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Seung Hoon Lee,1,* Hyung-Jin Kim,1,* Gi-Su Oh,1 Su-Bin Lee,1 Dipendra Khadka,1 Wal Cao,1 Seong-Kyu Choe,1 Hyeok Shim,2 Chang-Deok Kim,3 Tae Hwan Kwak,4 Hong-Seob So1,4 1Department of Microbiology, Wonkwang University School of Medicine, Iksan, Jeonbuk, 54538, Republic of Korea; 2Department of Hemato-Oncology, Wonkwang University School of Medicine, Iksan, Jeonbuk, 54538, Republic of Korea; 3Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, 34134, Republic of Korea; 4R&D Center, NADIANBIO Ltd, Iksan, Jeonbuk, 54538, Republic of Korea*These authors contributed equally to this workCorrespondence: Hong-Seob So, Department of Microbiology, Wonkwang University School of Medicine, 460 Iksan-Daero, Iksan, Jeonbuk, 54538, Republic of Korea, Tel +82-63-850-6950, Fax +82-63-855-6777, Email jeanso@wku.ac.krBackground: Dunnione has anti-inflammatory properties arising from its ability to alter the ratio of NAD+/NADH through NAD(P)H quinone oxidoreductase 1 (NQO1) enzymatic action, followed by subsequent inhibition of NF-κB and inflammatory cytokines. Psoriasis is a chronic, inflammatory skin disorder in which the IL-23/Th17 axis plays an important role in inflammation. However, it is unclear whether modulation of NAD+ levels affects psoriasis, such as skin inflammation. Therefore, in this study, we investigated the effect of NAD+/NADH ratio modulation on imiquimod (IMQ)-induced, psoriasis-like skin inflammation in mice.Methods: Psoriasis-like skin inflammation was generated by daily topical application of IMQ cream. The severity of dermatitis was assessed using the Psoriasis Area Severity Index (PASI) and histochemistry. Expression of inflammatory cytokines was detected by enzyme-linked immunosorbent assay and quantitative PCR. Acetylation of NF-κB p65 and STAT3 was determined by Western blotting.Results: Dunnione improved IMQ-induced epidermal hyperplasia and inflammation, consistent with decreased levels of inflammatory cytokines (IL-17, IL-22, and IL-23) in skin lesions. Moreover, we found that an increase in the NAD+/NADH ratio by dunnione restored SIRT1 activity, thereby reduced imiquimod-induced STAT3 acetylation, which modulates the expression of psoriasis-promoting inflammatory cytokines, such as IL-17, IL-22, and IL-23.Conclusion: Pharmacological modulation of cellular NAD+ levels could be a promising therapeutic approach for psoriasis-like skin disease.Keywords: psoriasis, NQO1, NAD+, SIRT1, inflammatory cytokine

Weakly interacting massive particles (WIMPs) may interact with a virtual pion that is exchanged between nucleons. This interaction channel is important to consider in models where the spin-independent isoscalar channel is suppressed. Using data from the first science run of the LUX-ZEPLIN dark matter experiment, containing 60 live days of data in a 5.5 tonne fiducial mass of liquid xenon, we report the results on a search for WIMP-pion interactions. We observe no significant excess and set an upper limit of 1.5 × 10−46 cm2 at a 90% confidence level for a WIMP mass of 33 GeV/c2 for this interaction.

The density of wood is a key indicator of the carbon investment strategies of trees, impacting productivity and carbon storage. Despite its importance, the global variation in wood density and its environmental controls remain poorly understood, preventing accurate predictions of global forest carbon stocks. Here we analyse information from 1.1 million forest inventory plots alongside wood density data from 10,703 tree species to create a spatially explicit understanding of the global wood density distribution and its drivers. Our findings reveal a pronounced latitudinal gradient, with wood in tropical forests being up to 30% denser than that in boreal forests. In both angiosperms and gymnosperms, hydrothermal conditions represented by annual mean temperature and soil moisture emerged as the primary factors influencing the variation in wood density globally. This indicates similar environmental filters and evolutionary adaptations among distinct plant groups, underscoring the essential role of abiotic factors in determining wood density in forest ecosystems. Additionally, our study highlights the prominent role of disturbance, such as human modification and fire risk, in influencing wood density at more local scales. Factoring in the spatial variation of wood density notably changes the estimates of forest carbon stocks, leading to differences of up to 21% within biomes. Therefore, our research contributes to a deeper understanding of terrestrial biomass distribution and how environmental changes and disturbances impact forest ecosystems.

Context: The rice-wheat (RW) system, spanning 13.5 million hectares in South Asia, is crucial for food security and livelihoods. However, intensive conventional tillage-based practices have harmed soil and environmental health, decreased productivity trends and increased greenhouse gas emissions. Objective: This study aims to develop resilient, climate-smart cropping systems within the RW system, focusing on soil and crop productivity, economic viability, and reduced greenhouse gas (GHG) emissions. Methods: Over eight years, the study evaluated diverse parameters compared to farmer practices (FP) in seven scenarios (Sc), including one representing FP (Sc1) and six based on conservation agriculture (CA) principles. The study assessed system crop productivity, economic returns, soil quality (organic carbon; OC, nitrogen; N, phosphorus; P, potassium; K contents, bulk density; BD, soil aggregation, infiltration rates, microbial counts, and earthworm density), and GHG emissions. Results: CA-based scenarios (Sc2 to Sc7) showed improved soil quality, lower bulk density, enhanced soil aggregation, and increased infiltration rates compared to Sc1. In the 0–15 cm layer, surface soil organic carbon (OC) and C stock were 63.7 % and 49.6 % higher, respectively, in CA-based scenarios. Additionally, available N, P and K contents in the surface layer increased by 10.2 %, 28.6 %, and 21.8 % under CA-based scenarios. Adoption of CA in intensified maize-based scenarios (Sc4 and Sc5) led to the increased system and economic yields, higher soil quality index (SQI), reduced GHG emissions and increased C stock compared to Sc1. Implications: The study highlights that Conservation Agriculture (CA) practices and diversified crop rotations can address issues like falling crop productivity, reduced economic returns, soil degradation, and increasing environmental impacts in northwestern India's traditional rice-wheat system. However, widespread adoption requires government policies, including C credit payments and guaranteed markets with supportive pricing.

Transformative change is needed to align common small‐scale ecological restoration approaches with expectations to restore millions of hectares of degraded lands globally. Currently, most restoration projects target small areas using costly manual methods that cannot be scaled up to meet global commitments. We propose that a judicious integration of agricultural practices into ecological restoration offers an opportunity to address this issue. This transformative process relies on three sequential and interconnected steps: (1) ensure that sufficient land is truly available for restoration; (2) compensate for the loss of agricultural production, income, or land value to encourage landholders to opt for restoration; and (3) develop scalable, affordable, and effective methods for restoring native ecosystems across the pledged hundreds of millions of hectares to deliver benefits to both nature and people. Large‐scale terrestrial restoration will require incorporating agronomic practices into the restoration toolbox to go beyond vague, ambitious promises and wishful thinking.

Applied nucleation and other spatially patterned restoration methods are promising approaches for scaling up projects to meet ambitious international restoration commitments in an ecologically and economically sound manner. Much of the corresponding literature to date, however, has centered around theoretical discussions and small‐scale studies that are largely divorced from constraints faced by restoration practitioners. We briefly review recent academic literature about applied nucleation and other spatially patterned restoration methods and discuss practical challenges to their implementation. We offer several recommendations to move spatially patterned restoration from an academic conversation to scalable application, including: (1) comparing different planting designs and natural regeneration within the same system at an appropriate scale; (2) monitoring ecological outcomes throughout the restored area over sufficient time to evaluate recovery; (3) quantifying costs and documenting other logistical constraints to implementation; and (4) exploring methods for using unplanted areas to provide benefits to landholders until planted vegetation establishes.

