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Background: Allergic conjunctivitis is a prevalent ocular condition characterized by inflammation of the conjunctiva due to hypersensitivity reactions to various allergens. Understanding its epidemiology and clinical characteristics is crucial for effective management and public health interventions. Methods: This cross-sectional study investigated the prevalence, triggers, and associated factors of allergic conjunctivitis among residents of the Southern region of Saudi Arabia. Data were collected using a structured questionnaire administered through Google Forms. Statistical analysis was performed using IBM SPSS, including descriptive statistics and bivariable/multivariable analyses. Results: A total of 693 participants were recruited through convenience sampling via online platforms. Among the participants, 73.9% reported ocular symptoms, while 26.1% did not. Dust emerged as the most common trigger for ocular symptoms (32.9%), followed by eye drops/contact lenses (8.7%), animal dander (6.9%), and chemicals (5.8%). Notably, 39.7% reported experiencing ocular symptoms throughout the year. Despite the prevalence of ocular symptoms, only 26.7% consulted an ophthalmologist. Multivariable analysis revealed that gender and seasonal variation in symptoms were associated with allergic conjunctivitis diagnosis. Females showed a lower odds ratio (OR) of being diagnosed with allergic conjunctivitis compared to males (OR: 0.62, 95% CI: 0.29–1.31), and participants experiencing symptoms with no specific season had significantly lower odds of being diagnosed with allergic conjunctivitis (OR: 0.28, 95% CI: 0.11–0.72). A history of allergic rhinitis demonstrated a strong positive association with allergic conjunctivitis diagnosis (OR: 3.77, 95% CI: 1.83–7.75). Conclusion: The study highlights the considerable burden of allergic conjunctivitis and the underutilization of healthcare services among affected individuals in the Southern region of Saudi Arabia. Tailored interventions and increased awareness are essential for effective management and mitigation of allergic conjunctivitis's impact on affected individuals and healthcare systems. [ABSTRACT FROM AUTHOR]

The article focuses on tracing changes in Slovak pre-service TEFL student teachers’ emotional states over the first semester of their university study and detecting possible factors inciting their emotions. It highlights the importance of understanding these emotional states as they significantly impact students’ perceptions of their suitability as educators. A mixed-methods approach was employed to collect qualitative and quantitative data through questionnaires, reflections, and interviews. The sample consisted of 67 non-native Slovak first-year TEFL students. It was found that the students experienced a range of emotions, from initial confusion and worry to eventual joy and contentment. Negative emotions were mainly triggered by the flood of new information and study-related factors, while positive emotions were associated with the supportive attitude of teachers and the freedom of university life. [ABSTRACT FROM AUTHOR]

Background: Heart failure with reduced ejection fraction (HFrEF) poses a significant global public health challenge, characterized by frequent episodes of acute decompensation that necessitate hospitalization and carry high morbidity and mortality risks. In India, the rising prevalence of HFrEF underscores the need to identify context-specific triggers of acute decompensation to develop targeted interventions for improving patient outcomes. Material & Methods: This hospital-based, observational study analyzed triggers of acute decompensation in 336 HFrEF patients admitted to two tertiary care hospitals in India from January to April 2024. Data were retrospectively extracted from medical records, including demographic information, clinical characteristics, and details on decompensation triggers. Outcomes recorded were length of hospital stay, in-hospital mortality, and ICU admission. Statistical analysis involved chi-square tests, t-tests, and multivariate logistic regression. Results: The mean age of the patients was 65.3 years, with 60.1% being male. Common triggers included excessive salt and water consumption (30.1%), non-adherence to medication (25%), acute infections (19.9%), myocardial ischemia (17.6%), and systemic hypertension (14.9%). The mean hospital stay was 7.2 days, in-hospital mortality was 7.4%, and 20.2% required ICU admission. Excessive salt and water consumption and non-adherence to medication were significantly associated with ICU admission (p < 0.001). Independent predictors of in-hospital mortality included age (OR: 1.05, p < 0.001), excessive salt and water consumption (OR: 2.5, p = 0.007), non-adherence to medication (OR: 2.1, p = 0.021), and renal failure (OR: 3.0, p = 0.005). Conclusion: This study identifies critical triggers of acute decompensation in HFrEF patients, particularly dietary noncompliance and medication non-adherence. Emphasizing patient education and adherence support is essential for managing heart failure effectively. Addressing these factors through comprehensive care plans can reduce hospitalizations and improve patient outcomes. Future research should validate these findings through prospective studies and explore tailored interventions to mitigate the risks associated with acute decompensation. [ABSTRACT FROM AUTHOR]

Background: The prodrome or premonitory phase is the initial phase of a migraine attack, and it is considered as a symptomatic phase in which prodromal symptoms may occur. There is evidence that attacks start 24–48 hours before the headache phase. Individuals with migraine also report several potential triggers for their attacks, which may be mistaken for premonitory symptoms and hinder migraine research. Methods: This review aims to summarize published studies that describe contributions to understanding the fine difference between prodromal/premonitory symptoms and triggers, give insights for research, and propose a way forward to study these phenomena. We finally aim to formulate a theory to unify migraine triggers and prodromal symptoms. For this purpose, a comprehensive narrative review of the published literature on clinical, neurophysiological and imaging evidence on migraine prodromal symptoms and triggers was conducted using the PubMed database. Results: Brain activity and network connectivity changes occur during the prodromal phase. These changes give rise to prodromal/premonitory symptoms in some individuals, which may be falsely interpreted as triggers at the same time as representing the early manifestation of the beginning of the attack. By contrast, certain migraine triggers, such as stress, hormone changes or sleep deprivation, acting as a catalyst in reducing the migraine threshold, might facilitate these changes and increase the chances of a migraine attack. Migraine triggers and prodromal/premonitory symptoms can be confused and have an intertwined relationship with the hypothalamus as the central hub for integrating external and internal body signals. Conclusions: Differentiating migraine triggers and prodromal symptoms is crucial for shedding light on migraine pathophysiology and improve migraine management. [ABSTRACT FROM AUTHOR]

Individuals with autoimmune diseases face a multiplicity of adverse disruptions throughout their lives that can span physical, emotional, social, and financial contexts. We employed the communication theory of resilience as a theoretical framework to explore how individuals with an autoimmune disease construct the connections between triggers and communicative resilience responses within their narratives. Utilizing abductive analysis, we identified four overarching trigger patterns: (1) linear, (2) cyclical, (3) compounding, and (4) branching. In examining the triggers and health journeys of individuals with autoimmune diseases, we can practically aid physician communication approaches for patients with complex symptomologies, diagnostic journeys, and trigger patterns. [ABSTRACT FROM AUTHOR]

