Appropriate nutrition during the first 1,000 days from pregnancy to a child's second birthday is a critical window for optimal growth, cognitive development, and long-term health, with proper complementary feeding practices playing a pivotal role. Despite this, evidence on the magnitude of appropriate complementary feeding practices and their associated factors remains limited at the local level in Ethiopia. Therefore, this study assessed the Complementary Feeding Practices and Associated Factors among Mothers of Children Aged 6-23 Months in Debre Berhan Town, Ethiopia, in 2021. A community-based cross-sectional study was conducted from July 1 to August 30, 2021, using a cluster sampling technique in four randomly selected kebeles, including all eligible mothers. Data were collected using a structured interviewer-administered questionnaire, and appropriate complementary feeding practice was assessed based on WHO-recommended indicators. Data were entered into EpiData version 3.1 and analyzed using SPSS version 25. Multivariable logistic regression was used to identify factors associated with appropriate complementary feeding practice at p < 0.05. The prevalence of appropriate complementary feeding practice was 43.7%, and factors significantly associated included being a housewife (AOR = 2.53; 95% CI: 1.05-6.08), attending postnatal care (AOR = 3.18; 95% CI: 2.03-4.97), institutional delivery (AOR = 2.14; 95% CI: 1.11-4.14), and child vaccination (AOR = 1.89; 95% CI: 1.15-3.12). The level of appropriate complementary feeding practice in Debre Berhan Town (43.7%) remains suboptimal compared with WHO recommendations for children aged 6-23 months. Postnatal care attendance, being a housewife, institutional delivery, and child vaccination were significantly associated with appropriate complementary feeding practice. Strengthening postnatal counseling and integrating appropriate infant and young child feeding messages into routine vaccination services may help improve complementary feeding practices.
School belonging is a key protective factor for socioemotional functioning during the preschool period. Counsellors working in preschool institutions play an important role in developing sense of school belonging by meeting their emotional and social needs and fostering a positive school environment. This study examined the views of school counsellors working in preschool education institutions in Türkiye regarding sense of school belonging and, to support these views and to reveal their reflection at the level of institutional practice, analysed routine guidance and counselling documents to identify how belonging-supportive practices are formally planned, implemented, and recorded over the school year. A phenomenological qualitative design was employed. Data were collected through structured interviews with school counsellors and complemented by document analysis of counselling artefacts to examine how belonging practices are formally planned, implemented, and documented across the school year. The document corpus comprised 186 written artefacts from 10 kindergartens. Data were analysed using computer-aided content analysis, and a hierarchical code-subcode model was utilised in MAXQDA 2020. Findings indicated that counsellors conceptualised school belonging as children's feelings of acceptance and security within the school community and described belonging-related differences in children's emotions, participation, and peer interactions. Counsellors also highlighted multi-level strategies targeting emotional safety, peer relationships, teacher practices, and family involvement. Complementing these findings, the document analysis yielded five practice-oriented domains through which counselling services may support school belonging: (1) emotional safety and adjustment to school routines, (2) support for peer relationships and social problem-solving, (3) cultivation of a positive classroom/school climate through teacher collaboration, (4) systematic family involvement and parent education, and (5) developmental monitoring and evaluation. Document analysis corroborated counsellors' reported perspectives by providing practice-level evidence of how belonging-supportive strategies were formally embedded in institutional plans and documented in artefacts. Preschool children's school belonging is supported through a year-long programme of practice spanning children, teachers, and families. Strengthening preventive counselling services that promote emotional safety, peer-inclusion, and family-school collaboration may improve school belonging in early childhood, as this phenomenon has far-reaching implications for children's educational trajectories, working lives, and broader societal and democratic engagement.
