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Abstract Background Health systems underwent substantial changes to respond to COVID-19. Learning from the successes and failures of health system COVID-19 responses may help us understand how future health service responses can be designed to be both effective and sustainable. This study aims to identify the role that innovation played in crafting health service responses during the COVID-19 pandemic. Methods Semi-structured interviews were conducted online, exploring 19 health professionals’ experiences in responding to COVID-19 in a large State health system in Australia. The data were collected from April to September 2022 and analysed utilising constant comparative analysis. The degree of innovation in health service responses was assessed by comparing them to pre-pandemic services using 5 categories adopted from the IMPISCO (Investigators, Methods, Population, Intervention, Setting, Comparators and Outcomes) framework, which classifies interventional fidelity as: 1/ Identical: No differences are found between health services; 2/ Substitution with alternatives that perform the same function, 3/ In-class replacement with elements that delivers roughly the same functionality, 4/ Augmentation with new functions, 5/ Creation of new elements. Services were decomposed into bundles and fidelity labels were assigned to individual bundle elements. Results New services were typically created by reconfiguring existing ones rather than being created de novo. The presence of pre-existing infrastructure (foundational technologies) was seen as critical in mounting fast health service responses. Absence of infrastructure was associated with delays and impaired system responses. Conclusions The need to reconfigure rapidly and use infrastructure to support this suggests we reconceive health services as a platform (a general-purpose service upon which other elements can be added for specific functions), where a common core service (such as a primary care practice) can be extended by adding specialised functions using mediators which facilitate the connection (such as virtual service capabilities). Innovation can be costly and time consuming in crises, and during the COVID-19 pandemic, innovations were typically patched together from pre-existing services. The notion of platforms seems a promising way to prepare the health system for future shocks.

Hard corals are precious marine creatures that comprise a complex form of symbiosis between symbiont algae and coral holobiont. For decades, corals have been challenged by disastrous events of climatic and anthropogenic etiologies. Such complex interactions have resulted in devastating disease episodes among coral populations worldwide. There is a scarcity of information about diseases of hard corals in the Gulf of Aqaba, Red Sea, Egypt. Therefore, the current study aims to investigate various diseases of hard corals in this pristine habitat within the Red Sea. Whitening and dark green dots were the most noticeable morphopathology among hard coral samples collected from Gulf of Aqaba. Some human-based pathogens, such as Rothia kristinae, Cupriavidus pauculus, and Delftia acidovorans, were isolated from some of the examined coral tissues, while the Burkholderia cepacia group was isolated from the nearby sediment. The final identities of the above-mentioned bacterial isolates have been molecularly confirmed using 16S RNA sequence analysis. Pathologically, diseased corals have been observed with changes such as some forms of tissue losses, degenerative changes, and eosinophilic granular amoebocytes/agranular cells infiltration. The frequent detection of some microbial pathogens of human origin could suggest deleterious forms of environmental pollution of anthropogenic origin. Ultimately, the entire existence of hard coral populations is mostly threatened by swiftly erupting climatic changes as well as environmental aquatic pollution. Thus, the current study concludes the real need for extensive ecological, biological, pathological, and immunological studies to determine the eminent threats and propose possible control means for better/sustainable hard coral populations.

Abstract Background The COVID-19 pandemic disrupted health systems around the globe. Lessons from health systems responses to these challenges may help design effective and sustainable health system responses for future challenges. This study aimed to 1/ identify the broad types of health system challenges faced during the pandemic and 2/ develop a typology of health system response to these challenges. Methods Semi-structured one-on-one online interviews explored the experience of 19 health professionals during COVID-19 in a large state health system in Australia. Data were analysed using constant comparative analysis utilising a sociotechnical system lens. Results Participants described four overarching challenges: 1/ System overload, 2/ Barriers to decision-making, 3/ Education or training gaps, and 4/ Limitations of existing services. The limited time often available to respond meant that specific and well-designed strategies were often not possible, and more generic strategies that relied on the workforce to modify solutions and repair unexpected gaps were common. For example, generic responses to system overload included working longer hours, whilst specific strategies utilised pre-existing technical resources (e.g. converting non-emergency wards into COVID-19 wards). Conclusion During the pandemic, it was often not possible to rely on mature strategies to frame responses, and more generic, emergent approaches were commonly required when urgent responses were needed. The degree to which specific strategies were ready-to-hand appeared to dictate how much a strategy relied on such generic approaches. The workforce played a pivotal role in enabling emergent responses that required dealing with uncertainties.

Abstract In this Perspective paper we explore the potential of integrating radiological imaging with other data types, a critical yet underdeveloped area in comparison to the fusion of other multi-omic data. Radiological images provide a comprehensive, three-dimensional view of cancer, capturing features that would be missed by biopsies or other data modalities. This paper explores the complexities and challenges of incorporating medical imaging into data integration models, in the context of precision oncology. We present the different categories of imaging-omics integration and discuss recent progress, highlighting the opportunities that arise from bringing together spatial data on different scales.

Abstract Pre-prohibition psychedelic research with complex psychiatric patients generated a wealth of treatment methodologies and practices, providing invaluable clinical insights pertaining to the medical administration of psychedelics in various mental health diagnoses. Building upon these early studies, which lack the rigor and research tools available today, contemporary psychedelic research has focused on investigating the safety and efficacy of psychedelics in randomized controlled trials via psychometric measures and symptom assessments. Both then and now, the treatment context and the role of clinicians in psychedelic treatment has been recognized as an essential feature for positive patient outcomes. To broaden the knowledge base of modern psychedelic research and support the training of clinicians conducting medically supervised psychedelic research studies, this paper provides a review of pre-prohibition clinical research narratives pertaining to the phenomenology of psychedelic treatment and the role of the non-pharmacological treatment factors in the patient experience. Lastly, this paper explores a range of clinician perspectives and psychological interventions employed in pre-prohibition psychedelic research to inform future research directions and best practice guidelines.

Progressive Supranuclear Palsy (PSP) is a rare and fatal neurodegenerative tauopathy which, with a rapid clinical progression coupled to a strong degree of clinico-pathologic correlation, has been suggested to be a “frontrunner” in translational development for neurodegenerative proteinopathies. Elegant studies in animals have contributed greatly to our understanding of disease pathogenesis in PSP. However, presently no animal model replicates the key anatomical and cytopathologic hallmarks, the spatiotemporal spread of pathology, progressive neurodegeneration, or locomotor and cognitive symptoms that characterize PSP. Current models therefore likely fail to recapitulate the key mechanisms that underly the pathological progression of PSP, impeding their translational value. Here we review what we have learned about PSP from work in animals to date, examine the gaps in modeling the disease and discuss strategies for the development of refined animal models that will improve our understanding of disease pathogenesis and provide a critical platform for the testing of novel therapeutics for this devastating disease.

