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Both type II (consumer/client-on-worker) and type III (worker-on-worker) workplace violence and mistreatment exist within the sign language interpreting field, however type III (also known as horizontal violence or lateral aggression) is more commonly reported. Between 22 to 90% of sign language interpreters have witnessed and/or experienced forms of horizontal violence or behaviors associated with it and 0 to 8% have knowingly perpetrated horizontal violence against another interpreter. This perspective article aims to provide a cross-industry approach by sharing general practices and previous strategies used within the mental and general healthcare settings. We describe how these tools have been adapted to other industries and model how to apply them to the sign language interpreting field. Available regulatory guidance emphasizes employer responsibility for identifying workplace violence hazards and implementing evidence-informed prevention strategies. Safety and Violence Education (SAVE) was designed for front-line healthcare professionals who are exposed to multiple, well-documented risk factors for workplace violence. The original SAVE curriculum primarily emphasized the perceived predominance of consumer/client-on-worker violence in community mental health settings. Critical steps in adapting SAVE for sign language interpreters involved organizational/administrative exposure control strategies, like cultivating awareness of how organizational culture intersects with emotional and psychological safety and emphasized behavioral/interpersonal approaches by recognizing, preventing, and mitigating worker-on-worker aggression, bullying, and relational-based conflict. The adapted SAVE sought to "break the cycle" of horizontal violence and establish a sustainable culture of safety, respect, and professional resilience among sign language interpreters.

To compare the reimbursements associated with posterior blepharoptosis, ectropion, entropion, pterygium, and chelation for band keratopathy surgeries performed in an operating room versus an office procedure room and assess the potential benefit of incentivizing the use of the more cost-effective option. Economic analysis. The 2022 Centers for Medicare and Medicaid Services database was used to determine the reimbursement for each procedure when performed in the operating room and office procedure room. Total services for each procedure were aggregated and used to estimate the total cost to the healthcare system based on location.Overhead costs for office procedures were calculated by examining the 3 main costs associated with these office procedures: disposables, human resources, and physical facilities.An incentive analysis was performed, which involved calculations examining the change in annual cost to Medicare if the reimbursement for the study procedures were increased to include overhead costs and various incentive payment percentages. Procedures performed in the operating room cost an average of $2200 more than office procedures. The average overhead cost for office procedures was $150. The total cost of the study procedures in 2022 was $177 million, with >90% of procedures performed in the operating room. Increasing reimbursement by 150% the cost of overhead, when 50% of procedures are performed in the office, saves the healthcare system $52 million. Increasing office reimbursement to cover overhead costs and provide a small incentive to perform procedures in the office could save the healthcare system millions of dollars.

To develop, clinically implement, and use automated treatment planning for lung cancer radiotherapy (RT) via an in-house treatment planning optimization system, the expedited constrained hierarchical optimization (ECHO). The ECHO system accepts segmented tumor and normal tissue contours and clinical dose/volume criteria as inputs and generates optimized fluence maps for intensity-modulated RT (IMRT) and leaf trajectories for volumetric-modulated arc therapy (VMAT). Dose/volume criteria for our clinically used seven lung cancer fractionation schedules were implemented in ECHO. For each schedule, ECHO internal optimization parameters were tuned using 5-7 previously treated patients and validated with additional 20-25 patients. Since May 2021, a total of 431 lung cancer patients have been treated with ECHO IMRT. Additionally, from April 2023, 93 lung SBRT patients were planned with ECHO VMAT. Treatment plans optimized with ECHO IMRT and VMAT provide more consistent target coverage and similar organ sparing compared with manually optimized plans. The average planning target volume was 390 cm3 (range: 12-3441) for IMRT and 17 cm3 (range: 2.5-56) for VMAT. The average optimization time was 33 min (range: 7-126) for IMRT and 56 min (range: 21-178) for VMAT. On average, ECHO-optimized plans save 1.5 h per plan compared to manual planning. We have implemented an automated system for lung RT treatment planning at our institution for seven fractionation schedules. Our ECHO approach is robust and adapts to changes in clinical criteria without requiring algorithm modifications or retraining. The proposed treatment planning automation framework saves resources and improves treatment plan quality and consistency.

