Evaluation of the Smokeless Tobacco Awareness, Attitude, and Response Knowledge (STAARK) Scale With Integrated Risk Assessment for Tailored Intervention.

Background Smokeless tobacco (SLT) use, particularly gutkha, is prevalent in India, with cultural acceptance contributing to widespread use, especially among tribal populations. Despite awareness programs, there is limited assessment of their effectiveness, leading to continued vulnerability, even among educated groups. This study aims to evaluate public health strategies by developing and validating the SLT Awareness, Attitude, and Response Knowledge (STAARK) scale, which assesses knowledge and attitudes post-awareness programs on SLT usage through questionnaires, identifying vulnerable individuals, and enabling targeted interventions to reduce SLT use and associated health risks, particularly through integrated risk assessment (IRA). Methods This study was performed during an SLT awareness program in Nagaland, utilizing a comprehensive survey to assess participants' demographics, knowledge, and attitudes. The STAARK score was calculated by combining normalized attitude and knowledge scores, ranging from 0 to 10, categorizing participants' comprehension and attitudes toward SLT usage awareness. The obtained scores were assessed twice for consistency evaluation of the scale, and vulnerable individuals were subjected to IRA for targeted intervention recommendations. Reliability and correlation analyses were performed, with Cronbach's alpha validating the scale's internal consistency. Results About 182 participants took up the assessment, with only 180 completing the survey among the population attending the awareness program. Demographic data revealed a diverse participant group, with ages ranging from 13 to 42 years. The survey assessed participants' knowledge and attitudes toward SLT, scoring them on a 0-10 scale for knowledge and a 10-60 scale for attitude. The STAARK scale was developed to combine these scores, providing a comprehensive measure of participants' understanding and attitudes toward SLT. The mean STAARK score was 5.27 with an observed lower limit of 2.40 and an upper limit of 6.50 in the responded population. Reliability testing using Cronbach's alpha showed acceptable internal consistency, though attitude had a weaker correlation with the overall STAARK score compared to knowledge. In a follow-up assessment with 88 participants, the STAARK score averaged 5.10, reinforcing the initial findings. The risk assessment of 17 participants with STAARK scores above six identified varying levels of risk, with most falling into the low- or moderate-risk categories. The study highlights the importance of targeted interventions to address SLT usage, particularly in populations with lenient attitudes toward its consumption. Conclusions The STAARK scale can serve as a key tool for evaluating SLT awareness programs by assessing participants' knowledge and attitudes and identifying high-risk individuals requiring personalized interventions for SLT usage cessation. It standardizes the assessment, enabling comparison across groups and times, and helps identify individuals with lenient attitudes toward SLT for targeted interventions. Its reliability ensures consistency, and by tracking changes in scores before and after programs, it assesses impact and guides future improvements. The STAARK scale is crucial for personalized, evidence-based public health efforts to reduce SLT use. However, eradicating SLT requires ongoing commitment, adaptability, and a focus on long-term outcomes to translate knowledge into lasting change.

Análisis bibliométrico de instrumentos de medición de la ira en el marco de salud mental

El artículo buscó como objetivo identificar el conocimiento acerca de la ira y los instrumentos psicométricos diseñados para evaluarla en el marco de la salud mental. En la metodología se consideró las bases de datos de Dialnet, Scielo, Google Scholar, Sciencedirect y Scopus, llegando a 26,290 artículos. De esta cifra, 11,523 artículos fueron eliminados debido a la condición de duplicación, y otros 7,523 por no encontrarse en un idioma elegible o por ser un documento incompleto. Además, se excluyeron 4,933 artículos cuyas temáticas no estaban relacionadas con los test de ira en el marco de la salud mental. Luego, se obtuvieron 2,311 artículos; pero tras una revisión manual, se eliminaron 1,259 más. Posteriormente, fue posible recuperar un total de 1,052. De estos, se seleccionaron 140 para análisis. Finalmente, después analizar la finalidad que buscaba cada artículo, quedaron un total de 50 artículos enfocados en instrumentos psicométricos que evalúan la ira en el marco de salud mental. Estableciéndose en los resultados que, la base de datos con la mayor frecuencia de estudios encontrados es Sciencedirect, con un 36% del total de estudios, además, España es el país con la mayor frecuencia de estudios encontrados, representando el 38% del total. Concluyendo que, los instrumentos más frecuentemente empleados se encuentran el STAXI-2, seguido del DAS y el DAX.