Aim: Ecological and anthropogenic factors shift the abundances of dominant and rare tree species within local forest communities, thus affecting species composition and ecosystem functioning. To inform forest and conservation management it is important to understand the drivers of dominance and rarity in local tree communities. We answer the following research questions: (1) What are the patterns of dominance and rarity in tree communities? (2) Which ecological and anthropogenic factors predict these patterns? And (3) what is the extinction risk of locally dominant and rare tree species?. Location: Global. Time period: 1990–2017. Major taxa studied: Trees. Methods: We used 1.2 million forest plots and quantified local tree dominance as the relative plot basal area of the single most dominant species and local rarity as the percentage of species that contribute together to the least 10% of plot basal area. We mapped global community dominance and rarity using machine learning models and evaluated the ecological and anthropogenic predictors with linear models. Extinction risk, for example threatened status, of geographically widespread dominant and rare species was evaluated. Results: Community dominance and rarity show contrasting latitudinal trends, with boreal forests having high levels of dominance and tropical forests having high levels of rarity. Increasing annual precipitation reduces community dominance, probably because precipitation is related to an increase in tree density and richness. Additionally, stand age is positively related to community dominance, due to stem diameter increase of the most dominant species. Surprisingly, we find that locally dominant and rare species, which are geographically widespread in our data, have an equally high rate of elevated extinction due to declining populations through large-scale land degradation. Main conclusions: By linking patterns and predictors of community dominance and rarity to extinction risk, our results suggest that also widespread species should be considered in large-scale management and conservation practices.

Machine learning has been found to be ubiquitously useful across many industries, presenting an opportunity to improve radiation detection performance using data-driven algorithms. Improved detector resolution can aid in the detection, identification, and quantification of radionuclides. In this work, a novel, data-driven, unsupervised learning approach is developed to improve detector spectral characteristics by learning, and subsequently rejecting, poorly performing regions of the pixelated detector. Feature engineering is used to fit individual characteristic photo peaks to a Doniach lineshape with a linear background model. Then, principal component analysis is used to learn a lower-dimension latent space representation of each photo peak where the pixels are clustered, and subsequently ranked, based on the cluster mean distance to an optimal point. Pixels within the worst cluster(s) are rejected to improve the full-width at half-maximum (FWHM) by 10% to 15% (relative to the bulk detector) at 50% net efficiency when applied to training data obtained from measurements of a 100 μCi 154Eu source using a H3D M400i pixelated cadmium zinc telluride detector. These results compare well with, but do not outperform, a greedy algorithm that accumulates pixels in order of FWHM from lowest to highest used as a benchmark. In the future, this approach can be extended to include the detector energy and angular response. Finally, the model is applied to newly seen natural and enriched uranium spectra relevant for nuclear safeguards applications.

Awatif M Alrasheeday,1 Hasna Sumir Alshammari,2,3 Bushra Alshammari,4 Sameer A Alkubati,4,5 Jordan H Llego,4,6 Azizah Dhaher Alshammari,7 Matar Hamed Alshammari,7 Ruqayyah Abdullah Almohammed,7 Saad Mohammed saad Alsheeb,7 Farhan Alshammari8 1Nursing Administration Department, College of Nursing, University of Hail, Hail, Saudi Arabia; 2Department of Community Health Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia; 3Family Medicine Academy, Hail Health cluster, Hail, Saudi Arabia; 4Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail, 2440, Saudi Arabia; 5Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen; 6College of Nursing, University of Luzon, Dagupan City, Philippines; 7Emergency Department, King Salman Specialist Hospital, Hail Health Cluster, Hail, Saudi Arabia; 8Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi ArabiaCorrespondence: Bushra Alshammari; Sameer A Alkubati, Email Bu.alsahmmari@uoh.edu.sa; s.alkubati@uoh.edu.saBackground: Many patients with type 2 diabetes mellitus (T2DM) face barriers to maintain a healthy lifestyle. This study investigated the perceived barriers to healthy eating and physical activity and compared them by demographic and diabetes-related characteristics among patients with T2DM.Methods: A cross-sectional study was conducted among 534 patients with T2DM attending primary healthcare centers in Hail City from January to June 2023. Data analyzed at a significance level of < 0.05.Results: Barriers to healthy eating and physical activity were perceived by 34.9% and 28% of patients, re-spectively. Personal and environmental barriers to healthy eating were perceived more frequently than social barriers (43.0% and 26.9%, respectively). Personal and environmental barriers to physical activity were perceived by 28.0% of patients, followed by social barriers (27.9%). The most frequently perceived barrier to healthy eating was a lack of motivation (61.6%), followed by insufficient information about healthy diets (32.2%). Regarding physical activity, a lack of motivation was the most frequently perceived personal barrier (32.0%), while a lack of a supportive work environment was the most frequently perceived social barrier (33.7%). Patients who were aged between 30 and 40 years, were highly educated, were diagnosed with DM within less than five years, and used insulin injections as a strategy to manage DM reported significantly higher levels of perceived barriers to healthy eating compared to their counterparts. In contrast, patients who were female, married, had poor financial status, and used insulin injections reported significantly higher levels of perceived barriers to physical activity compared to their counterparts.Conclusion: Over one-third of patients with T2DM seeking medical care in Hail City perceive barriers to healthy eating, mainly a lack of motivation, insufficient diet information. Educational programs that consider the unique characteristics of patients should be developed.Keywords: Healthy lifestyle, healthy eating, physical activity, barrier, adherence, type 2 diabetes mellitus, Saudi Arabia

To overcome the drawbacks of a single-stage evaporative cooler, an indirect-direct type evaporative cooler was proposed and fabricated. An alternative arrangement of mild steel plates wherein unmixed heat transfer occurs between air and water to form an indirect evaporative cooler. This is followed by a packing arrangement made of biomass-based coconut coir that forms a direct evaporative cooler. Experiments were conducted by varying the air and water flow rates, and the performance of the coconut coir was compared with that of a commercially available celdek packing. Experimental results indicated that a combination of an indirect-direct evaporative cooler helped cool air without an appreciable increase in air-specific humidity. The performance of the coconut coir is slightly lower than that of the Celdek coir in terms of the drop in DBT and wet-bulb effectiveness. A maximum wet bulb effectiveness of 0.78 and 0.63 was achieved for the celdek and coconut coir packings, respectively. The maximum performance was attained at an air velocity of 6 m/s and a water flow rate of 3 LPM. Owing to the different advantages of coconut coir over celdek packings, it is recommended to use coconut coir as an alternative packing in indirect-direct evaporative coolers.

Gitishree Das,1 Han-Seung Shin,2 Kyung-Jik Lim,2 Jayanta Kumar Patra1 1Research Institute of Integrative Life Sciences, Dongguk University-Seoul, Goyangsi, Republic of Korea; 2Department of Food Science & Biotechnology, Dongguk University-Seoul, Goyangsi, Republic of KoreaCorrespondence: Jayanta Kumar Patra, Research Institute of Integrative Life Sciences, Dongguk University-Seoul, Goyangsi, 10326, Republic of Korea, Email jkpatra@dongguk.eduBackground: Bio-based synthesis of metallic nanoparticles has garnered much attention in recent times owing to their non-toxic, environmentally friendly, and cost-effective nature.Methods: In this study, gold nanoparticles (S4-GoNPs) were synthesized by a simple and environmentally friendly technique using an aqueous extract of jamun leaves (JLE) as an effective capping, stabilizer, and reducing agent. JLE was screened for the presence of phytochemicals followed by synthesis, characterization, and evaluation of their antibacterial, antidiabetic, antioxidant, and photocatalytic degradation potentials using standard established procedures.Results: The phytochemical profile of JLE was found to be rich in flavonoids, tannins, terpenoid phenols, anthraquinones, and cardiac glycosides. Its GC-MS analysis revealed the presence of compounds majorly of them as the (1R)-2,6,6-Trimethylbicyclo[3.1.1]hept-2-ene (5.141%), 2(10)-pinene (4.119%), α-cyclopene (5.274%) α,α-muurolene (7.525%), naphthalene, 1,2,3,4,4a,5,6,8a-octahydro-7-methyl-4-methylene-1-(1-methylethyl)-(1.alpha.,4a.beta.,8a.alpha) (8.470%), delta-cadinene (23.246), α-guajene (3.451%), and gamma-muurolene (4.379%). The visual morphology and UV–Vis spectral surface plasmon resonance at 538 nm confirmed the successful synthesis of S4-GoNPs. The average particle size was determined as 120.5 nm with Pdi = 0.152, and − 27.6 mV zeta potential. Using the Scherrer equation, the average crystallite size was calculated as 35.69 nm. S4-GoNPs displayed significant antidiabetic properties, with 40.67% of α-amylase and 91.33% of α-glucosidase inhibition activity. It also exhibited promising antioxidant potential in terms of the DPPH (91.56%) ABTS (76.59%) scavenging. It displayed 31.04% tyrosinase inhibition at 0.1 mg/mL. Moreover, it also demonstrated encouraging antibacterial effects with zones of inhibition ranging from 11.02 – 14.12 mm as compared to 10.55– 16.24 mm by the reference streptomycin (at 0.01 mg/disc). In addition, S4-GoNPs also showed potential for the photocatalytic degradation of the industrial dye, methylene blue.Conclusion: In conclusion, these results suggest the promising applicability of green-synthesized S4-GoNPs in various sectors, including the biomedical, cosmetic, food, and environmental waste management industries.Keywords: gold nanoparticles, antidiabetic, antioxidant, antibacterial, tyrosinase inhibition