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Objective: This study aims to conduct an extensive analysis of autoimmune bullous diseases, particularly pemphigus vulgaris and bullous pemphigoid, in Shanghai, China, from 2016 to 2023. It seeks to understand the demographic profiles, comorbidities, mortality rates, risk factors, and socioeconomic impacts associated with autoimmune bullous disease. Methods: A cross-sectional study design was employed, enrolling 1,072 patients. Diagnostic measures included clinical manifestations, histopathology, direct immunofluorescence, and serologic tests. The study also involved a detailed socioeconomic analysis and evaluation of occupational risks. Results: The findings highlight a significant occupational risk in industries requiring enhanced safety measures, with a notable prevalence of autoimmune bullous disease among workers in these sectors. A considerable portion of the patients were from low-income backgrounds with limited literacy, indicating the economic burden of autoimmune bullous disease. A key discovery of the study is the potential pathological link between autoimmune bullous disease and interstitial lung disease. Conclusion: This research, one of the first comprehensive studies on autoimmune bullous disease in China, underscores the need for targeted healthcare strategies and further investigation into autoimmune bullous disease, particularly its relationship with interstitial lung disease. [ABSTRACT FROM AUTHOR]

Background. Medication errors can cause preventable adverse events. For example, inappropriate use of anticoagulants (AC) can result in bleeding and thromboembolic complications. Detection and analysis of AC medication errors allow to reveal deficiencies in the safety systems in healthcare organizations. Aim. The study was aimed to develop a method of systematic detection of anticoagulant medication errors for consequent audit, analysis and development of medication safety improvement measures. Materials and methods. The study was conducted in the multidisciplinary hospital and included 4924 patients admitted from January 2019 to December 2021 who received AC. Three laboratory triggers (international normalized ratio ≥4, serum creatinine ≥133 μmol/l, and glomerulofiltration rate 30 ml/min/1.73 m2) helped to reveal 4304 cases. Their matching with patient’s data helped to develop combined triggers. Two clinical pharmacologists reviewed all cases identified by combined triggers for checking medication errors. The trigger was considered positive when anticoagulant medication error was detected in the history selected by combined trigger. Results. Of the 4924 patients 253 (5.3%) were selected by combined triggers. Combined trigger allowed to reduce the amount of medical health records audit by 97.3%. Medication errors were detected in 137 patients. Positive predictive value of selected combined triggers varied from 0 to 63.9%. Aggregated positive predictive value of all combined triggers amounted to 54.2%. AC medication errors were detected in 2.8% patients. Conclusion. Method of systematic detection of AC medication errors using combined triggers in all hospitalized patients receiving AC allowed to reveal typical medication errors for consequent analysis and elaboration of measures to reduce preventable patient harm in healthcare settings.

Purpose: The purpose of this paper is to evaluate the insights of founding entrepreneurs to understand what they consider as motivating factors in their decision to act upon entrepreneurial intentions. Using this information, the entrepreneurial trigger event influence was conceptualized, and a scale developed for use in subsequent testable models. Design/methodology/approach: Qualitative and quantitative techniques were used to construct an instrument that measures the presence and influence of entrepreneurial behavior triggers. The concept of triggering events was explored with 14 founding entrepreneurs. Themes emerged from this enquiry process which informed the development of four primary entrepreneurial triggering events. Over 600 entrepreneurs participated in the study. Exploratory factor analysis was used to identify dimensions of entrepreneurial triggers and was tested using confirmatory factor analysis. Findings: Entrepreneurs perceive that personal fulfillment and job dissatisfaction serve as two significant trigger events which will lead individuals to engage in entrepreneurial behaviors. This research supports theorizing that suggests entrepreneurial trigger events have influence in motivating individuals to act upon entrepreneurial intentions and some trigger events may have more influence toward behavior than others. Research limitations/implications: This research is subject to multiple limitations. Trigger events were limited to those identified in literature and the interviews. Most entrepreneurs participating in this study were from a limited geographic region. The entrepreneurs in this study reported their triggering event based on their memory which could have been affected by inaccurate recall or memory bias. No attempt has been made to model the comparative effects of the different variables on entrepreneurial outcomes. Finally, the entrepreneurial trigger event instrument did not measure the participant's demographics or psychographics which could have played a role in the influence of reported trigger event. Practical implications: This study extends previous research that trigger events serve as catalysts for entrepreneurial behavior. Findings support the premise that different types of triggers have different levels of influence as antecedents of entrepreneurial behavior. Specifically, positive, negative, internal and external entrepreneurial triggering events were explicated. The Entrepreneurial Trigger Event Scale created to facilitate this study enables researchers to explore the effects of types and perceived influences of precipitating trigger events on the intentions of the individual that result in entrepreneurial behavior. The optimized instrument further expanded Shapero's (1975) proposed theory of the origins of entrepreneurial behavior. Social implications: The development of a scale provides researchers with the opportunity to include the influence of entrepreneurial trigger events, as perceived by entrepreneurs, in future testable models. Entrepreneurial development organizations can use the knowledge to assist in understanding when potential entrepreneurs may act upon entrepreneurial intentions. Information gained can have significant implications for understanding the initiation of entrepreneurial behavior, entity establishment and business growth. Originality/value: This research responds to a call for investigation into the influence of entrepreneurial trigger events on a person's decision to act upon entrepreneurial intentions. It is an early attempt to conceptualize a relevant construct of entrepreneurial trigger event influence and to develop a scale for use in empirical testing. It is distinguished by using planned behaviors, push and pull, motivation and drive reduction theories. These theories are applied to the perceptions of successful entrepreneurs to develop a construct and validate it. [ABSTRACT FROM AUTHOR]

Background: Substance use disorders have profound implications for individuals, their families, and society as a whole. At present, drug trafficking and addiction have ensnared every corner of the globe, impacting millions of individuals worldwide. This pressing issue of drug abuse is concerning due to the underlying conditions fueling it, including shifting cultural values, increasing economic stress, and weakened social support networks. Aims and Objectives: This study aimed to identify the trends in drug abuse and its influencing factors among patients undergoing treatment for addiction in rehabilitation centers in Telangana. Materials and Methods: The study, a descriptive cross-sectional analysis, involved 222 individuals grappling with drug addiction at the primary rehabilitation center for drug addiction treatment in Telangana. Information was gathered using a pre-tested, structured questionnaire between September and December 2022 under the Department of Pharmacology. Results: Among the respondents, 95% were male and 5% were female, with a majority falling in the 21–30 age brackets. The religious breakdown comprised 151 Hindus, 32 Muslims, and 30 Christians, while 41% hailed from tribal regions. Injection emerged as the most prevalent method of substance abuse among 194 participants. The onset of drug abuse mostly occurred between ages 11 and 20, primarily driven by self or peer pressure. Notably, 89% of participants reported being compelled to consume substances. Conclusion: The study found a significant correlation between male gender and drug consumption (P

Abstract Objective This study aims to conduct an extensive analysis of autoimmune bullous diseases, particularly pemphigus vulgaris and bullous pemphigoid, in Shanghai, China, from 2016 to 2023. It seeks to understand the demographic profiles, comorbidities, mortality rates, risk factors, and socioeconomic impacts associated with autoimmune bullous disease. Methods A cross-sectional study design was employed, enrolling 1,072 patients. Diagnostic measures included clinical manifestations, histopathology, direct immunofluorescence, and serologic tests. The study also involved a detailed socioeconomic analysis and evaluation of occupational risks. Results The findings highlight a significant occupational risk in industries requiring enhanced safety measures, with a notable prevalence of autoimmune bullous disease among workers in these sectors. A considerable portion of the patients were from low-income backgrounds with limited literacy, indicating the economic burden of autoimmune bullous disease. A key discovery of the study is the potential pathological link between autoimmune bullous disease and interstitial lung disease. Conclusion This research, one of the first comprehensive studies on autoimmune bullous disease in China, underscores the need for targeted healthcare strategies and further investigation into autoimmune bullous disease, particularly its relationship with interstitial lung disease.