The objective of the article was to identify knowledge about anger and the psychometric instruments designed to evaluate it in the framework of mental health. The methodology considered the databases of Dialnet, Scielo, Google Scholar, Sciencedirect and Scopus, reaching 26,290 articles. Of this figure, 11,523 articles were eliminated due to duplication status, and another 7,523 because they were not in an eligible language or because they were an incomplete document. In addition, 4,933 articles were excluded whose topics were not related to anger tests in the framework of mental health. Then, 2,311 articles were obtained; but after a manual review, 1,259 more were removed. Subsequently, it was possible to recover a total of 1,052. Of these, 140 were selected for analysis. Finally, after analyzing the purpose sought by each article, there were a total of 50 articles focused on psychometric instruments that evaluate anger in the mental health framework. Establishing in the results that the database with the highest frequency of studies found is Sciencedirect, with 36% of the total studies, in addition, Spain is the country with the highest frequency of studies found, representing 38% of the total. Concluding that, the most frequently used instruments are the STAXI-2, followed by the DAS and the DAX.

O objetivo do artigo foi identificar o conhecimento sobre a raiva e os instrumentos psicométricos concebidos para avaliá-la no âmbito da saúde mental. A metodologia considerou as bases de dados Dialnet, Scielo, Google Scholar, Sciencedirect e Scopus, chegando a 26.290 artigos. Desse número, 11.523 artigos foram eliminados por estarem duplicados e outros 7.523 por não estarem em idioma elegível ou por serem documentos incompletos. Além disso, foram excluídos 4.933 artigos cujos temas não estavam relacionados aos testes de raiva no âmbito da saúde mental. Obtiveram-se então 2.311 artigos; mas após uma revisão manual, mais 1.259 foram removidos. Posteriormente, foi possível recuperar um total de 1.052. Destes, 140 foram selecionados para análise. Por fim, após análise da finalidade buscada por cada artigo, obteve-se um total de 50 artigos focados em instrumentos psicométricos que avaliam a raiva no âmbito da saúde mental. Estabelecendo nos resultados que a base de dados com maior frequência de estudos encontrados é a Sciencedirect, com 36% do total de estudos, além disso, a Espanha é o país com maior frequência de estudos encontrados, representando 38% do total. Concluindo que os instrumentos mais utilizados são o STAXI-2, seguido do DAS e do DAX.

Análisis bibliométrico de instrumentos de medición de la ira en el marco de salud mental / Bibliometric analysis of anger measurement instruments in the mental health framework / Análise bibliométrica de instrumentos de mensuração da raiva no âmbito da saúde mental

El artículo buscó como objetivo identificar el conocimiento acerca de la ira y los instrumentos psicométricos diseñados para evaluarla en el marco de la salud mental. En la metodología se consideró las bases de datos de Dialnet, Scielo, Google Scholar, Sciencedirect y Scopus, llegando a 26,290 artículos. De esta cifra, 11,523 artículos fueron eliminados debido a la condición de duplicación, y otros 7,523 por no encontrarse en un idioma elegible o por ser un documento incompleto. Además, se excluyeron 4,933 artículos cuyas temáticas no estaban relacionadas con los test de ira en el marco de la salud mental. Luego, se obtuvieron 2,311 artículos; pero tras una revisión manual, se eliminaron 1,259 más. Posteriormente, fue posible recuperar un total de 1,052. De estos, se seleccionaron 140 para análisis. Finalmente, después analizar la finalidad que buscaba cada artículo, quedaron un total de 50 artículos enfocados en instrumentos psicométricos que evalúan la ira en el marco de salud mental. Estableciéndose en los resultados que, la base de datos con la mayor frecuencia de estudios encontrados es Sciencedirect, con un 36% del total de estudios, además, España es el país con la mayor frecuencia de estudios encontrados, representando el 38% del total. Concluyendo que, los instrumentos más frecuentemente empleados se encuentran el STAXI-2, seguido del DAS y el DAX

The objective of the article was to identify knowledge about anger and the psychometric instruments designed to evaluate it in the framework of mental health. The methodology considered the databases of Dialnet, Scielo, Google Scholar, Sciencedirect and Scopus, reaching 26,290 articles. Of this figure, 11,523 articles were eliminated due to duplication status, and another 7,523 because they were not in an eligible language or because they were an incomplete document. In addition, 4,933 articles were excluded whose topics were not related to anger tests in the framework of mental health. Then, 2,311 articles were obtained; but after a manual review, 1,259 more were removed. Subsequently, it was possible to recover a total of 1,052. Of these, 140 were selected for analysis. Finally, after analyzing the purpose sought by each article, there were a total of 50 articles focused on psychometric instruments that evaluate anger in the mental health framework. Establishing in the results that the database with the highest frequency of studies found is Sciencedirect, with 36% of the total studies, in addition, Spain is the country with the highest frequency of studies found, representing 38% of the total. Concluding that, the most frequently used instruments are the STAXI-2, followed by the DAS and the DAX

