Due to lack of human, physical, and infrastructural resources, most critically ill children in Honduras are cared for by general pediatricians outside of pediatric intensive care units, stressing the need to address the education of this critical group. To understand the educational needs of pediatric trainees in Honduras related to the care of critically ill children, and the impact of the local context to inform future curriculum development. We conducted a needs assessment with a sequential explanatory mixed methods design from 2023 to 2025. Participants included pediatric residents, graduates, and faculty of the 2 pediatric residency programs. Data on essential critical care knowledge and skills, educational needs, and educational strategies was collected through electronic surveys and semistructured virtual interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data, with rapid matrix analysis. Forty-five of 96 (47%) residents and 47 of 91 (52%) pediatricians completed the survey; 5 graduates participated in subsequent interviews. Only 69% of graduating residents (11 of 16) and attendings (33 of 48) felt moderately to extremely confident assessing critically ill children. Both surveyed groups considered all preidentified critical care diagnoses extremely important in their education, yet frequency of treatment, confidence with management, and degree of training were variable. Perceived confidence was dependent on knowledge, skills, available resources, and ability to adapt to constraints. Experiential and self-directed learning are key strategies in their education. Our findings revealed that teaching that builds adaptive expertise and self-directed learning skills is essential for pediatric trainees in Honduras.
Background and aim Ambulatory trauma represents a significant proportion of the orthopedic workload within the UK. Objective delays within ambulatory trauma pathways are poorly documented. This study aimed to quantify delays to surgery and identify modifiable factors to improve ambulatory trauma pathways within a district general hospital. Methods A retrospective analysis was conducted of adult ambulatory trauma patients requiring operative management without admission at a single DGH between September 2023 and January 2024 (n = 72). Overall delay (injury to surgery) and system delay (SD; booking to surgery) were analyzed. Subgroup analyses assessed injury type, subspecialist involvement, booking pathway, and theater setting. Results The mean SD was 4.5 days. Subspecialist involvement was associated with increased delay (4.8 vs 3.3 days, p = 0.02). Patients listed via the fracture clinic experienced longer delays than those booked directly from trauma meetings (7.3 vs 4.4 days, p = 0.18). Surgery on elective lists was associated with longer delays compared with trauma lists (6.2 vs 4.2 days, p = 0.03). Conclusions Ambulatory trauma patients experience significant delays to surgery. Delays were associated with the type of injury, need for subspecialty surgeons, and being listed on an elective list. These findings highlight current service provision deficiencies and the need for streamlined ambulatory trauma care pathways based on objective modifiable factors.
Nipah virus infection is an uncommon but highly lethal zoonotic illness that primarily presents with acute encephalitis and respiratory disease in humans. After its initial identification during the Malaysia-Singapore outbreak of 1998-1999, human outbreaks have since been reported in Bangladesh and India. Despite the relatively small number of reported cases, the Nipah virus remains a major clinical and public health concern because of its high mortality, capacity for person-to-person transmission, lack of approved antiviral treatment, and potential for amplification within healthcare settings. For clinicians, the major challenge lies in early recognition of a disease that initially presents with nonspecific febrile symptoms but may rapidly progress to severe encephalitis, acute respiratory distress syndrome, or both. Human-to-human transmission has been well documented in South Asian outbreaks, particularly in household and healthcare settings, underscoring the importance of prompt isolation and infection prevention measures. Laboratory confirmation relies primarily on reverse transcription polymerase chain reaction, with serology providing supportive evidence later in the course of illness. Management remains largely supportive, with intensive care often required in severe cases. This review provides a practical clinician-oriented overview of Nipah virus infection, focusing on epidemiology relevant to frontline practice, clinical presentation, transmission, diagnostic approach, infection control, treatment, prognosis, and outbreak response.
