搜索结果：sought

to analyze the factors associated with HIV among young people in a large Brazilian city. a case-control study was conducted with individuals aged 15 to 24 years old who sought services at the city's Testing and Counseling Centers. Cases consisted of young people with a positive HIV test result, while controls were those with a negative result. Data were analyzed using descriptive statistics, chi-square test, and logistic regression. men were 5.38 times more likely to have reactive HIV tests, sex workers were 31.5 times more likely to be infected with HIV, and those who sometimes or never used condoms were 2.43 times more likely to acquire the infection. Vaginal sex was a protective factor against HIV infection. factors associated with HIV should guide strategies that prioritize men, sex workers, and people with unprotected and non-vaginal sexual practices.

Acute otitis media (AOM) is the most common bacterial infection of childhood and the leading indication for antibiotic prescriptions and healthcare consultations globally. Colonization of the upper respiratory tract (URT) microbiome by bacterial respiratory pathogens precedes AOM episodes; however, the factors that influence colonization susceptibility and subsequent AOM are not well understood. We hypothesized that perinatal exposures, including mode of delivery, intrapartum antibiotic exposure, and infant feeding influence the composition of the URT microbiome at birth, modifying risk of AOM in infancy. We characterized the URT microbiome in nasopharyngeal swabs collected from 163 infants at birth. Swabs were generally collected within two days of delivery (median [IQR] collection time: 25 [17, 45] hours) and microbiome composition was evaluated with 16S rRNA V4 sequencing. Exposures evaluated included birth mode, intrapartum antibiotic exposures, and feeding type at hospital discharge. AOM episodes were identified through electronic health records data. We built Cox proportional hazards models to determine if perinatal exposures and/or microbiome characteristics at birth were associated with the time to first AOM episode in the first two years of life. URT microbiome diversity and composition were associated with feeding type at hospital discharge, wherein exclusive formula feeding was associated with increased diversity and the presence of Staphylococcus and Haemophilus spp. Increased URT microbiome diversity was associated with younger age at first AOM episode. Our findings suggest that perinatal exposures may influence the composition of the birth URT microbiome, and that this early composition may be related to AOM susceptibility in infancy. Ear infections are the most common bacterial infection of childhood and the leading indication for healthcare consultation and antibiotic receipt. Previous studies have demonstrated that the microbes that inhabit the upper respiratory tract, known as the microbiome, influence risk of ear infection. This study sought to understand how exposures around the time of birth, including delivery type, maternal antibiotic exposures, and infant feeding, influence the development of the infant microbiome, and in turn, how the microbiome is related to ear infections. An analysis of nasal swabs collected from infants shortly after birth demonstrated that increased microbial diversity is associated with earlier age at first ear infection episode. Overall, this study demonstrates that exposures in early life influence respiratory microbiome development, which contributes to infection susceptibility.

Intussusception is a pediatric emergency with delays in diagnosis. We sought to develop a novel deep learning model for the detection of target sign on point-of-care ultrasound (POCUS) images. POCUS image/video clip media files obtained during emergency department (ED) visits were included for study. Images underwent preprocessing to enhance and resize the region of interest (ROI), ImageNet high dimensional feature extraction and further training using various machine learning models, including classical machine learning, ensemble learning, transfer learning, and fine-tuning. Outputs were analyzed on a patient case, individual image frame and relative threshold bases. A POCUS image database of originally 785 media files from 49 patients, 8 of whom were positive for intussusception, was converted to 1,582 intussusception and 1,965 normal images for training. The output results show that the fine-tuning models performed better than the classical machine, ensemble and transfer learning models across three different analyses, and that the threshold-based approach to intussusception cases resulted in the greatest predictive performance. Intussusception is a potential candidate for development of deep learning tools due to limited capacity for pediatric focused imaging and accurate diagnosis. Prior studies are limited and have used either large private datasets or formal radiology studies. Modeling involved converting dynamic video files into several static images. Fine-tuning models were best adapted to the screening nature of POCUS images. Our work demonstrated the feasibility of developing a deep learning model for the detection of intussusception using a smaller dataset of POCUS images.