Background: Substance use disorders have profound implications for individuals, their families, and society as a whole. At present, drug trafficking and addiction have ensnared every corner of the globe, impacting millions of individuals worldwide. This pressing issue of drug abuse is concerning due to the underlying conditions fueling it, including shifting cultural values, increasing economic stress, and weakened social support networks. Aims and Objectives: This study aimed to identify the trends in drug abuse and its influencing factors among patients undergoing treatment for addiction in rehabilitation centers in Telangana. Materials and Methods: The study, a descriptive cross-sectional analysis, involved 222 individuals grappling with drug addiction at the primary rehabilitation center for drug addiction treatment in Telangana. Information was gathered using a pre-tested, structured questionnaire between September and December 2022 under the Department of Pharmacology. Results: Among the respondents, 95% were male and 5% were female, with a majority falling in the 21-30 age brackets. The religious breakdown comprised 151 Hindus, 32 Muslims, and 30 Christians, while 41% hailed from tribal regions. Injection emerged as the most prevalent method of substance abuse among 194 participants. The onset of drug abuse mostly occurred between ages 11 and 20, primarily driven by self or peer pressure. Notably, 89% of participants reported being compelled to consume substances. Conclusion: The study found a significant correlation between male gender and drug consumption (P<0.05), as well as between the 21 and 30 age group and drug intake (P<0.05). Additionally, the research highlighted a high prevalence of drug dependence among educated individuals, with familial conflicts and peer pressure being cited as common triggers for various forms of substance abuse. [ABSTRACT FROM AUTHOR]

I argue against elements of Alfred Mele's picture of the nature of intentions and the triggers of intentional actions. Mele (Philosophical Studies 176:2833–2853, 2019) offers rebuttals to my (Herdova, Philosophical Studies, 173(3), 573–587, 2016; Herdova, Philosophical Explorations, 21(3):364–383, 2018) and Ann Bumpus's (2001) arguments which limit the scope of proximal intentions as triggers of intentional actions. Here I offer a response to Mele and provide further arguments in favor of my alternative understanding of intentions and the causes of intentional actions. Contra Mele, I argue for the following interrelated theses. First, intentions, including proximal intentions, have an array of functions or dispositions beyond that of triggering intentional actions. Second, states other than proximal intentions can trigger at least some types of intentional actions. Therefore, it is not the case that all intentional actions need to be triggered by proximal intentions. [ABSTRACT FROM AUTHOR]

Introduction: Differentiating between migraine and COVID-19 headaches is essential for better treatment. Evidence-based research during the COVID-19 pandemic has found that university students are more likely to experience migraine. Migraine can affect academic performance, sleep pattern, social and emotional well-being if left untreated or misdiagnosed. This study aimed to determine the prevalence of migraine symptoms and the association of triggers, coping strategies and clinical characteristics with COVID-19 diagnosis. Methods: This cross-sectional study was conducted across higher educational institutions in Peninsular Malaysia. Convenience sampling was applied to recruit full-time university students. A reliable and validated instrument was used to evaluate demographic data, migraine symptoms, triggers, coping strategies and clinical characteristics of migraine (frequency, intensity, severity and duration) during COVID-19 diagnosis. Results: The response rate was 98.3%, where 485 out of 493 responses were analysed. The prevalence of migraine was 35.9% (n=174). None of the triggers, coping strategies and clinical characteristics of migraine were significantly associated with COVID-19 diagnosis. Conclusion: The university students in Peninsular Malaysia showed a considerable prevalence of migraine symptoms. During the pandemic, the common triggers for existing symptoms were stress and a lack of sleep (combined triggers). The coping strategy adopted by most of the university students was lifestyle changes and in the COVID-19 positive group maladaptive coping strategies were adopted indicating the need for further investigation. [ABSTRACT FROM AUTHOR]

Knowledge of hazard conditions due to mass movements is one of the non-structural measures for risk management, urban planning, and protection of natural resources. To obtain this type of mapping, a spatial construction was started by correlating the historical movements with the inherent variables of the terrain by means of the bivariate statistical method, which assigns densities or weights of evidence to estimate the degree of susceptibility. This model was combined with the triggering factors (rainfall and earthquake) to determine the spatiotemporal conditions (hazard). From this procedure, it was obtained that the susceptibility model presents 34% (32.33 km2) of the total area in the high and very high categories, especially in the regions of Mount Siradella and Mount Faro. The validation of the present model obtained a value of 0.945 with the ROC curve. For the hazard condition, 34.1% (32.06 km2) of the study area was found to be in the high and very high category, especially in the municipalities of El Grove, Sanxenxo, and A Illa de Arousa, which have the greatest extension. The present evaluation is an advance in the knowledge of the risk and the actions that can be derived, as in turn, this type of study is an easy tool to obtain due to its low cost and information processing. [ABSTRACT FROM AUTHOR]

A 32-year-old multigravida woman, with known familial hypokalaemic periodic paralysis, underwent spinal anaesthesia for an elective lower segment caesarean section. There are several case reports in the literature discussing the optimal anaesthetic technique. In the past there has not been an emphasis on aggressive and early potassium replacement. A target level to commence replacement of potassium at 4.0 mmol/L or less is proposed. Careful preoperative preparation, frequent perioperative monitoring and early potassium replacement resulted in no perioperative episodes of weakness in this case, in contrast with other case reports where potassium was either not monitored or not replaced early enough, resulting in postoperative attacks. Another factor to consider in hypokalaemic periodic paralysis is the avoidance of triggers, including certain medications. Misoprostol was used in this instance to avoid potential electrolyte derangements from other uterotonics. [ABSTRACT FROM AUTHOR]

On the surface of complex landslide areas, other types of slope processes often occur in addition to the landslide movements themselves. However, in order to define the interrelationships or analyse their triggers, it is necessary to have chronological information on their past occurrence. In this study, a spectrum of tree-ring-based (dendrogeomorphic) approaches for spatio-temporal analysis of these processes is presented. The different approaches are applied to a selected complex landslide area with the presence of both creep and rockfall movements. Tree-ring-based data were obtained from standard increment cores as well as from tree roots exposed in tension cracks and from the modified surface of stumps. The presented approaches allowed not only chronological reconstruction of past activity processes but also reconstruction of their spatial activity and even estimation of the rate of displacements of selected landslide blocks. For each methodological approach, their advantages and limitations were evaluated. In addition, the obtained chronological data were used to evaluate potential triggers. The uniqueness of the tree-ring-based data was evident in detecting a wide variability in both the preparatory (up to 2-year periods with above-average rainfall in the case of landslides) and triggering factors themselves (3–5-day rainfall totals for landslides, extreme river discharges for activity tension cracks, or the influence of low temperatures during the winter season). Thus, this study provides a comprehensive overview of dendrogeomorphic approaches that can be used to obtain unique data on the spatio-temporal activity of processes in landslide areas in the past, estimating their rates and preparatory and triggering factors. [ABSTRACT FROM AUTHOR]