Family caregivers play a crucial role in supporting patients with mental disorders after hospital discharge. However, caregivers often experience difficulties related to limited information, caregiving burden, and restricted access to mental health services. This study aimed to explore the informational and skill-related needs of caregivers of psychiatric patients after hospital discharge and to develop a prototype chatbot-based consultation system tailored to these needs in Indonesia. An exploratory qualitative design guided by Social Cognitive Theory was employed to explore caregiver needs and support the development of a preliminary rule-based chatbot prototype. Data were collected through semi-structured interviews with eight participants (five mental health professionals and three family caregivers), supported by analysis of 67 anonymized WhatsApp consultation records and five discharge education documents. Data were analyzed using inductive thematic analysis following Braun and Clarke's framework and organized using NVivo. Trustworthiness was enhanced through triangulation, member checking, and peer debriefing. The identified themes were translated into chatbot features including psychoeducation, caregiving guidance, relapse support, and referral navigation, followed by expert validation involving six multidisciplinary experts. Thematic analysis identified nine domains of caregiver needs: patient condition understanding, treatment and medication management, home care practices, community support, caregiver burden and coping strategies, supporting health services, barriers in online consultation systems, expectations for digital media, and future challenges in chatbot implementation. Caregivers emphasized the need for continuous psychoeducation, clear guidance for relapse prevention, and accessible consultation channels after discharge. Based on these findings, the identified caregiver needs were translated into a preliminary rule-based decision tree chatbot prototype (KJOL-ITEUNGBOT) designed to support caregiving information and referral navigation. Family caregivers of psychiatric patients in Indonesia face complex informational and psychosocial challenges after hospital discharge. A chatbot-based consultation system may serve as a potentially useful tool for supporting caregiver access to information and post-discharge guidance. Future research should evaluate the usability, effectiveness, and scalability of the chatbot in broader clinical settings.
Cytokine release syndrome (CRS) represents a spectrum of immune hyperactivation initiated by rapid T-cell engagement and amplified through innate immune cells, particularly monocytes and macrophages, with downstream cytokine cascades driving endothelial dysfunction, capillary leak and organ impairment. CRS is a frequent, class-associated toxicity of T-cell-engaging immunotherapies and is being observed with increasing regularity as T-cell-redirecting therapies progress through clinical development in solid tumours. Although CRS is typically less severe in patients with solid tumours relative to those with haematological malignancies, phase II-III trials of these emerging agents consistently report grade 1-2 CRS in the majority of patients, highlighting the need for effective prevention and management strategies, while preserving anti-tumour activity of the primary therapy. Current grading and management algorithms have been largely extrapolated from experience with chimeric antigen receptor T-cell therapies and rely on step-up dosing, premedication, supportive care and escalation to interleukin (IL)-6/IL-6R blockade and corticosteroids. However, steroid-refractory or high-grade CRS, as well as overlapping syndromes underscore the limitations of this approach and the need for mechanism-based interventions targeting upstream mediators and signalling hubs. These include IL-1 blockade, Janus kinase-signal transducer and activator of transcription inhibition, granulocyte-macrophage colony-stimulating factor neutralisation, tumour necrosis factor-alpha inhibition and interferon gamma blockade. In this narrative review, we synthesise the mechanistic rationale and emerging clinical evidence underpinning CRS prevention and management in solid tumours, with a particular focus on T-cell engager (TCE) and other T-cell-redirecting therapies. We then outline key risk-mitigation strategies and discuss their potential implications for anti-tumour immunity. Finally, we highlight key knowledge gaps, particularly the paucity of prospective solid tumour-specific data, with current CRS prevention and management strategies therefore remaining largely extrapolated from haematological malignancies, alongside the need for biomarker-driven risk stratification, optimal sequencing and prophylactic strategies and the development of next-generation TCE designs.