Zoonotic diseases are common threats to global health. A large number of infectious diseases are transmitted from animals to humans. The current study aimed to assess the community's knowledge, attitudes, and practices (KAP) regarding common zoonotic diseases in the Arbaminch district. A cross-sectional survey was carried out between November 2024 and June 2025. A total of 384 participants were interviewed in the study. Participants residing in these areas were randomly chosen. Data were collected using a structured questionnaire. The collected data were analyzed using Stata 17, and the results were reported using descriptive statistics and the chi-square test. The findings of this study revealed that a majority (55%) of participants had good knowledge about zoonotic diseases. Respondents know several modes of transmission for zoonotic diseases, with animal bites (32.5%) being the most recognized, followed by direct contact (15.5%), ingestion of raw products (10%), and inhalation (10%). Regarding attitudes, 63.2% of respondents exhibited a positive attitude towards the importance of zoonotic disease prevention and control, and 67.4% of respondents followed relatively good hygiene and preventive behaviors. However, risky practices were still common. Knowledge score showed a significant association with age. Attitudes of participants were significantly associated with education, age, occupation, and income. Similarly, practices were significantly associated with gender, education level, occupation, and income, with all associations being statistically significant (p < 0.05). The overall community knowledge, attitudes, and practices regarding zoonotic diseases were relatively good.
This study aimed to characterize practices and decision-making for extracorporeal membrane oxygenation (ECMO) for congenital anomalies of the kidney and urinary tract (CAKUT). General practices (GP) section inquired about institutional practices and barriers, ECMO criteria, and dialysis. The hypothetical cases (HC) illustrated four clinical scenarios with varying degrees of renal severity for ECMO candidacy. Then, 99 (42 centers) and 91 (38 centers) physicians completed the GP and HC components, respectively. The majority considered ECMO on a case-by-case basis (66%). Bilateral renal agenesis was the most common diagnosis for exclusion (52%). Prenatal markers used for ECMO exclusion included anhydramnios (43%) and lung volumes (43%). The majority of centers had nephrology involved in ECMO decision-making. Challenges for implementing ECMO included disease heterogeneity (79%) and poor evidence on outcomes (66%). HC responses demonstrated variability in considering ECMO for CAKUT. Variability among providers and institutes underscores the need for consensus-based guidelines to optimize decision-making and outcomes.
Dizziness and vertigo affect millions annually, creating a $13.3 billion US economic burden. Physical therapists are key in treating vestibular disorders, but entry-level training varies significantly, necessitating specialized post-professional education. This study evaluates whether the Advanced Vestibular Physical Therapist (AVPT) Certificate Program effectively prepares PTs to meet patient needs. A cross-sectional survey was distributed to 230 graduates from four AVPT cohorts. The 18-question survey assessed program impact on clinical practice, professional development, and patient outcomes using 5-point Likert scales, plus demographic information and open-ended feedback. Sixty-seven graduates responded (29% response rate). Nearly all (97%) agreed the program prepared them as frontline vestibular providers, while 92% reported improved patient outcomes. All participants (100%) agreed the program met continuing education needs, and 98% reported changed clinical practice. Average likelihood to recommend was 9.69/10. However, 30% reported employers did not value the certification, and 91% received no additional compensation. The AVPT program successfully creates competent expert vestibular providers, improving clinical confidence, differential diagnosis skills, and patient outcomes while addressing critical gaps in entry-level education.
Population-based organized prostate-specific antigen (PSA) screening is implemented in 80% of Japanese municipalities; however, Shiga Prefecture remains a unique exception without such a systematic program. This study characterized the longitudinal clinical features and treatment patterns in this opportunistic testing environment using data from 1716 patients diagnosed via prostate biopsy in 2012, 2017, and 2022. While median PSA levels remained stable (10.40-11.43 ng/mL), median age at diagnosis increased from 72 to 74 years. Over the decade, the incidence of International Society of Urological Pathology Grade Group 1 and cT1c stages decreased significantly (p < 0.001), with nearly 90% of cases being cT2 or higher in 2022. Risk classification showed a decrease in low-risk cases and a rise in high-risk cases. Regarding treatment, radical prostatectomy rates remained stable at approximately 25%, whereas the overall use of active surveillance (AS) increased from 1 to 9%. Notably, among low-risk patients, AS adoption rose markedly from 2.3% in 2012 to 68% in 2022. While clinical practices have evolved to successfully minimize unnecessary invasive intervention, these findings suggest that clinical progress alone cannot fully compensate for the lack of organized efforts to improve early detection.