The 3 Abrahamic religions, namely Judaism, Christianity, and Islam, regard the human being as the most noble and perfect being due to their monotheistic attitude and value him above all creatures. This dignity is such that even the human embryo is viewed as a complete and perfect human being. All 3 religions place a high value on unborn life generally and prohibit abortion but allow exceptions when the mother's life is in danger. In Judaism, abortion is permitted to save the mother's life based on the concept of rodef, and some scholars allow it for pregnancies resulting from adultery or potential birth defects. Catholicism uses the principle of "double effect" to justify abortion when necessary to save the mother. Islam prioritizes warding off harm over gaining benefits, permitting abortion only when a certain benefit to the mother outweighs the harm to the fetus. Although there is a controversy over the human embryo in the early days of its formation, all 3 religions agree on the illegitimacy of abortion in the final months of pregnancy. Perhaps the permission of abortion in the event of a risk for the mother's health to preserve her health and well-being is the most important common ground of these 3 heavenly religions. The abortion permission in other cases, such as disability, maiming, is a matter of dispute between the 3 religions.

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) provides temporary mechanical circulatory support, primarily for patients with compromised cardiac function. In individuals supported on femoral VA ECMO with concurrent pulmonary dysfunction, poorly oxygenated blood may be ejected from the left ventricle resulting in differential hypoxia to the upper body, or Harlequin syndrome. A retrospective, observational review of our institutional experience in managing patients who developed Harlequin syndrome from March 2016 to May 2021 was conducted. We evaluated interventions to correct Harlequin syndrome, pre-cannulation laboratory values, clinical outcomes, and overall survival to discharged. Forty-four patients developed Harlequin syndrome during the study period. Eleven (25%) patients underwent ECMO revision, while 33 (75%) patients did not. The ECMO revision group had a Survival after Veno-Arterial ECMO (SAVE) score of -15 (interquartile range (IQR) -17, -11), while the non-revision group had a SAVE score of -6.0 (IQR -10, -1). The median time to resolution of Harlequin syndrome for the entire cohort was 4.5 h (IQR 1.4, 7.80). Hospital length of stay was similar between groups. There were eight (73%) patients in the ECMO revision group who survived to decannulation, compared to 23 (70%) patients in the non-revision group. Our findings underscore Harlequin syndrome as a serious complication of femoral VA ECMO. Our observed findings also suggest that physiological interventions can effectively resolve Harlequin syndrome and should be considered as a key strategy before considering ECMO revision. The online version contains supplementary material available at 10.1007/s12055-026-02185-w.

One of the most serious medical conditions in children is choking. It is a critical pediatric emergency caused by foreign objects obstructing the airway, posing a serious threat to children's lives and representing a significant public health concern. Parental readiness and proper reaction are crucial to solving choking incidents in children. To investigate parental readiness and reaction toward choking in children in Saudi Arabia. This cross-sectional study was conducted in Saudi Arabia with a sample of 530 participants. The study employed an online survey to gather data from parents of children aged 0-6 years. The survey aimed to evaluate various factors, including knowledge and awareness regarding choking in children, parental practices, readiness, and reactions toward choking in children. Among 530 participants, over half (57.9%) had a good overall knowledge level about choking in children. The majority reported that children aged 1-5 years (73.8%) are most at risk for choking. In identifying choking hazards, parents showed high awareness, with 82.8% correctly identifying small pieces as dangerous. When asked about their immediate response to a choking incident, 70.2% reported they would attempt appropriate first aid measures. While most parents showed a basic understanding of choking risks, such as the dangers posed by small objects and the importance of supervision during eating, there remain notable gaps that could compromise child safety. Health campaigns teaching first aid and cardiopulmonary resuscitation for parents are essential to help parents treat choking conditions in children and potentially save lives.