Informed consent is a cornerstone of ethical practice. Eliciting patient questions during informed consent increases patient engagement and understanding, thus enhancing integrity of the consent process. However, a patient in visible pain can add an additional challenge to the informed consent process. The purpose of this research was to examine if and how anesthesiology residents ask for questions from a patient displaying severe pain during an informed consent simulation. Anesthesiology residents recruited from three anesthesia residency programs were video recorded performing an informed consent with a 52-year-old White male simulated patient awaiting urgent repair of a perforated gastric ulcer who was displaying verbal and nonverbal signs of pain. Two independent coders evaluated whether, when and how residents elicited patient questions during the informed consent process. Among a sample of 65 first- and third-year anesthesiology residents, more than 20% of residents did not elicit questions during the informed consent encounter. Those who elicited questions typically did so late in the process, with approximately 10% inviting questions only after the consent form had been signed. Most questions were closed-ended (yes/no questions). Although residents did not typically incorporate the patient's name when eliciting questions, most residents demonstrated eye contact. There were no differences in the number or characteristics of questions elicited based on resident gender or level of training. Our findings suggest there is a need for increased education regarding the purpose and approach to eliciting patient questions during the informed consent process, especially for patients who are experiencing pain. When a patient is about to have surgery, they talk with their doctor about what to expect. Then they must agree to have the surgery and agree to the anesthesia needed for the surgery. This is known as the informed consent process. Patients who are about to have surgery may have a lot of questions for their doctor. It is important for the doctor to ask the patient if they have any questions. This study looked at videos of a training session for anesthesiology residents, who are doctors in advanced training to give anesthesia. In this training session, the anesthesiology residents were asked to get informed consent from a patient. The patient was an actor pretending to be in a lot of pain. This study looked at whether the anesthesiology resident ever asked the patient if he had any questions. Our results show that sometimes the doctors did not ask if the patient had questions. Sometimes the doctors ask after the consent form has been signed. We need to train anesthesiology residents to always ask if the patient has questions before the patient agrees to the surgery and the anesthesia.
The aortic valve-sparing procedure has been performed for more than 2 decades and has proven durable results in several aortic and root phenotypes. Few studies have analyzed the impact of aortic valve regurgitation on the need for leaflet repair and outcomes after trileaflet aortic valve-sparing surgery. The aim of this study is to analyze in a large cohort the clinical and echocardiographic outcomes of trileaflet aortic valve-sparing surgery in patients with aortic root dilatation, focusing on the impact of preoperative aortic regurgitation and cusp repair. We extracted the data from the Heart Valve Society Aortic Registry (previously also known as AVIATOR). We selected patients with trileaflet aortic valves undergoing operations for aortic root dilatation (root/ascending aorta ≥45 mm) by the valve-sparing procedure. The primary outcome was the incidence of moderate or more aortic insufficiency and progression level of aortic insufficiency of at least 1 grade at follow-up. A cusp repair score was created as the cumulative sum of all leaflet repair techniques used per patients. A total of 1116 patients were included in the analysis. Mean age of patients was 53 ± 15 years, and 84% were male. The observed incidence of moderate/severe aortic insufficiency at 1, 5, and 10 years was 0.7%, 3%, and 6.8%, respectively. Both moderate or more aortic insufficiency and progression of aortic insufficiency by 1° increase significantly with time. Preoperative aortic insufficiency and the need for additional clamping sessions were independent predictors of aortic insufficiency progression, whereas the cusp repair score increases the risk of aortic insufficiency of moderate or more. In patients with trileaflet aortic valves undergoing sparing surgery, preoperative aortic insufficiency and the need of a more extensive cusp repair increase the long-term risk of aortic insufficiency. Time also impacts the recurrence of aortic insufficiency or its increase.
β-Blockers have been traditionally prescribed after acute myocardial infarction (MI), but contemporary evidence in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF ≥40%) have not provided consistent results. We assessed the robustness of the evidence for the efficacy of β-blocker therapy in this population using contemporary randomized controlled trials (RCTs) and pooled analyses. We systematically searched PubMed, Scopus, and Embase through August 1, 2025, for phase 3-4 RCTs evaluating β-blockers in patients with LVEF ≥40% during index MI hospitalization. Primary outcomes included robustness of each trial's primary endpoint; secondary outcomes included all-cause and cardiovascular mortality, recurrent MI, heart failure hospitalization, and unplanned revascularization. Fragility index (FI) and fragility quotient (FQ) were calculated. Data were pooled using random-effects meta-analysis. Four trials (REDUCE-AMI, CAPITAL-RCT, BETAMI-DANBLOCK, REBOOT) with 19,245 patients were included. Event rates were low across the various outcomes with limited robustness: FI and FQ values indicated high sensitivity to small changes in events. BETAMI-DANBLOCK suggested modest benefit for recurrent MI, while REDUCE-AMI and REBOOT showed no significant effect. Pooled analysis revealed a 9% relative risk reduction and 0.9% absolute risk reduction for the composite of death, recurrent MI, or heart failure hospitalization (number needed to treat = 111; FI = 5). In patients with MI and LVEF ≥40%, β-blocker therapy confers only modest absolute benefits, with trial results that are fragile. Routine use in this population may not provide consistent or clinically meaningful benefit, underscoring the need for individualized therapy.