Rare diseases affect small, dispersed populations and are often studied through multisite designs where equity-relevant demographic data are essential for inclusive recruitment and accurate interpretation. This study examined how sociodemographic variables are collected and reported in rare disease research and evaluated their alignment with the PROGRESS-Plus framework, which outlines Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, social capital, and additional "Plus" factors such as age and disability status. A systematic review of peer-reviewed articles was conducted alongside an environmental scan of demographic instruments from governmental, health-system, academic, and rare disease organizations. Screening and extraction coded variables as reported, indirectly derivable, or not reported and compared them with established standards. Of 647 records identified, 37 met inclusion criteria. Reporting was dominated by age and sex, while most other equity-relevant variables including gender identity, sexual orientation, race/ethnicity, distinctions-based Indigenous identity, socioeconomic position, language, migration, disability/function, religion, occupation, and social capital, were inconsistently captured. Environmental scan instruments were more comprehensive, revealing a capture-to-reporting gap. Demographic reporting in rare disease research is heterogeneous and insufficient for equity-focused analyses. A concise, standards-aligned sociodemographic dataset is needed to improve transparency, comparability, and detection of inequities across rare disease populations.
A position paper released by the European Association of Nuclear Medicine emphasised the need for multidisciplinary engagement to establish dosimetry-based personalised treatment in Radionuclide therapy (RNT). The uncertainty analysis results often ignored in routine clinical practice should be incorporated into the dose calculations to improve the efficacy and accuracy of treatment. In this study, patients with haematological malignancies undergoing radioimmunotherapy were evaluated. Our study aimed to calculate the uncertainties associated with each parameter of the single time point (STP) dosimetry chain and compare the with multiple time points (MTP) in the bone marrow and liver results. 28 patients received an intravenous injection of 111In-besilesomab (0.17 ± 0.01GBq) for pre-therapeutic dosimetry and were subsequently treated with 90Y-besilesomab(2.43 ± 0.53GBq). A dosimetry analysis was performed on bone marrow (BM) and liver with MTP and STP. We investigated the uncertainty in population mean effective half-life, volume, recovery coefficient, counts, measured activity, fitting parameters, time-integrated-activity, S-factors, and absorbed dose (AD) for a group of patients. The mean absorbed dose per unit administered activity (DpA) to BM was 5.8 ± 1.7 mGy/MBq with MTP and 5.8 ± 1.6 mGy/MBq with STP, and to the liver was 2.9 ± 1.9 mGy/MBq with MTP and 3.1 ± 2.4 mGy/MBq with STP. The mean fractional uncertainty associated with total absorbed dose to BM was 13.18 ± 3.46% with MTP and 18.75 ± 3.22% with STP, and to liver was 5.77 ± 3.13% with MTP and 49.78 ± 25.36% with STP. A moderate positive relationship (R2 = 0.7) was noted between post-injection acquisition time and AD uncertainty with STP for BM, whereas a strong positive relationship (R2 = 1) was noted for the liver. The absorbed dose uncertainty in STP was significantly higher compared to the MTP. Incorporating the uncertainty analysis for STP dosimetry parameters in routine clinical practice is strongly recommended. The accuracy in the acquisition time, population-based half-life and fitting function for time activity curve is vital for minimising uncertainty in STP dosimetry, which is less time-consuming and easier to implement in clinical practice than MTP.
Congenital anomalies and genetic disorders contribute substantially to perinatal morbidity and mortality, particularly in low- and middle-income countries. Prenatal healthcare providers play a key role in identifying affected pregnancies and referring to patients for genetic counselling; however, referral practices remain suboptimal. To assess the utilisation of genetic counselling services and perceptions of genetic counselling among prenatal healthcare providers in Gauteng Province, South Africa. An electronic survey was distributed to prenatal healthcare providers working in public and private healthcare sectors in Gauteng. The survey assessed access to genetic counselling services, referral practices, knowledge of referral indications, understanding of the genetic counsellor's role, and perceived barriers to referral. Fifty-four respondents were included. Seventy-four percent of participants reported being able to refer to patients for genetic counselling, but only 57% had utilised the service. No participant correctly identified all appropriate referral indications, and only 24% understood the scope of practice of genetic counsellors. Only 6% felt confident in their knowledge of genetic counselling. Although genetic counselling services are available and utilised in Gauteng, they are not accessed to their full potential. Improved education and clearer referral guidance are required to optimise prenatal genetic care in this setting.