O objetivo do artigo foi identificar o conhecimento sobre a raiva e os instrumentos psicométricos concebidos para avaliá-la no âmbito da saúde mental. A metodologia considerou as bases de dados Dialnet, Scielo, Google Scholar, Sciencedirect e Scopus, chegando a 26.290 artigos. Desse número, 11.523 artigos foram eliminados por estarem duplicados e outros 7.523 por não estarem em idioma elegível ou por serem documentos incompletos. Além disso, foram excluídos 4.933 artigos cujos temas não estavam relacionados aos testes de raiva no âmbito da saúde mental. Obtiveram-se então 2.311 artigos; mas após uma revisão manual, mais 1.259 foram removidos. Posteriormente, foi possível recuperar um total de 1.052. Destes, 140 foram selecionados para análise. Por fim, após análise da finalidade buscada por cada artigo, obteve-se um total de 50 artigos focados em instrumentos psicométricos que avaliam a raiva no âmbito da saúde mental. Estabelecendo nos resultados que a base de dados com maior frequência de estudos encontrados é a Sciencedirect, com 36% do total de estudos, além disso, a Espanha é o país com maior frequência de estudos encontrados, representando 38% do total. Concluindo que os instrumentos mais utilizados são o STAXI-2, seguido do DAS e do DAX

The projected impact of the inflation reduction act's climate provisions on cardiovascular and respiratory outcomes.

Onjective: Climate change and environmental pollution have known health effects. The recently introduced inflation reduction act (IRA) by the United States government includes funding initiatives to curb climate change, and reduce environmental pollution, in line with the nationally determined contribution (NDC) plan (40-50 % reduction in greenhouse gas [GHG] emissions by 2030, as compared with 2005). The projected cardiovascular health benefits of the IRA driven climate actions to achieve the NDC goals are not known. Methods: We used the Energy Policy Simulator (EPS), a simulation algorithm based on systems dynamics modelling estimating the impact of various energy policies, to model the impact of achieving NDC targets in the United States on health outcomes by 2050. We further investigated race-specific impact on mortality (absolute and relative) by 2050.We estimated the projected reduction in six adverse health outcomes between 2022 and 2050: asthma attacks, non-fatal heart attacks, hospital admissions, respiratory symptoms and bronchitis, lost workdays, and deaths. Results: Achievement of NDC targets by 2050 will result in 987,415 avoided asthma attacks, 41,565 avoided nonfatal heart attacks, 18,993 avoided hospital admissions, 1,493,010 avoided respiratory symptoms and bronchitis, 3,317,250 avoided lost workdays, and 32,659 avoided deaths (22,839 among white individuals, 4993 among Black individuals, 2801 among Asian individuals, and 2026 among other/multirace individuals). By 2050, minority racial groups had higher relative change in avoided deaths (white -0.74 %, Black -1.01 %, Asian -1.24 %, and other/multirace -1.75 %). Similarly, Hispanics/latinos higher relative reductions in deaths (-1.4 %) compared with non-Hispanic/Latinos (-0.7 %) by 2050. Conclusion: The IRA facilitated achievement of NDC GHG reduction goals by 2050 would result in substantial number of avoided adverse health outcomes and death. Racial and ethnic minorities are expected to have the largest relative reductions in deaths by 2050. The current report underscores the importance of continued climate action investment irrespective of political differences. The appreciation of this aspect of the IRA may be more important to overall preservation of health, beyond the reduction in medication costs.

The significant others' responses to trauma scale (SORTS): applying factor analysis and item response theory to a measure of PTSD symptom accommodation.

Background: Symptom accommodation by family members (FMs) of individuals with posttraumatic stress disorder (PTSD) includes FMs' participation in patients' avoidance/safety behaviours and constraining self-expression to minimise conflict, potentially maintaining patients' symptoms. The Significant Others' Responses to Trauma Scale (SORTS) is the only existing measure of accommodation in PTSD but has not been rigorously psychometrically tested.Objective: We aimed to conduct further psychometric analyses to determine the factor structure and overall performance of the SORTS. Method: We conducted exploratory and confirmatory factor analyses using a sample of N = 715 FMs (85.7% female, 62.1% White, 86.7% romantic partners of individuals with elevated PTSD symptoms).Results: After dropping cross-loading items, results indicated good fit for a higher-order model of accommodation with two factors: an anger-related accommodation factor encompassed items related largely to minimising conflict, and an anxiety-related accommodation factor encompassed items related primarily to changes to the FM's activities. Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction, although the factors showed somewhat distinct associations. Item Response Theory analyses indicated that the scale provided good information and robust coverage of different accommodation levels.Conclusions: SORTS data should be analysed as both a single score as well as two factors to explore the factors' potential differential performance across treatment and relationship outcomes.