Abdirazak Ahmed Adan,1 Mohamed Abdullahi Awale,1 Hassan Salad Ibrahim,2 Mohamed Abdullahi Omar,1 Ahmed Abdi Hassan,1 Abdikadir Muhumed Jinow,1 Faiza Ibrahim Mohamud1 1Faculty of Medicine and Surgery, Somali National University, Mogadishu, Somalia; 2Orthopedic Department, Mogadishu Somalia Turkey Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Abdirazak Ahmed Adan, Email raazik.adammd@gmail.comPurpose: This study aims to determine the frequency of hip fractures and associated risk factors among patients receiving care at the Somalia Turkish Training and Research Hospital in Mogadishu.Patients and Methods: A retrospective study of patients treated at the Somalia Turkish Training and Research Hospital in Mogadishu was carried out. 96 of the 108 patients who were admitted met the inclusion criteria. Analyzing the medical records of individuals diagnosed with hip fractures between January and December 2023 allowed for the collection of data on demographics, hip fracture type, and medical history and also conducted follow-ups to identify other potential contributing factors that may not be available in medical records. The main conclusions have been established using descriptive statistical analysis.Results: About 8.67% of all fracture cases were hip fractures, Elderly people (60+) represented the largest group at 64.6%, followed by younger people (17– 39) and Middle-aged people (40– 59) at 15.6%, and children (3– 16) at 4.2%. Females comprised 56.3% of cases, while males made up 43.8%. Most patients (78.1%) had low physical activity. Falls were the primary cause of fractures (83.3%), followed by other traumas (13.5%), and pathological fractures (7.3%). 32.3% of patients had comorbidities, 8.3% had a family history, and 22.9% had prior fractures. The most prevalent hip fractures (81.3%) were those of the femur neck, followed by subtrochanteric and intertrochanteric fractures (10.4% and 8.3%, respectively).Conclusion: This study emphasizes the frequency of hip fractures in Mogadishu, Somalia, as well as the significance of fall prevention, age, gender, and comorbidity treatment. We suggest comprehensive risk assessments, gender-specific bone health programs, fall prevention programs, focused prevention for the elderly, and public education campaigns to reduce the burden of hip fractures and encourage healthier people in our community by putting these measures into practice.Keywords: hip, fracture, demographics, prevalence, risk factors, falls

Wonnam Kim,1,&ast; Yeon-Cheol Park,2,3,&ast; Bonhyuk Goo,2 Jung-Hyun Kim,2 Dongwoo Nam,3,4 Eunseok Kim,5,6 Hyun-Jong Lee,7 Dong-Hyun Pyun,8,9 Hae Sun Suh,8– 10 Yoonsung Lee,11 Man S Kim,11 Byung-Kwan Seo,2,3 Yong-Hyeon Baek2,3 1Division of Pharmacology, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea; 2Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; 3Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea; 4Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; 5Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea; 6Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea; 7Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea; 8Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea; 9Institute of Regulatory Innovation Through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea; 10College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea; 11Clinical Research Institute, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Yong-Hyeon Baek, Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea, Tel +82 2 440 6099, Fax +82 2 440 714, Email byhacu@khu.ac.krPurpose: Knee osteoarthritis (KOA) is one of the most prevalent degenerative joint diseases worldwide. The herbal decoction, Dokhwalgisaeng-tang (DHGST), has been commonly used in East Asia to treat osteoarthritis. However, there is insufficient evidence to draw clear conclusions concerning its effectiveness and safety for patients with KOA. We aim to determine the efficacy, safety, and economic feasibility of DHGST compared with Celecoxib, an oral COX-2 inhibitor, for patients with degenerative KOA.Trial Design and Methods: This multicenter, randomized, noninferiority trial, involving 160 participants who will be randomized using block randomization with 1:1 allocation, will compare DHGST and Celecoxib. The total trial period is 24 weeks after random allocation, comprising 12 weeks of treatment and 12 weeks of follow-up. Participants with KOA will be administered 200 mg of DHGST (treatment group) or Celecoxib capsules (control group) for 12 weeks. Efficacy and safety evaluations will be conducted at weeks 0, 4, 8, and 12, and 24. The primary outcome measurement is the Korean Western Ontario McMaster score at week 12. Changes in pain intensity using a 100 mm visual analog scale, changes in quality of life using a EuroQol 5-dimension 5-level self-report survey, and patient satisfaction will also be measured to evaluate effectiveness between the two groups. A trial-based economic feasibility evaluation will be conducted to analyze treatment cost-effectiveness from societal and healthcare system perspectives. Drug safety will be assessed through adverse reactions and laboratory test findings.Discussion: This trial protocol has the following limitations. Applying a double-dummy design is not possible, as the tablet and granule forms can easily be distinguished visually, and achieving participant blinding is challenging. The trial findings are intended to inform participants, physicians, and other stakeholders in determining whether DHGST could be used as an alternative therapeutic option for KOA.Trial Registration Number: KCT0008424 (Clinical Research Information Service of the Republic of Korea), registered on 12 May 2023.Keywords: degenerative joint disease, Dokhwalgisaeng-tang, noninferiority trial, randomized controlled trial

Forests are a substantial terrestrial carbon sink, but anthropogenic changes in land use and climate have considerably reduced the scale of this system1. Remote-sensing estimates to quantify carbon losses from global forests2-5 are characterized by considerable uncertainty and we lack a comprehensive ground-sourced evaluation to benchmark these estimates. Here we combine several ground-sourced6 and satellite-derived approaches2,7,8 to evaluate the scale of the global forest carbon potential outside agricultural and urban lands. Despite regional variation, the predictions demonstrated remarkable consistency at a global scale, with only a 12% difference between the ground-sourced and satellite-derived estimates. At present, global forest carbon storage is markedly under the natural potential, with a total deficit of 226 Gt (model range = 151-363 Gt) in areas with low human footprint. Most (61%, 139 Gt C) of this potential is in areas with existing forests, in which ecosystem protection can allow forests to recover to maturity. The remaining 39% (87 Gt C) of potential lies in regions in which forests have been removed or fragmented. Although forests cannot be a substitute for emissions reductions, our results support the idea2,3,9 that the conservation, restoration and sustainable management of diverse forests offer valuable contributions to meeting global climate and biodiversity targets.

Understanding what controls global leaf type variation in trees is crucial for comprehending their role in terrestrial ecosystems, including carbon, water and nutrient dynamics. Yet our understanding of the factors influencing forest leaf types remains incomplete, leaving us uncertain about the global proportions of needle-leaved, broadleaved, evergreen and deciduous trees. To address these gaps, we conducted a global, ground-sourced assessment of forest leaf-type variation by integrating forest inventory data with comprehensive leaf form (broadleaf vs needle-leaf) and habit (evergreen vs deciduous) records. We found that global variation in leaf habit is primarily driven by isothermality and soil characteristics, while leaf form is predominantly driven by temperature. Given these relationships, we estimate that 38% of global tree individuals are needle-leaved evergreen, 29% are broadleaved evergreen, 27% are broadleaved deciduous and 5% are needle-leaved deciduous. The aboveground biomass distribution among these tree types is approximately 21% (126.4 Gt), 54% (335.7 Gt), 22% (136.2 Gt) and 3% (18.7 Gt), respectively. We further project that, depending on future emissions pathways, 17-34% of forested areas will experience climate conditions by the end of the century that currently support a different forest type, highlighting the intensification of climatic stress on existing forests. By quantifying the distribution of tree leaf types and their corresponding biomass, and identifying regions where climate change will exert greatest pressure on current leaf types, our results can help improve predictions of future terrestrial ecosystem functioning and carbon cycling.

Cystic fibrosis (CF) is a genetic disease characterized by a wide spectrum of severity, resulting from the inheritance of a mutant allele of the gene for cystic fibrosis transmembrane conductance regulator (CFTR). The aim of the study was to present a CFTR mutation analysis among the Albanian population and to identify rare variants.