The Apple app store and the Google Play Store are major platforms for downloading mobile applications (apps). E-cigarette entertainment apps, such as games and simulators, commonly feature youth-appealing characteristics, such as animated or youthful characters and instances of magic or fantasy. Both platforms' policies limit tobacco-related apps; however, enforcement is inconsistent. This study sought to determine if e-cigarette entertainment apps appear in searches for e-cigarette-related terms and whether they contain youth-appealing content. Using Python, the Apple App Store and the Google Play Store were searched for 41 e-cigarette-related terms. Two coders reviewed all returned apps to identify e-cigarette entertainment apps. These apps' store listings (the web page for the app on the store) and app content were coded for youth-appealing features using a codebook. Both platforms had e-cigarette-related apps (Apple App Store: 42; Google Play Store: 73). While almost all (n=40) App Store apps were cessation-focused, e-cigarette entertainment apps (n=33) were found on the Google Play store. Many e-cigarette entertainment apps contained themes such as violence (n=13) and visible smoke/aerosol (n=26). Characters coded in the apps were mostly animated (n=12). Four characters were coded as appearing under 18 years old. Youth-appealing features of tobacco ads are regulated in broadcast and print media, but regulations do not pertain to mobile apps. While Apple has removed much of the concerning content from its App Store, the Google Play Store has numerous e-cigarette entertainment apps containing youth-appealing features.

Background: This research sought to determine the math proficiency of pharmacy technicians and the potential causes for the technicians' feelings of deficiency when attending continuing pharmacy education activity (CPE) and performing pharmaceutical calculations. Methods: To investigate these questions, the following questionnaire and test methods were utilized. Pharmacy technicians attending a 2-hour CPE activity completed a pre-activity survey assessing demographics, attitudes toward solving math problems, and sample calculation problems. Subsequently, the post-activity evaluation included additional calculation problems for comparison. Results: Our research found that most participants were nationally certified (82% of participants), but that most had not completed or were unsure if they had completed a formalized training program (58% of participants). Pre-survey data revealed participants perceiving low confidence in their pharmaceutical mathematical capability, as well as their over-reliance on rote memorization as their biggest barriers to solving pharmacy calculations. Baseline performance on calculation problems averaged 32% correct, with technicians finding the greatest difficulty in percentage strength, pediatric dosing, and alligation problems. Post-activity scores improved to an average of 66% correct across these areas. Conclusion: This in-person CPE activity improved pharmacy technicians' calculation skills. Although many pharmacy technicians struggle with pharmaceutical math problems, the reasons for these issues can be attributed to low confidence and lack of training rather than inability. Future CPE activities can continue to be focused on improving knowledge of underlying math concepts.

To optimize osteoporosis therapy with the parathyroid hormone fragment teriparatide (PTH1-34), we sought to determine whether strontium (Sr) could potentiate the bone anabolic action of intermittent PTH1-34 in ovariectomized rats. Female rats were either Sham-operated or ovariectomized (Ovx) at 6 months of age. Eight weeks after surgery, Ovx rats received either vehicle solutions, 625 mg/kg/day Sr (5 days per week), 8 µg/kg/day PTH1-34 (5 days per week), or the combined treatments for 8 weeks. PTH1-34 reversed Ovx-induced deterioration of trabecular microarchitecture, apparent volumetric bone mineral density (vBMD), and strength, whereas Sr alone increased tissue-level vBMD without significantly affecting trabecular bone mass. Co-treatment with Sr and PTH1-34 further increased trabecular thickness (+ 8.9% vs. PTH1-34 alone), apparent and tissue-level vBMD (+ 9.6% and 6.7% vs. PTH1-34 alone), bone material properties (maximum force, + 18.2% vs. PTH1-34 alone; working energy, + 17% vs. PTH1-34 alone), and trabecular bone strength compared with PTH1-34 alone. In cortical bone, PTH1-34 increased bone volume, cortical thickness, and apparent vBMD, while co-treatment further enhanced cortical thickness (+ 7.2% vs. PTH1-34 alone) and apparent vBMD (+ 7% vs. PTH1-34 alone), maintained the Sr-induced increase in tissue-level vBMD, and significantly improved bone strength. In primary osteoblast cultures, Sr and PTH1-34, administered either alone or in combination, increased Rankl and decreased Opg expression, consistent with the elevated urinary levels of the bone resorption marker deoxypyridinoline in vivo. Sr or PTH1-34 alone stimulated Igf1 and Alpl expression, whereas co-stimulation further enhanced these osteogenic markers. In conclusion, combining Sr with PTH1-34 integrates the osteoanabolic effects of PTH1-34 on bone mass with the mineral-level effects of Sr on bone material properties, leading to synergistic stimulation of bone formation and superior improvements in bone quality and strength.