A cross-sectional survey among religious brothers and sisters (n = 250) with their specific lifestyle and related spiritual practices stated moments of awe perceptions. They responded to both the Awe/Gratitude scale and to free text fields to substantiate their quantitative responses. Qualitative content analysis of their free text responses resulted in six main categories of awe triggers: (1) Nature, (2) Special Moments, (3) Transcendence Perceptions, (4) Religious practices, (5) Distinct People, and (6) Aesthetics, Art and Culture. Awe perceptions can be an immediate feeling and the outcome of a process of reflection in response to admiration, inspiration, and elevation. As these perceptions are related to psychological well-being and prosocial behaviors, their training can generate positive effects on quality of life. [ABSTRACT FROM AUTHOR]

The article focuses on tracing changes in Slovak pre-service TEFL student teachers’ emotional states over the first semester of their university study and detecting possible factors inciting their emotions. It highlights the importance of understanding these emotional states as they significantly impact students’ perceptions of their suitability as educators. A mixed-methods approach was employed to collect qualitative and quantitative data through questionnaires, reflections, and interviews. The sample consisted of 67 non-native Slovak first-year TEFL students. It was found that the students experienced a range of emotions, from initial confusion and worry to eventual joy and contentment. Negative emotions were mainly triggered by the flood of new information and study-related factors, while positive emotions were associated with the supportive attitude of teachers and the freedom of university life.

Background: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation and variable expiratory airflow limitation. Objective: The objective of this study was to uncover factors contributing to poor asthma control in Erbil City, Iraq. Methods: To assess asthma control in Erbil City a cross-sectional observational study was conducted on 200 patients with asthma from the 1st, of June to the 31st, of December 2023. Demographics, clinical characteristics, triggers, comorbidities, inhaler problems, causes of visit, and state of asthma control were evaluated using Global Initiative for Asthma 2023 as the assessment tool questionnaire. Asthma control was divided into three levels: controlled, partly controlled, and uncontrolled. Results: In this study, 200 patients with asthma (108 females and 92 males) were studied. The mean age ± SD of the patients was 35.61 ± 17.182 years and the female-to-male ratio was nearly 1:1. Asthma control was very poor as only 24 patients (12%) were controlled. Neither sex nor age group has a statistically significant association with asthma control. Factors significantly associated with asthma control included improper inhaler technique (45.5%), fear of addiction (29%) improper inhaler prescription (27.5%), coat (23%), device type (22.5%), infections (21%), indoor and outdoor exposure (18%), tobacco smoking (17%), allergic rhinitis (28.5%), gastroesophageal reflux disease (21.5%) and short-acting beta agonist alone therapy 104(52%). Other factors were non-significantly associated with asthma control such as emotional stress (9.5%), food allergy (8.5%), obesity (15%), atopic dermatitis (6%), obstructive sleep apnea (15%), and pregnancy (5.5%). Conclusion: The current study concluded that factors associated with uncontrolled asthma were improper inhaler technique, fear of addiction, improper inhaler prescription, cost, device type, infections, indoor and outdoor exposure, tobacco smoking, allergic rhinitis, Gastro-esophageal Reflux Disease and short-acting beta agonist alone therapy.

Abstract Background Anaphylaxis is the most severe form of acute systemic and potentially life-threatening reactions triggered by mast and basophilic cells. Recent studies show a worldwide incidence between 50 and 112 occurrences per 100,000 person-years. The most identified triggers are food, medications, and insect venoms. We aimed to analyze triggers and clinical symptoms of patients presenting to a Swiss university emergency department for adults. Methods Six-year retrospective analysis (01/2013 to 12/2018) of all patients (> 16 years of age) admitted with moderate or severe anaphylaxis (classification of Ring and Messmer ≥ 2) to the emergency department. Patient and clinical data were extracted from the electronic medical database of the emergency department. Results Of the 531 includes patients, 53.3% were female, the median age was 38 [IQR 26–51] years. The most common suspected triggers were medications (31.8%), food (25.6%), and insect stings (17.1%). Organ manifestations varied among the different suspected triggers: for medications, 90.5% of the patients had skin symptoms, followed by respiratory (62.7%), cardiovascular (44.4%) and gastrointestinal symptoms (33.7%); for food, gastrointestinal symptoms (39.7%) were more frequent than cardiovascular symptoms (36.8%) and for insect stings cardiovascular symptoms were apparent in 63.8% of the cases. Conclusions Average annual incidence of moderate to severe anaphylaxis during the 6-year period in subjects > 16 years of age was 10.67 per 100,000 inhabitants. Medications (antibiotics, NSAID and radiocontrast agents) were the most frequently suspected triggers. Anaphylaxis due to insect stings was more frequently than in other studies. Regarding clinical symptoms, gastrointestinal symptoms need to be better considered, especially that initial treatment with epinephrine is not delayed.

Background: Anaphylaxis is the most severe form of acute systemic and potentially life-threatening reactions triggered by mast and basophilic cells. Recent studies show a worldwide incidence between 50 and 112 occurrences per 100,000 person-years. The most identified triggers are food, medications, and insect venoms. We aimed to analyze triggers and clinical symptoms of patients presenting to a Swiss university emergency department for adults. Methods: Six-year retrospective analysis (01/2013 to 12/2018) of all patients (> 16 years of age) admitted with moderate or severe anaphylaxis (classification of Ring and Messmer ≥ 2) to the emergency department. Patient and clinical data were extracted from the electronic medical database of the emergency department. Results: Of the 531 includes patients, 53.3% were female, the median age was 38 [IQR 26–51] years. The most common suspected triggers were medications (31.8%), food (25.6%), and insect stings (17.1%). Organ manifestations varied among the different suspected triggers: for medications, 90.5% of the patients had skin symptoms, followed by respiratory (62.7%), cardiovascular (44.4%) and gastrointestinal symptoms (33.7%); for food, gastrointestinal symptoms (39.7%) were more frequent than cardiovascular symptoms (36.8%) and for insect stings cardiovascular symptoms were apparent in 63.8% of the cases. Conclusions: Average annual incidence of moderate to severe anaphylaxis during the 6-year period in subjects > 16 years of age was 10.67 per 100,000 inhabitants. Medications (antibiotics, NSAID and radiocontrast agents) were the most frequently suspected triggers. Anaphylaxis due to insect stings was more frequently than in other studies. Regarding clinical symptoms, gastrointestinal symptoms need to be better considered, especially that initial treatment with epinephrine is not delayed. [ABSTRACT FROM AUTHOR]

Objective: This study aims to extend the Theory of Planned Behavior with Triggers (TPBT) to improve the prediction of physical activity (PA) behavior using the TPB model. Methods: Questionnaires, including the TPB scale, PA rating scale (PARS-3), and triggers scale, were administered to 596 Chinese college students, and the data were analyzed using SPSS 23.0 and AMOS 24.0. Results: Subjective norm (SN), attitude (AT), and perceived behavioral control (PBC) all significantly and positively affected behavioral intention (BI). The path coefficient of PA behavior was significantly influenced by the interaction term of three types of triggers and BI, and the TPB with Triggers (TPBT) model improved the explanation rate of PA behavior. Conclusion: Triggers have a moderating effect on the relationship between BI and PA behavior, and the TPBT model better explains college students' PA behavior. Among the three dimensions of triggers, people are more receptive to facilitator and signal triggers than spark triggers. This has practical implications for practitioners designing interventions to promote PA among college students. [ABSTRACT FROM AUTHOR]