Predicting difficult-to-manage (D2M) axSpA remains challenging, as both inflammatory and non-inflammatory factors contribute to treatment failure. Functional impairment captured by Health Assessment Questionnaire-Disability Index (HAQ-DI) and Multidimensional Health Assessment Questionnaire (MDHAQ) may provide additional predictive value, but are rarely evaluated in this context. To assess the predictive value of HAQ-DI and MDHAQ for identifying patients at risk of D2M axSpA in real-world clinical practice. Single-center retrospective observational study based on data from a clinical registry. The study included patients with axSpA initiating biologic or targeted synthetic disease-modifying antirheumatic drugs. Data included demographic, clinical, and laboratory parameters, as well as patient-reported outcomes. D2M status was defined according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. Health status was evaluated using HAQ-DI and MDHAQ. Logistic regression identified predictors of D2M status at baseline, 24 and 48 weeks. The cohort included 300 treatment courses in 217 patients (average age 45 years, 49% female, 83% HLA-B27 positive, 83% r-axSpA). At baseline, 11% patients met ASAS criteria for D2M axSpA, decreasing to 8.8% at week 48. D2M patients were older (p = 0.03), exercised less frequently (p = 0.04) and had higher disease activity. In multivariable models, baseline HAQ-DI independently predicted D2M status at baseline (OR 3.29, p = 0.008) and week 24 (OR 4.56, p = 0.005) and functional dimension of MDHAQ at week 24 (OR 3.47, p = 0.039). Functional impairment, reflected by higher HAQ-DI and MDHAQ scores, was the strongest predictor of D2M axSpA and may serve as a valuable tool for identifying these patients early and addressing nonpharmacological management strategies ahead. Everyday functioning helps predict which patients with axial spondyloarthritis will have difficult-to-manage disease Axial spondyloarthritis (axSpA) is a long-term inflammatory rheumatic disease that mainly affects the spine and causes pain, stiffness, and reduced mobility. Some patients respond well to treatment, while others continue to experience troublesome symptoms even when receiving innovative drugs such as biologic or targeted synthetic. If two or more of such therapies fail, these patients are described as having difficult-to-manage (D2M) axSpA. Being able to identify such patients early may help doctors provide better care and distinguish between the true need of modification of pharmacotherapy or rather addressing other aspects of the disease, such as pain and functional decline due to causes not related to inflammation. In this study, we followed adults with axSpA who were receving biologic or targeted synthetic treatments. We collected clinical information, laboratory results, and patients’ own reports about how their symptoms affect daily activities. Two questionnaires “HAQ-DI” and “MDHAQ” were used to measure everyday functioning, such as the ability to dress, stand, walk, or complete routine tasks. We found that patients with D2M axSpA had worse functional limitations from the beginning and throughout treatment, even though inflammation markers in blood tests were similar to other patients. Higher HAQ-DI and MDHAQ scores strongly predicted which patients would continue to struggle during treatment. These findings suggest that assessing everyday functioning “not only inflammation” can help identify people who may need additional support. Early use of exercise programs, physical therapy, and personalized care strategies could improve outcomes for these patients.
