental health literacy level were related to specific college majors. Results revealed that mental health literacy significantly differed across majors, F(18, 598) = 5.09, p

Abstract Monitoring yellow fever in non-human primates (NHPs) is an early warning system for sylvatic yellow fever outbreaks, aiding in preventing human cases. However, current diagnostic tests for this disease, primarily relying on RT-qPCR, are complex and costly. Therefore, there is a critical need for simpler and more cost-effective methods to detect yellow fever virus (YFV) infection in NHPs, enabling early identification of viral circulation. In this study, an RT-LAMP assay for detecting YFV in NHP samples was developed and validated. Two sets of RT-LAMP primers targeting the YFV NS5 and E genes were designed and tested together with a third primer set to the NS1 locus using NHP tissue samples from Southern Brazil. The results were visualized by colorimetry and compared to the RT-qPCR test. Standardization and validation of the RT-LAMP assay demonstrated 100% sensitivity and specificity compared to RT-qPCR, with a detection limit of 12 PFU/mL. Additionally, the cross-reactivity test with other flaviviruses confirmed a specificity of 100%. Our newly developed RT-LAMP diagnostic test for YFV in NHP samples will significantly contribute to yellow fever monitoring efforts, providing a simpler and more accessible method for viral early detection. This advancement holds promise for enhancing surveillance and ultimately preventing the spread of yellow fever.

Abstract Fruit, as a source of antioxidants and phenolic compounds, is perishable. It also has an underutilized component. Fruit leather has a long shelf life in the form of thin sheets with a distinctive texture. This study aimed to investigate the effect of seaweed (Eucheuma cottonii) addition on the physicochemical and sensory quality of fruit leather made from the combination of red dragon fruit and watermelon rind. The physicochemical quality was characterized by measuring the critical quality parameters of fruit leathers, including proximate analysis, water activity, total phenol, antioxidant activity, texture, and organoleptic analysis. The statistical analysis of phenolic compound activity, antioxidant activity, vitamin C, moisture content, carbohydrates, and water activity (aw) was conducted using a one-way ANOVA test, while the analysis of ash content, protein, fat, tensile strength, elongation, and organoleptic properties was performed using the Kruskal–Wallis test. Increasing seaweed concentration significantly increased moisture, ash, protein, vitamin C, total phenol, water activity, and elongation but decreased fat content. Furthermore, the increase in seaweed concentration reduced liking toward taste and color significantly but increased texture liking. The best product was the F2 product with 10% seaweed. F2 has the following attributes: 11.07% of moisture content, 2.34% of ash, 1.53% of protein, 0.19% of fat, 84.86% of carbohydrate, 8.17 mg/100 g of vitamin C, 0.41 of water activity, 0.54 N/m2 of tensile strength, 22.22% of elongation, 107.39 ppm of IC50, 1.66 mg/GAE g of total phenolics.

Abstract Background Deprescribing has been defined as the planned process of reducing or stopping medications that may no longer be beneficial or are causing harm, with the goal of reducing medication burden while improving patient quality of life. At present, little is known about the specific challenges of decision-making to support deprescribing for patients who are accessing palliative care. By exploring the perspectives of healthcare professionals, this qualitative study aimed to address this gap, and explore the challenges of, and potential solutions to, making decisions about deprescribing in a palliative care context. Methods Semi-structured interviews were conducted with healthcare professionals in-person or via video call, between August 2022 – January 2023. Perspectives on approaches to deprescribing in palliative care; when and how they might deprescribe; and the role of carers and family members within this process were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the NHS Health Research Authority (ref 305394). Results Twenty healthcare professionals were interviewed, including: medical consultants, nurses, specialist pharmacists, and general practitioners (GPs). Participants described the importance of deprescribing decision-making, and that it should be a considered, proactive, and planned process. Three themes were developed from the data, which centred on: (1) professional attitudes, competency and responsibility towards deprescribing; (2) changing the culture of deprescribing; and (3) involving the patient and family/caregivers in deprescribing decision-making. Conclusions This study sought to explore the perspectives of healthcare professionals with responsibility for making deprescribing decisions with people accessing palliative care services. A range of healthcare professionals identified the importance of supporting decision-making in deprescribing, so it becomes a proactive process within a patient’s care journey, rather than a reactive consequence. Future work should explore how healthcare professionals, patients and their family can be supported in the shared decision-making processes of deprescribing. Trial registration Ethical approval was obtained from the NHS Health Research Authority (ref 305394).