Asthma, a serious global health problem, has been an area of interest due to its increasing prevalence, expanding treatment costs, and rising burden on patients and the community. Since asthma cannot be cured, clinical episodes can be prevented and controlled by adequate management and sufficient knowledge of the disease. Appropriate treatment may relieve asthma symptoms and improve quality of life. However, poor knowledge of asthma disease and medication use, misdiagnoses, misuse of inhalers and inadequate self-management of disease symptoms may have a greater impact on the disease process. Therefore, assessment of the population's knowledge and attitude toward asthma is essential. To the best of our knowledge, no previous studies has assessed the population's knowledge and attitude regarding asthma in Beirut, thus this study was conducted to assess the knowledge and attitude of Lebanese adults regarding asthma in Beirut, Lebanon. Additionally, the goal of this study was to determine the incidence from the studied sample of participants with physician-diagnosed and physicianundiagnosed asthma treated by bronchodilators/inhaled corticosteroids (BD/ICS). Furthermore, to identify from the sample studied the participants having the likelihood of asthma disease and to highlight the natural products used by the participants in managing asthma-related symptoms. Four hundred participants were enrolled in a cross-sectional study that was carried out using web-based anonymous questionnaires about asthma disease evaluating their knowledge towards the disease and attitude in Beirut, Lebanon. The study revealed that Lebanese adults had an inadequate level of knowledge regarding asthma, its medications, and asthma triggers. This lack of knowledge was reflected in their attitude towards the disease. Moreover, our study showed that 9.1% of the asthmatic participants who were questioned were undiagnosed yet by the physician and 33.3% of those were using BD/ICS to relieve their asthma symptoms. Furthermore, it is noteworthy that 18.75% of the questioned participants had recurrent respiratory symptoms and had features that associated with asthma, thus increasing the risk of developing chronic airway disease and asthma. However, only 8.25% of questioned participants were asthmatic. In conclusion, there is a need to improve the Lebanese community's knowledge and attitude by increasing the level of awareness about the disease. Several recommendations were suggested to advance the knowledge of asthma in order to improve future health outcomes. [ABSTRACT FROM AUTHOR]

Marine Protected Areas (MPAs) are being deployed globally to protect the Earth's biodiversity in rapidly changing oceans. Nesting climate change considerations within adaptive MPA management and monitoring is becoming a more common approach, and while climate change is increasingly addressed in MPA planning, implementation gaps remain. This study applied the climate robustness index (CRI) to MPA monitoring plans to assess how climate change is outlined within site- and regional-level plans. Previously developed to assess MPA management plans, the CRI scores plans based on their degree of incorporation of climate change adaptation principles, including core elements of adaptive management. We supplemented our CRI findings for monitoring plans by associating index scores of MPAs in the United States with selected MPA traits, as well as by examining specific physical, ecological, and sociological climate change impacts that were being considered within the monitoring scope of a subset of monitoring plans. We found considerable gaps in actionable targets and thresholds in MPA monitoring plans, consistent with a previous study evaluating MPA management plans, demonstrating that the adaptive management cycle is incomplete in many cases. We consider the importance of completing the adaptive management cycle as a core climate adaptation strategy, and explore the roles of social-ecological objectives and local partnerships as avenues to continue to improve MPA outcomes in a changing world. [ABSTRACT FROM AUTHOR]

Simple Summary: Equine headshaking syndrome is a painful condition causing the horse to shake or flick its head violently without any obvious reason. Treatments for the condition are poorly effective and information on the condition in Australian horses is lacking. An online survey was sent to owners of headshaking horses in Australia to gather more information on when headshaking occurs and what treatments have been used to address it. The results showed that more geldings were affected than mares, and geldings were older when they first started headshaking compared to mares. Bright sunlight, wind, and high pollen count were the most reported triggers, and more than half of the owners reported that headshaking occurred in a specific season each year. Most owners had used more than two types of treatment, but few treatments were reported effective when used alone. The finding that a large proportion of horses start headshaking in spring and summer, combined with owner reports that light-blocking masks do not work well as a treatment, suggests that day length rather than brightness should be considered as an important factor in headshaking. This study provides new information on the causes and treatments of headshaking in horses in Australia. Equine headshaking syndrome is a poorly understood neuropathic pain condition presenting as uncontrollable shaking, flicking, or striking of the head. Therapeutic options are limited, and treatments are only partially successful. Currently, epidemiological information on headshaking in the Southern Hemisphere is lacking. An online survey was circulated to Australian owners of headshaking horses to collect information on triggers, symptoms, seasonality, treatments, and perceived treatment efficacy. The responses (n = 216) showed the mean age at symptom onset as 9.6 (±4.7) years. More geldings were affected than mares (76% vs. 24%), and symptom onset occurred later in geldings compared to mares (10.1 ± 4.7 vs. 7.9 ± 4.0 years; p < 0.01). Bright sunlight, wind, and high pollen were the most commonly reported triggers (61%, 46% and 40%, respectively), and seasonal onset of symptoms was reported by 54% of respondents. In total, 71% of respondents reported using two or more treatments. The most common treatments were supplements (68%), nose nets (63%), light-blocking masks (48%), bodywork (48%) and pharmaceutical compounds (38%). Overall, treatments were considered ineffective by 33% of respondents. The findings were in agreement with surveys from the Northern Hemisphere. Of note was the perception of bright light as a primary trigger, alongside the reported low treatment efficacy of light-blocking masks. Seasonal intensification of symptoms and its relationship to day length merits further exploration. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a serious problem in all cultures. This study aimed to identify Jordanian men's and women's strategies of preventing IPV using focus groups and open-ended questionnaires. Participants identified many strategies to prevent IPV, which fell within three themes: (1) shields of prevention; (2) understanding the triggers of IPV; and (3) resources of prevention. Participants described their opinions on preventing IPV and discussed the role of extended family, financial dependence, triggers of IPV, and coping strategies used by women. Preventing IPV requires substantial changes in the personal characteristics of men and women, communication skills, and law enforcement. [ABSTRACT FROM AUTHOR]

The escarpments of sub-horizontally deposited rocks represent regional centres of geomorphological activity whose evolution is controlled by the occurrence of different types of slope processes. Surprisingly, historical landslide activity on escarpments of Cretaceous rocks has not yet been studied in detail at the regional level using precise absolute dating methods. In this study, dendrogeomorphic methods including sparse dating with seasonal accuracy were used to determine the activity of flow-like landslides that model the eastern margin of the Bohemian Cretaceous Basin. Geophysical ERT (electrical resistivity tomography) measurements and grain size analysis of the landslide material revealed high saturation of the landslide body with groundwater and a high content of fine-grained fraction, which potentially slows down the infiltration of water into the landslide body, thus moving mainly in its near-surface part. Dendrogeomorphic dating (of 177 Picea abies (L.) Karst. individuals) revealed 7 years of landslide activity in the five landslides studied. The dated movements appear to have a low-magnitude character as indicated by the structure, intensity and duration of the dated growth disturbances. In addition, the dated movements have the character of secondary post-failure movements within up to three generations of older landslide bodies. Dating with seasonal accuracy specified their occurrence to the period July to August. This study represents the first use of dendrogeomorphic methods to characterise landslide movements in a Cretaceous escarpment setting, providing a new perspective on this globally widespread phenomenon. [ABSTRACT FROM AUTHOR]