We examined the Significant Others' Responses to Trauma Scale (SORTS), a measure of symptom accommodation in PTSD, among a large sample of family members.As measured by the SORTS, accommodation in PTSD could be broken down into two aspects: anger-related accommodation and anxiety-related accommodation.Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction.

Enhanced production of trans-cinnamic acid in Photorhabdus luminescens with homolog expression and deletion strategies.

AIM: This study aimed to overproduce industrially relevant and safe bio-compound trans-cinnamic acid (tCA) from Photorhabdus luminescens with deletion strategies and homologous expression strategies that had not been applied before for tCA production. METHODS AND RESULTS: The overproduction of the industrially relevant compound tCA was successfully performed in P. luminescens by deleting stlB (TTO1ΔstlB) encoding a cinnamic acid CoA ligase in the isopropylstilbene pathway and the hcaE insertion (knockout) mutation (hcaE::cat) in the phenylpropionate catabolic pathway, responsible for tCA degradation. A double mutant of both stlB deletion and hcaE insertion mutation (TTO1DM ΔstlB-hcaE::cat) was also generated. These deletion strategies and the phenylalanine ammonium lyase-producing (PI-PAL from Photorhabdus luminescens) plasmid, pBAD30C, carrying stlA (homologous expression mutants) are utilized together in the same strain using different media, a variety of cultivation conditions, and efficient anion exchange resin (Amberlite IRA402) for enhanced tCA synthesis. At the end of the 120-h shake flask cultivation, the maximum tCA production was recorded as 1281 mg l-1 in the TTO1pBAD30C mutant cultivated in TB medium, with the IRA402 resin keeping 793 mg l-1 and the remaining 488 mg l-1 found in the supernatant. CONCLUSION: TCA production was successfully achieved with homologous expression, coupled with deletion and insertion strategies. 1281 mg l-1is the highest tCA concentration that achieved by bacterial tCA production in flask cultivation, according to our knowledge.

Comparison of myocardial perfusion study and invasive hemodynamic measurement of the significance of non-infarct-related residual stenoses in ST elevation myocardial infarction patients.

BACKGROUND: Nearly 50% of ST elevation myocardial infarction (STEMI) patients have multivessel coronary artery disease. The optimal selection of non-culprit lesions for complete revascularization is a matter of current debate. Little is known about the predictive value of myocardial perfusion study (MPS) in this scenario. METHODS: We enrolled 49 STEMI patients (61.5 ± 10.3 years) with at least one major non-culprit lesion (50-90%) other than left main coronary artery lesions. Overall 63 non-infarct- related artery (IRA) stenoses (65.2 ± 11.9%) were recommended for further evaluation using Fractional Flow Reserve (FFR) measurement as is standard in our institution. Prior to FFR, all patients were scheduled for non-invasive MPS using single-photon emission computed tomography (SPECT). Both FFR and MPS were performed 4-8 weeks after STEMI with MPS preceding FFR within no more than 48 hours. An FFR value of ≤0.80 was considered significant and guided the final revascularization strategy. The results of MPS were correlated to FFR as well as to the clinical and angiographic characteristics of both culprit and non-infarct-related lesions. RESULTS: Based on FFR, 30 out of 63 stenoses (47.6%) in 27 patients were considered hemodynamically significant (FFR 0.69 ± 0.08, range 0.51-0.79) compared to residual 33 stenoses considered negative (FFR 0.87 ± 0.04, range 0.81-0.96). The MPS revealed abnormal myocardium (23.6% average, range 5-56%) in 21 patients (42.8%). Among those patients, only 9 showed the evidence of ischemic myocardium (average 10.8%, range 4-18%) with low sensitivity of MPS in predicting positive FFR. Besides that, higher proportion of patients (71.4% vs. 42.9%, P=0.047) with overall lower FFR values (0.73 vs. 0.80, P=0.014, resp.) in non-IRAs as well as higher proportion of patients with more severely compromised flow in IRAs (P=0.048) during STEMI had MPS-detected abnormal myocardium. CONCLUSION: In STEMI patients with multivessel coronary artery disease, we observed rather weak correlation between MPS using SPECT and invasive hemodynamic measurement using FFR in ischemia detection.

Current management of familial adenomatous polyposis.