Student-reported quality and coverage of school-based relationships and sex education (RSE) vary, with gender/sexual-minority and disadvantaged students reporting poorer provision. Experience of RSE among younger adolescents is under-explored. We examined student-reported RSE coverage and priorities and how coverage, and sexual-health knowledge and awareness of services, varies between students and schools. The data came from a pre-intervention survey of students aged 12-13 years within a trial of an RSE intervention involving 50 English schools. There was most coverage of basic information, such as puberty and safeguarding. There was least coverage of topics more appropriate for older students, such as sexual relationships, and topics teachers might find difficult to broach, e.g. pornography and masturbation. Girls, gay/lesbian students, students of bisexual/other sexual orientation, minority-ethnic students and students reporting lower academic commitment reported lower coverage than others. Knowledge of RSE-related topics and sexual-health services was generally low. Boys, students of bisexual/other orientation and students with higher school commitment had higher knowledge. Students of bisexual/other orientation and students of lower commitment reported lower awareness of services. Coverage and knowledge did not vary with school-level attainment or local deprivation. Future forms of RSE provision should ensure content and teaching methods meet the needs of all students.

Education has long been recognized as the key to the survival -- not only of the individual -- but of society as a whole. A number of challenges emerged and one is required to master certain new knowledges and skills. The key role in training an individual to be able to readily tackle the challenges of the 21st century is one played by the education system, i.e. teachers. The importance and necessity of teacher training has been recognized in numerous European and Croatian documents and in recommendations based on various scientific research. The aims of this paper are to single out the key teachers' competencies and to analyse the learning outcomes of lifelong learning programmes that focus on acquisition of pedagogical competencies in the Republic of Croatia with both qualitative and quantitative research method. The conducted analysis showed that no programme with its compulsory part ensures the acquisition of the necessary key teachers' competencies but also seeks to provide them with the elective part of the programme. This means that acquisition of key pedagogical competencies is left to the volition of students who may or may not enrol in certain elective courses. The obtained results indicate there is a need to design and prescribe a single programme at the national level, one that would be certain to ensure that all the teachers acquire key pedagogical competencies through the completion of the programme.

Abstract Background Chronic pain often clusters in families, where parents and their offspring both experience chronic pain conditions. Young children of parents with irritable bowel syndrome (IBS) represent an at-risk group for the development of abdominal pain, disability, and excess health care visits in later childhood. Parental solicitous responses to children’s expressions of discomfort and maternal modeling of their own illness behavior contribute to a greater focus on somatic sensations, leading to illness behaviors in children. This randomized controlled trial will test the effectiveness of an early preventive web-based psychosocial intervention (REACH)[TM] vs. an educational web-based safety comparison condition delivered to parents with IBS to alter parental responses and lead to improved child health and decreased health care costs. Methods Parents with IBS who have children ages 4–7 years are recruited via community-based approaches (e.g., social media advertisements, school electronic distribution, research networks) and health care providers. The target sample is 460 parents randomized to REACH, a web-based social learning and cognitive behavior therapy (SLCBT) intervention or an educational web-based safety comparison condition (EC). Participants will be assessed at baseline, 6-week (immediate post-intervention), 6-month, 12-month, and 18-month follow-up periods (months post-completion of intervention). The primary outcome is change in parental solicitous/protective behaviors. Secondary outcomes include parent risk and protective factors, child health and symptom outcomes, and health care utilization and cost savings. Discussion This study adapts a validated, parent-delivered intervention to treat chronic pain in children to a web-based application designed to prevent the development of chronic pain in very young, high-risk children. If successful, this strategy can both prevent adverse sequelae of this condition from developing as well as be widely accessible. Furthermore, the availability of a prevention model for parent training could result in significant short- and long-term health benefits across a broad spectrum of conditions. Trial registration ClinicalTrials.gov NCT05730491. Registered on February 15, 2023.

Abstract Metallic implants are integral in modern medicine, offering excellent biocompatibility and mechanical properties. However, implant-related infections pose a major challenge. Current drug delivery methods, such as surface-coated and drug-eluting implants, are limited by finite drug supplies and complex manufacturing steps. Recent approaches like local drug synthesis, including enzyme-prodrug therapies, present innovative solutions but are hampered by the inherent limitations of enzymes as well as complex procedures. Here, we introduce a simpler alternative: using the intrinsic properties of implant materials to activate prodrugs. Through a simple thermal treatment, metallic implants gain catalytic properties to locally generate nitric oxide, an antibacterial agent. Our findings show this treatment is non-toxic to cells, does not affect cell proliferation rates, and effectively inhibits bacterial biofilm formation. This material-driven approach eliminates the need for external chemical or enzymatic interventions, offering a promising solution to prevent implant-related infections and improve patient outcomes in implant medicine.