Crop diversification through crop rotation or cover cropping is widely recognized as an important strategy to improve agroecosystem sustainability, enhance soil health, and suppress soilborne diseases. Rotating crops or introducing cover crops can disrupt pathogen life cycles, improve nutrient cycling, and promote beneficial microbes. However, the outcomes of diversification practices are often complex, influenced by soil type, crops, and pathogen pressures. Evaluating how cover crops and crop phase affect crop soilborne diseases and root-associated microbiome is critical for designing resilient cropping systems. This study evaluated the legacy effects of cover crops and crop phase on soybean root diseases and root-associated microbiome. Soybean plants were grown in soils collected from a corn-soybean rotation field experiment with and without cover crops, and then challenged with either Fusarium graminearum inoculum or soybean cyst nematode (SCN) in the growth chamber. Soils with a cover crop history significantly reduced F. graminearum-induced root rot, but had a limited impact on SCN, indicating divergent disease responses. Microbial profiling revealed that F. graminearum inoculum strongly reshaped bacterial communities, reducing Shannon diversity and enriching fast-growing copiotrophic taxa, including Bacteroidota genera (Pedobacter, Chitinophaga, Flavobacterium, and Mucilaginibacter) and Proteobacteria genera (Dyella, Pseudomonas, Rhizobium, and Paraburkholderia) regardless of cover crops. In contrast, SCN infection increased bacterial Shannon diversity in soybean-phase soils regardless of cover crops but decreased fungal Shannon diversity in soybean soils without cover crops, highlighting pathogen-specific microbial shifts. Cover cropping enhanced microbial heterogeneity under both pathogen pressures, enriching microbial taxa potentially involved in nutrient cycling (Chitinophaga and Mucilaginibacter), antagonism (Flavobacterium, Streptomyces, Pseudonocardia, and Nocardioides), and competitive interactions (Paraburkholderia). Correlation analyses further linked specific bacterial and fungal genera with disease suppression. Soilborne pathogens and cropping practices exerted interconnected, pathogen- and crop-specific effects on root microbial communities. Cover cropping offers a promising strategy to enhance microbial-mediated disease resilience in soybean systems, providing ecological insights into microbiome-driven plant health.
Fast-track and outpatient surgery have significantly reduced postoperative hospital stays across many surgical specialties. As a result, patients are increasingly discharged with strong opioid prescriptions, contributing to the global opioid crisis. Careful follow-up and opioid tapering are essential. While multidisciplinary Transitional Pain Services (TPS), involving pain specialists, psychologists, and physiotherapists, have shown promise, their widespread implementation is limited by costs and complexity. To address these barriers, we implemented a nurse-led TPS, supervised by a pain specialist and embedded within a multidisciplinary pain clinic. The aim of this study was to evaluate its effectiveness in clinical practice, including a mechanism-based treatment approach to postsurgical pain aimed at opioid tapering and optimizing the use of adjuvant analgesics. This observational cohort study included postoperative patients discharged with >20 mg oral oxycodone equivalents and/or those experiencing or at risk for neuropathic pain. Referred patients received telephone consultations by a nurse practitioner (NP) one to two weeks post-discharge. Each consultation included assessment of pain severity, neuropathic characteristics (using the first two items of the DN4 questionnaire), current analgesic use, and willingness to taper opioids. Patient education and motivational interviewing techniques were employed to support opioid tapering. Descriptive statistics and paired t-tests were used to analyze the data. Between June 2019 and July 2025, 243 patients were enrolled in the TPS. Following nurse-led counseling, 73 % of patients discontinued opioid use entirely, 23 % significantly tapered their dosage (from mean 101-43 mg oral oxycodone equivalent), and 4 % continued at the same dose. Anti-neuropathic medications were initiated in 22 % of patients. A nurse-led Transitional Pain Service is a feasible and effective approach to support opioid tapering in postoperative patients. In addition, early screening for neuropathic pain allows for targeted treatment. This model offers a scalable alternative to traditional multidisciplinary TPS programs.
