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Pedagogical module for weaning process from mechanical ventilation (WPMV) is the specific need for advanced nursing education in cardiothoracic intensive care unit (CICU). The CICU nurses need to have Advanced nursing personnel in the CICU require comprehensive theoretical knowledge and applied clinical reasoning skills including patient data analysis, structural decision-making, and care decision justifications to safely adjust ventilator settings following cardiothoracic surgery. However, currently no specific a pedagogical module for advanced nursing education used for CICU in Malaysia. To investigate the effectiveness of a structured pedagogical module for WPMV in improving knowledge and applied clinical reasoning among Cardiothoracic Intensive Care Unit (CICU) nurses. This study utilizes a quasi-experimental, non-randomized pre-post design. A total of 24 CICU nurses participated. Participants were grouped based on an institutional competency threshold of 70%, which reflects the standard passing criterion for clinical assessments in the study setting. The 70% cutoff represents the standard institutional passing threshold established by the Medical Education and Nursing Division at the National Heart Institute (IJN) for postgraduate clinical assessments and unit privilege. This study focuses primarily on within-group changes following the intervention, while the comparison group is used as a performance benchmark rather than for inferential comparison. The implementation of the pedagogical module led to a statistically significant improvement in participants' knowledge and applied clinical reasoning. Participants in the intervention group demonstrated a statistically significant improvement in theoretical scores (mean difference&#x2009;=&#x2009;37.63, p&#x2009;<&#x2009;0.001). The large effect size indicates substantial educational impact. Due to the small and unequal group sizes, between-group comparisons were interpreted descriptively rather than inferentially. The WPMV pedagogical module significantly improves theoretical knowledge and applied clinical reasoning among CICU nurses. However, conclusions are limited to educational outcomes, and further research is required to evaluate its impact on clinical practice and patient outcomes.

Naswar, a form of smokeless tobacco, has become an important public health concern in southern Iran due to its increasing use and associated health risks. Despite its growing social acceptance, limited evidence is available regarding the combined influence of individual, cognitive, and social factors on Naswar consumption. This study aimed to investigate the individual and social determinants of Naswar use among residents of Bandar Abbas, southern Iran. This cross-sectional study was conducted from June to September 2024 among 399 individuals aged 15&#x2009;years and older recruited from urban healthcare centers in Bandar Abbas. Data were collected through face-to-face interviews using a validated questionnaire assessing demographic characteristics, knowledge, attitudes, social norms, behavioral intention, and Naswar use. Descriptive statistics, univariate analyses, and multivariable logistic regression were performed to identify factors associated with current Naswar consumption. The prevalence of Naswar use was 6% in the study population. Univariate analyses indicated that male gender, lower educational level, and lower socioeconomic status were associated with higher odds of use. Greater knowledge of Naswar harms, more negative attitudes toward use, and stronger anti-use social norms were associated with lower odds of consumption. In the multivariable model, higher knowledge and stronger anti-use social norms remained significant protective factors, whereas stronger behavioral intention toward Naswar use was identified as a significant risk factor. Naswar use in Bandar Abbas is influenced more by psychosocial factors than demographic characteristics alone. Prevention strategies should strengthen health knowledge, reinforce anti-use social norms, and target behavioral intentions through culturally appropriate interventions.

Doctors have been identified as having a crucial role in responding to anticipated and experienced stigma of People with Mental Illness (PWMI). This paper aims to evaluate the effectiveness of the READ (Responding to Experienced and Anticipated Discrimination), an anti-stigma training for medical students, by measuring changes in their knowledge, attitudes, and skills, in responding to patients anticipated and experienced discrimination. The Mental Health Knowledge Schedule (MAKS), the Mental Illness Clinicians' Attitudes version 2 (MICA2), and an OSCE (Observed Structured Clinical Examination) were used to determine participants' knowledge, attitudes, and behaviours towards PWMI before and immediately after the training. There was evidence of difference in MICA2 mean total scores in the intervention group were compared to the control group after adjusting for age, gender and MICA baseline mean total scores (MD: -7.88; p&#x2009;<&#x2009;0.001; 95% CI: -10.23 to -3.96). Moreover, the intervention group was 4.45 times more likely to be scored "pass" in the OSCE compared to the control group (p&#x2009;=&#x2009;0.046, 95% CI: 1.03 to 19.26) after adjusting for age, gender and OSCE baseline scores. The positive changes in students' attitudes and skills after the READ training should encourage further research on the causal pathways of this positive relationship.