This study sought to understand the professional practices in caring for people living with HIV/AIDS considering the global commitments to end the AIDS epidemic by 2030 in a priority municipality of Santa Catarina, Brazil. Qualitative research based on the constructivist branch of grounded theory was carried out in primary health and specialized care with in-depth interviews with 45 participants, including healthcare providers, managers, and people living with HIV/AIDS, from 2020 to 2021. Data analysis obtained the core category "Unveiling local professional practices aimed at global commitments to confront the HIV/AIDS epidemic", supported by seven subcategories that evince the expansion of timely rapid testing with reception and counseling, guarantee of access, early diagnosis and immediate start of antiretroviral therapy, engagement with the therapeutic regimen and its contradictions, social stigmatization, fear and overcoming HIV/AIDS, and the limitations of information systems. Practices related to preventive and clinical aspects stood out, with nurses playing a leading role in them. Coping with the social stigmatization by people living with HIV/AIDS experience still features an incipient approach in several dimensions: themselves, their families, healthcare providers, and social life. Overcoming the HIV/AIDS epidemic requires articulated and equitable strategies that consider the social determinants of health, expand access, and promote the well-being of people living with HIV/AIDS. Este estudo objetivou compreender as práticas profissionais no cuidado às pessoas que vivem com HIV/aids frente aos compromissos globais estabelecidos para o fim da epidemia de aids até 2030, em um município prioritário de Santa Catarina, Brasil. Trata-se de uma pesquisa qualitativa ancorada na vertente construtivista da Teoria Fundamentada nos Dados, realizada nos cenários da atenção primária à saúde e da atenção especializada, valendo-se de entrevistas em profundidade com 45 participantes, dentre profissionais da assistência, gestores e pessoas que vivem com HIV/aids, realizadas entre 2020 e 2021. A análise dos dados originou a categoria central “Desvelando práticas profissionais locais voltadas aos compromissos globais para o enfrentamento da epidemia de HIV/aids”, sustentada por sete subcategorias que revelam a ampliação da testagem rápida oportuna com acolhimento e aconselhamento, garantia de acesso, diagnóstico precoce e início imediato da terapia antirretroviral, o engajamento ao regime terapêutico e suas contradições, a estigmatização social, o medo e a superação frente ao HIV/aids, e as limitações dos sistemas de informação. Sobressaíram as práticas relacionadas a aspectos preventivos e clínicos com protagonismo do enfermeiro. Observou-se uma abordagem incipiente quanto ao enfrentamento da estigmatização social vivenciada pelas pessoas com HIV/aids em diferentes dimensões: por elas próprias, por seus familiares, por profissionais de saúde e no convívio social. Superar a epidemia de HIV/aids demanda estratégias articuladas e equitativas que considerem os determinantes sociais da saúde, ampliem o acesso e promovam o bem-estar das pessoas que vivem com HIV/aids. Este estudio tuvo como objetivo comprender las prácticas profesionales en el cuidado de las personas que viven con VIH/sida a la luz de los compromisos mundiales establecidos para poner fin a la epidemia del sida para el 2030, en un municipio prioritario de Santa Catarina, Brasil. Se trata de una investigación cualitativa basada en el enfoque constructivista de la Teoría Fundamentada en Datos, realizada en entornos de atención primaria de salud y especializada, con base en entrevistas en profundidad con 45 participantes, entre los que se incluyen profesionales de la asistencia, gestores y personas que viven con VIH/sida, llevadas a cabo entre el 2020 y el 2021. El análisis de datos dio como resultado la categoría central “Revelación de prácticas profesionales locales orientadas a los compromisos mundiales para afrontar la epidemia del VIH/sida”, respaldada por siete subcategorías que revelan la ampliación de las pruebas rápidas oportunas con apoyo y asesoramiento, el acceso garantizado, el diagnóstico precoz y el inicio inmediato de la terapia antirretroviral, la participación en el régimen terapéutico y sus contradicciones, la estigmatización social, el miedo y la superación de los desafíos frente al VIH/sida, y las limitaciones de los sistemas de información. Sobresalieron las prácticas relacionadas con los aspectos preventivos y clínicos, en las que los enfermeros desempeñaron un papel protagonista. Se observó un enfoque incipiente con respecto al afrontamiento de la estigmatización social que experimentan las personas con VIH/sida en diferentes dimensiones: por parte de ellas mismas, de sus familias, de los profesionales de la salud y en la vida social. Para superar la epidemia del VIH/sida se necesitan estrategias coordinadas y equitativas que tengan en cuenta los determinantes sociales de la salud, amplíen el acceso y promuevan el bienestar de las personas que viven con VIH/sida.