Federated learning (FL) has become a highly promising paradigm for privacy-preserving distributed model training by enabling edge devices to train without sharing raw data. But in practice, edge environments are both non-stationary and asymmetric, with varying data distributions due to shifts in user behaviour, sensing conditions, and overall environmental dynamics. This causes concept drift (sudden, gradual, and recurrent), leading to poor model performance, slower convergence, and predictive bias. Current approaches to FL are not combined to tackle problems of drift adaptation, differential privacy (DP) and resource efficiency (FedAvg, DP-FedAvg). To address these constraints, we present FedDriftGuard. This Federated learning layer unifies client-level drift detection, drift-adaptive aggregation, and adaptable differential privacy into a single, FLE architecture-compatible system. The proposed DP-DriftNet model implements attention-based time encoding to capture changing data patterns and drift-directed feature weighting to allow greater flexibility in the presence of distributional changes. A drift-optimal privacy scheduler allocates noise probabilistically, subject to a limited privacy budget, thereby enforcing an appropriate privacy-utility trade-off without cancelling formal DP guarantees. Also, update sparsification, compression and periodic transmission techniques are used to reduce communication overhead. Decades of experimentation on real-world and synthetic drift datasets have shown that FedDriftGuard outperforms baseline FL techniques, achieving accuracy and F1-score gains of 9-14% and 11-17%, respectively, with adaptation latency 28% shorter and communication cost 20-35% lower. Such findings are statistically significant and confirm the soundness of the suggested method. FedDriftGuard offers effective, scalable privacy-preserving learning in adaptable, edge-drifting environments.
Tanzania has adopted artificial intelligence (AI)-assisted chest X-ray screening for tuberculosis (TB), including the use of CAD4TB version 6, which is registered by the Tanzania Medicines and Medical Devices Authority (TMDA). While GeneXpert, practical reference standard used in routine practice, remains the primary bacteriological confirmatory test in routine practice, there is currently no established national threshold for CAD4TB use in either active case finding (ACF) or passive case finding (PCF) settings. This study evaluates the implementation and operational use of CAD4TB version 6 within mobile TB screening units in Tanzania and highlights challenges affecting its effective use. We conducted a retrospective analysis of screening data from 11,923 individuals collected from mobile clinics equipped with digital X-ray, CAD4TB version 6, and GeneXpert systems. Comparisons were made between manual chest X-ray interpretation, CAD4TB scores, and GeneXpert results within the subset of individuals who underwent confirmatory testing. The findings reveal substantial inconsistencies in screening workflows, including non-uniform use of CAD4TB prior to GeneXpert testing, missing radiological records, and deviations from intended protocols across sites. Descriptive analysis showed that CAD4TB scores generally aligned with GeneXpert-positive cases within the tested subset; however, due to selective application of GeneXpert and incomplete data, these observations cannot be interpreted as measures of diagnostic accuracy. This study should be interpreted as an implementation and operational assessment of AI-assisted TB screening rather than a diagnostic accuracy or threshold-setting study. The findings highlight important gaps in protocol adherence, data completeness, and workflow standardization, underscoring the need for prospective, protocol-driven studies to establish validated national thresholds for CAD4TB use in Tanzania.
Hidradenitis suppurativa (HS), an inflammatory skin disorder characterized by painful nodules and abscesses, has varying prevalence among different races/ethnicities. This study explored the social drivers of health, burden, and impact of HS among different racial and ethnic groups. An online, cross-sectional survey was conducted among adult patients with HS (September 2023-December 2023) in the USA. Patients were recruited through HS Connect (patient advocacy group) and AmeriSpeak (US national sample panel). Descriptive data were collected using patient-reported outcome measures and de novo questions about patients' disease knowledge and perception, healthcare access and utilization, impact on quality of life (QoL), and social impact. All analyses were descriptive and stratified by racial/ethnic groups. The study included 583 patients (mean age, 34.8 years; 95.5% female) representing a range of racial backgrounds: Black or African American (n = 273; 46.8%), white (n = 236; 40.5%), Two or More Races (n = 47; 8.1%), American Indian or Alaska Native (n = 18; 3.1%), Asian (n = 7; 1.2%), and Native Hawaiian and Other Pacific Islander (n = 2; 0.3%). Ethnic representation also varied (Hispanic/Latino = n = 76; 13.0%). Patients of all races and ethnicities reported considerable QoL impact (Dermatology Life Quality Index, EQ-5D-5L), with results for smaller subgroups (n < 10) included for descriptive completeness only and not intended for comparison with other groups. During flaring, most patients used over-the-counter products/medications (54.2%) or nonmedical intervention/home remedy (56.9%) Up