Background: This study investigated influenza vaccination coverage and its predictors among medical staff in multiple Chinese regions to develop targeted vaccination promotion measures.Methods: A cross-sectional questionnaire survey was conducted on medical workers from Beijing, Hebei, Hunan, Shaanxi, Yunnan and other provinces. Questionnaires collected demographic information, influenza/vaccine knowledge, personal and family vaccination history, and vaccine-related health beliefs. We calculated intra-class Correlation Coefficient (ICC) to evaluate hospital clustering due to nested data, adopted binary logistic regression as primary analysis, and applied two-level multilevel logistic regression to correct biased standard errors for robustness.Results: 476 valid questionnaires were retrieved from 483 distributed ones (98.6%). ICC = 0.021 suggested negligible hospital clustering, and the overall vaccination rate was only 16.4% (78/476). Multivariate analysis identified three positive predictors: vaccine training (OR = 2.503, 95% CI 1.337-4.686), family influenza infection (OR = 2.606, 95% CI 1.338-5.076) and family vaccination (OR = 8.266, 95% CI 4.100-16.663). Perceived barriers negatively predicted uptake (OR = 0.589, 95% CI 0.452-0.767). Staff in primary hospitals had higher coverage than those in tertiary hospitals (OR = 3.640, 95% CI 1.420-9.333).Conclusion: The overall influenza vaccination rate among medical staff remains relatively low. To increase the vaccination rate, in addition to strengthening professional training on influenza vaccine-related knowledge, it is also essential to optimize vaccination accessibility and foster a positive social and occupational vaccination atmosphere. Meanwhile, based on the health belief model of influenza vaccination, targeted health education should be carried out by focusing on reducing perceived barriers and improving health beliefs, so as to effectively enhance the influenza vaccination status of medical staff.

Preexposure prophylaxis (PrEP) is a key biomedical HIV prevention strategy that relies heavily on adherence for optimal effectiveness. In China, most PrEP users purchase their medication online, making it challenging to monitor and support adherence effectively. This protocol aims to describe a digital intervention developed to monitor and improve the medication adherence of real-world e-consumers of PrEP and an evaluation plan assessing its acceptability, feasibility, and effectiveness. The Real-Time Monitoring and Precision Intervention for HIV PrEP Adherence (REMOTE) trial is a parallel-group, open-label, online-delivered, active-controlled, and stratified randomized controlled trial conducted among 430 e-consumers of PrEP (320 event-driven regimen users and 110 daily regimen users) in China. People who have purchased PrEP online, have taken PrEP in the previous 3 months, and plan to continue for the next 6 months will be stratified by regimen type and randomized into control and intervention groups at a 1:1 ratio. A WeChat-based digital platform will deliver the REMOTE intervention. The monitoring module follows ecological momentary assessment principles. The intervention design is guided by the stages of change theory, tailoring strategies to different nonadherence risks based on monitoring results. Intervention components include low-risk (health education and an artificial intelligence chatbot), medium-risk (peer forum and admonitory education), and high-risk (customized reminders and physician counseling) strategies. The control group will use a simplified platform with only real-time monitoring. The primary outcome is the proportion of participants achieving optimal adherence for 6 months, assessed via real-time monitoring and validated via surveys at baseline and the 1-, 3-, and 6-month follow-ups. Secondary outcomes include PrEP adherence knowledge, self-efficacy, risk perception, adherence barriers, stigma, and social support, measured via surveys. Intention-to-treat analysis will be conducted. Funding for the study was approved in March 2024. Ethics approval for the study was granted in July 2024. The pilot trial was completed in November 2025. Baseline data collection commenced in January 2026. By February 5, 2026, recruitment and baseline data collection were completed, with 448 participants enrolled. The data have not been viewed by the research team. The intervention is currently ongoing, and the study is expected to conclude in August 2026. Results are anticipated to be published in early 2027. The REMOTE trial pioneers a real-time monitoring and precision intervention for e-consumers of PrEP. Leveraging technology and ecological momentary assessment, it delivers a personalized, real-time intervention that is crucial for adherence. The findings could significantly impact future HIV prevention strategies. Chinese Clinical Trial Registry ChiCTR2400088278; https://www.chictr.org.cn/showproj.html?proj=236414. DERR1-10.2196/92750.