BackgroundEarly detection of sleep apnea, the health condition where airflow either ceases or decreases episodically during sleep, is crucial to initiate timely interventions and avoid complications. Wearable artificial intelligence (AI), the integration of AI algorithms into wearable devices to collect and analyze data to offer various functionalities and insights, can efficiently detect sleep apnea due to its convenience, accessibility, affordability, objectivity, and real-time monitoring capabilities, thereby addressing the limitations of traditional approaches such as polysomnography. ObjectiveThe objective of this systematic review was to examine the effectiveness of wearable AI in detecting sleep apnea, its type, and its severity. MethodsOur search was conducted in 6 electronic databases. This review included English research articles evaluating wearable AI’s performance in identifying sleep apnea, distinguishing its type, and gauging its severity. Two researchers independently conducted study selection, extracted data, and assessed the risk of bias using an adapted Quality Assessment of Studies of Diagnostic Accuracy-Revised tool. We used both narrative and statistical techniques for evidence synthesis. ResultsAmong 615 studies, 38 (6.2%) met the eligibility criteria for this review. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting apnea events in respiration (apnea and nonapnea events) were 0.893, 0.793, and 0.947, respectively. The pooled mean accuracy of wearable AI in differentiating types of apnea events in respiration (normal, obstructive sleep apnea, central sleep apnea, mixed apnea, and hypopnea) was 0.815. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting sleep apnea were 0.869, 0.938, and 0.752, respectively. The pooled mean accuracy of wearable AI in identifying the severity level of sleep apnea (normal, mild, moderate, and severe) and estimating the severity score (Apnea-Hypopnea Index) was 0.651 and 0.877, respectively. Subgroup analyses found different moderators of wearable AI performance for different outcomes, such as the type of algorithm, type of data, type of sleep apnea, and placement of wearable devices. ConclusionsWearable AI shows potential in identifying and classifying sleep apnea, but its current performance is suboptimal for routine clinical use. We recommend concurrent use with traditional assessments until improved evidence supports its reliability. Certified commercial wearables are needed for effectively detecting sleep apnea, predicting its occurrence, and delivering proactive interventions. Researchers should conduct further studies on detecting central sleep apnea, prioritize deep learning algorithms, incorporate self-reported and nonwearable data, evaluate performance across different device placements, and provide detailed findings for effective meta-analyses.

Background and Aim: Bovine viral diarrhea (BVD) is endemic in North Africa and the Mediterranean Basin with high socioeconomic impacts. However, there are no data on this disease in Libya. One of the aims of this study was to provide data on BVD in Libya, to fill in the gap in the region and to investigate the level of seroprevalence of BVD virus (BVDV) in Libya and associated risk factors. Materials and Methods: A total of 1599 serum samples were collected from cattle herds belonging to seven Libyan regions. All sera were assayed using a screening enzyme-linked immunosorbent assay for the detection of antibodies against BVDV. Results: The overall seroprevalence of BVDV was estimated to be 48.6% (95% confidence interval, 46.08%–50.98%). A seroprevalence rate of 36.8% was detected in cattle aged 2 years. Statistically significant differences (p = 0.001) were observed between age groups. BVDV seroprevalence was significantly associated with geographical region (p = 0.033). Conclusion: To the best of our knowledge, this is the first study on BVD in Libya, and the results suggest that BVD is endemic in Libya. Further studies are required to isolate and characterize the circulated BVDV in Libya.

Technology implementation can significantly benefit organizations, but ensuring it aligns with their business needs and goals is crucial. Adopting an enterprise architecture approach can aid healthcare enterprises in overcoming challenges during the transformation process. In particular, this study examines how The Open Group Architecture Framework (TOGAF) can facilitate digital transformation while ensuring alignment with business needs. Using the Architecture Development Method (ADM) of TOGAF, the study analyzes the current architecture of the National Center for Diabetes, Endocrinology, and Genetics (NCDEG) in Jordan, intending to develop a target architecture that helps NCDEG effectively achieve its goals. [JJCIT 2024; 10(2.000): 182-197]

Abstract Background With the spread and rise in the number of infections of COVID-19 globally, patients experienced neurologic manifestations such as headache and dizziness, along with other serious medical conditions such as stroke and seizures. Many reported cases highlighted headache to be one of the most common COVID-19-related neurological symptoms. With the evolution of the pandemic, broad studies are needed to better understand the mechanism of headache with COVID-19. The aim of this study is to recognize the epidemiology, characteristic and progression of headache among patients with COVID-19 in Lebanon. Methods A retrospective cohort study was done to assess 439 patients for headache during the course of COVID-19. The Statistical Package for Social Sciences (SPSS) version 26 was used for descriptive analysis. Results A confirmed COVID-19 Infection by PCR test was confirmed among 86% of the participants. Tension-like headache was the most common type of headache experienced by participants during COVID-19. Pain was mainly diffuse (48.7%), and compressing in nature (77.0%). Moreover, about 29% required a physician consultation and 7.7% had emergency visits. Partial relief by analgesics was reported in 54.9%, and mainly by paracetamol (64.6%). Those who reported having a history of primary headache before contracting COVID-19 were 46.7%. Among them, 36.7% patients reported a change in the type of headache and about 49.6% reported increased severity. Conclusion Headache accompanied with COVID-19 is a common symptom during the early stages of illness. COVID-19 related headache was characterized as mainly involving the whole head region, pressuring, and partially relieved by analgesics. Thus, headache should raise early concern for the probability of being infected by COVID-19.

Abstract Traumatic experiences in childhood can lead to trauma symptoms and impaired mental health, especially when children are exposed to war and political violence. Despite significant attention to child's exposure to traumas, few instruments to detect potentially traumatic events have been validated psychometrically. Our study aimed to develop, adapt and validate a user-friendly traumatic events checklist in Palestinian children living in three areas affected by low-intensity war and ongoing political and military violence. 965 Palestinian children (494 males and 471 females) living in the Gaza Strip, West Bank and East Jerusalem were administered with a tailor-made Traumatic Events checklist, Children Impact of Events scale, and Strengths and Difficulties Scale. Exploratory and Confirmatory factor analysis was run to detect the factorial structure of the checklist. Furthermore, ANOVA was performed to identify statistically significant demographic differences among participants. A three factors structure emerged with Political violence-related traumatic experiences (PVTE), military violence against individuals (MVI), and military violence against individuals and families (MVF). Gaza children and adolescents resulted in being the most exposed to potentially traumatic events. The instrument can clearly portray potentially traumatic experiences in children exposed to violent events and adverse childhood experiences.

Mathematics teaching material integrated with Islamic values can support the achievement of mathematics learning objectives in cognitive and affective aspects. This research aims to conduct a literature review related to the research and development of mathematics teaching material integrated with Islamic values. The method used in this research is a Systematic Literature Review (SLR) which consists of 36 studies in the period 2018 - 2022. The key question in this research is how the articles regarding research and development of mathematics teaching materials integrated with Islamic values are distributed based on year of publication, level of education, Islamic values, and mathematics topics. The results of this research show that most studies related to mathematics teaching materials integrated with Islamic values were carried out in 2020, researchers conducted a lot of research on teaching materials integrated with Islamic values at the junior high school level, teaching materials integrated with Islamic values were mostly applied to the topic of numbers, and the most widely used Islamic value is the Quran. This research is expected to be a reference to carry out further research related to mathematics teaching materials integrated with Islamic values, and using mathematics teaching material integrated with Islamic values can be the option to make the mathematics learning process more meaningful.