Background: Burns are a global public health problem, accounting for around 300,000 deaths annually. Burns have significant consequences for patients, families, healthcare teams and systems. Evidence suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making processes and family care. Research is needed on how to optimise palliative care referrals. Aim: To identify triggers for palliative care referral in critically burned patients based on professionals' views, experiences and practices. Design: Qualitative study using in-depth interviews. Setting/participants: All five Burn Intensive Care Units reference centres across Portugal were invited; three participated. Inclusion criteria: Professionals with experience/working in these settings. A total of 15 professionals (12 nurses and 3 physicians) participated. Reflexive thematic analysis was performed. Results: Three main triggers for palliative care referral were identified: (i) Burn severity and extension, (ii) Co-morbidities and (iii) Multiorgan failure. Other triggers were also generated: (i) Rehabilitative palliative care related to patients' suffering and changes in body image, (ii) Family suffering and/or dysfunctional and complex family processes, (iii) Long stay in the burn intensive care unit and (iv) Uncontrolled pain. Conclusions: This study identifies triggers for palliative care in burn intensive care units based on professionals' views, clinical experiences and practices. The systematisation and use of triggers could help streamline referral pathways and strengthen the integration of palliative care in burn intensive care units. Research is needed on the use of these triggers in clinical practice to enhance decision-making processes, early and high-quality integrated palliative care and proportionate patient and family centred care. [ABSTRACT FROM AUTHOR]

This research delves into the cybersecurity implications of neural network training in cloud-based services. Despite their recognition for solving IT problems, the resource-intensive nature of neural network training poses challenges, leading to increased reliance on cloud services. However, this dependence introduces new cybersecurity risks. The study focuses on a novel attack method exploiting neural network weights to discreetly distribute hidden malware. It explores seven embedding methods and four trigger types for malware activation. Additionally, the paper introduces an open-source framework automating code injection into neural network weight parameters, allowing researchers to investigate and counteract this emerging attack vector. [ABSTRACT FROM AUTHOR]

Background: Given the lack of previous studies on adverse events (AEs) in the area of occupational healthcare in Spain, it is very important to begin to understand this phenomenon in order to act on it. The objective was to accurately quantify AE occurring in occupational healthcare in MC Mutual during May 2021. Methods: We conducted a review of a representative random sample of 250 clinical records to identify AEs through an active search audit, focused on the frequency, type, severity, and preventability of these events, categorized using standardized scales. Results: We detected seven AEs in the sample of clinical records, representing 3% AEs per clinical record, while in the APEAS Spanish Study, they were detected in 10% of patients. The most frequent AE type was postoperative, followed by medication and diagnostic delay. The AEs were of intermediate severity and high severity and with a variable degree of being preventable. Conclusions: The detection of AEs has been useful in the development of projects and action plans such as specific training courses, safety patient newsletters, ambulatory risk maps, and treatment plans framed in the official certification of patient safety. These results should be evaluated in other companies similar to MC Mutual. [ABSTRACT FROM AUTHOR]

Introduction. In Ukraine, on average, 30% of people are obese and 25% are overweight. In parallel with the increase in the number of overweight patients, the percentage of people with migraine is increasing. The prevalence of migraine is high, it affects 12-15% of the population. Both diseases negatively affect not only the function of internal organs, but also the nervous-psychological state of patients, leading to anxiety and depressive disorders. The aim of the study was to analyze the features of the structure of anxiety disorders in obese patients with chronic migraine. Materials and methods: 180 patients (90 women and 90 men) were examined and divided into two clinical groups: 1st group – 60 persons with chronic migraine with an average BMI=23.5.8±1.10 kg/m2; 2nd group – 60 obese patients with chronic migraine, BMI=34.6±1.42 kg/m2. The control group consisted of 60 patients without a headache and with averange BMI=19.5±0.7 kg/m2. The ICHD-3 criteria were used to diagnose migraine. The DSM-5 criteria were used to diagnose anxiety disorders. The patient's level of anxiety was measured using Taylor Manifest Anxiety Scale (TMAS). Statistical processing was performed using dispersion and correlation analysis. Results: Phobic anxiety disorders were in 1.5 times more common in 2nd group patients (c2=9.81, p

The aim of the study was to investigate the relationship between body mass index (BMI) and clinical and anamnestic data in patients with bronchial asthma (BA). Material and methods. 553 patients with BA and 95 apparently healthy individuals without medical or family history of asthma, allergy or atopy symptoms were examined. Patients were divided into three groups depending on BMI: Group I included 152 patients with normal body weight (NBW), II – 206 overweight patients, III – 195 with obesity. BA control was assessed by using the ACQ-5 questionnaire, and the AQLQ was used to assess quality of life. The study was approved by the Bioethics Commission of the Medical Institute of Sumy State University. Statistical analysis of the obtained results was carried out using the SPSS-17 program. Results. There were no significant sex– and age-related differences (p > 0.05) between clinical groups. Complaints, medical history, clinical and instrumental indicators, disease severity, control, and quality of life of patients were analyzed to identify features of BA associated with obesity. The study has found that BA patients with obesity experienced a higher frequency of positive family history (p = 0.004), exacerbations during the cold season (p = 0.001), sensitivity to weather changes (p = 0.001), acute respiratory diseases (p = 0.001), stress (p = 0.001), and a combination of non-specific triggers (p = 0.001) which could result in exacerbations compared to patients with NBW. Exacerbations caused by flowering plants were more common in BA patients with NBW (55.3 %) compared to those with obesity (43.1 %). When comparing BA in individuals with obesity to those with NBW, there were several distinctive features. These included a higher frequency of symptoms such as cough and shortness of breath at rest or with minor physical exertion, weakness, fatigue, sleep disturbances, heartburn; night and day symptoms when using salbutamol, a severe and uncontrolled course with more pronounced obstructive disorders and lower reversibility, pneumonia, exacerbation episodes, and lower quality of life. Conclusions. BA with obesity compared to BA with NBW is characterized by a number of differences such as non-allergic factors as triggers, more severe course, lower level of control and quality of life, pain, pronounced bronchial obstruction with lower reversibility.