Warming global temperatures are driving species to shift beyond their historical geographic ranges into novel, expanded ranges, where they may have both positive and negative effects on recipient populations. Although no framework currently exists to anticipate these effects, invasion biology theory suggests expanders' effects may be predictable from expanders' historical roles and trophic positions. We conducted a global synthesis of over 1,200 population-level effects of marine range-expanding species reported across 1,075 studies. We hypothesized that, similar to invasive species, expanding species' impacts could be predicted by (H1) their ecological roles in their historical ranges and (H2) their trophic levels. We found that effects in these species' historical ranges reliably predict their impacts in expanded ranges, but that, overall, marine range expanders tend to be more detrimental-or less beneficial-in novel communities. Higher trophic level expanders tend to have stronger effects (both positive and negative) on resident species than lower trophic level expanders. Effect magnitudes were further modulated by the type of interaction (e.g., predation, competition, physical disturbance, etc.), with the strongest effects arising from indirect interactions. Finally, we found that native producers experienced some of the strongest effects when compared to humans, vertebrates, or invertebrates. Together, our results indicate that existing knowledge of species' roles are key to anticipating which climate-driven range expansions are likely to have the largest effects on recipient communities.

Lipoprotein glomerulopathy (LPG) is a rare hereditary glomerular disease characterized by lipoprotein thrombi within dilated glomerular capillaries for which effective treatments remain limited. This report concerns a 25-year-old Japanese woman with an 8-year history of persistent proteinuria and severe dyslipidemia who presented with heavy proteinuria (3.31&#xa0;g/gCr) despite preserved renal function. Kidney biopsy revealed features typical of LPG on light and electron microscopy, and serum apoE levels were markedly elevated. The patient was started on pemafibrate, a selective peroxisome proliferator-activated receptor-alpha modulator known to exert stronger triglyceride-lowering effects and to have a more favorable hepatic and renal safety profile compared with conventional fibrates. Following treatment, the patient's triglyceride levels decreased substantially and her proteinuria progressively improved. Complete remission (0.05&#xa0;g/gCr) was achieved within 7&#xa0;months, and she remained stable thereafter. Although partial remission with fibrates has been previously reported in patients with LPG, there have been no reports of complete remission in those treated with pemafibrate. To our knowledge, this is the first documented case of complete remission of proteinuria induced by pemafibrate in a patient with LPG. Pemafibrate may be a promising targeted therapy for this rare glomerular disorder.