to 36.5% of patients reported challenges in procuring food, utilities, medicine/healthcare, phone, clothing, or childcare when needed in the past year. Among those who paid out-of-pocket for their HS treatment, 55.6% reported that it stopped them from visiting a healthcare provider for treatment. The findings indicate a high burden and impact of HS across all races and ethnicities. Patients reported social drivers of health and challenges with healthcare utilization, indicating the need for integrating social workers and care management teams in dermatology practice, which could facilitate improved care of patients with HS. Hidradenitis suppurativa is a painful skin condition that causes lumps and abscesses. It affects people of all races and ethnicities but is more common in Black or African American individuals. This study surveyed 583 adults in the USA to understand how hidradenitis suppurativa affects people from different racial and ethnic backgrounds. Our focus was on how the disease impacts their daily lives, their ability to access healthcare, how often they visit doctors, their quality of life, and their mental and emotional well-being. Most people said that hidradenitis suppurativa lowers their quality of life and makes daily activities harder. During flaring, many used home remedies instead of seeing a doctor. People suffering from hidradenitis suppurativa also reported trouble getting basic needs such as food, medicine, and transportation. These challenges occurred among patients from different racial and ethnic groups; results for very small subgroups (Asian, Native Hawaiian/Other Pacific Islander) are reported descriptively only and should not be interpreted as representative of these groups or compared with other groups. The research underscores the importance of improving awareness and tailoring care for people with hidradenitis suppurativa, particularly those facing barriers to healthcare.
Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally, particularly in women with antepartum hemorrhage (APH). Current risk assessment methods lack standardized predictive tools that are both simple and reliable for clinical application. We conducted a secondary analysis of a prospectively collected cohort of 100 pregnant women presenting with APH at ≥28 weeks' gestation at a tertiary care centre in northern India. Multivariable logistic regression was used to identify significant predictors of PPH. A point-based clinical risk score was then developed based on the multivariable model and internally validated using bootstrap techniques with 1000 replicates. PPH occurred in 30% of patients (n=30). Multivariable analysis identified four independent predictors of PPH: maternal age (adjusted odds ratio [OR] 1.29 per year; 95% confidence interval [CI] 1.10-1.51; p=0.002), gravidity (OR 2.11 per unit; 95% CI 1.00-4.43; p=0.049), gestational age at delivery (OR 0.64 per week; 95% CI 0.44-0.94; p=0.021), and antepartum blood transfusion (OR 2.44; 95% CI 1.02-5.84; p=0.045). The prediction model demonstrated excellent discrimination with an area under the receiver operating characteristic (ROC) curve of 0.86 (95% CI 0.80-0.92) and good calibration (slope 0.95). Bootstrap internal validation yielded an optimism-corrected AUC of 0.84. The resulting four-factor risk score stratified patients into four risk categories with PPH rates ranging from 4% (low risk) to 100% (very high risk). The four-variable score provides an accurate, easily applicable tool with excellent predictive performance. The score is a promising tool that, pending external validation, may facilitate early identification of high-risk patients and improve maternal outcomes. Further research should focus on external validation of this tool in diverse populations and its integration into clinical practice.
There have been discussions as to the time of elective induction of labour to curb the continuation of pregnancy that might endanger the lives of both the mother and child. This research was conducted to assess foetal and maternal consequences of planned delivery at 40 and 41weeks in women with low-risk singleton pregnancy. A randomised controlled trial with equal allocation of participants (96 pregnant women in each arm) into 40weeks and 41weeks. Participants were randomised at the antenatal clinic at 39 weeks for induction of labour. The main outcome was the caesarean section rate. Secondary outcomes were maternal (genital tract laceration rate) and foetal (rates of meconium staining of amniotic fluid, SCBU admission, perinatal mortality, birth trauma, birth weight, and neonatal APGAR score at 1 and 5 minutes). Student t-test and chi-square test were used for inter-group comparison. Incidence of caesarean delivery (26.6% vs. 21.3%; p=0.406), and genital laceration (2.1% vs. 5.6%; p=0.268) did not differ between groups. Significantly higher birth weight was noted among women induced at 41weeks (3.41 ± 0.37kg) than 40weeks (3.28 ± 0.46kg) (p=0.043). Also, there was significant variation in meconium staining of amniotic fluid between 40weeks (11.7%) and 41weeks (25.8%) (p=0.014). Other foetal outcomes showed no significant difference. Inducing labour at 40weeks is safe for low-risk women as it does not significantly increase the cesarean delivery rate and adverse perinatal outcomes. Therefore, elective induction of labour at 40weeks should be recommended and introduced into obstetric practice without the fear of adverse outcomes.