This review article critically examines the role of political economy variables in shaping education policy in the context of a global learning crisis. It surveys the literature on how factors such as democracy, institutional arrangements, ideology, and transnational dimensions influence the promotion of equitable learning. The article assesses the role of these factors in the case of Egypt through a review of educational developments over the past three decades in a country that shares many challenges with low- and middle-income countries. Presenting novel data and key indicators on Egypt and a framework for analysing equitable learning elsewhere, the article maps the dimensions of the learning crisis that has developed in parallel to the adoption of a new global learning agenda supported by international agencies. The analysis suggests that democracy and institutional features are not robust explanatory variables for the adoption or successtion of effective education policy. Instead, the article shows how commitment to equity, patterns of privatization, and levels of international debt and development assistance are the critical elements of understanding the learning crisis.

Cow's milk allergy (CMA) is one of the most common presentations of food allergy in early childhood. Management of CMA involves individualized avoidance of cow's milk and other mammalian milk and foods containing these. Optimal elimination of cow's milk avoidance includes: label reading; information about safe and nutritious substitute foods; appropriate choice of infant formula or a plant-based food; establishing tolerance to baked milk and monitoring nutritional intake and growth. Substitute formulas are divided into soy formula (not hydrolyzed), milk-based extensively hydrolyzed formulas, rice based extensive, and partially hydrolyzed formulas and amino acid-based formulas. The use of other mammalian milks is not recommended for the management of cow's milk allergy due to a high level of cross-reactivity and nutritional concerns. For toddlers who are eating well, children, and adults, a suitable plant-based beverage may be a suitable alternative to a specialized formula, following careful nutritional considerations. Families need to be instructed on finding suitable nutritious foods and how to prepare suitable meals at home. Individuals with CMA also need to know how to identify and treat acute severe reactions.

In Canada, every day, contaminants of emerging concern (CEC) are discharged from waste treatment facilities into freshwaters. CECs such as pharmaceutical active compounds (PhACs), personal care products (PCPs), per- and polyfluoroalkyl substances (PFAS), and microplastics are legally discharged from sewage treatment plants (STPs), water reclamation plants (WRPs), hospital wastewater treatment plants (HWWTPs), or other forms of wastewater treatment facilities (WWTFs). In 2006, the Government of Canada established the Chemicals Management Plan (CMP) to classify chemicals based on a risk-priority assessment, which ranked many CECs such as PhACs as being of low urgency, therefore permitting these substances to continue being released into the environment at unmonitored rates. The problem with ranking PhACs as a low priority is that CMP’s risk management assessment overlooks the long-term environmental and synergistic effects of PhAC accumulation, such as the long-term risk of antibiotic CEC accumulation in the spread of antibiotic resistance genes. The goal of this review is to specifically investigate antibiotic CEC accumulation and associated environmental risks to human and environmental health, as well as to determine whether appropriate legislative strategies are in place within Canada’s governance framework. In this research, secondary data on antibiotic CEC levels in Canadian and international wastewaters, their potential to promote antibiotic-resistant residues, associated environmental short- and long-term risks, and synergistic effects were all considered. Unlike similar past reviews, this review employed an interdisciplinary approach to propose new strategies from the perspectives of science, engineering, and law.

This study explores the link between financial inclusion and food security in Algeria from 2003 to 2022. Using a composite financial inclusion index and the Vector Error Correction Model (VECM), we analyse the data, subjecting it to various diagnostic tests. Surprisingly, our results reveal that financial inclusion (FI) has a significant and positive impact on undernourishment prevalence, indicating a negative effect on food security in both the short and long term. Likewise, food imports (FIM) contribute to higher undernourishment prevalence, implying a weakening of food security in the long-run. Conversely, unemployment rate (UEM) and food production (FOP) show no substantial long-term impact on food security, although UEM has an opposing effect in the short run, meaning it improves food security at the short term; which can be attributed to the informal economy and other State’s policies. Notably, income per capita (INCAPITA) negatively affects undernourishment prevalence, improving food security. These findings offer a nuanced understanding of the complex relationship between financial inclusion and food security in Algeria, emphasizing the need for multifaceted, context-specific policies to address the country's unique challenges.

Este artículo profundiza en la evolución del arte en la era digital y su influencia en la estética y el pensamiento artístico contemporáneo. La tecnología ha desencadenado una revolución en la creación y apreciación artística, trasladando la creatividad desde los lienzos tradicionales al vasto dominio digital. Esta transformación hacia el pensamiento digital ha llevado a los artistas a cuestionar y redefinir las normas convencionales, explorando nuevas formas de expresión y colaboración. Las obras de arte digital se distinguen por su flexibilidad y maleabilidad, permitiendo la creación de experiencias interactivas y obras en constante transformación. Este artículo explora cómo la estética digital se basa en conceptos como la interactividad, el dinamismo y la influencia mediática abriendo horizontes ilimitados en el ámbito creativo. Además, se analiza la construcción epistemológica en el arte digital y su impacto en la concepción contemporánea del conocimiento. En última instancia, el arte digital se presenta como una manifestación vívida de la creatividad humana que trasciende las limitaciones físicas y redefine nuestra comprensión misma del arte en el contexto del siglo XXI, desafiando y expandiendo las fronteras tradicionales de la expresión artística y explorando nuevas dimensiones de creatividad e interpretación.

Creative reasoning is a person's ability to solve mathematical problems in a manner of thinking that deviates from the norm, yet remains logical and grounded in a strong mathematical foundation. While crucial for students, many have not yet attained proficiency in creative reasoning, necessitating comprehensive research on the subject. This study aims to elucidate students' creative reasoning abilities in tackling straight-line equation problems, focusing on indicators such as creativity, plausibility, and anchoring. Employing a qualitative approach with a case study design, the research involved three students from Madrasah Tsanawiyah who had studied straight-line equations. The primary instrument was the researcher, supported by a creative reasoning ability description test and interviews. Data collection utilized triangulation techniques, encompassing tests and interviews. Analysis of the research findings entailed describing students' creative mathematical reasoning abilities for each creative reasoning indicator in straight-line equation material. Results indicated that while students could provide correct and reasonable arguments in solving mathematical problems, they struggled to devise alternative methods and employ strategies based on mathematical concepts. Consequently, they only met the plausibility criterion, falling short in creativity and anchoring. Thus, it can be concluded that students have not yet achieved creative reasoning proficiency in solving straight-line equation problems.

Abstract. Objectives:. To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery. Design:. Retrospective cohort study. Setting:. Mariner claims database. Patients/Participants:. Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study. Intervention:. Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing. Main Outcome Measures:. One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation. Results:. Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08–2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08–1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00–1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59–0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63–1.18, P = 0.41). Conclusions:. Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population. Level of Evidence:. Prognostic Level III.