We encountered a male infant with extremely low birth weight born at 22 weeks and 0 days of gestational age in the toilet at home. He was resuscitated with chest compression and bag-valve-mask ventilation by the emergency medical service crew and was transported to our institution 50 minutes after birth. The patient was intubated and given intratracheal artificial surfactant after admission. After he recovered from the initial hypotensive phase, we maintained the blood pressure at an appropriate level using nitroglycerin to avoid cerebral overcirculation. He was discharged home at 170 days of life with no signs of intraventricular hemorrhage or periventricular leukomalacia. His overall developmental quotient at one year and seven months of corrected age was 104, and he showed no apparent developmental delay. This case demonstrates that appropriate medical management can save the lives of extremely preterm infants born outside medical institutions.

Large language models in artificial intelligence have been among the tools with a significant and real impact on people's daily lives. In this regard, they serve as an aid in specific fields, such as education, helping educators with cumbersome tasks such as periodic evaluations. This study focused on analyzing the benefits of large language models, particularly the chain-of-thought (CoT) strategy, for the task of evaluating students' Spanish-language medical record writing. The aim was 2-fold: first, we attempted to save time and resources, and second, we used the reasoning of the CoT strategy to evaluate the rubrics and their interpretations. The proposed solution assessed the application of 2 models-Llama 3.1 and Claude 3.5-in combination with one-shot and CoT to evaluate how medical students write medical records in Spanish. First, machine learning metrics were applied to measure the performance of the solutions. Then, different statistical analyses were performed at the clinical record and item levels. Finally, differences between the proposed models and evaluators were studied in depth. A maximum of 3807 items were evaluated. Claude obtained the best accuracy with slight differences between one-shot and CoT (86.4% and 85.0%, respectively). However, Claude with CoT outperformed the rest of the combinations on all complementary metrics, initially achieving a sensitivity of 94.2%, specificity of 59.5%, precision of 85.8%, and F1-score of 89.6%. Expert review of CoT reasoning determined that 63.8% of the discrepancies were model hits, raising Claude's final accuracy to 94.6% (SD 4.3%). In the final phase, sensitivity was 98.0% (SD 2.3%), specificity improved to 83.3% (SD 14.3%), and F1-score reached 96.2% (SD 3.3%). Sectional analysis showed greater difficulties in the "History of present illness" section (n=125 discordances). CoT demonstrated strong potential for supporting the evaluation of clinical records written in Spanish by medical students and providing feedback to them. More importantly, it showed significant promise in assisting professors by assessing the quality of their rubrics and identifying possible errors.

Cardiac abnormalities are among the most common and complex risk factors of pediatric acute ischemic stroke (AIS). Although endovascular treatment (EVT) is increasingly used in children, uncertainty persists regarding its safety and effectiveness in patients with underlying cardiac disease, leading to therapeutic hesitation in this high-risk population. The aim of this study was to determine whether the association between EVT and functional outcomes after pediatric AIS differs according to cardiac abnormality status. This study was a retrospective secondary analysis of a prospective, multinational cohort registry (Save ChildS Pro). The registry enrolled patients between 2018 and 2023, with 90-day follow-up. Participants included children aged 28 days to 18 years with confirmed AIS due to large vessel occlusion and available 90-day Pediatric Stroke Outcome Measure (PSOM) scores. Cardiac abnormalities were defined as congenital or acquired cardiac disease documented by echocardiography or medical records. The primary outcome was poor functional outcome at 90 days, defined as PSOM score >0.5. Secondary outcomes included ordinal 90-day modified Rankin Scale (mRS) scores and longitudinal neurologic recovery assessed using the Pediatric NIH Stroke Scale (pedNIHSS). Treatment-subgroup interaction was assessed using penalized logistic regression. Of 208 eligible patients, 178 were included in the final analysis after excluding those with missing outcome data [43% female; mean age: 11.5 years]. Among 178 children, 56 (31.5%) had cardiac abnormalities. EVT was more frequently performed in children with cardiac abnormalities than in those without (p = 0.003). Cardiac abnormality status was not independently associated with outcome (odds ratio, 0.93; 95% CI, 0.36-2.52), and no significant interaction between EVT and cardiac abnormality was observed. Ordinal mRS shift analysis and longitudinal pedNIHSS modeling supported similar recovery trajectories. Adverse event rates did not differ by EVT status in either subgroup. In this multinational pediatric AIS cohort, EVT was associated with improved functional outcomes and accelerated neurologic recovery, with no evidence that cardiac abnormality status modifies association of treatment with outcome or safety. These findings support consideration of EVT in children with cardiac abnormalities when clinically indicated. This study provides class IV evidence that endovascular therapy in pediatric patients with AIS is associated with improved functional outcome irrespective of underlying cardiac abnormality status.