Henny Suzana Mediani,1,&ast; Fidy Randy Sada,2,&ast; Aan Nuraeni,3,&ast; Muhammad Arsyad Subu4,&ast; 1Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Faculty of Nursing, Universitas Katolik De La Salle Manado, Manado, Indonesia; 3Department of Critical Care of Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia; 4Nursing Program, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates&ast;These authors contributed equally to this workCorrespondence: Henny Suzana Mediani, Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia, Tel +62 822-1739-1965, Email henny.mediani@unpad.ac.idBackground: In the Intensive Care Unit (ICU), it is vital to meticulously monitor symptoms and thoroughly understand the treatment objectives for critically ill patients. This highlights the necessity of integrating palliative care in this environment. Despite the potential advantages, several barriers impede the effective integration of palliative care in the ICU. Notably, many healthcare professionals (HCPs) in Indonesian ICUs have not fully leveraged the incorporation of palliative care.Purpose: This study aimed to investigate and clarify the experiences of healthcare providers (HCPs) involved in administering palliative care to ICU patients in Indonesia.Methods: This research employed a qualitative descriptive phenomenological approach. Semi-structured, in-depth individual interviews were conducted with four nurses and three doctors working in an Indonesian hospital. Colaizzi’s method was used for data analysis.Results: The analysis identified six themes from the interviews, reflecting the experiences of healthcare professionals in delivering palliative care in the ICU. These themes are: 1) Provide Professional Caring, 2) Caring and curing collaboration, 3) Quality Intensive Communication, 4) End-of-Life Care, 5) Controlling Feelings, and 6) Provide Holistic Caring.Conclusion: Providing care for ICU patients demands not only the expertise of HCPs but also compassion, communication skills, and a holistic approach to patient care. By offering comprehensive palliative care in the ICU, healthcare professionals can address the diverse needs of patients and their families, promoting comfort, respect, and an improved quality of life throughout the illness. This inclusive approach enhances the experience for both patients and their families while supporting healthcare providers in delivering empathetic and patient-centered care. It is recommended that hospitals develop policies to enhance palliative care services in Indonesia.Keywords: ICU patient, healthcare professionals, palliative care

Shaimaa G Ghazy,1 Mostafa A Abdel-Maksoud,2 Ibrahim A Saleh,3 Mohamed A El-Tayeb,2 Amr A Elsaid,4 Metwally A Kotb,5 Diana A Al-Sherif,6 Heba S Ramadan,5 Ahmed Elwahsh,7,8 Ahmed M Hussein,9,10 Ahmad S Kodous11,12 1Radiation Therapy Department, Armed Forces Medical Complex, Alexandria, Egypt; 2Botany and Microbiology Department- College of Science- King Saud University, Riyadh, Saudi Arabia; 3Faculty of Science, Zarqa University, Zarqa, 13110, Jordan; 4Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 5Medical Biophysics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt; 6Applied Medical Science Faculty, Sixth October University, Sixth October, Giza, Egypt; 7Central Radiology Institute, Kepler University Hospital GmbH, Linz, Austria; 8Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy; 9Department of Pharmaceutical Sciences, Division of Pharmacology and Toxicology, University of Vienna, Vienna, 1090, Austria; 10Zoology Department, Faculty of Science, Al Azhar University, Assiut, Egypt; 11Pharmacology Department, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College & Hospitals, Chennai, TN, India; 12Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, EgyptCorrespondence: Ahmad S Kodous; Ahmed M Hussein, Email ahmadkmp11@gmail.com; ahmed.hussein@univie.ac.atPurpose: The local management approach for node-positive breast cancer has undergone substantial evolution. Consequently, there exists a pressing need to enhance our treatment strategies by placing greater emphasis on planning and dosimetric factors, given the availability of more conformal techniques and delineation criteria, achieving optimal goals of radiotherapy treatment. The primary aim of this article is to discuss how the extent of regional nodal coverage influences the choice between IMRT and 3D radiation therapy for patients.Patients and Methods: A total of 15 patients diagnosed with left breast cancer with disease involved lymph nodes were included in this study. Delivering the recommended dose required the use of a linear accelerator (LINAC) with photon beams energy of 6 mega voltage (6MV). Each patient had full breast radiation using two planning procedures: intensity-modulated radiotherapy (IMRT) and three-dimensional radiotherapy (3D conformal). Following the guidelines set forth by the Radiation Therapy Oncology Group (RTOG), the planned treatment coverage was carefully designed to fall between 95% and 107% of the recommended dose. Additionally, Dose Volume Histograms (DVHs) were generated the dose distribution within these anatomical contours.Results and Conclusion: The DVH parameters were subjected to a comparative analysis, focusing on the doses absorbed by both Organs at Risk (OARs) and the Planning Target Volume (PTV). The findings suggest that low doses in IMRT plan might raise the risk of adverse oncological outcomes or potentially result in an increased incidence of subsequent malignancies. Consequently, the adoption of inverse IMRT remains limited, and the decision to opt for this therapy should be reserved for situations where it is genuinely necessary to uphold a satisfactory quality of life. Additionally, this approach helps in reducing the likelihood of developing thyroid problems and mitigates the risk of injuries to the supraclavicular area and the proximal head of the humerus bone.Keywords: radiotherapy, LINAC, RTOG, breast cancer, photon exposure and secondary cancer risk

Gusgus Ghraha Ramdhanie,1,&ast; Altia Nurrohmah,2,&ast; Adelse Prima Mulya,3,&ast; Henny Suzana Mediani,1,&ast; Nina Sumarni,3,&ast; Aep Maulid Mulyana,4,&ast; Mega Hasanul Huda5,&ast; 1Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia; 2Undergraduate Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia; 3Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia; 4Internship Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia; 5Department of Pediatric Nursing, Faculty of Nursing Science, Universitas Indonesia, Depok, West Java, 16424, Indonesia&ast;These authors contributed equally to this workCorrespondence: Gusgus Ghraha Ramdhanie, Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia, Tel +62 813-2397-3679, Email gusgus.ghraha.ramdhanie@unpad.ac.idBackground: Invasive procedures in children can lead to painful and uncooperative procedures. It is essential to determine the appropriate method to create a comfortable environment for children during invasive procedures. However, audiovisuals are one of the distraction techniques used in pain management.Purpose: This study aims to identify and categorize related audiovisual distraction techniques in reducing pain due to invasive procedures among children.Methods: This study uses a systematic scoping review. A literature review was conducted using PubMed, EBSCO, Science Direct, Scopus and grey literature through Google Scholar. The study was eligible for inclusion if it included articles published from 2012 to 2022, full-text and open accessed articles, and in Indonesian and English language. Studies were excluded if they were review studies and the adult population. The keywords in English were ”Children” OR ‘Child’ OR ”Kids” OR ‘Youth’ OR ‘Adolescents’ OR ‘Teenager’ OR ‘Teens’ OR ‘Young People’ OR ‘Pediatric’ OR ‘Paediatric’ OR ‘Childhood’ AND ”Audiovisual” OR ‘Movie’ OR ‘Video’ OR ‘Animation’ AND ”Pain” AND ”Invasive procedures” and keyword in Indonesia were ”Anak” OR ‘Remaja’ OR ‘Bayi’ OR ‘Balita’ AND ”Audiovisual” OR ‘Film’ OR ”Video” OR ‘Animasi’ OR “Nyeri” AND ‘Prosedur invasif’.Results: We found 15 articles showing audiovisual distraction techniques in managing pain among children undergoing invasive procedures. Three types of audiovisual interventions were used, including virtual reality (VR), video music, and animated cartoons. In addition, types of invasive procedures that benefited from the analyzed interventions were infusion, surgery, injection, blood draw, dressing change, circumcision, endoscopy, and phlebotomy.Conclusion: Our findings highlight that virtual reality, video music, and animated cartoons have clinical implications in helping to distract from pain in children undergoing invasive procedures. Our study indicates that the potential of audiovisual intervention can be used as an intervention strategy in the pediatric nursing area.Keywords: audiovisual, child, invasive procedures, pain