Delirium remains a prevalent and serious complication in intensive care units (ICUs), yet the translation of evidence-based monitoring and management into routine nursing practice faces persistent implementation gaps. Sustainable and scalable educational strategies are urgently needed to address this challenge. This study employed a mixed-methods approach to comprehensively evaluate the impact of a train-the-trainer (TTT) delirium education program using a multidimensional outcome framework. Quantitatively, we assessed changes in ICU nurses' competencies across the learning, behavior, and results levels of the Kirkpatrick model. Qualitatively, we explored the underlying experiential mechanisms and contextual drivers to explain the quantitative outcomes and inform program optimization. A mixed-methods quasi-experimental study with an embedded qualitative component was conducted in a tertiary ICU in China. Forty-seven nurses participated in the TTT program. Quantitative data acquisition included validated instruments for delirium knowledge assessment, standardized clinical simulation evaluations using the CAM-ICU tool, and the General Self-Efficacy Scale, collected at baseline and three months post-intervention. For qualitative data acquisition, semi-structured interviews were conducted with 12 purposively sampled nurses to explore experiential learning trajectories, behavioral drivers, and implementation barriers. Thematic analysis was guided by Social Cognitive Theory and performed using systematic coding procedures. Quantitative analysis revealed statistically significant improvements across all outcome metrics: delirium knowledge scores (p < 0.05), clinical assessment accuracy (p < 0.05), and self-efficacy (p < 0.001). Qualitative analysis identified four core thematic patterns: (1) Experiential learning trilogy-simulation, practice, and teaching; (2) From experience to evidence-the construction of clinical confidence; (3) Environmental forces-barriers and facilitators in practice implementation; and (4) Systemic spillover effects-enhanced interprofessional communication and recognition of hypoactive delirium. Nurses also provided actionable recommendations for training optimization, notably the need for standardized video resources to ensure content consistency. The TTT program significantly enhanced ICU nurses' delirium care competencies, driven by simulation-based practice, repeated application, and peer teaching. Contextual challenges and the need for standardized video resources inform future implementation and fidelity considerations. This study provides a feasible, scalable framework for evidence-based delirium care.
There are significant numbers of people who suffer from oral diseases worldwide; however, dental research remains behind in embracing health equity principles in its practices. Health equity means the existence of a fair and just lack of difference in health status between populations and opportunities for all people to achieve the maximum degree of health possible. Besides being an ethical issue, health equity is also a necessity to guarantee the objectivity, inclusion, and relevance of scientific research. This narrative literature review seeks to discuss the need for health equity to be included at all stages of dental research. Hypothesis formation, study design, research practice, data analysis, and dissemination of results are the topics discussed in the review. The global impact of diseases of the mouth on public health will be described, as well as the factors behind the disparity of oral health status around the world. Also, the existence of epistemological issues within the methodology used for dental research will be highlighted, possibly leading to biased and non-inclusive scientific knowledge creation. Finally, new perspectives and methodologies are introduced, allowing researchers to rethink dental research and adapt it to society's needs.
The amygdala is the nucleus of the brain that is largely responsible for perceiving danger and plays a role in emotion, behavior, control and learning. A small amygdala has been associated to aggression. Horned ewes are expected to be more aggressive and have a smaller amygdala. Both horned and hornless ewes exhibit intraspecific head-butting behavior and both species are at risk for traumatic brain injury. The aim of this study was to investigate the neuronal density, glial cells and blood-brain barrier (BBB) of the amygdala in horned and hornless ewes. Four horned and six hornless ewe heads (age: 16.00 ± 4.00 months) were obtained from the abattoir. The brains were carefully removed and preserved in 10.00% formalin for 5 days. Bilateral amygdalae were sectioned. The samples were stained with Hematoxylin and Eosin, immunohistochemical (glial fibrillary acidic protein) and Terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling methods, and the histological structures of the amygdala were examined by light microscopy. The Mann-Whitney U test was used to analyze the data. Neuronal density was estimated to be 143,230 ± 12,540 per mm3 in horned and 152,230 ± 18,430 per mm3 in hornless ewes. Horned subjects had reduced numbers of neurons, damaged BBB and localized inflammatory areas. More apoptotic neurons were observed in horned ewes. Further studies are needed to determine whether these differences in neuronal density, glial cells, and BBB are acquired (due to trauma) or congenital. The results of this study might need further similar studies to be conducted in the future.
