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Abstract Background The use of immersive technology in healthcare education is on the rise, yet its impact on learner engagement, knowledge retention, and specifically in areas like hand hygiene training, remains underexplored. The aim of this scoping review was to summarize the existing studies of immersive technology in hand hygiene training of healthcare providers and health professions students. Methods A scoping review following the Levac et al. framework was conducted. The literature search was performed in databases PubMed, CINAHL Ultimate, ScienceDirect (Elsevier), Web of Science in addition to Google Scholar and ProQuest Dissertation & Theses. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews (PRIMSA-ScR) guideline was used to report the results. We analysed data using tabular and descriptive summary. Results In the final analysis 11 studies from seven countries were included. Most of the studies (n = 10, 90,91%) used virtual reality in hand hygiene training of healthcare providers and health professions students. Most studies have found that immersive technology is useful in teaching hand hygiene (n = 6, 54,55%). There are some theories and concepts that support the teaching of hand hygiene with immersive technology, but most of the research is not supported by them. Theories or concepts were included in two studies (18,18%). Conclusion Immersive technology, especially virtual reality, enhances hand hygiene learning and engagement compared to traditional methods. However, most studies lack theoretical support. To advance this field, exploring immersive technology for further research and incorporating relevant theories is encouraged. Additionally, conducting a thorough cost-effectiveness analysis and establishing a robust evaluation framework, encompassing both short-term and long-term outcomes, will be beneficial for a comprehensive understanding of the impact of immersive technology in hand hygiene education.

Epileptični status (ES) je resno in pogosto nevrološko urgentno stanje z visoko obolevnostjo in smrtnostjo. Po etiološki razvrstitvi je lahko simptomatski ali kriptogeni oz. brez znanega vzroka. Klinično ga razdelimo v 4 faze: zgodnji, napredovali, refraktorni (RES) in superrefraktorni ES (SRES). Tudi zdravljenje je temu primerno stopenjsko. V prvi fazi damo benzodiazepin, nato zdravljenje nadaljujemo z bolj specifičnimi protiepileptičnimi zdravili. Ko se razvije RES, bolniki večinoma potrebujejo zdravljenje s splošnimi anestetiki v enotah intenzivne terapije (EIT). Elektroencefalografija (EEG) je dobra diagnostična metoda, ki v določenih primerih (nekonvulzivni ES, žariščni ES, RES in SRES) z novimi izkušnjami in znanjem postaja nepogrešljiva pri obravnavi bolnikov z ES. Kljub resnosti in urgentnosti stanja lahko z ustrezno obravnavo in zdravljenjem močno izboljšamo napoved izida pri bolniku in zmanjšamo smrtnost.

Tools that assess school supports for highly mobile, military-connected students are lacking. This study describes the development and preliminary validation of the Inventory of School Supports-Parent Report (ISS-PR). Participants were 433 parents (74% female; 62.5% White, 12% Black, 6.5% Asian, 5.5% Pacific Islander, 4% Native American, and 9.5% bi/multiracial; 19% Latinx) of students (grades 3-5) from families with an active-duty military parent. Parents completed the ISS-PR and rated: (a) how welcoming schools were toward military-connected families; (b) parent-teacher relationship quality; and (c) satisfaction with their child's school. We created three proportional index composite scores: a 26-item school supports score, a 13-item parent-focused supports score, and a 13-item child-focused supports score. Results supported the ISS-PR's psychometric properties: summary scores were positively linked to parent-teacher relationship quality, school welcoming, and parent satisfaction with the school. We also found evidence for test-retest reliability for parents completing the inventory with students who had either moved schools or remained in their previous schools. Future studies could use the ISS-PR to assess whether parents' perceptions of the availability and importance of school supports for military-connected families are related to other constructs such as overall school climate, student academic performance, and socioemotional functioning. Schools could use the inventory to determine which supports could potentially have the greatest impact for military-connected families and to what extent parents are aware of the supports schools offer.

The unbound usage of plastic products in modern society has brought convenience and poses significant environmental challenges. Recycling Shops (RS) are vital in mitigating plastic waste problems in urban waste management. During the recycling process, RS generates non-recyclable plastics that demand scientific solutions for its management. This study conducted material flow analysis (MFA) to estimate the yearly recycled plastic waste in the RSs of Khulna City. Subsequently, a life cycle assessment (LCA) was performed to explore the suitable management facilities for non-recyclable plastics. The results highlighted the contribution of the informal plastic recycling sector to the city's waste management system by recycling 6324 tons of plastic waste per year. Polypropylene (PP) and Polyethylene (PE) were the most abundant polymers among the recycling plastics in RS. The LCA results revealed that among the five considered cases, Open Burning showed the maximum impact on the environment while Sanitary Landfill exhibited the lowest environmental impact across eighteen impact categories. The sanitary landfilling of non-recyclable plastics was identified as an environmentally friendly approach for managing non-recyclable plastics. This study addressed the urgency for appropriately managing non-recyclable plastics to protect the human and environment from plastic pollution in Bangladesh including recommendations for improving current practices.