Extensively calcified lesions are typically at low risk for lesion-level acute events, which may be related to less vulnerable plaques. This study sought to evaluate the lesion-level association between total calcification volume and plaque vulnerability. Data were derived from the prospective, observational PECTUS-obs study, in which patients with myocardial infarction underwent intracoronary optical coherence tomography (OCT) imaging of all fractional flow reserve-negative nonculprit lesions. OCT images were analyzed by a core laboratory for plaque vulnerability features (lipid-rich plaque, thin-cap fibroatheroma, layered plaque, macrophage accumulation, microvessel, and cholesterol crystal) and by a validated artificial intelligence algorithm (OCT-AID) for automated volumetric calcium quantification. Total calcium volume was indexed for lesion length and stratified by quartiles (Q1-Q4), from lowest to highest. Among 488 lesions from 414 patients, calcium plaques were identified in 470 (96.3%) lesions. The lesion-level median indexed total calcium volume ranged from 0.004 mm3/mm (IQR: 0.001-0.011) in Q1 to 0.83 mm3/mm (IQR: 0.63-1.18) in Q4. The lower quartiles demonstrated the highest prevalence of lipid-rich plaques, macrophage accumulation, and microvessels. Thin-cap fibroatheroma and layered plaques accumulated predominantly in the middle quartiles (Q2-Q3). Cholesterol crystals showed no significant differences between quartiles. Overall, Q1-Q3 lesions demonstrated a greater mean number of plaque vulnerability features than Q4 lesions (P < 0.001 for all). Most severely calcified nonculprit lesions demonstrate a significantly lower prevalence of plaque vulnerability features as compared to less calcified, more lipid-rich lesions, which may contribute to the lower lesion-level acute event rate observed in heavily calcified lesions.

Apalutamide is an androgen receptor antagonist used to treat patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) or metastatic castration-sensitive prostate cancer (mCSPC). One of the most frequent adverse events associated with apalutamide is skin rash, particularly in Japanese patients. However, preventive skin care may reduce the frequency of apalutamide-induced skin rashes. We sought to compare the cumulative incidence of skin rashes in patients on apalutamide therapy with and without preventive skin care. This retrospective, real-world study included 27 patients in the control group (those who were not administered skin care) and 38 patients in the skin care group (those who were administered preventative skin care). After a median follow-up of 7 months, grade 3 apalutamide-induced skin rashes occurred in 8.1% (3/37) of patients in the skin care group and 53.6% (15/28) of patients in the control group. Based on Gray's test, the difference in incidence between groups was statistically significant (P = .002). Preventive skin moisturization may reduce apalutamide-induced adverse skin events in patients with mCSPC or nmCRPC. Incorporating routine skin care may help patients experience the full efficacy of apalutamide while maintaining a good quality of life.