Limestone cave systems constitute an important ecological niche supporting numerous bat species in Southeast Asia, with Myanmar, having a particular high number of understudied caves. Investigating the natural and anthropogenic ecological drivers that influence higher densities and species diversity of bats co-roosting in these natural caverns is therefore vital for identifying regions of heightened conservation need. We examine characteristics of limestone caves and alternative sites of bat congregation/roosting associated with cave-dwelling bat abundance at 41 sites in Pinlaung Township, Southern Shan State, Myanmar. The characteristics evaluated included cave surface area and complexity, microclimate conditions, seasonality, and a modified biotic vulnerability (BV) index. Larger caves and caves with warmer temperatures were significantly more likely to support higher total numbers of bats. Further distance from the road was also associated with higher bat abundance; as the distance increased, human disturbance decreased, resulting in larger bat populations. The majority (63.2 %) of caves were classified as moderately vulnerable (BV class B), 18.4 % highly vulnerable (BV class A), and 18.4 % vulnerable (BV class C), indicating that environmental protections are essential to ensuring the long-term sustainability of cave-dwelling bat habitat within limestone karsts. Most cave sites evaluated faced multiple threats to bat populations, including bat hunting, guano harvesting, and cave development, which are known threats to cave-dwelling bats in other parts of Southeast Asia. This study identifies Southern Shan State, Myanmar as a critical habitat for limestone karst cave-dwelling bat species habitat that is in urgent need of conservation.
Attention-deficit hyperactivity disorder (ADHD) is an increasingly recognized yet under-addressed challenge within the medical profession, affecting medical students and physicians (including residents and faculty). While current literature emphasizes high rates of depression, anxiety, and burnout in these groups, ADHD - despite its persistence into adulthood and its impact on academic, clinical, and interpersonal functioning - receives comparatively less attention. Reported ADHD prevalence among medical students, residents, and practicing physicians varies widely and may be underestimated due to stigma, underreporting, and diagnostic bias. Untreated ADHD can hinder academic performance, impede residency matching, threaten patient care, and worsen mental health. In prior work, we introduced the 5-Minute Video Summary (5MVS), a multisensory, five-minute physician-narrated video that distills a scientific article's key findings while also commenting on strengths and limitations using varied visuals and vocal delivery to support attention and retention. The present manuscript conceptually extends this ADHD-supportive, technology-enabled approach "upstream" to the foundational task the 5MVS depends on: completing the initial reading of scientific literature. We introduce "Record and Read" (R&R), a self-implemented strategy that leverages auditory reinforcement and the production effect. Learners record themselves reading an article aloud, then listen to the recording while following along and highlighting salient points. R&R is intended to reduce procrastination, increase sustained engagement, and improve comprehension for medical students and physicians with ADHD, potentially offering flexibility and independence, though technological access and stamina demands may pose barriers. While we propose R&R as a complementary tool for medical students and physicians with ADHD to promote both engagement with full-text articles and efficient consolidation, this approach has yet to be systematically studied via pilot, acceptability, or feasibility testing - underscoring its need for empirical evaluation. Many medical students and doctors struggle with depression, anxiety, and burnout, but less attention has been paid to another common challenge: attention-deficit/hyperactivity disorder (ADHD). Individuals with ADHD can find it hard to focus, stay organized, start tasks, and finish them on time. Medical students and doctors may avoid seeking evaluation for ADHD due to stigma, fear of consequences, or difficulty accessing diagnosis and care, leading to under-recognition in these groups. This paper was written to propose a practical way to support an important part of medical education that can be especially difficult for people with ADHD: reading scientific articles. Research papers are often long, densely written, and low in visual cues, which can make it easy to lose focus and hard to remember key points. In earlier work, the authors described the idea of a “5-Minute Video Summary,” a short, engaging video that helps readers grasp an article’s main message and think about its strengths and limitations. In this manuscript, the authors propose a companion strategy called “Record and Read” (R&R). With R&R, a medical student or physician records themselves reading an article aloud, then listens to the recording while following along and highlighting important information. The goal is to make it easier to start reading, stay engaged, and understand what was read using both voice and text. Importantly, R&R is a proposed approach and has not yet been empirically tested; future studies are needed to evaluate whether it improves comprehension, efficiency, and learning outcomes.