Background Mental health (MH) conditions are prevalent in adolescents with childhood-onset SLE (cSLE). Early identification is crucial in preventing poor patient outcomes; however, MH screening rates remain low.Local problem From July 2021–January 2022, only 15% of adolescents in a paediatric tertiary care cSLE clinic were being screened for depression and anxiety. By November 2023, we aimed to increase the percentage of patients with cSLE (≥12–18 years) screened for depression (Patient Health Questionnaire: PHQ-9) and anxiety (Generalised Anxiety Disorder-7: GAD-7) from 15% to 80%.Methods This quality improvement project employed the Model for Improvement framework. Stakeholders included the clinic team, patients and families, and MH providers. Statistical process control charts were used to analyse the outcome measure for percentage of screened patients with cSLE. Patient and caregiver satisfaction surveys were conducted at baseline and after screening as a balancing measure.Interventions MH screening workflow with a referral algorithm was developed with stakeholders. Additional interventions included two MH training workshops for healthcare providers and a preclinic reminder of eligible patients for screening.Results Over 21 months, 146 patients with cSLE completed 270 MH screens, increasing the screening rate from 15%, peaking at 100%, to a median of 56%. Sixty-six individuals (45%) reported symptoms of depression and/or anxiety on their initial screen. Of 270 screens, 44 individuals (17%) reported moderate to severe symptoms meeting the screening workflow criteria for referral to a MH service; 10% of patients screened were referred and seen by the MH service within 2–12 weeks. Patients and caregivers reported satisfaction with the MH screening process and quality of MH follow-up.Conclusion Despite not sustainably meeting the target, MH screening rates increased in the cSLE clinic by nearly fourfold, demonstrating feasibility and acceptability. Patients expressed satisfaction with their mental health follow-up, emphasising its importance in their care.

Advanced pancreatic cancer is underscored by progressive therapeutic resistance and a dismal 5-year survival rate of 3%. Preclinical data demonstrated glutamine supplementation, not deprivation, elicited antitumor effects against pancreatic ductal adenocarcinoma (PDAC) alone and in combination with gemcitabine in a dose-dependent manner. The GlutaPanc phase I trial is a single-arm, open-label clinical trial investigating the safety of combination L-glutamine, gemcitabine, and nab-paclitaxel in subjects (n = 16) with untreated, locally advanced unresectable or metastatic pancreatic cancer. Following a 7-day lead-in phase with L-glutamine, the dose-finding phase via Bayesian design begins with treatment cycles lasting 28 days until disease progression, intolerance, or withdrawal. The primary objective is to establish the recommended phase II dose (RP2D) of combination L-glutamine, gemcitabine, and nab-paclitaxel. Secondary objectives include safety of the combination across all dose levels and preliminary evidence of antitumor activity. Exploratory objectives include evaluating changes in plasma metabolites across multiple time points and changes in the stool microbiome pre and post L-glutamine supplementation. If this phase I clinical trial demonstrates the feasibility of L-glutamine in combination with nab-paclitaxel and gemcitabine, we would advance the development of this combination as a first-line systemic option in subjects with metastatic pancreatic cancer, a high-risk subgroup desperately in need of additional therapies.

BackgroundSupporting and understanding the health of patients with chronic diseases and cardiovascular disease (CVD) risk is often a major challenge. Health data are often used in providing feedback to patients, and visualization plays an important role in facilitating the interpretation and understanding of data and, thus, influencing patients’ behavior. Visual analytics enable efficient analysis and understanding of large datasets in real time. Digital health technologies can promote healthy lifestyle choices and assist in estimating CVD risk. ObjectiveThis review aims to present the most-used visualization techniques to estimate CVD risk. MethodsIn this scoping review, we followed the Joanna Briggs Institute PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search strategy involved searching databases, including PubMed, CINAHL Ultimate, MEDLINE, and Web of Science, and gray literature from Google Scholar. This review included English-language articles on digital health, mobile health, mobile apps, images, charts, and decision support systems for estimating CVD risk, as well as empirical studies, excluding irrelevant studies and commentaries, editorials, and systematic reviews. ResultsWe found 774 articles and screened them against the inclusion and exclusion criteria. The final scoping review included 17 studies that used different methodologies, including descriptive, quantitative, and population-based studies. Some prognostic models, such as the Framingham Risk Profile, World Health Organization and International Society of Hypertension risk prediction charts, Cardiovascular Risk Score, and a simplified Persian atherosclerotic CVD risk stratification, were simpler and did not require laboratory tests, whereas others, including the Joint British Societies recommendations on the prevention of CVD, Systematic Coronary Risk Evaluation, and Framingham-Registre Gironí del COR, were more complex and required laboratory testing–related results. The most frequently used prognostic risk factors were age, sex, and blood pressure (16/17, 94% of the studies); smoking status (14/17, 82%); diabetes status (11/17, 65%); family history (10/17, 59%); high-density lipoprotein and total cholesterol (9/17, 53%); and triglycerides and low-density lipoprotein cholesterol (6/17, 35%). The most frequently used visualization techniques in the studies were visual cues (10/17, 59%), followed by bar charts (5/17, 29%) and graphs (4/17, 24%). ConclusionsOn the basis of the scoping review, we found that visualization is very rarely included in the prognostic models themselves even though technology-based interventions improve health care worker performance, knowledge, motivation, and compliance by integrating machine learning and visual analytics into applications to identify and respond to estimation of CVD risk. Visualization aids in understanding risk factors and disease outcomes, improving bioinformatics and biomedicine. However, evidence on mobile health’s effectiveness in improving CVD outcomes is limited.