More than 100,000 patients are on the U.S. transplant waitlist, with proportionally fewer organ donations coming from rural areas. Optimization of donation services in rural and frontier communities could address this discrepancy. We sought to better understand attitudes, knowledge, and concerns regarding organ donation and transplantation among frontier populations by surveying patients in the United States Great Plains region. A 15-item survey was distributed for voluntary completion to patients &#x2265;18 years at three rural clinics in the Great Plains from July 2025 to January 2026. The survey included questions on demographics, exposure to and knowledge of organ donation, and attitudes regarding organ donation and transplantation. A total knowledge score was created by scoring participants' accuracy in selecting which organs/tissues can be donated. Statistical analyses included Fisher exact and Mann Whitney U testing, as well as a multiple logistic regression. A p-value of &#x2264;0.05 was considered significant. Among 101 respondents (74.3% female, 77.2% registered donors), 90.1% were White and 7.9% were Native American/Alaska Native (NA/AN). Registered donors had significantly higher knowledge scores than non-donors (p=0.0012). Men were more likely to limit transplant acceptance to donations from friends/relatives (p=0.024), while NA/AN respondents showed higher willingness for unconditional living donation (p=0.039). Multivariable regression identified knowledge score as the sole independent predictor of donor status amongst variables surveyed (OR 1.48; 95% CI 1.13-1.99). The primary concern with donation reported was fear of health complications (37.5%) and the most requested intervention was more information on the donation process (18.1%). Medical literacy appears to be positively associated with organ donor status in this population. Sex-, race-, and education-specific differences in donation attitudes exist and may inform targeted interventions. Addressing knowledge gaps and specific concerns through education and outreach could provide a strategy to increase donation rates in rural populations.

The perioperative period is a critical phase for kidney transplantation. Emerging evidence indicates the potential utility of several perioperative strategies to support immediate graft function and patient outcomes. In other countries surveying only anesthesiologists, there is broad variation in the reported routine care for kidney transplant recipients. We sought to describe routine perioperative care for kidney transplant from a multidisciplinary perspective including perioperative clinicians (nephrologists, surgeons and anesthesiologists) caring for kidney transplant recipients in Canada. We created an evidence-informed qualitative and quantitative survey of routine perioperative practices using an iterative and collaborative process. The survey was reviewed by our multidisciplinary group and tested by 3 nephrologists, 3 surgeons and 3 anesthesiologists prior to circulation. After research ethics board approval, an online survey was distributed via e-mail to all Canadian adult kidney transplant centers. Transplant directors were asked by e-mail to distribute the survey to transplant nephrologists, surgeons and anesthesiologists involved in the perioperative care of kidney transplant recipients at their center. Survey responses were collected electronically from January 13, 2025 to April 13, 2025. We recorded all answers to our survey questions including multiple choice and free-text responses. We defined agreement as >70% of respondents selecting the same response for a routine perioperative care question. Descriptive statistics were used to describe the variation across disciplines and across transplant centers in Canada. Respondents included 18 nephrologists, 14 surgeons and 39 anesthesiologists representing all kidney transplant centers in Canada (n=18). We found several areas of agreement including preoperative hemoglobin optimization and transfusion targets, hemodynamic monitoring, immunosuppression and use of preoperative dialysis. Routine care was variable with respect to the use of diuretics, blood pressure targets and intravascular fluid. We were unable to link reported routine care practices with patient or graft outcomes. We also are unable to provide consensus recommendations for perioperative care based on this survey study. We describe perioperative care for kidney transplantation by transplant nephrologists, surgeons and anesthesiologists in Canada. Some elements of care exhibit variation in practice while others show consistency between transplant clinicians and transplant hospitals. These findings identify priority areas of practice variation that may inform the design of future comparative studies and the development of evidence-informed perioperative strategies.