Delayed presentation of congenital anomalies is common in Nepal, highlighting the importance of timely diagnosis. Female community health volunteers (FCHVs), who are integral to health care delivery in communities, may offer an opportunity for early identification and referral of these anomalies. This study explored the perceptions, willingness, and motivations of FCHVs in Nepal regarding their potential role in the identification of congenital external genitourinary (GU) anomalies. Twelve FCHVs from Devdaha municipality, Rupandehi district, Nepal, participated in a focus group discussion (FGD). FCHVs were purposively sampled to ensure diversity in geographic setting (urban/rural), age, and years of experience. A semi-structured FGD guide was used to explore knowledge, attitudes, perceived community acceptance, and recommendations for future training. Data was analyzed using inductive thematic analysis following Braun and Clarke's framework. Five key themes emerged: (1) lack of confidence in identifying and refering congenital GU anomalies, (2) positive attitude toward community-based screening, (3) perceived barriers (e.g., stigma and parental resistance) and facilitators (e.g., existing child health roles), (4) recommendations for practical, skill-based training, and (5) motivation for FCHVs' work. While FCHVs recognized the importance of identifying congenital anomalies and associated risks or complications, most lacked confidence due to limited prior training. Most FCHVs expressed willingness to participate in screening, particularly when they perceived the role as aligned with their existing responsibilities. There was consensus on the need for targeted training before implementing a formal program. This study provides early evidence on the feasibility of integrating congenital anomaly screening into community health systems, highlighting training and referral strengthening as next potential steps.
The Relative Age Effect (RAE) could influence talent identification and playing opportunities in youth football. The aim of this study was to examine the influence of RAE and maturity status on competitive playing time in an elite football academy. A cross-sectional study was conducted looking at 172 cases of male youth football players (U12-U15). Although data were collected over two seasons (2023-2024 and 2024-2025), the analyses did not include between-season comparisons. Accumulated competitive minutes played across the season were analyzed using a linear mixed-effects model, and associations between the categorical variables were examined using the chi-square test. The findings showed that none of the primary effects were statistically significant. The results suggest a trend in the expected direction; however, the effect was not statistically significant for status, (p = .057), and quartile, (p =.054). Late-maturing players were associated with a significant decrease in playing time (minutes) (p = .017). In contrast, being a defender (p = .035), and belonging to quartile 2 (p = .034) were linked to significant increases in playing time (minutes). There were more midfielders with late development (adjusted residual = 3.7), and more defenders with early development than expected by chance (adjusted residual = 1.98). These findings suggest that both RAE and maturity status influence playing opportunities in elite youth football, highlighting the need for development-oriented competition structures.
Global climate change is negatively impacting honeybee production and productivity, threatening survival, health, and pollination functions which are vital for agriculture and biodiversity. Thus, this study employed integrated machine learning and geospatial modeling (Random Forest, Support Vector Machine, XGBoost, and LightGBM) to predict current and future habitat suitability in Ethiopia under SSP2-4.5 and SSP5-8.5 (2041-2080), therefore promoting conservation and climate-resilient agriculture. Variable importance analysis revealed that agro-ecological zones were the most influential predictors, accounting for 14%-22% of the variance across models. Among bioclimatic factors, Bio19 (coldest quarter precipitation) emerged as a prominent driver (14.1% in RF; 10.3% in XGBoost), indicating the importance of dry-season water availability. Model performance varied: Random Forest had the best predictive precision (specificity = 0.93); however, XGBoost better identified spatial clustering patterns. Under present conditions, Random Forest predicted 30.02% of the study area as highly suitable, especially in the Western Highlands, whereas LightGBM predicted 18.62%, showing increased habitat fragmentation. Forecasts for the future (considering only climate and static topography) indicate a significant reduction in highly suitable habitats, with a 46.2% decline under SSP5-8.5 by the 2070s. Landscape-level measurements indicated increased fragmentation, including a reduction in Shannon diversity (1.48-1.29) and a 19.2% increase in fractal dimension, indicating more complex patch topology. These findings recommended the need to restore pollinator corridors in highland refugia, promoting drought-tolerant plants like Vachellia abyssinica, and integrating adaptive apiculture approaches.