Industrial textile production is a significant contributor to freshwater pollution, particularly in water-intensive processes such as denim finishing. This study presents a process-based assessment of wastewater quality and rinse-water reuse potential using a stage-specific Water Quality Index (WQI) framework. By analyzing effluents from six major denim finishing stages, critical pollution hotspots were identified, and the feasibility of cascading rinse-water recovery was evaluated. Results demonstrate that WQI values decreased significantly after rinsing, with reductions reaching up to approximately 70% depending on the process stage. Furthermore, the proposed stepwise reuse strategy has the potential to reduce freshwater consumption by nearly two-thirds while maintaining operational performance. Beyond a site-specific application, the proposed methodology offers a transferable framework for industrial water optimization and circular water management in textile facilities globally. The findings contribute to advancing sustainable industrial practices and support progress toward SDG 6 and SDG 12.
The RxPONDER trial established that adjuvant chemotherapy does not confer survival benefit in postmenopausal women with hormone receptor-positive (HR+)/HER2-negative breast cancer, 1-3 positive lymph nodes, and a low 21-gene Recurrence Score (RS ≤ 25). Whether these findings have been adopted in routine clinical practice in Asian populations remains unclear. We conducted a multicentre retrospective cohort study of postmenopausal Chinese patients with HR+/HER2-breast cancer and limited nodal involvement who underwent surgical treatment and Oncotype DX testing between 2017 and 2023. Among 385 eligible patients, 54.8% had an RS ≤ 25, yet 46.4% of this low-genomic-risk group received adjuvant chemotherapy. Chemotherapy use declined substantially following publication of RxPONDER, indicating a marked shift in treatment patterns. Importantly, no disease-free survival (DFS) benefit was observed with chemotherapy in patients with RS ≤ 25. Multivariable analyses revealed that higher nodal burden, high histologic grade, and low progesterone receptor expression independently influenced chemotherapy decision-making despite low genomic risk. These real-world data provide supportive evidence consistent with the RxPONDER findings in a Chinese population; however, given the relatively short follow-up duration, longer-term outcomes are warranted to further substantiate these observations.
Motivational factors are widely recognized as central to students' engagement in cognitively demanding learning; however, the role of STEM career interest in the development of computational thinking during adolescence remains insufficiently understood. It is also unclear whether this association differs by gender. Grounded in Social Cognitive Career Theory, this study examined the association between STEM career interest and computational thinking among high school students and tested the moderating role of gender. Data were collected from 467 students (Mage = 16.05, SD = 1.20; 57.2% female) enrolled in public science high schools in Diyarbakır, Türkiye, using a descriptive correlational design. Participants completed the STEM Career Interest Scale and the Computational Thinking Skills Scale. Moderation analysis was conducted using PROCESS (Model 1) with 5,000 bootstrap resamples. STEM career interest was positively associated with computational thinking. Gender showed no significant main effect, and the interaction between STEM career interest and gender was not significant, indicating that the strength of this association was similar for female and male students. These findings suggest that, within academically selective STEM-focused environments, motivational orientations toward STEM are linked to computational thinking in comparable ways across genders. The results highlight the importance of supporting students' motivational engagement, alongside instructional practices, in fostering computational thinking during secondary education.
Chronobiology has advanced scientifically since 2000. Translating this knowledge and approach to medicine can alter diagnosis, treatment, and prevention, and improve health. Adding time-of-day (or time-of-year) information is both a concrete and conceptual change to clinical practice and public health relevant to humans and other animals, with low implementation costs. Successful translation of chronobiology to medicine requires new methods, training, and organizational and regulatory action.