Therapies capable of resolving rheumatoid arthritis (RA)-associated lung disease, particularly in the setting of environmental exposures, are lacking. This study sought to determine whether blocking interleukin (IL)-33 in a murine model of RA-associated lung disease induced by combined collagen-induced arthritis (CIA) and repeated inhalant lipopolysaccharide (LPS) exposures could be advantageous. Arthritis prone male DBA/1J mice received CIA (vs saline) injections (days 1 and 21) plus intranasal LPS (100 ng) or saline daily for 4 weeks and were subsequently treated with 5 doses of anti-IL-33 (10 mg/kg) or isotype over 11 days. Anti-IL-33 therapy significantly (P < .05) mitigated several CIA+LPS-induced effects. Anti-IL-33 reduced arthritis inflammatory score by 76% and serum acute phase reactant pentraxin-2 by 70% and reversed weight loss induced by CIA+LPS coexposure. Anti-IL-33 reduced CIA+LPS-induced antimalondialdehyde acetaldehyde but not anticitrullinated autoantibodies in serum and reduced serum levels of inflammatory mediators. Lung cell infiltrates induced by coexposure, including neutrophils, activated lung macrophages, transitional monocytes-macrophages, monocytic-like cells, and dendritic cells, were reduced with anti-IL-33. Anti-IL-33 also reduced CIA+LPS-induced lung levels of chemokines involved in monocyte-macrophage recruitment and fibrotic/repair mediators collagen deposition, IL-33 expression, inflammatory CC motif chemokine receptor 2+ monocytes/macrophages, and airway Muc5b immunostaining induced by CIA+LPS were reduced with anti-IL-33. CIA+LPS-induced lung expression of post-translational modified autoantigens including citrullinated and malondialdehyde acetaldehyde and its common substrate, vimentin, was reduced with anti-IL-33 treatment. Blocking IL-33 was beneficial in hastening lung recovery after establishment of disease by coexposure to CIA+LPS and potentially represents a novel therapeutic approach in RA-associated lung disease. SIGNIFICANCE STATEMENT: Blocking the interleukin (IL)-33 signaling pathway after the establishment of, but not during the induction of, rheumatoid arthritis (RA)-associated lung disease, as modeled by coexposure of collagen-induced arthritis with repetitive inhalant endotoxin, demonstrated beneficial consequences in reducing inflammatory joint, systemic, and lung disease. Treatment with anti-IL-33 agents, particularly in men with a history of environmental exposures, may represent a novel approach to reduce disease burden in humans with established RA-lung disease, underscoring an important role for the IL-33 pathway.

We sought to determine if modified ultrafiltration (MUF) in the current era was associated with improved outcomes after neonatal cardiopulmonary bypass (CPB). Retrospective analysis of the PC4/NEPHRON dataset from 22 centers (2015-18). Neonates were stratified by MUF use and outcomes were compared. Multivariable regression models were adjusted for center use of MUF and high-risk covariates. There were 1,654 neonatal CPB operations, 993 (60%) utilized MUF. MUF was not evenly distributed among centers. Patient characteristics were similar between cohorts with notable exceptions: the MUF cohort had fewer Hispanic neonates, more STAT 5 operations, shorter CPB times, more frequent use of deep hypothermic circulatory arrest and fewer STS preoperative risk factors. The MUF cohort had less fluid accumulation, including in the operating room and at peak postoperative fluid balance. Mortality, duration of invasive ventilation, length of stay and clinically important bleeding were not different between MUF and non-MUF neonates. In multivariable analysis, neonates receiving MUF had a higher likelihood of achieving a first daily negative fluid balance prior to postoperative day 3 (OR 1.98, 95% CI = 1.38-2.84). MUF use was associated with lower early postoperative fluid accumulation. MUF did not result in a significantly shorter duration of invasive ventilation, a shorter length of stay, or lower mortality.

Identifying traits of narcissistic personality disorder (NPD) is clinically challenging, yet early detection can significantly improve outcomes. Online forums have become a major source of self-expression, offering new opportunities to understand mental health. However, analyzing this complex language requires new tools. This study aims to determine whether a machine learning model could be trained to reliably detect language patterns associated with NPD traits in Reddit posts. Specifically, we sought to identify both authors who exhibit these traits and posts discussing individuals with these traits. We analyzed 75,985 posts from 4 Reddit communities (r/Narcissism, r/DeepThoughts, r/Showerthoughts, and r/ImposterSyndrome). A subset of 966 posts was annotated by 2 psychiatrists to create a reliable dataset. Using a range of machine learning techniques, from traditional text analysis to modern transformer-based embedding models, we trained the system to distinguish posts containing NPD-trait markers from general reflective posts. This secondary analysis of deidentified public Reddit data was exempted by the Bo&#x11f;azi&#xe7;i University FMINAREK (Fen Bilimleri ve M&#xfc;hendislik Alanlar&#x131; &#x130;nsan Ara&#x15f;t&#x131;rmalar&#x131; Etik Kurulu) Institutional Review Board (exemption/application number 2025-13). Our models demonstrated high accuracy. The modern embedding-based models were particularly effective, achieving a mean F1-score of 0.90, indicating a strong balance between recall and precision by correctly identifying posts with NPD-trait markers while minimizing false positives. The models remained effective even when common keywords such as "narcissism" were removed, with a mean relative F1-score decrease of 3.6% for the frequency-based baseline classifier and less than 2% (1.9% and 0.8%) for the embedding models. This study demonstrates that automated analysis of online posts is a promising approach for understanding and identifying NPD traits. Although this technology has potential for future clinical applications, it is currently a research tool and should be used only with strict ethical oversight, not for public-facing diagnosis.