Staphylococcus aureus is one of food poisoning bacteria. This study assessed the prevalence, virulence factors, and antimicrobial susceptibility profiles of S. aureus isolated from frozen fish and shrimp in Egypt. Ninety samples from frozen fish fillets and shrimps (45 for each) were examined for S. aureus prevalence using VITEK 2 compact system, followed by molecular confirmation by nuc gene, virulence characterization, and its resistance genes. The overall prevalence rate of S. aureus was 14.44% (13/90). Fish fillet had the highest mean total S. aureus count (9.50 ± 3.50 × 105 colony forming unit g-1), followed by shrimp (7.50 ± 3.30 × 105 colony-forming unit g-1), with a non-significant difference among fish fillet and shrimp. All confirmed S. aureus isolates were lecithinase producers and showed β-hemolysis, and coagulase positive, and confirmed molecularly coa gene positive. All isolates were resistant to ampicillin (100%), both erythromycin and clindamycin (69.23%), and tetracycline (61.53%), followed by vancomycin (46.15%). However, all isolates were sensitive to linezolid, tigecycline (84.70%), and trimethoprim/sulfamethoxazole (61.53%). Twelve (92.30%) phenotypically cefoxitin and oxacillin-resistant and molecularly mecA recovered S. aureus isolates were confirmed as methicillin-resistant S. aureus, while based on vancomycin-resistant pheno-typically, and molecularly vanA recovered S. aureus isolates were confirmed as vancomycin-resistant S. aureus. The emergence of multidrug-resistant methicillin-resistant S. aureus and vancomycin-resistant S. aureus in frozen fish fillets and shrimp indicates public health hazards, so there is a need for food safety measures alongside reliable detection methods of resistant bacteria along the food chain.
Lung transplantation (LT) remains a life-saving intervention for patients with end-stage lung disease, but recipient age continues to be a key determinant of long-term outcomes. As the candidate population ages and allocation policies shift, understanding how age and donor-recipient variables impact survival is increasingly critical. This study aimed to evaluate the association between recipient age and long-term survival after LT, and to characterize age-specific differences in mortality risk factors in a national cohort. We conducted a retrospective cohort study of 30,494 adult LT recipients using data from the Scientific Registry of Transplant Recipients (SRTR) from 2006 to 2022. Recipients were stratified by age at transplant into three groups: 18-64, 65-69, and ≥70 years. Primary outcome was all-cause mortality; secondary outcomes included graft dysfunction, rejection rates, and cause of death. Kaplan-Meier and Cox proportional hazards models were used to evaluate survival risk factors. Survival declined progressively with increasing age, with recipients aged ≥70 years showing significantly lower 5-year survival. Multivariable analysis identified treated rejection, low body mass index (BMI), pre-transplant intensive care unit (ICU) stay, and post-transplant dialysis as independent predictors of mortality. The impact of risk factors varied by age: rejection had less effect in older recipients, extracorporeal membrane oxygenation (ECMO) predicted mortality only in younger patients, and dialysis was significant mainly in the 65-69 years group. Importantly, donor age and sex did not significantly affect survival. Advanced recipient age is independently associated with reduced long-term survival after LT, and this association persists after adjustment for donor and procedural factors. The relative importance of risk predictors varies across age groups, highlighting distinct, age-dependent risk profiles that may inform candidate selection and counselling. Together, these findings underscore the need to further refine selection strategies to support the ethical and effective allocation of scarce donor lungs.
Parotid oncocytoma is a rare benign neoplasm for which surgical excision remains the standard treatment. Although the recurrence rate is generally low, it increases significantly in cases with multifocal lesions or incomplete surgical excision. In such scenarios, postoperative radiotherapy (RT) has been shown to improve local control, reduce recurrence rates, and minimize the need for reoperation. This report presents a representative case of parotid oncocytoma, with a focused discussion on therapeutic decision-making from a radiation oncologist's perspective. We report the case of a 61-year-old man who underwent left superficial parotidectomy for a firm mass located below his left ear. Postoperative pathological examination confirmed parotid oncocytoma. Contrast-enhanced computed tomography (CT) revealed an enhancing nodule in the deep portion of the left parotid gland, measuring 1.6 cm in maximum diameter. Following multidisciplinary team (MDT) discussion, postoperative radiotherapy was recommended to avoid potential facial nerve injury associated with repeat parotid surgery. This case illustrates the use of postoperative adjuvant radiotherapy for left parotid oncocytoma. Although parotid oncocytoma is benign, adjuvant radiotherapy may be considered in selected cases with a high risk of recurrence.