Women with bipolar disorder (BD) are at high risk of postpartum psychosis (PP). The factors that increase risk of PP among women with BD are not fully understood. Here, we examine whether sleep disruption in the perinatal period (poor sleep quality in late pregnancy and sleep deprivation related to childbirth) is associated with PP in a longitudinal study of pregnant women with BD. Participants were 76 pregnant women with lifetime DSM-5 bipolar I disorder or schizoaffective-BD, followed from week 12 of pregnancy to 12 weeks postpartum. Demographics and lifetime psychopathology were assessed at baseline via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry). Psychopathology and sleep disruption within the current perinatal period were assessed in the third trimester and at 12 weeks postpartum. Data were supplemented by clinician questionnaires and case-note review. After controlling for prophylactic use of mood stabilising medication, the loss of at least one complete night of sleep across labour/delivery was associated with five times the odds of experiencing PP compared to no or less than one night of sleep loss across labour/delivery (OR 5.19, 95 % CI 1.45–18.54; p = 0.011). Sleep quality in late pregnancy was not associated with PP, and perinatal sleep disruption was not associated with postpartum depression. Lack of objective measures of sleep factors. In the context of other aetiological factors, severe sleep loss associated with childbirth/the immediate postpartum may act as a final trigger of PP. These findings could have important clinical implications for risk prediction and prevention of PP. • Perinatal sleep factors and postpartum psychiatric outcomes assessed longitudinally • Acute, childbirth related sleep loss associated with postpartum psychosis • No relationship between perinatal sleep factors and postpartum depression. • Implications for risk prediction of postpartum psychosis in bipolar disorder [ABSTRACT FROM AUTHOR]

Objective: To evaluate self‐reported substance user profiles for individuals with migraine and compare these to the general population. Background: There is increasing attention to lifestyle influences such as substance use as presumed migraine triggers. Methods: Data on substance use were collected by survey in a large migraine cohort and from the biannual survey in the general Dutch population for substances. A representative cohort of Dutch patients with migraine (n = 5176) and the Dutch general population (n = 8370) was included. Patients with migraine were subdivided into episodic (EM) and chronic migraine (CM). Substance consumption was compared between the general population and patients with migraine, and between migraine subgroups after standardization for sex and level of education. Results: Included patients with migraine were 83.4% female (4319/5176) and had a mean (standard deviation) age of 44.8 (11.3) years. Patients with migraine reported less illicit drug use (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.42–0.55; p < 0.001), less current and lifetime smoking (OR 0.60, 95% CI 0.55–0.65; p < 0.001 and OR 0.75, 95% CI 0.71–0.79; p < 0.001), and less current alcohol consumption (OR 0.66, 95% CI 0.62–0.70; p < 0.001) compared with the general population. Prevalence of substance use was compared between CM and EM participants and showed higher illicit drug use (OR 1.73, 95% CI 1.11–2.69; p = 0.011), higher current smoking (OR 1.61, 95% CI 1.22–2.11; p < 0.001) but less alcohol use (OR 0.54, 95% CI 0.43–0.68; p < 0.001) for participants with CM compared with EM. No differences were found for a history of smoking (OR 1.18, 95% CI 0.92–1.50, p = 0.19). Conclusions: Individuals with migraine are less likely to use illicit drugs, smoke, or drink alcohol compared with the general population. Patients with CM less often consume alcohol, while they more often use illicit drugs and smoke compared to those with EM. [ABSTRACT FROM AUTHOR]

Background: During pregnancy and early motherhood, risks of relapse and worsening are high for women with a history of eating disorders (EDs), as are adverse sequelae for their babies. However, systematic descriptions of the processes that these women undergo through pregnancy, birth, and early motherhood are lacking, as are good descriptions of the various trajectories these women follow through pregnancy and early motherhood. This study addresses both these knowledge gaps. Methods: We used a longitudinal research interview design, recruiting a non-clinical sample of 24 women with a history of severe EDs from routine pregnancy controls in five public, local, family health care centers in Norway. The participants were interviewed twice, first during pregnancy and then 4-6 months after delivery. Data were analyzed according to grounded theory. The focus was on modeling the trajectories of EDs through pregnancy, birth, and early motherhood. All the participants were diagnosed (DSM-5) using the Eating Disorder Examination and then completed the Eating Disorder Examination Questionnaire. Results: Five perceived trajectories through pregnancy and early motherhood were identified: "The mastering mother," in which an ED pathology seems to be absent through pregnancy and early motherhood; "The inadequate mother," in which the ED pathology worsens before pregnancy, through pregnancy, and early motherhood; "The overwhelmed mother," in which the ED worsens during pregnancy and early motherhood; "The depressed mother," in which the ED is put on hold during pregnancy, but worsens in early motherhood; and "The succeeding mother," in which the ED worsens during pregnancy, but reduces in early motherhood. Discussion: ED trajectories through pregnancy and early motherhood vary greatly among women with a history of EDs. This may indicate different psychological dynamics through these phases. A model with five trajectories captures a large degree of the variation. The model may help clinicians' preparedness when dealing with these patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the incidence of triggers, prodromal symptoms, hypersensitivity symptoms accompanying headache and responses to triptans were modified during a continuous 9-month fremanezumab therapy for migraine prophylaxis. Patients and methods: We studied 63 patients with high-frequency episodic migraine (HFEM). Enrolled patients received fremanezumab for nine consecutive months before defining the response rates and being stratified into treatment responders (≥50–74% reduction in monthly headache days (MHDs)), super responders (≥75%), partial non-responders (<50%) and super non-responders (<30%). Through headache diaries, patients provided data in order to document the impact of fremanezumab on the incidence of triggers, associated symptoms followed by headache and response to triptans (the use of the migraine treatment optimization questionnaire-4 (mTOQ-4)) during the 9-month treatment period. Results: Fremanezumab had early (after 3 monthly cycles) beneficial effects on the response to triptans in the majority of responders with relevant increases in mTOQ-4 scoring, but also in half of partial non-responders. A significant reduction in median days with migraine-associated symptoms was seen in responders after 6 months of therapy with fremanezumab, mostly for osmophobia, photophobia, phonophobia and nausea/vomiting, but partial non-responders also benefited. Likewise, the incidence of self-reported prodromal symptoms was significantly reduced in responders and was modestly diminished in partial non-responders. Triggers remained unaffected in both responders and non-responders. Conclusions: Fremanezumab given for at least 6–9 months may exert neuromodulatory effects in the migraine brain. These effects could result both in the inhibition of migraine chronification, but also in the diminishing of the magnitude of migraine-associated symptoms, mostly in responders and in partial non-responders. [ABSTRACT FROM AUTHOR]

Aims: Knowledge about adverse drug events caused by drug–drug interactions (DDI‐ADEs) is limited. We aimed to provide detailed insights about DDI‐ADEs related to three frequent, high‐risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. Methods: We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e‐triggers) to preselect patients with potential DDI‐ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI‐ADEs using internationally prevailing standards. Results: In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e‐triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI‐ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI‐INR+ e‐trigger (0.76), followed by DDI‐AKI e‐trigger (0.57). Conclusion: The highly preventable nature and severity of DDI‐ADEs, calls for action to optimize ICU patient safety. Use of e‐triggers proved to be a promising preselection strategy. [ABSTRACT FROM AUTHOR]

This article explores how an integrated concept map of student engagement could improve its use in higher education (HE). In doing so it addresses three problems: (i) there is no consistently accepted understanding of student engagement; (ii) no meta-theory integrates engagement's diverse and complex concepts, nor does the literature identify a clear process of what triggers engagement; and (iii) no integrated concept map that addresses these problems is available. The first problem is rooted in diverse research perspectives that prevent a widely accepted understanding. The second is tackled by using George Ritzer's meta-theory of social analysis that helps integrate the subject matter of engagement and Jack Mezirow's transformative learning theory (TLT) that explains what triggers engagement and disengagement. The third difficulty is addressed by combining meta theory and TLT to offer for discussion an integrative concept map of this complex construct. [ABSTRACT FROM AUTHOR]