INTRODUCTION: APC-associated polyposis is a rare hereditary disorder characterized by the development of multiple adenomas in the digestive tract. Individuals with APC-associated polyposis need to be managed by specialized multidisciplinary teams in dedicated centers. AREAS COVERED: The study aimed to review the literature on Familial adenomatous polyposis (FAP) to provide an update on diagnostic and surgical management while focusing on strategies to minimize the risk of desmoid-type fibromatosis, cancer in anorectal remnant, and postoperative complications. FAP individuals require a comprehensive approach that includes diagnosis, surveillance, preventive surgery, and addressing specific extracolonic concerns such as duodenal and desmoid tumors. Management should be personalized considering all factors: genotype, phenotype, and personal needs. Total colectomy and ileo-rectal anastomosis have been shown to yield superior QoL results when compared to Restorative Procto colectomy and ileopouch-anal anastomosis with acceptable oncological risk of developing cancer in the rectal stump if patients rigorously adhere to lifelong endoscopic surveillance. Additionally, a low-inflammatory diet may prevent adenomas and cancer by modulating systemic and tissue inflammatory indices. EXPERT OPINION: FAP management requires a multidisciplinary and personalized approach. Integrating genetic advances, innovative surveillance techniques, and emerging therapeutic modalities will contribute to improving outcomes and quality of life for FAP individuals.

Infarct-related artery only revascularization versus multi-vessel revascularization for patients with Killip I-IV acute myocardial infarction and multivessel disease.

BACKGROUND: The optimal revascularization strategy for non-culprit vessels is still up for debate nowadays, particularly when it comes to individuals with different Killip classes. Therefore, the aim of our study was to investigate whether multivessel revascularization, as compared with infarct-related artery (IRA) alone revascularization, improves long-term prognosis in patients who have experienced an acute myocardial infarction (AMI) and have multivessel coronary artery disease (CAD). METHODS: A retrospective analysis was conducted on clinical data from 646 patients who presented with AMI and multivessel CAD at Beijing Chaoyang hospital between November 2014 and November 2020. Based on various revascularization strategies, patients were categorised into two groups: IRA-only revascularization (n = 416) and multivessel revascularization (n = 230). The primary endpoint was cardiovascular death. RESULTS: In the following 60.6 months (60.6 ± 23.9), the primary endpoint occurred in 3% of the multivessel revascularization group versus 9.6% in the IRA-only revascularization group (HR 0.284, CI 0.120-0.669, p = 0.002). For the Killip I-II patients (n = 533), the primary endpoint occurred in 2.6% of the multivessel revascularization group versus 9.5% in the IRA-only revascularization group (HR 0.236, CI 0.083-0.667, p = 0.003). For Killip III-IV patients (n = 113), there was no significance differences in the primary endpoint. After using the inverse probability weighted method, the benefit of complete revascularization was consistently observed. CONCLUSIONS: Multivessel revascularization significantly reduced the incidence of cardiovascular death for patients presenting with AMI and multivessel CAD, particularly for Killip I-II patients. There were no significant differences in the primary outcome across the groups of patients with Killip III-IV.

A New Approach of Complexing Polymers Used for the Removal of Cu2+ Ions.

This study presents two modified polymers for Cu2+ ion removal from aqueous media. Shredded maize stalk (MC) and a strong-base anionic resin (SAX) were modified with indigo carmine (IC) in order to obtain two different complexing polymers, i.e., IC-MC and SAX-IC. Initially, the complex reaction between IC and Cu2+ in the solution was studied. Additionally, the complex formation Cu2+-IC in liquid solutions was evaluated at different pH ranges of 1.5, 4.0, 6.0, 8.0, and 10.0, respectively. For Cu2+ ions, adsorption onto the IC-MC and IC-SAX batch experiments were conducted. The contact time for evaluating the optimum adsorption for Cu2+ ions on the complexing materials was established at 1 h. Efficient Cu2+ ion adsorption on the IC-MC and SAX-IC at pH = 10 was achieved. The adsorption of Cu2+ ions depends on the quantity of IC retained on MC and SAX. At 2.63 mg IC/g MC(S4) and 22 mg IC/g SAX(SR2), a high amount of Cu2+ ion adsorption was reported. The highest adsorption capacity (Qe) of IC-MC was obtained at 0.73 mg/g, and for IC-SAX, it was attained at 10.8 mg/g. Reusability experiments were performed using the HCl (0.5 M) solution. High regeneration and reusability studies of IC-MC and IC-SAX were confirmed, suggesting that they can be used many times to remove Cu2+ ions from aqueous matrices. Therefore, the development of complexing materials could be suitable for Cu2+ ion removal from wastewater.

[Non-invasive ventilation in acute respiratory failure of oncology-hematology patients: What are its current benefits and limitations?] / Ventilation non invasive dans l'insuffisance respiratoire aiguë des patients d'onco-hématologie : quelle place en 2023 ?