This study aims to develop and evaluate a multidimensional instrument, the ICU-SCOPE questionnaire, for assessing situation awareness in intensive care units (ICUs). The study sought to integrate clinical, organizational, and leadership perspectives to capture situation awareness as a system-level construct relevant to patient safety and quality of care. A sequential exploratory mixed-methods design was employed between August and December 2025 in Bali, Indonesia. The qualitative phase involved in-depth interviews and focus group discussions with 42 ICU clinicians, hospital quality officers, and hospital administration and management experts from 12 hospitals. Thematic analysis was used to develop a conceptual model and generate questionnaire items. The quantitative phase involved a cross-sectional survey of 732 ICU healthcare professionals from 38 hospitals (19 government and 19 private hospitals), with psychometric evaluation conducted using exploratory factor analysis and descriptive domain-level analysis. Qualitative analysis identified five interrelated themes shaping ICU situation awareness: situation perception of patient trajectory, communication and team coordination, operational environment and technology awareness, professional workload and cognitive preparedness, and executive leadership and safety climate. Exploratory factor analysis of the 25-item ICU-SCOPE questionnaire supported a five-factor structure consistent with the qualitative model, explaining 68.3% of the total variance. Domain-level analysis showed higher scores for communication and leadership domains, while workload and environmental domains demonstrated comparatively lower scores, indicating potential areas for improvement. The study relied on self-reported data and was conducted within a single geographical region, which may limit generalizability. Further validation using confirmatory factor analysis and application in different healthcare systems is warranted to strengthen external validity. The ICU-SCOPE questionnaire provides healthcare organizations with a structured tool to assess situation awareness across cognitive, team, environmental, workload, and leadership dimensions. The instrument can support targeted quality improvement initiatives, benchmarking, and monitoring of safety-related conditions in ICU settings. By enabling systematic assessment of situation awareness, ICU-SCOPE has the potential to contribute to safer critical care environments, improved teamwork and enhanced patient safety outcomes. Improved situation awareness may also support staff well-being by identifying workload and organizational factors that contribute to cognitive strain. This study is among the first to develop a situation awareness measurement instrument for ICUs using a mixed-methods approach that integrates frontline clinical experience with organizational and leadership perspectives. ICU-SCOPE advances existing safety culture assessments by explicitly operationalizing situation awareness as a multidimensional, system-level construct applicable to real-world intensive care practice.

Per- and polyfluoroalkyl substances (PFAS) are persistent contaminants detected in aquatic systems globally, yet environmental data for PFAS in saltwater environments remain scarce relative to freshwater systems. Similarly, toxicity data describing the developmental impacts of environmentally relevant exposure concentrations of PFAS remains limited for marine biota, with the majority of toxicity studies utilizing freshwater models and/or exposure concentrations that are several orders of magnitude higher than those measured in saltwater systems. Therefore, the present study sought to characterize the occurrence and extent of PFAS contamination in Matagorda Bay - an urbanized estuary along the Gulf Coast of Texas (USA) - and to evaluate the developmental effects of PFAS on an estuarine fish model, Cyprinodon variegatus. Most field-collected sediment samples contained measurable quantities of PFAS, with PFOS consistently detected as the dominant compound. Field-collected data were used to select five structurally distinct PFAS (PFOS, PFOA, PFNA, PFDA, PFOSA) for a series of graded dose-response studies conducted with environmentally informed aqueous concentrations of individual PFAS (0-44 &#x3bc;g/L) through 6 days post-fertilization. Hatch success, survival, and morphology of newly hatched larvae were evaluated as endpoints. PFAS exposure did not result in mortality; however, compound-specific sublethal effects on development were observed. PFNA and PFOS produced the most pronounced and consistent responses, including increased total length and alterations in energy allocation. In contrast, PFOA, PFOSA, and PFDA elicited weaker or more variable responses, with limited evidence of consistent significant dose-dependent effects. These findings indicate that PFAS can differentially alter developmental processes in estuarine fishes at environmentally informed concentrations, even in the absence of acute toxicity. Moreover, compound-specific effects observed in the present study highlight the importance of considering PFAS as a diverse class of contaminants in ecological risk assessments.