Ran Zhang,1,2 Ya-Jie Lei,1,2 Sheng-Yue Wen,1,2 Jian Pang,1,2 Yue-Long Cao,1,2 Min Zhang,1,2 Hong-Sheng Zhan,1,2 Xun Lin,3 Bo Chen1,2 1Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Institute of Orthopedics and Traumatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Bo Chen; Xun Lin, Tel +86-21-20256519, Email cbm818@shutcm.edu.cn; linxund@163.comPurpose: To prove more accurately that Chinese herbal bath therapy may be a safe, effective, simple alternative treatment modality for knee OA, we designed a randomized, double-blind, placebo-controlled trial to explore the effectiveness of SSBD for the relief of pain, daily activities, and quality of life in patients with knee OA.Patients and Methods: A single-center, 52-week, randomized controlled trial of SSBD versus placebo is being performed. A total of 200 patients with symptomatic knee OA will be randomly allocated to the SSBD treatment or placebo intervention group for 4 weeks. The two groups of patients are allowed to steam and bathe their knees once every other day, using one packet of SSBD each time, for 30 minutes, 3 times a week, for a total of 4 weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at 4 weeks is the primary outcome measure, and the secondary outcomes include WOMAC stiffness and function scores, the Lysholm knee scale score, quality of life, the Brief Pain Inventory score, the Patient’s Global Impressions of Improvement Scale score and the Clinical Global Impressions of Severity scale score. The safety of the herbal medications will also be evaluated.Conclusion: We will discuss whether SSBD has greater advantages in terms of efficacy, safety, and patient overall perception than does placebo control in middle-aged and elderly patients with knee OA. The findings may provide new and valuable information about the efficacy and safety of Chinese herbal bath therapy in the treatment of knee osteoarthritis.Keywords: balneotherapy, traditional Chinese medicine, complementary and integrative medicine, randomized placebo-controlled trial, knee osteoarthritis

Ji Eun Song,1 Eunjeong Ji,2 Nak-Hyun Kim,1,3 Jung Hun Ohn,1,3 Yejee Lim,1,3 Jongchan Lee,1,3 Hye Won Kim,1,3 Sun-Wook Kim,1,3 Jiwon Ryu,1,3 Hee-Sun Park,1,3 Eun Sun Kim1,3 1Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 2Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of KoreaCorrespondence: Eun Sun Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea, Email apolio3700@gmail.comPurpose: Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients.Patients and Methods: This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days.Results: Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025– 0.290; p = 0.001).Conclusion: The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions.Keywords: aspiration pneumonia, older patients, gugging swallowing screen, prevention, quality improvement

Nour Amin Elsahoryi,1 Hadil Shafee Subih,2 Fadwa Hammouh,3 Fwziah Jammal Hammad2 1Department of Nutrition, Faculty of Pharmacy and Medical Sciences, The University of Petra, Jordan; 2Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid Jordan; 3Department of Nutrition and Dietetics, Faculty of Health Sciences, American University of Madaba, Madaba, JordanCorrespondence: Nour Amin Elsahoryi, Email nour.elsahoryi@uop.edu.joAim: This study aimed to determine the current stage of change (SOG) toward seven healthy eating behaviors and two healthy lifestyle behaviors related to blood pressure (BP) control. The lifestyle behaviors included smoking Behavior and practicing regular exercise, while the dietary behaviors included the DASH diet guidelines.Methods: A total of 1109 outpatients participated in this cross-sectional study that was conducted between 2021 and 2022 in Jordan. A staging algorithm assessed SOG for several BP control-related behaviors for diagnosed hypertension patients. Data were collected by a structured interview-based questionnaire.Results: There was a high degree of maintenance toward consuming diets with high grains, fruit, vegetables, meat, and poultry, less saturated fat, and more low-fat dairy products. More than half of the participants were in the pre-action stage for quitting smoking, practicing physical exercise, and consuming sweets and added sugars. Significant associations were observed between the degree of maintenance for several behaviors (p < 0.01). Age, income, education level, disease duration, and nutrition consultation availability were the most related factors to the SOG of the studied behaviors (p < 0.01).Conclusion: Patients with hypertension in Jordan are still in the pre-action stages for quitting smoking, practicing physical exercise, and consuming 5 servings of refined sweets and added sugars weekly. The current outcome suggests a need for nutritional counseling, education, and interventions to raise awareness of lifestyle factors influencing BP among hypertension patients.Keywords: hypertension, stage of change, SOG, health behavior

Qi Wang,1,2,&ast; Wen-Na Li,3,&ast; Wuxiyar Otkur,4 Yu Cui,1 Hui-Sheng Chen1,2 1Department of Neurology, General Hospital of Northern Theater Command, Shenyang, 110016, People’s Republic of China; 2Dalian Medical University, Dalian, People’s Republic of China; 3Department of Neurology, Tangshan Central Hospital, Tangshan, People’s Republic of China; 4School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hui-Sheng Chen, Department of Neurology, General Hospital of Northern Theater Command, 83 Wen Hua Road, Shenyang, 110016, People’s Republic of China, Tel +86 024 28897511, Email chszh@aliyun.comBackground: We conducted a post-hoc analysis of the RICAMIS trial to investigate the effect of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) on the efficacy of remote ischemic conditioning treatment.Methods: In this post-hoc analysis, NLR, PLR, and SII were measured before randomization. Patients were divided into two groups based on their cut-off values: high vs low NLR, high vs low PLR, and high vs low SII groups. Each group was further subdivided into RIC and control groups. The primary endpoint was a poor outcome (mRS 2– 6 at 90 days). Differences in the primary endpoint between the RIC and control subgroups were compared, and the interactions of treatment assignment with NLR, PLR, and SII were evaluated.Results: A total of 1679 patients were included in the final analysis. Compared with the control group, RIC significantly improved functional outcomes regardless of the inflammation status. The improved probability of poor outcome in the RIC vs control group was numerically greater in the high vs low inflammation group (NLR, 7.8% vs 5.1%; PLR, 7% vs 6.5%; SII, 9% vs 5.3%). However, we did not find an interaction effect of an intervention (RIC or control) with different NLR, PLR, or SII on clinical outcomes (P > 0.05). In addition, the NLR and SII were independently associated with functional outcomes in all patients, regardless of whether they received RIC.Conclusion: Inflammation may not affect the efficacy of RIC in patients with acute moderate ischemic stroke, although a lower probability of poor outcome at 90 days was identified in patients with a high vs low inflammatory status.Keywords: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, remote ischemic conditioning, ischemic stroke

Fatemah Mohammed AlAhmari,1 Hind Saleh Albahouth,2 Hadeel Ali Almalky,2 Ebtihal Saad Almutairi,2 Muzun Hamoud Alatyan,2 Lama Ali Alotaibi2 1Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; 2College of Dentistry, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Fatemah Mohammed AlAhmari, King Saud University, Riyadh, Saudi Arabia, Email falahmari@ksu.edu.saObjective: Periodontal diseases are chronic inflammatory disorders influenced by systemic health of the individual. This study aimed to investigate the association between hypothyroidism and periodontal disease in a cohort of adult Saudi population.Methods: This case–control study included 201 adults with hypothyroidism on hormone replacement therapy and 188 healthy controls. The medical files of patients were reviewed to check thyroid stimulation hormone (TSH) and free thyroxine (FT4) levels. Participants completed a questionnaire on demographic and health information, followed by a comprehensive periodontal examination. Pearson chi-square and binary logistic regression analyses determined associations, with a significance set at p ≤ 0.05.Results: Gingivitis was found in 20.9% of cases and 58% of controls. Periodontitis stages I, II, III and IV were in general higher in cases compared to controls (23.4%, 27.9%, 21.9%, 6% in cases versus 13.8%, 17%, 9.6%, 1.6% in controls, respectively). Mean PPD and CAL values were higher in cases (5.54 ± 2.5 and 3.88 ± 3.1) than in controls (4.03 ± 1.6 and 1.72 ± 2.4). Significant associations between periodontal status and hypothyroidism were found (p < 0.0001). The periodontal status in hypothyroid cases correlated significantly with hormone replacement therapy dose and duration (p < 0.0001).Conclusion: The findings of the current study showed that, in a cohort of adult Saudi subjects, patients with hypothyroidism have higher prevalence and more severe periodontal disease symptoms compared to controls, suggesting significant association.Keywords: hypothyroidism, periodontal diseases, hormone replacement therapy, association, case–control study