Abstract In men, reduced levels of testosterone are associated with the prevalence and progression of multiple sclerosis (MS), a chronic and disabling demyelinating disorder. Testosterone has been shown to promote myelin repair. Here, we demonstrate that the cooperation between testosterone and CXCR4 signaling involving astrocytes is required for myelin regeneration after focal demyelination produced in the ventral mouse spinal cord by the infusion of lysolecithin. The testosterone-dependent remyelination of axons by oligodendrocytes was accompanied by an increase in astrocytes expressing CXCR4, its ligand CXCL12 and the androgen receptor (AR) within the demyelinated area. Depriving males of their testosterone or pharmacological inhibition of CXCR4, with the selective antagonist AMD3100, prevented the appearance of astrocytes expressing CXCR4, CXCL12 and AR within the demyelinated area and the concomitant recruitment of myelin forming oligodendrocytes. Conditional genetic ablation of either CXCR4 or AR in astrocytes also completely blocked the formation of new myelin by oligodendrocytes. Interestingly, the gain of function mutation in CXCR4 causing WHIM syndrome allows remyelination to take place, even in the absence of testosterone, but its potentiating effects remained observable. After testosterone deprivation or CXCR4 inhibition, the absence of astrocytes within the demyelinated area led to the incursion of Schwann cells, most likely derived from spinal nerves, and the formation of peripheral nerve type myelin. In patients with progressive MS, astrocytes expressing CXCR4 and AR surrounded myelin lesions, and their presence opposed the incursion of Schwann cells. These results highlight a mechanism of promyelinating testosterone signaling and the importance of normalizing its levels in combined myelin repair therapies.

Abstract Background Refugee children are at high risk of mental health problems but face barriers to accessing mental health services, a problem exacerbated by a shortage of mental health professionals. Having trained lay counsellors deliver therapy via telephone could overcome these barriers. This is the first study to explore feasibility and acceptability of telephone-delivered therapy with refugee children in a humanitarian setting. Methods An evidence-based intervention, Common Elements Treatment Approach, was adapted for telephone-delivery (t-CETA) and delivered by lay counsellors to Syrian refugee children in informal tented settlements in the Beqaa region of Lebanon. Following delivery of t-CETA, semi-structured interviews were conducted with counsellors (N = 3) and with children who received t-CETA (N = 11, 45% female, age 8–17 years) and their caregivers (N = 11, 100% female, age 29–56 years) (N = 25 interviews). Thematic content analysis was conducted separately for interviews with counsellors and interviews with families and results were synthesized. Results Three themes emerged from interviews with counsellors and four themes from interviews with families, with substantial overlap between them. Synthesized themes were: counselling over the phone both solves and creates practical and logistical challenges; t-CETA is adapted to potential cultural blocks; the relationship between the counsellor and the child and caregiver is extremely important; the family’s attitude to mental health influences their understanding of and engagement with counselling; and t-CETA works and is needed. Counselling over the phone overcame logistical barriers, such as poor transportation, and cultural barriers, such as stigma associated with attending mental health services. It provided a more flexible and accessible service and resulted in reductions in symptoms for many children. Challenges included access to phones and poor network coverage, finding an appropriate space, and communication challenges over the phone. Conclusions Despite some challenges, telephone-delivered therapy for children shows promising evidence of feasibility and acceptability in a humanitarian context and has the potential to increase access to mental health services by hard-to-reach populations. Approaches to addressing challenges of telephone-delivered therapy are discussed. Trial Registration ClinicalTrials.gov ID: NCT03887312; registered 22nd March 2019.

Abstract Background Single nucleotide polymorphisms (SNPs) have been linked with prostate cancer (PCa) and have shown potential as prognostic markers for advanced stages. Loss of function mutations in PKCι have been linked with increased risk of malignancy by enhancing tumor cell motility and invasion. We have evaluated the impact of two coding region SNPs on the PKCι gene (PRKCI) and their prognostic potential. Methods Genotypic association of non-synonymous PKCι SNPs rs1197750201 and rs1199520604 with PCa was determined through tetra-ARMS PCR. PKCι was docked with interacting partner Par-6 to determine the effect of these variants on PKCι binding capabilities. Molecular dynamic simulations of PKCι docked with Par-6 were performed to determine variant effects on PKCι protein interactions. The possible impact of changes in PKCι protein interactions on epithelial cell polarity was hypothesized. Results PKCι rs1199520604 mutant genotype TT showed association with PCa (p = 0.0055), while rs1197750201 mutant genotype AA also showed significant association with PCa (P = 0.0006). The binding interaction of PKCι with Par-6 was altered for both variants, with changes in Van der Waals energy and electrostatic energy of docked structures. Conclusion Genotypic analysis of two non-synonymous PKCι variants in association with PCa prognosis was performed. Both variants in the PB1 domain showed potential as a prognostic marker for PCa. In silico analysis of the effect of the variants on PKCι protein interactions indicated they may be involved in PCa progression through aberration of epithelial cell polarity pathways.

Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: “(laparoscopic OR endoscopic) AND (anterior AND lumbar).” Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio’s “metafor” package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6–43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9–90.4). Complications occurred in 19.2% (95% CI, 13.4–27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6–11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.

Although employee engagement has become a vital issue in business, research on how different bundles of Human Resource (HR) practices affect employee engagement remains insufficient. This study addresses two primary aims: firstly, to investigate the direct and indirect effects of general HR practices and organizational support on employee engagement in the Vietnamese retail sector; secondly, to assess the mediating role of job enrichment in these relationships. Using Partial Least Square-Structural Equation Modeling (PLS-SEM) analysis on a sample of 796 retail employees in Vietnam, this study contributed to such a gap by investigating the mechanisms connecting different HR practices with job enrichment and engagement. Firstly, our findings confirm the direct positive impacts of organizational support and job enrichment on engagement and of organizational support and general HR practices on job enrichment itself. Secondly, although general HR practices are not found to influence employee engagement directly, their indirect influence is still significant via the full mediation of job enrichment. This research makes a substantial contribution to the current body of knowledge by enhancing our comprehension of the mechanisms that link HR practices and employee engagement. The study provides practical insights for Vietnamese retail organizations, emphasizing the importance of job enrichment, well-designed HR practices, and strong organizational support in promoting long-term employee engagement. This ultimately leads to the development of a more dedicated and committed workforce in Vietnam’s dynamic retail industry.

Abstract Background and Aims Antibiotic resistance (ABR) is a global public health emergency which has seen an uptick in low‐ to middle‐income countries in recent times due to a plethora of aggravating factors and has led to a whole host of setting‐specific pathogens registering high rates of resistance, causing outbreaks with graver mortality and morbidity. This review analyzes available literature to determine the causes and effects of ABR and recommend solutions to the problem in a Pakistani setting. Methods Sources for this narrative review were identified via electronic databases using keyword search methods. The information was retrieved using databases such as PubMed and Science Direct. Additionally, websites such as CDC and World Health Organization were used to attain pertinent information. All the sources were selected as per their relevance and appropriateness toward the purpose of this review. Results This review details the causes by dividing them into three primary strata, namely (1) under‐regulation, (2) over‐prescription and self‐medication, and (3) lack of medical stewardship. This is made much graver when the COVID‐19 pandemic and the subsequent erratic treatment response is considered, with the pandemic augmenting already high levels of consumption. These factors have led a cascade of effects including, but not limited to, a considerable increase in ABR in pathogens to first‐line drugs Conclusion ABR is a serious and growing issue which will result in undesirable personal, local, and national consequences if unchecked. Mitigation and reversal of this trend is necessary by developing existing programs and investing in novel therapies and pharmaceutical research and strengthening regulatory policies and mechanisms.