Acute respiratory failure (ARF) is a leading cause, along with sepsis, of admission to the intensive care unit (ICU) of patients with active cancer. Presenting variable clinical severity, ARF in onco-hematological patients has differing etiologies, primarily represented by possibly opportunistic acute infectious pneumonia (de novo hypoxemic ARF), and decompensation in chronic cardiac or respiratory diseases (e.g., acute pulmonary edema or exacerbated chronic obstructive pulmonary disease). In these patients, orotracheal intubation is associated with a doubled risk of in-hospital mortality. Consequently, over the last three decades, numerous researchers have attempted to demonstrate and pinpoint the precise role of non-invasive ventilation (NIV) in the specific context of ARF in onco-hematological patients. While the benefits of NIV in the management of acute pulmonary edema or alveolar hypoventilation (hypercapnic ARF) are well-demonstrated, its positioning in de novo hypoxemic ARF is debatable, and has recently been called into question. In the early 2000s, based on randomized controlled trials, NIV was recommended as first-line treatment, one reason being that it allowed significantly reduced use of orotracheal intubation. In the latest randomized studies, however, the benefits of NIV in terms of survival orotracheal intubation have not been observed; as a result, it is no longer recommended in the management of de novo hypoxemic ARF in onco-haematological patients.

Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD.

Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.

Exposure and cognitive restructuring treatment in Arabic-speaking individuals with PTSD yield significant changes in shame, self-blame, fear, anger, and alienation.Changes in PTSD symptoms are positively associated with changes in specific trauma appraisals.There is no evidence of differences between both treatments for any specific trauma appraisal.

Perioperative outcomes of ileorectal anastomosis - an analysis of 823 patients.

AIM: Ileorectal anastomosis (IRA) following total abdominal colectomy (TAC) allows for resortation of bowel continuity but prior studies have reported rates of anastomotic leak (AL) to be as high as 23%. We aimed to report rates of AL and complications in a large cohort of patients undergoing IRA. We hypothesized that AL rates were lower than previously reported and that selective use of diverting loop ileostomy (DLI) is associated with decreased AL rates. METHOD: Patients undergoing TAC or end-ileostomy reversal with IRA, with or without DLI, between 1980 and 2021 were identified from a prospectively maintained institutional database and retrospectively analysed. Redo IRA cases were excluded. Short-term (30-day) surgical outcomes were collected using our database. AL was defined using a combination of imaging and, in the case of return to the operating room, intraoperative findings. RESULTS: Of 823 patients in the study cohort, DLI was performed in 27% and performed more frequently for constipation and inflammatory bowel disease. The overall AL rate was 3% (1% and 4% in those with and without DLI, respectively) and diversion was found to be protective against leak (OR 0.28, 95% CI 0.08-0.94, p = 0.04). However, patients undergoing diversion had a higher overall rate of postoperative complications (51% vs. 36%, p < 0.001) including superficial wound infection, urinary tract infection, dehydration, blood transfusion and portomesenteric venous thrombosis (all p < 0.04). CONCLUSION: Our study represents the largest series of patients undergoing IRA reported to date and demonstrates an AL rate of 3%. While IRA appears to be a viable surgical option for diverse indications, our study underscores the importance of careful patient selection and thoughtful consideration of staging the anastomosis and temporary faecal diversion when necessary.

Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis.

OBJECTIVE: To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock. DESIGN: Retrospective cohort study. SETTING: Two intensive care units in Argentina. PATIENTS: Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24h of the AKI diagnosis. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis. RESULTS: 80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC=0.52, p=0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60-0.83; p=0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57-0.80; p=0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%. CONCLUSIONS: urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.

Perceived friendships protect against the development of anger following childhood adversities in UK military veteran men residing in Northern Ireland.

Background: Experience of childhood adversity is associated with greater anger as an adult, particularly in men. Soldiers and veterans report higher incidence of adverse childhood experiences, many of whom also experience elevated rates of PTSD and anger. However, little is known about factors which may protect against the development of anger after experiencing childhood adversity.Objective: This study aims to assess the potential protective aspects of perceived social support in military veterans.Methods: Data from the Northern Ireland Veterans' Health and Wellbeing Study (N = 590, Mage = 56) was utilised in regression models to examine perceived social support (family, friend, partner; MSPSS) as a moderator of the association between adverse childhood experiences (ACEQ-10) and anger (DAR-7). This sample comprised men who were UK Armed Forces veterans residing in Northern Ireland.Results: Significant interaction effects, visualised using interaction plots, were found between perceived friend support and both child abuse and household challenge. When men perceived high friend support, there was no association between child abuse or household challenge and anger. For veteran men who perceived the maximum amount of partner support, there was no association between child abuse and anger. Family support did not change the positive association between child abuse, child neglect or household challenge and future anger.Conclusions: This study indicates that it is especially important to foster supportive and empathetic friendships for men that have experienced adversity as a child, perhaps through programmes such as Men's Sheds, as these friendships may alleviate the negative influences of child abuse and household challenge on anger.