Abstract Xenotransplantation represents a possible solution to the organ shortage crisis and is an imminent clinical reality with long-term xenograft survival in pig-to-nonhuman primate (NHP) heart and kidney large animal models, and short-term success in recent human decedent and clinical studies. However, concerns remain about safe clinical translation of these results, given the inconsistency in published survival as well as key differences between preclinical procurement and immunosuppression and clinical standards-of-care. Notably, no studies of solid organ pig-to-NHP transplantation have achieved xenograft survival longer than one month without CD40/CD154 costimulatory blockade, which is not currently an FDA-approved immunosuppression strategy. We now present consistent survival in consecutive cases of pig-to-NHP kidney xenotransplantation, including long-term survival after >3 hours of xenograft cold preservation time as well as long-term survival using FDA-approved immunosuppression. These data provide critical supporting evidence for the safety and feasibility of clinical kidney xenotransplantation. Moreover, long-term survival without CD40/CD154 costimulatory blockade may provide important insights for immunosuppression regimens to be considered for first-in-human clinical trials.

Abstract Animal models lack physiologic relevance to the human system which results in low clinical translation of results derived from animal testing. Besides spheroids or organoids, hydrogel-based 3D in vitro models are used to mimic the in vivo situation increasing the relevance while reducing animal testing. However, to establish hydrogel-based 3D models in applications such as drug development or personalized medicine, high-throughput culture systems are required. Furthermore, the integration of oxygen-reduced (hypoxic) conditions has become increasingly important to establish more physiologic culture models. Therefore, we developed a platform technology for the high-throughput generation of miniaturized hydrogels for 3D cell culture. The Oli-Up system is based on the shape of a well-plate and allows for the parallel culture of 48 hydrogel samples, each with a volume of 15 µl. As a proof-of-concept, we established a 3D culture of gelatin-methacryloyl (GelMA)-encapsulated mesenchymal stem/stromal cells (MSCs). We used a hypoxia reporter cell line to establish a defined oxygen-reduced environment to precisely trigger cellular responses characteristic of hypoxia in MSCs. In detail, the expression of hypoxia response element (HRE) increased dependent on the oxygen concentration and cell density. Furthermore, MSCs displayed an altered glucose metabolism and increased VEGF secretion upon oxygen-reduction. In conclusion, the Oli-Up system is a platform technology for the high-throughput culture of hydrogel-based 3D models in a defined oxygen environment. As it is amenable for automation, it holds the potential for high-throughput screening applications such as drug development and testing in more physiologic 3D in vitro tissue models.

Background A significant percentage of patients with congenital heart disease surviving into adulthood will develop arrhythmias. These arrhythmias are associated with an increased risk of adverse events and death. We aimed to assess arrhythmia prevalence, risk factors, and associated health care usage in a large national cohort of patients with adult congenital heart disease. Methods and Results Adults with a documented diagnosis of congenital heart disease, insured by Clalit and Maccabi health services between January 2007 and December 2011, were included. We assessed the associations between arrhythmia and subsequent hospitalization rates and death with mixed negative binomial and Cox proportional hazard models, respectively. Among 11 653 patients with adult congenital heart disease (median age, 47 years [interquartile range, 31–62]), 8.7% had a tachyarrhythmia at baseline, 1.5% had a conduction disturbance, and 0.5% had both. Among those without a baseline arrhythmia, 9.2% developed tachyarrhythmias, 0.9% developed a conduction disturbance, and 0.3% developed both during the study period. Compared with no arrhythmia (reference group), arrhythmia in the previous 6 months was associated with a higher multivariable adjusted hospitalization rate, 1.33‐fold higher than the rate of the reference group (95% CI, 1.00–1.76) for ventricular arrhythmia, 1.27‐fold higher (95% CI, 1.17–1.38) for atrial arrhythmias, and 1.33‐fold higher (95% CI, 1.04–1.71) for atrioventricular block. Atrial tachyarrhythmias were associated with an adjusted mortality hazard ratio (HR) of 1.65 (95% CI, 1.44–2.94), and ventricular tachyarrhythmias with a >2‐fold increase in mortality risk (HR, 2.06 [95% CI, 1.44–2.94]). Conclusions Arrhythmias are significant comorbidities in the adult congenital heart disease population and have a significant impact on health care usage and survival.