Thermal stress is a major environmental factor affecting honeybee (Apis mellifera) physiology, colony stability, and overall welfare. Here, we report a novel electrochemical fingerprinting strategy based on differential pulse voltammetry (DPV) combined with supervised chemometric modeling for the discrimination of thermally stressed honeybee larvae. Larvae were exposed to optimal brood temperature (34.5&#xa0;&#xb0;C) or mild hyperthermic conditions (36.0&#xa0;&#xb0;C for 1&#xa0;h), and their electrochemical responses were recorded using glassy carbon electrodes modified with a carboxylated multiwalled carbon nanotube/Kolliphor dispersion. The resulting voltammetric profiles exhibited two reproducible anodic signals, including a peak associated with octopamine (OA), a key neurochemical mediator of stress. Partial least squares discriminant analysis (PLS-DA) models were constructed using the complete voltammetric profile and selected signal regions. The model based on the full DPV fingerprint achieved the best predictive performance, reaching an accuracy of 0.96 in the independent test set, whereas models based on individual peak regions showed lower discrimination capability. These results demonstrate that the complete electrochemical fingerprint provides a more comprehensive representation of the physiological response to thermal stress than single-analyte analysis alone. The proposed strategy introduces a shift from targeted electrochemical quantification toward multivariate physiological fingerprinting, offering a rapid and robust tool for environmental stress monitoring and honeybee welfare assessment. To the best of our knowledge, this is the first study to combine DPV-based electrochemical fingerprinting with supervised chemometric classification for the assessment of thermal stress in honeybee larvae.

Case-based learning (CBL) is a recent development in veterinary education, praised for enhancing clinical decision-making and preparing students for practice. This study explores the impact of supplementary online case-based learning (eCBL) self-assessment resources on student satisfaction, confidence, engagement, exam performance, and short-term knowledge retention. Findings were compared with other common study methods to enhance relevance to current UK veterinary cohorts. Fourth-year veterinary students at the University of Cambridge completed three multiple-choice exams over 3 weeks alongside anesthesia teaching. Students were randomly assigned one of three study methods-eCBL, flashcards, or lecture slide review-for the second and third exams. Exam score improvements were analyzed using the Mann-Whitney U test. Pre- and post-exam questionnaires were thematically analyzed using Clarke and Braun's method to assess student satisfaction and confidence. Students using eCBL reported higher satisfaction and engagement with the curriculum and felt more confident and prepared for exams and clinical placements. While exam score improvements did not significantly differ between groups, students in the eCBL group expressed greater perceived value of their study experience. eCBL resources improve student satisfaction and engagement, especially when aligned with clinical relevance and the "Day One Competencies" from the Royal College of Veterinary Surgeons. Students appreciated the self-assessment opportunities and context-rich scenarios offered by eCBL. Although no significant differences in exam performance were observed, eCBL aligns well with existing study practices and may enhance short- term knowledge retention with more sustained use.

The importance of conventional plastics is undeniable; however, their non-biodegradability makes them one of the biggest environmental problems. Among the alternatives to mitigate environmental damages, the production of polyhydroxyalkanoates (PHB) provides a biodegradable solution, making them accessible to a wide variety of applications. In general, biopolymers accumulate as energy and carbon storage material in microorganisms such as bacteria and microalgae. In the present study, the impact of different sources like carbon, glucose, nitrogen and sodium was tested on the production of PHB in the cultures of the microalgae Scenedesmus acutus. To evaluate the effect of the variables, a fractional Taguchi experimental design was devised and executed, thus, 16 experimental runs and 3 replicas in each treatment were considered. Results showed calculated concentrations of the biopolymer in a range from 7.5 to 24.7% w/w of dry weight. Additionally, the PHB was identified by spectroscopic and thermogravimetric analysis. Statistical analysis was performed, showing differences in biomass production, PHB concentration in g L-&#x2009;1 and the percentage of PHB. Likewise, a Pareto diagram was used to consider the biomass production results, with glucose, biomass-glucose, and biomass-sodium as determining factors in the PHB production. The present research provides significant data on critical factors related with PHB production, to the best of our knowledge, thus showing S. acutus may be a promising candidate among PHB producers through a low-cost means.