Perceived friend and partner support were protective factors against the development of anger for veterans that experienced child abuse or household challenge.Child neglect had the strongest association with adult anger, unchanged by any type of perceived support.Programmes which foster friendships may be particularly beneficial for veterans transitioning out of the military.

Assessing and predicting the trend of cardiovascular risk factors in 40-80-year population based on the Ira-PEN program as an integrated service in primary health care.

BACKGROUND: In Iran, half of all mortalities and 79% of those induced by noncommunicable diseases are attributed to cardiovascular diseases. In Iran, due to the high rate of noncommunicable diseases, a modified program (PEN) called Ira-PEN was integrated into the primary care program in health centers. The Ira-PEN program is adapted from the comprehensive WHO-PEN program to estimate the 10-year risk of cardiovascular diseases to control the main risk factors of noncommunicable diseases nationally. This study was conducted to investigate the process of service provision to determine the information needs and the necessary interventions in the comprehensive health service centers of Ardabil Province. MATERIALS AND METHODS: The present descriptive and analytical study was conducted in the Ardabil University of Medical Sciences. It used the data available in the registration system of the Health Network. The research population consisted of all people aged between 40 and 80 who visited the comprehensive health service centers to perform risk assessment of cardiovascular strokes in the province from 2018 to the end of 2021. The collected data were added to Excel. FORCAST function was used to predict the future through a linear regression analysis. To compare the final results, which is actually a reduction in mortality due to cardiovascular diseases, the difference test of two mortality rates due to cardiovascular diseases was used in 2018 and 2021. Test of two death proportions was performed through z test and Minitab21 Software. RESULTS: The prevalence of cardiovascular disease risk factors was as follows: history of heart attack (0.59%), history of stroke (0.51%), history of diabetes (7.9%), history of high blood pressure (15.7%), and history of prediabetics (12.8%). The probability of suffering from lipid disorder was 26.4% and BMI > 30 was 32.4%. The risk factors of hypertension, abdominal obesity, and smoking showed a decrease in the measurement of disease risk factors during 4 years. CONCLUSIONS: Identification of the common risk factors in the region helps to focus interventions on effective prevention and treatment measures and adopt evidence-based policies in order to reduce these risk factors. Since the investigated risk factors are rooted in inappropriate behaviors and lifestyles, by modifying these behaviors and changing lifestyles, their prevalence can be reduced and reducing these risk factors will lead to a reduction in the prevalence of cardiovascular diseases.

Trans-eQTL hotspots shape complex traits by modulating cellular states.

Regulatory genetic variation shapes gene expression, providing an important mechanism connecting DNA variation and complex traits. The causal relationships between gene expression and complex traits remain poorly understood. Here, we integrated transcriptomes and 46 genetically complex growth traits in a large cross between two strains of the yeast Saccharomyces cerevisiae. We discovered thousands of genetic correlations between gene expression and growth, suggesting functional connections. Local regulatory variation was a minor source of these genetic correlations. Instead, genetic correlations tended to arise from multiple independent trans-acting regulatory loci. Trans-acting hotspots that affect the expression of numerous genes accounted for particularly large fractions of genetic growth variation and of genetic correlations between gene expression and growth. Genes with genetic correlations were enriched for similar biological processes across traits, but with heterogeneous direction of effect. Our results reveal how trans-acting regulatory hotspots shape complex traits by altering cellular states.

Dietary Supplementation of Mixed Organic Acids Improves Growth Performance, Immunity, and Antioxidant Capacity and Maintains the Intestinal Barrier of Ira Rabbits.

The aim of this study was to investigate the effects of mixed organic acids (MOAs) on growth performance, immunity, antioxidants, intestinal digestion, and barrier function in Ira rabbits. A total of 192 weaned male Ira rabbits at 35 days of age were randomly assigned to four groups with six replicates of eight rabbits each. The rabbits in the control group (CON) were fed a basal diet, and the antibiotic group (SAL) was fed a basal diet supplemented with 60 mg/kg salinomycin. The test groups were fed a basal diet supplemented with 1000 mg/kg and 2000 mg/kg MOAs (MOA1 and MOA2, respectively). The experiment lasted for 55 days. The results showed that the ADG of Ira rabbits in the SAL group and MOA1 group was higher than that in the CON group (p < 0.05). The serum IL-6 and liver MDA levels of Ira rabbits in the SAL group, MOA1 group, and MOA2 group were lower than those in the CON group (p < 0.05). In addition, sIgA levels in the jejunal mucosa of Ira rabbits in the SAL group and MOA1 group were increased compared with those in the CON group (p < 0.05). Compared with the CON group, the gene expression of IL-6 was decreased (p < 0.05) in the jejunal mucosa of Ira rabbits in the SAL, MOA1, and MOA2 groups, while the gene expression of IL-1ß tended to decrease (p = 0.077) and the IL-10 content tended to increase (p = 0.062). Moreover, the gene expression of ZO-1 in the jejunal mucosa of Ira rabbits was elevated in the MOA1 group compared with the CON group (p < 0.05). In conclusion, dietary supplementation with MOAs can improve growth performance, enhance immune function and antioxidant capacity, and maintain the intestinal barrier in weaned Ira rabbits.