In this study, porous hydroxyapatite-metakaolin geopolymer (HAP-MK-GP) granules were prepared with a novel method for adsorption of organic pollutants from aqueous solutions, using brilliant green dye as a model compound. The preparation involved combining finely powdered hydroxyapatite, metakaolin, and solid sodium metasilicate in a high-shear granulator. Then, hydrogen peroxide (H2O2) was added at different concentrations (0.0, 5.0, 7.5, or 10.0%) as a combined granulation fluid and blowing agent. In the resulting granules, metakaolin geopolymer bound the powdered hydroxyapatite as granules and contributed to the adsorption capacity. To determine their structural, morphological, and mechanical properties, the granules were characterized with infrared spectroscopy, X-ray fluorescence, scanning electron microscopy, specific surface area and porosity analysis, and compressive strength tests. The granules had a high porosity and promising compressive strength and Young's modulus of 0.8 and 10 MPa, respectively, potentially enabling their use in large-scale adsorption columns. The monolayer adsorption mechanism of brilliant green dye onto HAP-MK-GP granules was confirmed by fitting the obtained batch adsorption data to the Langmuir isotherm model which showed that the adsorption capacity was approximately 41 mg/g. The optimum conditions were: pH of 7, initial dye concentration of 100 mg/L, adsorbent dose of 3 g/L, agitation speed of 250 rpm, contact time of 30 min, and temperature of 298 K. The adsorption kinetic data indicated that the adsorption followed the pseudo-second-order kinetic model. The thermodynamic parameters, including Gibbs free energy, enthalpy, entropy, and activation energy, indicated that adsorption was spontaneous, endothermic, and was based on physisorption. The rate-limiting step was film diffusion. Based on the results, HAP-MK-GP granules could be a feasible adsorbent for the removal of dyes from industrial wastewater. Moreover, the facile granulation method presented here could be applied to other powdered adsorbents as well to prepare adsorbent granules.

Background: Cow's milk allergy (CMA) is the most common food allergy in infants. The replacement with specialized formulas is an established clinical approach to ensure adequate growth and minimize the risk of severe allergic reactions when breastfeeding is not possible. Still, given the availability of multiple options, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF) and soy formulas (SF), there is some uncertainty as to the most suitable choice with respect to health outcomes. Furthermore, the addition of probiotics to a formula has been proposed as a potential approach to maximize benefit. Objective: These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA. Methods: WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders. Results: After reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow's milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as “conditional” following the GRADE approach due to the very low certainty about the health effects based on the available evidence. Conclusions: If breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients' and caregivers’ values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.

ABSTRACT: Background: Lumbar spinal fusion surgery is a well-established treatment for various spinal disorders. However, one of its complications, pseudoarthrosis, poses a significant concern. This study aims to explore the incidence, time and predictive factors contributing to pseudoarthrosis in patients who have undergone lumbar fusion surgery over a 10-year period. Methods: Data for this research was sourced from the PearlDiver database where insurance claims of patients who underwent multilevel lumbar spinal fusion between 01/01/2010 and 10/31/2022 were examined for claims of pseudoarthrosis within the 10 years of their index procedure. A variety of demographic, comorbid, and surgical factors were assessed, including age, gender, Elixhauser Comorbidity Index (ECI), surgical approach, substance use disorders and history of spinal disorders. Statistical analyses, including chi-squared tests, multivariate analysis, and cox survival analysis were employed to determine significant associations. Results: Among the 76,337 patients included in this retrospective study, 2.70% were diagnosed with symptomatic lumbar pseudoarthrosis at an average of 7.38 years in a 10-year follow-up. Multivariate and Cox hazard analyses revealed that significant predictors of symptomatic pseudoarthrosis development following multilevel primary lumbar fusion include vitamin D deficiency, osteoarthritis, opioid and NSAID use, tobacco use, and a prior history of congenital spine disorders. Conclusions: In summary, this study revealed a 2.70% incidence of symptomatic lumbar pseudoarthrosis within 10 years of the index procedure. It highlighted several potential predictive factors, including comorbidities, surgical approaches, and substance use disorders, associated with the development of symptomatic pseudoarthrosis. Future research should focus on refining our understanding of these factors to improve patient outcomes and optimize healthcare resource allocation.

ABSTRACT: Background: Patients with long-term follow-up after cervical decompression and fusion have often been noted to have development of adjacent segment degeneration with a smaller subset of these patients progressing to adjacent segment disease (ASD), which results in the development of new symptomatic radiculopathy or myelopathy referable to a site either directly above or below a prior fused segment. The cause of ASD is multifactorial often involving natural age-related progression of spondylosis, accelerated progression following cervical decompression and fusion, operative technique, and patient-related factors. The effect of age at the time of index cervical decompression and fusion on the need for reoperation for ASD is not fully understood. This study aims to establish underlying risk factors for the development of symptomatic cervical ASD following cervical decompression and fusion requiring reoperation in patients of various age groups. Methods: A retrospective database review of patients aged 20 or greater with insurance claims of primary cervical decompression and fusion over the course of 11 years and 10 months (January 01, 2010–October 31, 2022) was conducted using an insurance claims database. The primary outcome was to evaluate the incidence of cervical ASD requiring reoperation amongst patients stratified by age at the time of their primary procedure. Secondary outcomes included an evaluation of various risk factors for ASD following cervical decompression and fusion including surgeon-controlled factors such as the number of levels fused and approach taken, patient cervical pathology including cervical disc disorder and cervical spondylosis, and underlying patient medical comorbidities including osteoporosis and vitamin D deficiency, and substance use. Results: A total of 60,292 patient records were analyzed, where the overall reoperation incidence for symptomatic ASD was 6.57%, peaking at 8.12% among those aged 30 to 39 and decreasing with age. Regression analysis revealed ages lower than 50 years as more predictive for the development of symptomatic ASD requiring reoperation. Multivariate regression analysis identified predictive factors for reoperation, including age, Elixhauser Comorbidity Index (ECI), multiple-level surgery, cervical spondylosis, cervical disc disorder, osteoporosis, and vitamin D deficiency. Notably, these factors had a variable impact across various age groups, as revealed by subgroup analysis. Conclusions: The incidence of reoperation secondary to symptomatic ASD is 6.57%, highest in those aged 30 to 39. The surgical approach had no significant impact on the need for reoperation, but multiple-level fusions posed a consistent risk in the development of symptomatic ASD requiring reoperation. Patient factors like degenerative disc disease, spondylosis, osteoporosis, and vitamin D deficiency were associated, urging further age-specific risk assessment and nonoperative intervention exploration.

The gut microbiota has gained significant attention in research and the media for its role in health and disease. Dysbiosis, an imbalance in gut microbiota composition and function, is increasingly recognized as a contributing factor in the development of various gastrointestinal and extraintestinal conditions. In this growing understanding, biotics (probiotics, prebiotics, synbiotics, and postbiotics) have become a significant industry in many countries. Aggressive marketing often creates confusion, contributing to a gap between hype and reality regarding the effective use of these biotics. This article offers a concise overview of the current consensus definitions for various types of biotics. It will also review existing evidence on the effectiveness of different biotics in preventing and treating diseases in the pediatric population. Doing so will separate the hype from the reality, providing a balanced view of the benefits and limitations of biotics in pediatric care.