Windy Rakhmawati,1,&ast; Henny Suzana Mediani,1,&ast; Meita Dhamayanti,2,&ast; Ida Maryati,3,&ast; Asty Samiaty Setiawan,4,&ast; Sri Hendrawati,1,&ast; Nenden Nur Asriyani Maryam,1,&ast; Alfiah Hasanah,5,&ast; Aep Maulid Mulyana,6,&ast; Dini Mariani,7,&ast; Imat Rochimat8,&ast; 1Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 2Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 3Department of Maternity Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 4Department of Public Dental Health, Faculty of Dentistry, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 5Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 6Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia; 7Department of Nursing, Polytechnic Health Ministry of Health Tasikmalaya, Tasikmalaya, West Java, 46115, Indonesia; 8Department of Pharmacy, Polytechnic Health Ministry of Health Tasikmalaya, Tasikmalaya, 46115, Indonesia&ast;These authors contributed equally to this workCorrespondence: Windy Rakhmawati, Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia, Tel +62 82119492124, Email windy.rakhmawati@unpad.ac.idBackground: Infants are in a critical period during which often occur many problems, such as growth, development, and motor delays. One of the interventions that can potentially reduce these problems is by giving a massage therapy.Purpose: This study aims to conduct a systematic scoping review of massage therapy’s potential for growth and development among infants under nine months.Methods: This study followed a Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA-ScR). We collected data from three databases, including PubMed, Scopus, and CINAHL with full text, published in 2013– 2022, subjects aged less than nine months, full-text articles, and randomized controlled trials. Studies were excluded if they were not in English.Results: Of the 11 studies found, it shows that therapy massage can effectively increase infants’ growth and development, including body weight, length, visual-motor coordination and integration, hand-eye, hearing, speech, social, vagal activity, language, locomotion, stationary, and reflexes. The interventions include medium chain triglyceride oil massage, Dabur Lal Tail massage, oil massage, massage by mothers, and massage therapy without additives for 5– 45 minutes. In addition, massage therapy has a positive effect on infants with various conditions, including preterm infants, infants with HIV-infected mothers, and infants with Down’s syndrome.Conclusion: Our findings highlight that infants receiving massage therapy were significantly more likely to increase growth and development than the population who were not given massage therapy. However, further investigation into preventing the severity of growth and developmental problems is urgently needed.Keywords: development, growth, infant, intervention, massage therapy

Tamer M Shehata,1,2 Bandar Aldhubiab,1 Heba S Elsewedy3 1Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Alhofuf, Al-Ahsa, 36362, Saudi Arabia; 2Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt; 3Department of Pharmaceutical Sciences, College of Pharmacy, AlMaarefa University, Riyadh, 11597, Saudi ArabiaCorrespondence: Heba S Elsewedy; Tamer M Shehata, Email hsewedy@um.edu.sa; tshehata@kfu.edu.saBackground: Monitoring noncommunicable diseases is regarded as a critical concern that has to be managed in order to avoid a wide variety of complications such as increasing blood lipid levels known as dyslipidemia. Statin drugs, mostly, Rosuvastatin (RSV) was investigated for its effectiveness in treating dyslipidemia. However, reaching the most efficient treatment is essential and improving the effect of RSV is crucial. Therefore, a combination therapy was a good approach for achieving significant benefit. Although RSV is hydrophobic, which would affect its absorption and bioavailability following oral administration, overcoming this obstacle was important.Purpose: To that end, the purpose of the present investigation was to incorporate RSV into certain lipid-based nanocarriers, namely, nanostructured lipid carrier (NLC) prepared with virgin coconut oil (CCO).Methods: The optimized RSV-NLC formula was selected, characterized and examined for its in vitro, kinetic, and stability profiles. Eventually, the formula was investigated for its in vivo hypolipidemic action.Results: The optimized NLC formulation showed a suitable particle size (279.3± 5.03 nm) with PDI 0.237 and displayed good entrapment efficiency (75.6± 1.9%). Regarding in vitro release, it was efficiently prolonged for 24 h providing 93.7± 1.47%. The optimized formula was established to be stable after 3 months storage at two different conditions; 4°C and 25°C. Importantly, including CCO in the development of RSV-NLC could impressively enhance lowering total cholesterol level in obese rat models, which endorse the potential synergistic action between RSV and CCO.Conclusion: The study could elucidate the impact of developing NLC using CCO for improving RSV anti-hyperlipidemic activity.Keywords: Rosuvastatin, natural compounds, coconut oil, nanostructured lipid carrier, optimization, hypolipidemic activity

Min-Kyung Ji,1,&ast; Yaerim Chun,2,&ast; Geonwoo Jeong,3 Hyun-Seung Kim,4 Won-Jae Kim,5 Je-Hwang Ryu,6 Hoonsung Cho,3 Hyun-Pil Lim1,2 1Dental 4D Research Center, Chonnam National University, Gwangju, Republic of Korea; 2Department of Prosthodontics, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea; 3Department of Materials Science and Engineering, Chonnam National University, Gwangju, Republic of Korea; 4KJ Meditech Co., Ltd, Gwangju, Republic of Korea; 5Department of Oral Physiology, School of Dentistry, Stem Cell Secretome Research Center, Chonnam National University, Gwangju, Republic of Korea; 6Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Hyun-Pil Lim, Department of Prosthodontics, School of Dentistry, Chonnam National University, Gwangju, 61186, Republic of Korea, Tel +82-10-2645-7528, Fax +82-62-530-5577, Email mcnihil@jnu.ac.kr Hoonsung Cho, Department of Materials Science and Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea, Tel/Fax +82-62-530-1717, Email cho.hoonsung@jnu.ac.krPurpose: This study aimed to confirm the synergy effect of these two materials by evaluating osteoblast and antibacterial activity by applying a double-layered hydroxyapatite(HA) zirconium oxide(ZrO2) coating to titanium.Methods: The specimens used in this study were divided into four groups: a control group (polished titanium; group T) and three experimental groups: Group TH (RF magnetron sputtered HA deposited titanium), Group Z (ZrO2 ALD deposited titanium), and Group ZH (RF magnetron sputtered HA and ZrO2 ALD deposited titanium). The adhesion of Streptococcus mutans (S.mutans) to the surface was assessed using a crystal violet assay. The adhesion, proliferation, and differentiation of MC3T3-E1 cells, a mouse osteoblastic cell line, were assessed through a WST-8 assay and ALP assay.Results: Group Z showed a decrease in the adhesion of S. mutans (p < 0.05) and an improvement in osteoblastic viability (p < 0.0083). Group TH and ZH showed a decrease in adhesion of S. mutans (p < 0.05) and an increase in osteoblastic cell proliferation and cell differentiation (p < 0.0083). Group ZH exhibited the highest antibacterial and osteoblastic differentiation.Conclusion: In conclusion double-layered HA and ZrO2 deposited on titanium were shown to be more effective in inhibiting the adhesion of S. mutans, which induced biofilm formation, and increasing osteoblastic differentiation involved in osseointegration by the synergistic effect of the two materials.Keywords: zirconium oxide, hydroxyapatite, atomic layer deposition, radio frequency magnetron sputter, osteoblast activity, antibacterial effect

Jia Yi Tan,1 Yong Hao Yeo,2 Kok Hoe Chan,3 Hamid S Shaaban,4 Gunwant Guron4 1Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ, USA; 2Department of Internal Medicine/Pediatrics, Corewell Health, Royal Oak, MI, USA; 3Division of Hematology/Oncology, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; 4Division of Hematology/Oncology, Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ, USA Correspondence: Kok Hoe Chan, Division of Hematology/Oncology, the University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, Email kok.hoe.chan@uth.tmc.eduPurpose: Our study aims to describe the mortality trends and disparities among individuals with thalassemia in the United States (US).Patients and Methods: We used CDC WONDER database to calculate the age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and used the Joinpoint Regression Program to measure the average annual percent change (AAPC). Subgroup evaluations were performed by sex, age, race, census region, and urbanization level.Results: From 1999 to 2020, there were 2797 deaths relatd to thalassemia in the US. The AAMR of thalassemia-related death showed a decreasing trend from 0.50 (95% CI, 0.41– 0.58) in 1999 to 0.48 (95% CI, 0.41– 0.55) in 2020 with the AAPC of − 1.42 (95% CI, − 2.42, − 0.42). Asians have the highest AAMR (1.34 [95% CI, 1.20– 1.47]), followed by non-Hispanic Blacks (0.65 [95% CI, 0.59– 0.71]), non-Hispanic Whites (0.32 [95% CI, 0.30– 0.33]), and Hispanics (0.11 [95% CI, 0.08– 0.14]). Cardiovascular disease remains the leading cause of death among individuals with thalassemia. The urban population has a higher AAMR than the rural population (0.43 [95% CI, 0.41– 0.45] vs 0.29 [95% CI, 0.26– 0.32]).Conclusion: Our study calls for targeted interventions to address the racial and geographic disparities existed among individuals of thalassemia in the US.Keywords: thalassemia, beta-thalassemia, alpha-thalassemia, epidemiology, mortality

The necessity for substantial societal transformations to meet the Sustainable Development Goals (SDGs) has become more urgent, especially in the wake of the COVID-19 pandemic. This paper examines the critical role of disruptive technologies, specifically Industry 5.0 and Society 5.0, in driving sustainable development. Our research investigation focuses on their impact on product development, healthcare innovation, pandemic response, and the development of nature-inclusive business models and smart cities. We analyze how these technologies influence SDGs 3 (Good Health and Well-Being), 4 (Quality Education), 9 (Industry, Innovation, and Infrastructure), and 11 (Sustainable Cities and Communities). By integrating these concepts into smart cities, we propose a coordinated framework to enhance the achievement of these goals. Additionally, we provide a SWOT analysis to evaluate this approach. This study aims to guide industrialists, policymakers, and researchers in leveraging technological advancements to meet the SDGs.