Obstructive Sleep Apnea Syndrome (OSAS) is increasingly recognized as a serious, worldwide public health concern characterized by significant systemic consequences, primarily metabolic dysfunction driven by intermittent hypoxia (IH). The specific metabolic phenotype of pediatric OSAS remains largely unexplored, as the pediatric form differs substantially from the adult phenotype. To address this gap, this pilot investigation sought to characterize plasma acylcarnitine signatures in a children cohort using tandem mass spectrometry. We analyzed 27 plasma acylcarnitines in 11 children (4-10&#xa0;years) with polysomnography-confirmed moderate-to-severe OSAS using FIA-MS/MS. The resulting data were compared to age-stratified reference limits for the pediatric population. Our data reveal a severe and statistically significant depletion exclusively in two species, Acetylcarnitine (C2) and Octenoylcarnitine (C8:1), compared to age-matched reference values, which remained significant even after stringent False Discovery Rate (FDR) correction. Our study has provided important insights into the pediatric OSAS metabolic landscape, albeit based on a small sample size. We observed a selective reduction of circulating C2 and C8:1 in children with OSAS, proposing them as intriguing biomarkers and/or possible targets of nutritional intervention, warranting further investigation.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritious foods, nutrition education, breastfeeding support, and referrals to low-income women and their children up to age 5. WIC participants' weight is measured and discussed at appointments, creating an opportunity for weight stigma to be transmitted. Weight stigma has recently received attention within the WIC setting because experiencing weight stigma in health care is associated with delays in care and health care avoidance. This study aimed to fill a gap in our understanding of WIC staff's training needs and advice to reduce weight stigma experienced by WIC clients. We conducted semi-structured in-depth qualitative interviews with WIC clinic staff in partnership with the Minnesota Department of Health WIC. The study included 25 staff members across 16 local agencies. We employed a rapid qualitative template analysis to analyze the interviews. Staff sought guidance on how much emphasis to place on weight and wanted to focus on health behavior goals, rather than weight. Staff wanted comprehensive training on weight stigma and practical skills to confidently discuss weight with clients, including across diverse cultural contexts. Finally, staff desired virtual trainings that are WIC-specific and include interactive components. Appropriate training on weight stigma and guidance for how weight should be discussed during appointments can improve the client experience in WIC and, in turn, may improve program retention. Findings from this study will be used to develop a systems-level intervention, including comprehensive workforce training, to address weight stigma at WIC.

Arginine methylation, catalyzed by protein arginine methyltransferases (PRMTs), is a critical post-translational modification that modulates gene expression and signal transduction. Although the involvement of PRMTs in malignancy is increasingly recognized, a comprehensive pan-cancer synthesis of this family remains elusive. We sought to elucidate the multi-omic landscape of PRMTs and define their biological contributions to colorectal cancer (CRC) progression. Using multi-omic data from TCGA and GTEx, we performed an integrative pan-cancer analysis of PRMT expression, genetic alterations, epigenetic modifications, and their associations with prognosis, genomic heterogeneity, stemness, the tumor microenvironment, and oncogenic pathways. After validating PRMT expression patterns across multiple independent CRC cohorts from the GEO database, PRMT1 was prioritized for further investigation. Its expression was assessed in a real-world CRC cohort using immunohistochemistry, while its oncogenic potential was scrutinized through in vitro proliferation assays. PRMT family genes exhibit heterogeneous molecular profiles across cancers, which correlate significantly with genomic instability, stemness, immune infiltration, and oncogenic pathway activation. Clinical validation demonstrated that PRMT1 is markedly upregulated in CRC, where its overexpression correlates with larger tumor size, advanced T stage, and lymph node metastasis. Loss-of-function experiments demonstrated that PRMT1 is essential for maintaining CRC cell proliferation. Our study highlights the multifaceted roles of PRMTs across the pan-cancer spectrum. By identifying PRMT1 as a key driver of CRC progression, this work provides a rationale for the development of PRMT-targeted therapies and personalized diagnostic biomarkers.