Abstract Background Midwives are essential providers of primary health care and can play a major role in the provision of health care that can save lives and improve sexual, reproductive, maternal, newborn and adolescent health outcomes. One way for midwives to deliver care is through midwife-led birth centres (MLBCs). Most of the evidence on MLBCs is from high-income countries but the opportunity for impact of MLBCs in low- and middle-income countries (LMICs) could be significant as this is where most maternal and newborn deaths occur. The aim of this study is to explore MLBCs in four low-to-middle income countries, specifically to understand what is needed for a successful MLBC. Methods A descriptive case study design was employed in 4 sites in each of four countries: Bangladesh, Pakistan, South Africa and Uganda. We used an Appreciative Inquiry approach, informed by a network of care framework. Key informant interviews were conducted with 77 MLBC clients and 33 health service leaders and senior policymakers. Fifteen focus group discussions were used to collect data from 100 midwives and other MLBC staff. Results Key enablers to a successful MLBC were: (i) having an effective financing model (ii) providing quality midwifery care that is recognised by the community (iii) having interdisciplinary and interfacility collaboration, coordination and functional referral systems, and (iv) ensuring supportive and enabling leadership and governance at all levels. Conclusion The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings.

Abstract Multiple Sclerosis (MS) is a chronic autoimmune inflammatory disorder of the central nervous system (CNS). Current therapies mainly target inflammatory processes during acute stages, but effective treatments for progressive MS are limited. In this context, astrocytes have gained increasing attention as they have the capacity to drive, but also suppress tissue-degeneration. Here we show that astrocytes upregulate the immunomodulatory checkpoint molecule PD-L1 during acute autoimmune CNS inflammation in response to aryl hydrocarbon receptor and interferon signaling. Using CRISPR-Cas9 genetic perturbation in combination with small-molecule and antibody-mediated inhibition of PD-L1 and PD-1 both in vivo and in vitro, we demonstrate that astrocytic PD-L1 and its interaction with microglial PD-1 is required for the attenuation of autoimmune CNS inflammation in acute and progressive stages in a mouse model of MS. Our findings suggest the glial PD-L1/PD-1 axis as a potential therapeutic target for both acute and progressive MS stages.

Vaccine-preventable diseases continue to generate a substantial burden on health, healthcare systems, and societies, which is projected to increase with population ageing. There is a need to better understand the full value of adult immunisation programmes corresponding to the broader value of vaccine frameworks that are recommended for evidence-based decision-making. This review aims to summarise and map evidence for the value of selected adult immunisation programmes (seasonal influenza, pneumococcal disease, RSV, and HZ) in ten diverse countries. We conducted a structured literature review of evidence published from 2017 to 2023. An existing framework was used to structure the assessment, developing matrices demonstrating the elements of value evidenced for each vaccine and country of focus. Our analysis showed substantial evidence base on the value of adult immunisation programmes, but the availability of evidence varied by value element and by vaccine. The impact on the quality of life of the vaccinated individual was the most evidenced value element. Mortality benefits for vaccinated individuals and cost-offsets to healthcare systems were also well-evidenced. The availability of evidence for ‘broader’ societal value elements (such as transmission value, carer productivity and impact on social equity, and antimicrobial resistance prevention) varied. No evidence was identified relating to the broader value elements of macroeconomic effects, value to other interventions, or effects on the quality of life of caregivers. Robust evidence exists to show that adult immunisation programmes generate substantial value for population health and health systems, yet some elements of broader value remain underrepresented in the academic literature. Without such evidence, the full value of immunisation programmes is underestimated, risking suboptimal policy decisions.

Lipoid proteinosis is a rare autosomal recessive genodermatosis characterized by the deposition of hyaline material in the skin and internal organs. Skin involvement is in the form of blisters in infancy healing with pock-like scars, yellow waxy papules, plaques, moniliform blepharosis and diffuse infiltration. Neurological manifestations such as epilepsy, schizophrenia and memory loss have also been reported. We report the case of a 24-year-old female with lipoid proteinosis with neuro-psychiatric symptoms. Her non-contrast computed tomography of the head showed symmetrical calcification involving bilateral medial temporal lobes. We also review the literature on previous publications of lipoid proteinosis cases with neuropsychiatric involvement.

This study examines the role of digital business incubators, focusing specifically on the Qatar Digital Incubation Center (DIC), in fostering digital entrepreneurship. The methodology used is qualitative, employing content analysis to interpret textual and visual data from sources such as online databases, documents, reports, and academic research papers. International benchmark reports are used to assess Qatar's global ranking in research, development, innovation, and digital entrepreneurship. The findings highlight Qatar's commitment to digital transformation and its efforts to create a supportive ecosystem for entrepreneurship. They underscore Qatar's dedication to driving innovation through investments in telecommunications, information technology, education, and initiatives like the Qatar National Research Fund. Qatar's digital competitiveness is evident through its ICT infrastructure, extensive 5G implementation, and initiatives like the Smart Qatar Program. The DIC plays a pivotal role in supporting digital entrepreneurs by providing resources, mentorship, and a collaborative environment. By collaborating with government agencies, academic institutions, and industry partners, the DIC contributes to the growth and success of digital startups, fostering innovation, and positioning Qatar as a hub for digital entrepreneurship and technological innovation. This study provides valuable insights into the development of Qatar's digital entrepreneurship ecosystem and the significance of digital business incubators, including the DIC.

Background. Generalized morphea is a rare fibrosing skin illness that progresses from erythematous, violet-colored skin patches to sclerotic plaques. Another uncommon immune-mediated connective tissue disease called eosinophilic fasciitis (EF) evolves to cause sclerosis and woody skin induration. The coexistence of the two is extremely rare and has a poorer prognosis. Our case report is one of the first to report burn injuries as a trigger factor for EF and generalized morphea overlap. Case Presentation. A 36-year-old man presented with acute onset of rapidly progressing skin thickening, tender edema, and skin contractures involving all extremities, shortly after enduring burn injuries from a gasoline explosion. Workup was remarkable for peripheral eosinophilia, hypergammaglobulinemia, and elevated C-reactive protein. Skin biopsy demonstrated sclerodermoid changes and sclerotic thickening of subcutaneous fibrous septa associated with stromal mucin, dermal perivascular, diffuse lymphoplasmacytic infiltrate with eosinophils, decreased CD34 expression, and increased factor XIIIa. He was subsequently diagnosed with an overlap of generalized morphea and eosinophilic fasciitis. The patient had only limited improvement with steroids, methotrexate, mycophenolate mofetil, and intralesional triamcinolone acetonide injections. Conclusion. Generalized morphea with concomitant EF indicates some degree of therapeutic resistance and poor prognosis with a low quality of life. Burn injuries can be a trigger factor for this overlap syndrome. Prompt identification of at-risk individuals and initiating aggressive management are necessary.