The aim of this study is to identify the barriers and facilitating factors affecting discharge preparation during the hospital-to-home transition period for treatment-na&#xef;ve tuberculosis patients, thereby providing a basis for the development of personalised interventions. This study employed a qualitative descriptive research design. Using purposive and maximum diversity sampling strategies, 15 treatment-na&#xef;ve tuberculosis patients were selected from an infectious diseases hospital in western China to participate in semi-structured in-depth interviews. The interview data was then organised, analysed and distilled using the Colaizzi 7-step analysis method. The discharge experience during the hospital-to-home transition period for newly diagnosed TB patients comprised two themes and seven subthemes. These included facilitating factors for discharge preparedness diverse home-based treatment supervision methods, plentiful digital healthcare resources, strong desire to return to work, and robust social support and impeding factors for discharge preparednessLack of disease knowledge, Unmet needs regarding patient self-management and a heavy psychological burden. This study demonstrates that the discharge preparedness of newly diagnosed TB patients during the hospital-to-home transition is influenced by multiple factors. Healthcare professionals should conduct precise assessments of patients' discharge preparedness challenges, utilizing these factors to deliver targeted discharge preparation training.

Mixed reality (MR) applications are increasingly used in museums and heritage sites; however, their deployment often lacks methodological coherence, with spatial narrative, interaction, and evaluation treated as separate elements. This protocol presents a standardized, field-deployable methodology that distinguishes itself from prior evaluation frameworks by integrating dynamically adaptive spatial narratives with a hybrid assessment model. The approach unifies spatial narrative sequencing, guided interactive interfaces, and multimodal user experience metrics-specifically triangulating subjective psychometric evaluations with objective behavioral telemetry (e.g., spatial dwell times and interaction logs). The protocol describes a two-site, three-arm concurrent control trial adaptable to indoor museums and semi-open archaeological venues. Participants are assigned to one of three conditions: a traditional digital guide, a MR static narrative, or a MR adaptive narrative. A standardized six-zone route is implemented, with assessments conducted at baseline, immediately after the visit, and at a 14-day follow-up. Outcome measures include spatial presence, usability, narrative engagement, perceived authenticity, and knowledge acquisition. The protocol further incorporates structured behavioral logging, predefined technical thresholds, and systematic cybersickness monitoring to ensure safety and feasibility under routine visitor conditions. This framework provides researchers and cultural institutions with a reproducible methodology to coordinate spatial storytelling and interface control, enabling rigorous evaluation of MR interventions in heritage contexts.

As one of the critically important transcription factors, interferon regulatory factors (IRFs) modulate the host transcriptional program triggered by pathogen-associated molecular patterns in variety of marine invertebrates. Their activation is indispensable for initiating and modulating innate immune defenses across animal taxa. However, the functional characteristics and regulatory mechanisms of IRFs in echinoderms remain poorly understood. In this study, a newly identified IRF family member, Si-IRF1/2, was cloned and characterized in the sea urchin Strongylocentrotus intermedius. Si-IRF1/2 comprises a full-length ORF of 1668 bp, corresponding to a 555-amino-acid protein. Computational analysis identified a conserved IRF domain at the N-terminal region. This conserved signature was identified through integrated domain prediction and corroborated by multiple sequence alignment with orthologs from diverse species. Phylogenetic analysis showed that Si-IRF1/2 clusters closely with members of the vertebrate IRF1/2 proteins and molluscan IRF1/2 homologs. The tissue-specific expression profile of Si-IRF1/2 was assessed by qRT-PCR. Although transcripts were ubiquitously present, expression was markedly enriched in coelomocytes, indicating a specialized role in this immunologically relevant tissue. Moreover, expression of Si-IRF1/2 was upregulated when stimulated with lipopolysaccharide (LPS) and poly (I:C). Subcellular localization assays showed that Si-IRF1/2 is predominantly localized in the nucleus. The results of the RNAi experiment indicate that after Si-IRF1/2 was knocked down, the mRNA expressions of Si-strongylocins and Si-IL17s in coelomocytes changed significantly at 12&#x202f;h after LPS stimulation. The transcriptional regulatory capacity of Si-IRF1/2 was further confirmed by dual-luciferase reporter assays, which demonstrated its ability to enhance the activity of promoters from multiple immune-related genes, including interleukin-6 (IL-6), Interferon-&#x3b1;/&#x3b2; (IFN&#x3b1;/&#x3b2;), Signal transducer and activator of transcription 3 (STAT3), activator protein-1 (AP-1), interferon-stimulated response element (ISRE), nuclear factor-&#x3ba;B (NF-&#x3ba;B), and tumor necrosis factor &#x3b1; (TNF&#x3b1;). Under LPS stimulation, overexpression of Si-IRF1/2 promoted activation of mitogen-activated protein kinase pathways, specifically c-Jun N-terminal kinase (JNK) and extracellular signal-regulated kinase 1/2 (ERK1/2). Taken together, these findings provide new insights into the immune-regulatory role of Si-IRF1/2 to establish a conceptual framework for breeding sea urchin lines with improved resistance to disease, while simultaneously providing new knowledge of innate immune mechanisms mediated by IRFs in invertebrates.