Deciphering the regulatory mechanisms of the cAMP/protein kinase A pathway and their roles in the pathogenicity of Candida auris.

The emergence of multidrug-resistant fungal pathogens is a significant concern for global public health. Candida auris poses a considerable threat as a multidrug-resistant fungal pathogen. Our recent study revealed that the adenylyl cyclase Cyr1 and protein kinase A (PKA) pathways play distinct and redundant roles in drug resistance and pathogenicity of C. auris. However, the upstream and negative feedback regulatory mechanisms of C. auris are not yet fully understood. In this study, we discovered that the small GTPase Ras1, along with its nucleotide exchange factor Cdc25 and GTPase-activating protein Ira2, plays a major role in regulating cAMP/PKA-dependent traits, while G-protein-coupled receptor Gpr1 and heterotrimeric G-protein α subunit Gpa2 play a minor role. Pde2 plays a major role in negative feedback regulation of the cAMP/PKA pathway, while Pde1 plays a minor role. Hyperactivation of the Ras/cAMP/PKA pathway by deleting PDE2 or BCY1 renders C. auris cells thermosensitive and susceptible to nutrient deficiency, which leads to attenuated virulence. Our study demonstrates the distinct contributions of hyperactivation of the Ras/cAMP/PKA signaling pathway to C. auris pathogenesis and suggests potential therapeutic targets for C. auris-mediated candidiasis. IMPORTANCE Candida auris is a major concern as a multidrug-resistant fungal pathogen. While our previous studies highlighted the crucial roles of the cAMP/protein kinase A (PKA) pathway in regulating drug resistance, stress responses, morphogenesis, ploidy change, biofilm formation, and pathogenicity in this pathogen, their regulatory mechanism remains unclear. In our study, we provided evidence that the cAMP/PKA signaling pathway in C. auris is primarily governed by the small GTPase RAS rather than a G-protein-coupled receptor. Additionally, we discovered that the negative feedback regulation of cAMP, controlled by phosphodiesterases, is vital for C. auris virulence by promoting resistance to high temperatures and nutrient deficiencies. These findings underscore the diverse pathobiological significance of the Ras/cAMP/PKA signaling pathway in C. auris, shedding light on potential therapeutic targets and strategies for combating this multidrug-resistant fungal pathogen.

Impacts of the Inflation Reduction Act on the Economics of Clean Hydrogen and Synthetic Liquid Fuels.

The Inflation Reduction Act (IRA) in the United States provides unprecedented incentives for deploying low-carbon hydrogen and liquid fuels, among other low-greenhouse gas (GHG) emissions technologies. To better understand the prospective competitiveness of low-carbon or negative-carbon hydrogen and liquid fuels under the IRA in the early 2030s, we examined the impacts of the IRA provisions on the costs of producing hydrogen and synthetic liquid fuel made from natural gas, electricity, short-cycle biomass (agricultural residues), and corn-derived ethanol. We determined that, with IRA credits (45V or 45Q) but excluding the incentives provided by other national or state policies, hydrogen produced by electrolysis using carbon-free electricity (green H2) and by natural gas reforming with carbon capture and storage (CCS) (blue H2) is cost-competitive with the carbon-intensive benchmark gray H2, which is produced by steam methane reforming. Biomass-derived H2 with or without CCS is not cost-competitive under the current IRA provisions. However, if the IRA allowed biomass gasification with CCS to claim a 45V credit for carbon-neutral H2 and a 45Q credit for negative biogenic CO2 emissions, this pathway would be less costly than gray H2. The IRA credit for clean fuels (45Z), currently stipulated to end in 2027, would need to be extended or similar policy support would need to be provided by other national or state policies in order for clean synthetic liquid fuel to be cost-competitive with petroleum-derived liquid fuels. The levelized IRA subsidies per unit of CO2 mitigated for all of the hydrogen and synthetic liquid fuel production pathways, except for electricity-derived synthetic liquid fuel, range from $65-$384/t of CO2. These values are within or below the range of the U.S. federal government's estimates of the social cost of carbon (SCC) in the 2030-2040 time frame.