Indonesia's commitment to the global Sustainable Development Goals (SDGs) is exemplified by its Village SDGs program, which serves as a strategic pilot initiative. Nevertheless, the efficacy of the Village SDGs is contingent upon several critical factors, including resource availability, community engagement, and stakeholder collaboration. These factors present significant challenges that impede progress. Given that villages constitute 91% of Indonesia's territory, developments at this local level have profound implications for the national implementation of the SDGs. This study elucidates that persistent challenges in resource allocation and stakeholder coordination remain despite advancements in embedding the SDGs within the national legal framework. The assessment of the Village SDGs highlights local capacity disparities and underscores the necessity for enhanced support mechanisms. Integrating the SDGs within village governance necessitates tailored approaches that are sensitive to local contexts. This paper establishes a comprehensive framework for the Village SDGs roadmap within local governance to achieve the global agenda. It explores three pivotal aspects, namely the incorporation of the SDGs into the national legal framework, the evaluation of Village SDGs implementation, and the contextualisation of the SDGs within village governance. Employing a normative legal approach and secondary data sources, the research reveals significant progress while also identifying critical gaps that must be addressed to ensure the effective implementation of the Village SDGs.

Clinton Njinju Asaba,1 Cyril Jabea Ekabe,2 Humblenoble Stembridge Ayuk,3 Bella Nyemkuna Gwanyama,4 Razieh Bitazar,1 Terence Ndonyi Bukong1 1Armand-Frappier Sante Biotechnologie Research Center, Institut National de la Recherche Scientifique, Laval, Québec, Canada; 2Department of Translational Biomedical Sciences, University of Rochester, Rochester, NY, USA; 3Department of Environmental Immunology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, 04318, Germany; 4Department of Microbiology & Immunology, McGill University, Montreal, Québec, CanadaCorrespondence: Terence Ndonyi Bukong, Email terencendonyi.bukong@inrs.caAbstract: The late 2019 emergence of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, caused profound and unprecedented disruption to the global socio-economic structure, negatively affecting millions of lives worldwide. A typical hallmark of severe COVID-19 is hyper inflammation due to aberrant cytokine release (cytokine storm) by innate immune cells. Recent studies have revealed that SARS-CoV-2, through its spike (S) protein, can activate the body’s innate immune cells via Toll-Like Receptors (TLRs), particularly TLR4. In silico studies have demonstrated that the S protein binds with high affinity to TLR4, triggering downstream signaling processes that result in pro-inflammatory cytokine release. Compared to other TLRs, such as TLR2, TLR4 plays a more significant role in initiating and sustaining the inflammatory response associated with severe COVID-19. Furthermore, interactions between the virus and target cells can enhance the cellular expression of TLR4, making cells more susceptible to viral interactions and subsequent inflammation. This increased expression of TLR4 upon viral entry creates a feedback loop, where heightened TLR4 levels lead to amplified inflammatory responses, contributing to the severity of the disease. Additionally, TLR4’s potent activation of inflammatory pathways sets it apart from other TLRs, underscoring its pivotal role in the pathogenesis of COVID-19. In this review, we thoroughly explore the multitude of regulatory signaling pathways that SARS-CoV-2 employs to incite inflammation. We specifically focus on the critical impact of TLR4 activation compared to other TLRs, highlighting how TLR4’s interactions with the viral S protein can exacerbate the severity of COVID-19. By delving into the mechanisms of TLR4-mediated inflammation, we aim to shed light on potential therapeutic targets that could mitigate the inflammatory damage caused by severe COVID-19. Understanding the unique role of TLR4 in the context of SARS-CoV-2 infection could pave the way for novel treatment strategies that specifically inhibit this receptor’s activity, thereby reducing the overall disease burden and improving patient outcomes.Keywords: SARS-CoV-2, cytokine storm, toll-like receptor 4, hyperinflammation, ACE2 receptors, innate immunity

Ikeu Nurhidayah,1,2 Nani Nurhaeni,3 Allenidekania Allenidekania,3 Dewi Gayatri,4 Henny Suzana Mediani1 1Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia; 2Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia; 3Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia; 4Basic Science and Fundamental Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, IndonesiaCorrespondence: Ikeu Nurhidayah, Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia, Email ikeu.nurhidayah@unpad.ac.idBackground: Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered.Purpose: This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients.Methods: Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results: Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child’s quality of life. However, Caphosol mouthwash did not significantly reduce mucositis.Conclusion: Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children.Systematic Review Registration: PROSPERO registration number was CRD42023456278.Keywords: children, cancer, chemotherapy, oral care, mucositis

Abdulaziz M Al-Garni,1 Hasan S Alamri,1 Waddah M Alalmaei Asiri,1 Abdulaziz Muflih Abudasser,1 Amal Saad Alawashiz,2 Fatima Ahmed Badawi,2 Ghaidaa Abdulrahman Alqahtani,2 Sultan Saad Ali Alnasser,2 Abdulwahab Mufareh Assiri,2 Khalid Talab Salem Alshahrani,2 Osama Ayed Saleh Asiri,2 Ohoud Hussain Moalwi,2 Manar Saeed Alqahtani,2 Reema S Alqhatani2 1Department of Internal Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia; 2College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Abdulaziz M Al-Garni, Department of Internal Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia, Email amoalqarni@kku.edu.saBackground: Use of different social media platforms has increased radically over the past decade, emerging as an important part of adolescents and young people’s everyday life. This might exert potential adverse effects on sleep quality and daytime performance of young adults.Aim of Study: To assess the relation between use of social media platforms and sleep quality among public secondary school students.Methods: A cross-sectional study was conducted on 961 students in Aseer region, Saudi Arabia. Students were asked to fill in a structured interview questionnaire covering personal data, pattern of social media use, sleep quality using The Pittsburgh Sleep Quality Index (PSQI) and their mental health status using the depression, anxiety and stress scale (DASS-21).Results: Students’ ages ranged from 15 to 20 years with a mean age of 16.7 ± 2.1 years old. A total of 570 (59.3%) students were females. Tiktok (80%), Snapchat (77.9%), Instagram (63.8%) and YouTube (58.8%) were the most reported platforms used. Regarding their sleep quality, 34.7% of students were poor sleepers. TikTok use (OR 1.33, 95% CI 1.01– 1.77), hours spent on social media (OR 1.26, 95% CI 1.16– 1.37) and having moderate to severe depressive symptoms (OR 1.69, 95% CI 1.19– 2.40) were significant independent predictors of poor sleep among the studied sample.Conclusion: The present study emphasized the association between prolonged use of social media and poor sleep quality among Saudi adolescents. Awareness and behavioral change strategies and activities concerning the drawbacks of poor sleep and proper use of social media are urgently called for to control mental and physical health consequences of poor sleep and social media addiction.Keywords: adolescents, mental health, Saudi Arabia, screen time, sleep quality, snapchat, social media, students, tiktok

Ming-Jr Jian,1,&ast; Tai-Han Lin,1,&ast; Hsing-Yi Chung,1,2 Chih-Kai Chang,1 Cherng-Lih Perng,1 Feng-Yee Chang,3 Hung-Sheng Shang1 1Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 2Graduate Institute of Medical Science, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 3Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China&ast;These authors contributed equally to this workCorrespondence: Hung-Sheng Shang, Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China, Tel +886920713130, Email iamkeith001@gmail.comPurpose: The World Health Organization has identified Klebsiella pneumoniae (KP) as a significant threat to global public health. The rising threat of carbapenem-resistant Klebsiella pneumoniae (CRKP) leads to prolonged hospital stays and higher medical costs, necessitating faster diagnostic methods. Traditional antibiotic susceptibility testing (AST) methods demand at least 4 days, requiring 3 days on average for culturing and isolating the bacteria and identifying the species using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), plus an extra day for interpreting AST results. This lengthy process makes traditional methods too slow for urgent clinical situations requiring rapid decision-making, potentially hindering prompt treatment decisions, especially for fast-spreading infections such as those caused by CRKP. This research leverages a cutting-edge diagnostic method that utilizes an artificial intelligence-clinical decision support system (AI-CDSS). It incorporates machine learning algorithms for the swift and precise detection of carbapenem-resistant and colistin-resistant strains.Patients and Methods: We selected 4307 KP samples out of a total of 52,827 bacterial samples due to concerns about multi-drug resistance using MALDI-TOF MS and Vitek-2 systems for AST. It involved thorough data preprocessing, feature extraction, and machine learning model training fine-tuned with GridSearchCV and 5-fold cross-validation, resulting in high predictive accuracy, as demonstrated by the receiver operating characteristic and area under the curve (AUC) scores, laying the groundwork for our AI-CDSS.Results: MALDI-TOF MS analysis revealed distinct intensity profiles differentiating CRKP and susceptible strains, as well as colistin-resistant Klebsiella pneumoniae (CoRKP) and susceptible strains. The Random Forest Classifier demonstrated superior discriminatory power, with an AUC of 0.96 for detecting CRKP and 0.98 for detecting CoRKP.Conclusion: Integrating MALDI-TOF MS with machine learning in an AI-CDSS has greatly expedited the detection of KP resistance by approximately 1 day. This system offers timely guidance, potentially enhancing clinical decision-making and improving treatment outcomes for KP infections.Keywords: carbapenem, colistin, diagnostic accuracy, antibiotic stewardship, MALDI-TOF MS