Objective: The management of patients after a first unprovoked seizure (FUS) can benefit from stratification of the average 50% risk for further seizures. We characterized subjects with FUSs, out of a large generally healthy homogenous population of soldiers recruited by law to the Israeli Defense Forces, to investigate the role of the type of service, as a trigger burden surrogate, in the risk for additional seizures. Methods: Soldiers recruited between 2005 and 2014, who experienced an FUS during their service, were identified from military records. Subjects with a history of epilepsy or lack of documentation of FUS characteristics were excluded from the study. Data on demographics and military service and medical details were extracted for the eligible soldiers. Results: Of 816 252 newly recruited soldiers, representing 2 138 000 person‐years, 346 had an FUS, indicating an incidence rate of 16.2 per 100 000 person‐years. The FUS incidence rate was higher in combat versus noncombat male and female soldiers (p <.0001). Most subjects (75.7%) were prescribed antiseizure medications (ASMs), and 29.2% had additional seizures after the FUS. Service in combat units, abnormal magnetic resonance imaging, and being prescribed ASMs were correlated with a lower risk of having multiple seizures (95% confidence interval [CI] =.48–.97,.09–.86,.15–.28, respectively). On multivariate analysis, service in combat units (odds ratio [OR] =.48 for seizure recurrence, 95% CI =.26–.88) and taking medications (OR =.46, 95% CI =.24–.9) independently predicted not having additional seizures. Significance: FUS incidence rate was higher in combat soldiers, but they had a twofold lower risk of additional seizures than noncombat soldiers, emphasizing the value of strenuous triggers as negative predictors for developing epilepsy. This suggests a shift in the perception of epilepsy from a "yes or no" condition to a continuous trend of predisposition to seizures, warranting changes in the ways etiologies of epilepsy are weighted and treatments are delivered. [ABSTRACT FROM AUTHOR]

Aim: An individual with a blood–injection–injury (BII) phobia often avoids exposure to triggers, such as blood tests and clinic appointments, leading to potentially serious health complications. This population‐based study examined the prevalence, stability and course of BII phobia in children and adolescents. Methods: The data came from the Trondheim Early Secure Study, conducted from 2007 to 2018. All children born in Trondheim, Norway, in 2003 and 2004 were invited to attend. Clinical interviews were conducted by trained personnel to assess BII phobia in 1042 children (51% female) every 2 years from 4 to 14 years of age. Latent growth curves and logistic regression analyses were used in the data analysis. Results: Just under 20% of the cohort experienced a BII phobia at least once, with no significant sex differences. The prevalence of BII phobias increased from 3% at 4 years of age and peaked at about 8% at 10 years of age, before levelling off. The two‐year stability increased as 12–14 years of age approached. Conclusion: The prevalence of BII was affected by age, but not sex. Early BII phobias often recede with time, but children may need treatment if they persist from 8 years of age. [ABSTRACT FROM AUTHOR]

Children commonly encounter primary headaches, with various factors playing a role in their onset. The daily routine notably contributes to the occurrence of primary headaches in children. This study aims to profile children experiencing headaches on weekends (WH) in comparison to those primarily having headaches midweek (MWH). Out of 109 children visiting a pediatric headache clinic, 60 prospectively filled out questionnaires regarding their headaches. The average age was 11.8 years, and 63% were of female sex. Most of the children suffered from migraine headaches (60%), while the rest suffered from tension-type headaches (TTH, 15%), mixed headaches (17%), or undetermined headaches (8%). None of the children suffered from a headache only on the weekend. In contrast, 14 (23%) children suffered from a headache exclusively in midweek. Children with learning difficulties were similarly distributed between the WH and the MWH groups (48% and 52%, respectively). Children without learning difficulties suffered significantly more from MWH compared to WH (79% vs. 21%, respectively). In conclusion, children did not suffer from WH alone. Self-reported triggers were not significantly different in WH and MWH patients. Proper profiling of headache types and triggers may lead to more accurate management of these patients. [ABSTRACT FROM AUTHOR]

Rockfall remains a prominent hazard for transportation corridors worldwide. Recent studies have shown promising results in resolving the relationships between rockfall activity and triggers, including in some cases detecting precursor activity prior to failure, which could have implications to improving safety and performance of transportation corridors. The aim of this study is to better understand rockfall failure processes and triggers for cut slopes in interbedded sedimentary rock through a long-term study using photogrammetry data with high spatiotemporal frequency. The combination of daily data, high-precision rockfall volume estimation, and 22-month monitoring duration is unique among studies that evaluate rockfall triggers and allows us to derive insights into differences in rockfall triggering between blocks of different volumes. The data collected allowed the relative frequency of rockfalls of different volumes to be well-constrained for volumes ranging from 0.01 m3 up to 76 m3 (the largest event that occurred during the monitoring period). A quantitative comparison between precipitation and rockfall activity established that precipitation was the primary trigger for rockfall at the site, with only 1.4% of 24-h photo intervals without precipitation having at least one rockfall, as compared to 25.0% of photo intervals with precipitation (and 57.1% of photo intervals with at least 5 mm of precipitation). The marginal impact of additional rainfall above 8 mm per 24-h period on rockfall probability was negligible among all rockfalls observed, whereas the probability of the largest rockfalls at the site (> 1 m3) occurring continued to increase as a function of precipitation up to 20 mm per 24-h period. Detailed analysis of change data leading up to the largest (76 m3) rockfall observed illustrated the progressive failure mechanism of the block, including observations of forward toppling motion and smaller precursor rockfalls around its perimeter. This rockfall was also used for a proof-of-concept demonstration of the potential for a spatiotemporal rockfall density metric to be used to help identify areas of potential hazard. Ultimately, the findings from this study contribute to knowledge on rockfall processes outside alpine regions, which have historically been less well-studied. [ABSTRACT FROM AUTHOR]

Marine Protected Areas (MPAs) are being deployed globally to protect the Earth’s biodiversity in rapidly changing oceans. Nesting climate change considerations within adaptive MPA management and monitoring is becoming a more common approach, and while climate change is increasingly addressed in MPA planning, implementation gaps remain. This study applied the climate robustness index (CRI) to MPA monitoring plans to assess how climate change is outlined within site- and regional-level plans. Previously developed to assess MPA management plans, the CRI scores plans based on their degree of incorporation of climate change adaptation principles, including core elements of adaptive management. We supplemented our CRI findings for monitoring plans by associating index scores of MPAs in the United States with selected MPA traits, as well as by examining specific physical, ecological, and sociological climate change impacts that were being considered within the monitoring scope of a subset of monitoring plans. We found considerable gaps in actionable targets and thresholds in MPA monitoring plans, consistent with a previous study evaluating MPA management plans, demonstrating that the adaptive management cycle is incomplete in many cases. We consider the importance of completing the adaptive management cycle as a core climate adaptation strategy, and explore the roles of social-ecological objectives and local partnerships as avenues to continue to improve MPA outcomes in a changing world.