In today’s technologically advanced world, the escalating prevalence of phishing attacks necessitates an urgent exploration of effective countermeasures. This study delves into the crucial investigation of how self-regulation influences phishing susceptibility, while also examining the mediating role of information processing and the moderating influence of financial knowledge. A comprehensive survey was meticulously crafted, targeting 370 recent university graduates. The collected data underwent rigorous analysis using Hayes’ PROCESS macro, unveiling a mediated moderation model. The findings reveal that self-regulation does not directly predict phishing susceptibility. However, information processing, whether systematic or heuristic, significantly impacts phishing susceptibility. Additionally, information processing serves as a mediator, connecting self-regulation to phishing susceptibility. Notably, the interaction between systematic information processing and financial knowledge emerged as a significant determinant of phishing susceptibility. By establishing a comprehensive mediated moderation model, this study provides invaluable insights for individuals and organizations seeking to bolster their defenses against phishing attacks. Furthermore, it emphasizes the vital role of financial knowledge and employees’ heuristic information processing in mitigating cyber threats. This research serves as a crucial scientific contribution, offering compelling evidence that proactive management of contributing factors can effectively mitigate the escalating threats posed by phishing attacks.

BackgroundGestational diabetes (GDM) affects approximately 14% of pregnancies globally and is associated with short- and long-term complications for both the mother and child. In addition, GDM has been linked to chronic low-grade inflammation with recent research indicating a potential immune dysregulation in pathophysiology and a disparity in regulatory T cells.ObjectiveThis systematic review and meta-analysis aimed to determine whether there is an association between GDM and the level of Tregs in the peripheral blood.MethodsLiterature searches were conducted in PubMed, Embase, and Ovid between the 7th and 14th of February 2022. The inclusion criteria were any original studies published in the English language, measuring differentiated Tregs in women with GDM compared with glucose-tolerant pregnant women. Meta-analysis was performed between comparable Treg markers. Statistical tests were used to quantify heterogeneity: τ2, χ2, and I2. Study quality was assessed using a modified version of the Newcastle-Ottawa scale.ResultsThe search yielded 223 results: eight studies were included in the review and seven in the meta-analysis (GDM = 228, control = 286). Analysis of Tregs across all trimesters showed significantly lower Treg numbers in women with GDM (SMD, −0.76; 95% CI, −1.37, −0.15; I2 = 90%). This was reflected in the analysis by specific Treg markers (SMD −0.55; 95% CI, −1.04, −0.07; I2 = 83%; third trimester, five studies). Non-significant differences were found within subgroups (differentiated by CD4+FoxP3+, CD4+CD127−, and CD4+CD127−FoxP3) of both analyses.ConclusionGDM is associated with lower Treg numbers in the peripheral maternal blood. In early pregnancy, there is clinical potential to use Treg levels as a predictive tool for the subsequent development of GDM. There is also a potential therapeutic intervention to prevent the development of GDM by increasing Treg populations. However, the precise mechanism by which Tregs mediate GDM remains unclear.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42022309796.

ABSTRACTProbiotics are used for both generally healthy consumers and in clinical settings. However, theoretical and proven adverse events from probiotic consumption exist. New probiotic strains and products, as well as expanding use of probiotics into vulnerable populations, warrants concise, and actionable recommendations on how to work toward their safe and effective use. The International Scientific Association for Probiotics and Prebiotics convened a meeting to discuss and produce evidence-based recommendations on potential acute and long-term risks, risks to vulnerable populations, the importance for probiotic product quality to match the needs of vulnerable populations, and the need for adverse event reporting related to probiotic use. The importance of whole genome sequencing, which enables determination of virulence, toxin, and antibiotic resistance genes, as well as clear assignment of species and strain identity, is emphasized. We present recommendations to guide the scientific and medical community on judging probiotic safety.

Abstract Background Racial and ethnic disparities in mental health service utilisation and access is well established. Mental illness is common among Arab populations globally, but most individuals display negative attitudes towards mental health and do not seek professional help. The aim of this systematic review was to determine 1) help-seeking behaviours 2) help-seeking attitudes and 3) help-seeking barriers and facilitators, related to mental health services among Arab adults. Method A pre-defined search strategy and eligibility criteria allowed for database searching using terms related to: mental health, Arabs, help-seeking, as well as experiences and behaviours. Seventy-four articles were included and analysed through narrative synthesis. Results were reported using the PRISMA guidelines. The review protocol was registered prospectively on PROSPERO (CRD42022319889). Results Arabs across the world have negative attitudes towards formal help-seeking and are reluctant to seek help, despite the presence of psychological distress. There is little information on factors that influence help-seeking behaviours and rates of service use. Preference for informal help sources such as family and friends were expressed and considered more acceptable. Low mental health literacy, stigma, gender, age, education, religion, acculturation, and immigrant status were the most common factors influencing help-seeking attitudes. Barriers to help-seeking included stigma, privacy and confidentiality, trust, mental health literacy, language, logistics, and culture related barriers. Increasing societal and family awareness, external support and encouragement, shared culture between the client and therapist, quality of doctor patient relationship, and feelings of connectedness with the host country among refugees were mentioned facilitators. Mixed findings for the role of religion, and family and community, in relation to facilitating or hindering help-seeking were reported. Conclusions There is an increased likelihood and preference to seek informal sources of psychological support among Arabs. Contextual and cultural factors impeding help-seeking for Arabs are common across the world. Future research should address actual utilisation rates of services to better understand factors that influence help-seeking behaviours and facilitators to help-seeking. Increasing mental health literacy and developing anti stigma campaigns is necessary. Developing culturally informed interventions should inform future efforts to promote help-seeking among this population.

Teachers are professional educators with the main task of educating, teaching, guiding, directing, training, assessing, and evaluating students in every teaching and learning process in schools. In the learning process, various skills are needed for the continuity of the learning process, one of which is the skill of making lesson plans. The skill of a teacher in making lesson plans determines the learning outcomes that will be accepted by students. This study aims to analyze the effect of RADEC-based workshop activities in improving the skills of elementary school teachers to make good lesson plans. This study uses the One Group pretest posttest method with a sample of elementary school teachers in Purwakarta Regency. The instrument used is the result of adaptation of the assessment of the learning implementation plan in the PPG program. There are seven indicators used in the instrument used. The results showed that the RADEC model had an impact on teachers in developing learning planning skills. The average n-gain score obtained from this study was 58 which was categorized as quite effective.

Abstract Background Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare entity first described in 2004. We present a case of PGNMID with recurrent hematuria and nephrotic range proteinuria with three biopsies over 46 years. Case presentation A 79-year-old Caucasian female presents with a history of two separate episodes of biopsy-proven recurrent GN over a course of 46 years. Both biopsies from 1974, and 1987 were reported as membranoproliferative GN (MPGN). The patient presented in 2016 for the third time with symptoms of fluid overload, slight worsening in renal function, and proteinuria along with glomerular hematuria. A third kidney biopsy was performed, and the final diagnosis was proliferative glomerulonephritis with monoclonal IgG/κ deposits. Conclusion With three renal biopsies obtained over 46 years, our case opens a unique window into the natural history of PGNMID. The three biopsies demonstrate the immunologic and morphologic evolution of PGNMID in the kidney.