Aep Maulid Mulyana,1,&ast; Windy Rakhmawati,2,&ast; Iqbal Pramukti,3,&ast; Mamat Lukman,3,&ast; Riki Wartakusumah,4,&ast; Henny Suzana Mediani2,&ast; 1Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia; 2Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia; 3Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia; 4Department of Nursing Science, Faculty of Medicine Public Health, and Nursing, Universitas Gadjah Mada, Sleman, Yogyakarta, 55284, Indonesia&ast;These authors contributed equally to this workCorrespondence: Henny Suzana Mediani, Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 40132, Indonesia, Tel +62 822-1739-1965, Email henny.mediani@unpad.ac.idBackground: Children with sickle cell disease (SCD) are more likely to have deficient serum levels of vitamin D for bone metabolism. However, appropriate interventions are essential to prevent its progression and alleviate symptoms.Purpose: The aim of this study is to determine interventions for managing bone disease in children with SCD.Methods: This study uses a scoping review. A literature review was conducted using PubMed, CINAHL, ScienceDirect, Scopus, and Google Scholar search engines. The study was eligible for inclusion if it included articles published from 2013 to 2023, full-text, and original study design. Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool.Results: This review identified six studies and 114 children with SCD, including 57 boys (50%) and 57 girls (50%). The majority of SCD types experienced were HbSS (86.84%), HbS-B0 Thal (7.01%), HbSC (5.27%), and the HbSS Arab-Indian haplotype (0.88%). Bone disease problems that often arise in children with SCD include Avascular Necrosis (AVN) (78.08%), Osteonecrosis of the Femoral Head (ONFH) (18.42%), and other bone problems (3.50%). Meanwhile, four types of intervention findings were used in managing bone disease among children with SCD: 1). Surgical procedures 53 (41.09%) included total hip arthroplasty (THA), Osteotomy, and Multiple epiphyseal drilling with Autologous Bone Marrow Implantation (AMBI); 2). Invasive procedures 67 (51.93%) included intravenous bisphosphonates, hydroxyurea (HU), and core decompression (CD) with bone marrow aspirate concentrate injection: 3). Oral pharmacological or Vitamin D3 (cholecalciferol) 4 (3.10%); 4). Non-pharmacology or physical therapy 5 (3.88%).Conclusion: Our findings highlight that surgical, invasive, pharmacological, and physical therapy interventions positively impact increasing bone mineral density (BMD) and functional improvement of bone disease among children with SCD. The interventions provided excellent functional outcomes with minimal complications and no life-threatening side effects.Keywords: bone disease, children, intervention, incidence, sickle cell disease

The nuclear dependence of the inclusive inelastic electron scattering cross section (the EMC effect) has been measured for the first time in B10 and B11. Previous measurements of the EMC effect in A≤12 nuclei showed an unexpected nuclear dependence; B10 and B11 were measured to explore the EMC effect in this region in more detail. Results are presented for Be9, B10, B11, and C12 at an incident beam energy of 10.6 GeV. The EMC effect in the boron isotopes was found to be similar to that for Be9 and C12, yielding almost no nuclear dependence in the EMC effect in the range A=4-12. This represents important new data supporting the hypothesis that the EMC effect depends primarily on the local nuclear environment due to the cluster structure of these nuclei.

Determining the drivers of non-native plant invasions is critical for managing native ecosystems and limiting the spread of invasive species1,2. Tree invasions in particular have been relatively overlooked, even though they have the potential to transform ecosystems and economies3,4. Here, leveraging global tree databases5-7, we explore how the phylogenetic and functional diversity of native tree communities, human pressure and the environment influence the establishment of non-native tree species and the subsequent invasion severity. We find that anthropogenic factors are key to predicting whether a location is invaded, but that invasion severity is underpinned by native diversity, with higher diversity predicting lower invasion severity. Temperature and precipitation emerge as strong predictors of invasion strategy, with non-native species invading successfully when they are similar to the native community in cold or dry extremes. Yet, despite the influence of these ecological forces in determining invasion strategy, we find evidence that these patterns can be obscured by human activity, with lower ecological signal in areas with higher proximity to shipping ports. Our global perspective of non-native tree invasion highlights that human drivers influence non-native tree presence, and that native phylogenetic and functional diversity have a critical role in the establishment and spread of subsequent invasions.

This study was designed to evaluate how treating Prosopis juliflora pods with polyethylene glycol and carbohydrase enzyme will affect its chemical composition and how the inclusion of treated P. juliflora pods in Boschveld chicken's diets will affect growth performance and nutrient digestibility. Before P. juliflora pods were administrated to the diets, they were pre-treated with enzyme, PEG and a combination of both and analysed for their nutrient content. Five diets, namely PJPM1: commercial standard pullet grower diet as a control; PJPM2: commercial standard grower diet with untreated 30 % of P. juliflora; PJPM3: commercial standard grower diet with PEG treated 30 % of P. juliflora; PJPM4: commercial standard grower diet with carbohydrase enzyme treated 30 % of P. juliflora; PJPM5: commercial standard grower diet with PEG and carbohydrase enzyme treated 30 % of P. juliflora. A total of 300 six-week-old Boschveld chickens were used in this trial. After 42 days of feeding trial, three Boschveld chickens per replicate (n = 90) were randomly selected for the determination of nutrient digestibility. Results on the chemical composition of raw P. juliflora pods meal, pre-treated with enzyme, PEG and combination of both show significant difference (P < 0.05) in CP, Ash, NDF, CF, EE, Hemicellulose, NFC and NFE. Only overall feed intake shows significant different (P < 0.05) in all dietary treatments and all the measured parameters of nutrient digestibility. Enzyme and PEG positively contribute to the chemical composition, growth performance, and nutrient digestibility of diets containing P. juliflora fed to Boschveld chickens.

Hypopharyngeal cancer usually presents at a locally advanced stage. Almost all patients are treated with a curative intent. As surgical approaches are functionally and cosmetically morbid, nonsurgical modalities are preferred. This review emphasizes a comprehensive diagnosis workflow, the integration of less toxic induction chemotherapy regimens, and a multidisciplinary approach to patient care. It aims to optimize treatment outcomes while preserving quality of life, particularly in the Indian healthcare context.

Oropharyngeal cancer typically presents at a nonmetastatic stage and is primarily treated with curative intent. While surgical options are available, they are often associated with significant functional and cosmetic morbidity, leading to a preference for nonsurgical modalities. The updated guidelines address the management of oropharyngeal squamous cell carcinoma in the Indian context, emphasizing the importance of a multidisciplinary approach. The guidelines detail diagnosis workflows, treatment protocols for early-stage and locally advanced cancers, and the role of human papillomavirus (HPV) status in guiding therapy. Special attention is given to emerging treatment deintensification strategies for HPV-associated cancers, aiming to optimize outcomes while minimizing treatment-related toxicity.

Oral cavity cancer (OCC) essentially presents at a non-metastatic stage. Almost all patients are treated with a curative intent. Surgical approaches are the mainstay of treatment accompanied by radiotherapy and chemotherapy where applicable. This updated guideline emphasizes a personalized approach to the treatment of OCC, considering tumor characteristics, patient preferences, and the latest advancements in diagnostic methods. These guidelines aim to optimize treatment strategies, improve patient quality of life, and ensure adherence to the most current clinical practices in managing OCC, especially with respect to the Indian scenario.