Based on attachment theory, individuals develop relational schemas that shape cognitive-emotional social relationship expectations (e.g., others are a source of safety). Social relationships (e.g., intimate relationships or close friendships) are a source of long-term happiness. However, expectations that they will save someone from life's challenges are a common fallacy (e.g., a shining prince/princess bringing lifelong happiness). This places illusionary expectations on others to not disappoint despite normal behavioral realities (e.g., relational misunderstandings and conflict). This project psychometrically developed the rescue fantasy beliefs (RFB) and expected relational disappointment (ERD) scales. Analysis of the scales demonstrated satisfactory reliability, discriminant validity, and convergent validity. Serial mediation analysis demonstrated that higher RFB is associated with higher shopping addiction. ERD and current relational satisfaction sequentially mediated this relationship. The results demonstrated a serial connection between RFB and lower ERD. This serial illusionary expectation gap in others is associated with lower current relational satisfaction and higher shopping addiction. Addictive shopping can function as a compensatory coping strategy to unmet social needs. Business marketing implications discuss how new offerings can encourage meaningful in-person social connections to better address underlying needs (for those with greater RFB).

Background/Objectives: The treatment of multidrug-resistant and hypervirulent Klebsiella pneumoniae is one of today's biggest healthcare challenges. The depletion of therapeutic options necessities the application of new methods. One promising approach is to use phage-derived enzymes that target the capsule and make the causative more visible to the immune system. As proteins, these enzymes must be optimised by reducing their size and antigenicity to make them suitable for repeated use. Methods: In this study, the recently isolated and cloned K2B1orf61 K2 capsule-specific depolymerase was analysed structurally, and certain amino acid residues were deleted by cloning. The following amino acid residues were removed from the 80th (D2_N80), 115th (D3_N115), and 200th (D4_N200) N-terminal, and 250 (D5_C250) and 20 (D6_C20) from the C-terminal positions of the wild-type molecule (D1_wt). The resulting derivative molecules were compared with in vitro and in vivo tests. Results: In the presence of wild-type depolymerase, human serum was able to eliminate the target bacterium and save the lives of mice challenged with the bacterium in an originally lethal intraperitoneal model. However, the D5_C250 derivative lost all activity, meaning that the bacteria with the K2 capsule in the serum survived and all the mice died. Derivatives D2_N80, D3_N115, and D6_C20 exhibited prolonged activity in the serum killing assay, effectively eliminating bacteria within 5 h. Similar activity differences were revealed in the intraperitoneal experiment: D5_C250 had no rescue effect; however, D1_wt, D2_N80, D3_N115, D4_200, and D6_20 resulted in survival rates of 100%, 60%, 80%, 100%, and 20%, respectively. Conclusions: Our results demonstrate that molecular trimming is a promising procedure for developing ideal therapeutic depolymerases.