The Trichodesmium genus comprises some of the most abundant N2-fixing organisms in oligotrophic marine ecosystems. Since nitrogenase, the key enzyme for N2 fixation, is irreversibly inhibited upon O2 exposure, these organisms have to coordinate their N2-fixing ability with simultaneous photosynthetic O2 production. Although being the principal object of many laboratory and field studies, the overall process of how Trichodesmium reconciles these two mutually exclusive processes remains unresolved. This is in part due to contradictory results that fuel the Trichodesmium enigma. In this review, we sift through methodological details that could potentially explain the discrepancy between findings related to Trichodesmium's physiology. In doing so, we exhaustively contrast studies concerning both spatial and temporal nitrogenase protective strategies, with particular attention to more recent insights. Finally, we suggest new experimental approaches for solving the complex orchestration of N2 fixation and photosynthesis in Trichodesmium.

Background: Lung ultrasound (LUS) is increasingly used as an extension of physical examination, informing clinical diagnosis, and decision making. There is particular interest in the assessment of patients with pulmonary congestion and extravascular lung water, although gaps remain in the evidence base underpinning this practice as a result of the limited evaluation of its inter-rater reliability and comparison with more established radiologic tests. Methods: 30 patients undergoing haemodialysis were prospectively recruited to an observational cohort study (NCT01949402). Patients underwent standardised LUS assessment before, during and after haemodialysis; their total LUS B-line score was generated, alongside a binary label of whether appearances were consistent with an interstitial syndrome. LUS video clips were recorded and independently scored by two blinded expert clinician sonographers. Low-dose non-contrast thoracic CT, pre- and post dialysis, was used as a “gold standard” radiologic comparison. Results: LUS detected a progressive reduction in B-line scores in almost all patients undergoing haemodialysis, correlating with the volume of fluid removed once individuals with no or minimal B-lines upon pre-dialysis examination were discounted. When comparing CT scans pre- and post dialysis, radiologic evidence of the change in fluid status was only identified in a single patient. Conclusions: This is the first study to demonstrate that LUS detects changes in extravascular lung water caused by changing fluid status during haemodialysis using a blinded outcome assessment and that LUS appears to be more sensitive than CT for this purpose. Further research is needed to better understand the role of LUS in this and similar patient populations, with the aim of improving clinical care and outcomes.

This study investigates the impact of the COVID-19 pandemic on energy literacy and conservation behavior among occupant groups in academic buildings in Kuwait. It explores influential factors, focusing on the pandemic's effect on attitudes, intentions, and behaviors related to energy conservation. The research adopts a mixed-methods approach, incorporating quantitative and qualitative data collection methods. Participants, including students, faculty, and staff, completed surveys, participated in questionnaires, focus groups, and took part in interviews. Statistical tests are used to validate the survey data, while thematic analysis is applied to the qualitative data. The findings of the research showed that COVID-19 had a significant impact on participants' attitudes, intentions, and behavior regarding energy literacy and conservation. Specifically, the student group experienced a significant increase in the relationship between their intentions and behavior, while the faculty group exhibited a strong correlation between intention and behavior. The study also found that education, awareness, personal motivation, values, religiosity, and culture were all crucial factors in promoting energy literacy and conservation behavior. The study recommends specific educational interventions, fostering a culture of conservation, providing access to information and resources, promoting community engagement, incorporating religiosity, and improving policies and infrastructure to enhance energy literacy in academic buildings. Additionally, the study highlights the importance of tailored educational interventions that consider the specific needs and challenges of different occupant groups and suggests incorporating religious perspectives to align with the cultural and religious context of the Kuwaiti population. The study's findings offer comprehensive insights into the impact of unforeseen events, such as pandemics, on energy literacy and conservation behavior. These insights have practical implications for policymaking and implementation. Future research could explore the effectiveness of various educational interventions and examine the role of social and cultural factors in shaping energy literacy and behavior.

Introduction:Zuotai is an ancient mineral-herbal mixture containing β-HgS in Tibetan medicine. It is used to treat nervous system diseases, similar to Chinese medicine cinnabar and Indian Ayurveda medicine Rasasindura. However, one of the key problems faced by Zuotai is that its indications are ambiguous. Our previous study found that Zuotai exhibited the activity of ameliorating depressive-like behaviors in a chronic mild stress model. However, due to the inherent limitations of animal models in simulating human disease, clear results often require more than one model for confirmation.Methods: Therefore, another depression model, chronic restraint stressed (CRS) mice, was used to validate the antidepression effect of Zuotai. Prophylactic treatment was conducted for 21 consecutive days while mice were subjected to chronic restraint stress.Results: It was observed that Zuotai and β-HgS alleviated anhedonia, behavioral despair, stereotype behavior, and reduced exploratory and spontaneous movement in CRS mice. Zuotai and β-HgS also reversed the increases of stress hormone corticosterone (Cort) in serum and pro-inflammatory cytokines in serum and brain, and increased the serotonin in cortex in CRS mice, with positive dose-effect relationship. The number of Ki67-positive cells in the dentate gyrus and the level of brain-derived neurotrophic factor (BDNF) in the hippocampus were slightly elevated in CRS mice treated with Zuotai; however, there was no statistically significant difference. Although Zuotai increased the total Hg concentration in main organs, the levels remained below those needed to result in observed adverse effect, at least for kidney and liver; and Zuotai showed no observed adverse effect on the brain histopathology, the cell proliferation in dentate gyrus, as well as the hippocampal and cortical organ coefficients.Conclusion:Zuotai exhibited the alleviation of depressive-like behaviors in CRS mice, accompanying with ameliorating stress hormone, peripherical and cerebral inflammation, and monoamine neurotransmitter.

Introduction Peanut allergies cause serious health problems worldwide. A strong finding has shown that the early introduction of peanuts into the diet of infants at high risk of food allergy reduces the prevalence of peanut allergy. Allergies to peanuts, sesame and tree nuts have been shown to coexist in 60% of cases and vary according to geographical location and dietary habits. Insights into the prevalence of nut and seed allergies in societies with varying consumption levels are essential for developing population-specific weaning guidelines. Understanding the age at which peanut allergy develops is paramount for successful early introduction strategies.Methods and analysis We will perform a cross-sectional study at two tertiary allergy centres in Warsaw and Bydgoszcz. Two hundred forty children aged 4–36 months with eczema or egg allergy will undergo an extensive assessment of their peanut, sesame and tree nut allergy status through skin testing, specific IgE measurements and oral food challenges. The primary outcome is the prevalence of peanut, sesame and tree nut allergies in Polish children at high risk of food allergy. Additionally, the timing of the development of peanut, sesame and tree nut allergies in the first 3 years of life in a high-risk population will be assessed.Ethics and dissemination The Ethics Committee of the Medical University of Warsaw, Poland approved this protocol (KB/86/2021). The results of this study will be submitted to a peer-reviewed journal no later than 1 year after data collection. The abstract will be presented at relevant national and international conferences.Although the authors may be able to commit to journal submission no later than 1 year after data collection, publication dates remain beyond their control.Trial registration number NCT05662800.