Magnetic particle imaging (MPI) is an innovative imaging modality offering high spatio-temporal resolution for reconstructing magnetic particle distributions. To achieve high-quality MPI images, traditional methods such as the X-space method and system matrix (SM) method operate in the time and frequency domains, respectively. Both time and frequency domain signals essentially consist of harmonic components, meaning that the quality of the reconstruction is closely tied to the accuracy of these harmonic elements. However, the presence of background noise and the complexities associated with SM collection significantly hinder harmonic quality, leading to degradation of reconstruction fidelity. To tackle these challenges, we propose a unified framework based on harmonic knowledge to enhance the quality of reconstruction. In particular, our approach involves pretraining autoencoders by restoring masked SMs, thereby modeling the relationship between harmonics. Subsequently, using appropriate decoders, the pretrained encoder can be transferred to tasks such as spectrum denoising and SM super-resolution. Our framework's effectiveness is validated on these two tasks through simulation and publicly available datasets, where it consistently outperforms state-of-the-art (SOTA) methods. In addition, our framework shows marked improvements in reconstruction quality for both time and frequency domain data collected with our in-house MPI system.

To evaluate the Integrated-Cardiac Rehabilitation Employing Smartphone Technology (I-CREST) program's implementation fidelity, impact mechanisms, experiences, and contextual factors influencing its delivery from post-myocardial infarction participants and healthcare professionals. A mixed-methods approach following the Medical Research Council (MRC) guidelines for complex interventions, focusing on implementation, mechanisms of impact, and context. Three quantitative data sources were collected: (&#x2170;) records of intervention delivery; (&#x2171;) records of intervention delivery time; (&#x2172;) content analysis on the frequency of contextual factors from the qualitative interview data. Qualitative data were collected through individual semi-structured interviews with 14 I-CREST participants and healthcare professionals (HCPs). The I-CREST program achieved a high level of intervention delivery fidelity, with an average delivery time of 3.02&#x2005;h per participant over 6 weeks. Deductive content analysis of participants' experiences found key mechanisms of impact, including knowledge and belief, self-regulation skills and abilities, and social facilitation. Thematic analysis of participants' experiences found four main themes: benefits of the I-CREST intervention; a change in mindset; life beyond the 6-weeks intervention; and the potential of I-CREST. Inductive content analysis of both participants' and HCPs experiences identified implementation-level factors such as recruitment, interoperability and cost, and mechanism/experience-level factors like work commitments and motivation that influenced the I-CREST program's implementation, mechanisms of impact, participants' experiences and trial outcomes. The I-CREST program is a promising home-based cardiac telerehabilitation option that was well accepted. However, further revisions are needed if I-CREST is to achieve its full intended benefits and see successful implementation in real-world clinical settings.