Elevated concentrations of soil carbon dioxide with partial root-zone drying enhance drought tolerance and agro-physiological characteristics by regulating the expression of genes related to aquaporin and stress response in cucumber plants.

Water scarcity and soil carbon dioxide elevation in arid regions are considered the most serious factors affecting crop growth and productivity. This study aimed to investigate the impacts of elevated CO2 levels (eCO2 at rates of 700 and 1000 ppm) on agro-physiological attributes to induce drought tolerance in cucumbers by activating the expression of genes related to aquaporin and stress response, which improved the yield of cucumber under two levels of irrigation water conditions [75% and 100% crop evapotranspiration (ETc)]. Therefore, two field experiments were conducted in a greenhouse with controlled internal climate conditions, at the Mohamed Naguib sector of the national company for protected agriculture, during the winter seasons of 2021-2022 and 2022-2023. The treatments included eCO2 in soil under normal and partial root zoon drying (PRD, 100% ETc Full irrigations, and 75% ETc). All the applied treatments were organized as a randomized complete block design (RCBD) and each treatment was replicated six times. Untreated plants were designed as control treatment (CO2 concentration was 400 ppm). The results of this study showed that elevating CO2 at 700 and 1000 ppm in soil significantly increased plant growth parameters, photosynthesis measurements, and phytohormones [indole acetic acid (IAA) and gibberellic acid (GA3)], under partial root-zone drying (75% ETc) and full irrigation conditions (100% ETc). Under PRD condition, eCO2 at 700 ppm significantly improved plant height (13.68%), number of shoots (19.88%), Leaf greenness index (SPAD value, 16.60%), root length (24.88%), fresh weight (64.77%) and dry weight (61.25%) of cucumber plant, when compared to untreated plants. The pervious treatment also increased photosynthesis rate, stomatal conductance, and intercellular CO2 concentration by 50.65%, 15.30% and 12.18%; respectively, compared to the control treatment. Similar findings were observed in nutrient concentration, carbohydrate content, Proline, total antioxidants in the leaf, and nutrients. In contrast, eCO2 at 700 ppm in the soil reduced the values of transpiration rate (6.33%) and Abscisic acid (ABA, 34.03%) content in cucumber leaves compared to untreated plants under both water levels. Furthermore, the results revealed that the gene transcript levels of the aquaporin-related genes (CsPIP1-2 and CsTIP4) significantly increased compared with a well-watered condition. The transcript levels of CsPIP improved the contribution rate of cell water transportation (intermediated by aquaporin's genes) and root or leaf hydraulic conductivity. The quantitative real-time PCR expression results revealed the upregulation of CsAGO1 stress-response genes in plants exposed to 700 ppm CO2. In conclusion, elevating CO2 at 700 ppm in the soil might be a promising technique to enhance the growth and productivity of cucumber plants in addition to alleviating the adverse effects of drought stresses.

Impact of donor expanded criteria kidney transplantation on clinical outcomes and survival: A single-center experience.

INTRODUCTION: The scarcity of suitable donor organs has led to the inclusion of Expanded Criteria Donor (ECD) kidneys to augment the donor pool, despite potential concerns regarding post-transplant outcomes. METHODS: This retrospective study analyzed the clinical outcomes of a cohort of 317 kidney transplant recipients from deceased donors at a single center between 2008 and 2018. Patients were categorized into ECD and Standard Criteria Donor (SCD) groups, with primary nonfunctioning grafts excluded. Comprehensive laboratory evaluations were conducted, including HLA typing and serum creatinine levels. Immunosuppressive regimens were standardized, and statistical analyses were performed using the SPSS program. RESULTS: The sample consisted of 83 (26.18%) patients who received kidney transplants from ECDs and 234 (73.82%) from SCDs. The ECD group showed a longer cold ischemia time (p = 0.019) and a higher rate of delayed graft function (DGF) compared with the SCD group. No significant differences were observed in graft survival (p = 0.370) or patient survival (p = 0.993) between the ECD and SCD groups. However, differences in graft survival were noted between the groups when stratified by DGF status: ECD with DGF vs. ECD without DGF (p = 0.029), ECD with DGF vs. SCD with DGF (p = 0.188), ECD with DGF vs. SCD without DGF (p = 0.022), ECD without DGF vs. SCD with DGF (p = 0.014), ECD without DGF vs. SCD without DGF (p = 0.340), and SCD with DGF vs. SCD without DGF (p = 0.195). No differences in patient survival rates were observed among these groups for all pairwise comparisons (p > 0.05) when stratified by donor criteria and DGF status. CONCLUSIONS: Graft and patient survival rates were comparable between ECD and SCD kidney transplant recipients.

Factors Influencing Drug Shortages and Their Resolution in South Korean Community Pharmacies.

Purpose: Drug shortages directly affect the final stage in the pharmaceutical supply chain, prescription fulfillment in community pharmacies (CPs). This study investigated the current state of drug shortages, their resolution, and influencing factors within CPs. Methods: A cross-sectional online survey was conducted among pharmacists working at pharmacies in Seoul between 7 and 31 October 2022. The survey gathered data on pharmacies and pharmacists' characteristics, drug distribution, information, communication, and administrative practices. Logistic regression was used to identify the factors influencing these rates. Regression results are presented as odds ratios (OR) and 95% confidence intervals (CIs). Results: Of the 1200 pharmacists approached, 713 participated, yielding a response rate of 59.4%. After excluding incomplete responses, data from 671 respondents were analyzed. Pharmacies with higher prescription drug sales demonstrated a lower OR for drug shortages (OR=0.66, 95% CI=0.60-0.72) compared to those with lower sales volumes. Resolution rates were significantly higher when pharmacies were located near clinics (OR=3.30, 95% CI=2.3-4.74) and general hospitals (OR=3.45, 95% CI=2.35-5.07) compared to those without nearby medical facilities. Additionally, good communication with prescribers increased the resolution rates (OR=1.46, 95% CI=1.26-1.69). Conclusion: This study examines the influence of pharmacy purchasing power on drug shortages, identifying proximity to healthcare facilities and communication with prescribers as factors affecting the resolution rates. These findings provide valuable insights for pharmacists, policymakers, and future researchers to optimize drug supply chain management and mitigate shortages in community settings.

Whether medicine supply is really meeting primary health care needs: a mixed-methods study in Shandong Province, China.

BACKGROUND: With the aging population, the increasing prevalence of chronic non-communicable diseases, and the diversified needs for primary health care (PHC) medicines, it is necessary to rethink the functional role of the supply of PHC medicines. This study aims to evaluate the supply of PHC medicines and the status of meeting PHC medicine needs. METHODS: The mixed-methods study was conducted to evaluate the supply of PHC medicines in Shandong Province. In the quantitative study, survey questionnaires were distributed to county hospitals, township hospitals, and patients, and a prescription review was performed in township hospitals. In the qualitative study, semi-structured interviews were conducted with the pharmacy managers, physicians, and patients in county hospitals, township hospitals, and village clinics. A senior pharmacist from a tertiary hospital who has rich experience on the indications for medicine use, accompanied us on a visit to inspect the PHC pharmacies to survey medicine equipment with a professional perspective. RESULTS: Quantitative analysis revealed that 211 county hospitals and 1,581 township hospitals participated in the survey, revealing the median annual frequency of medicine shortages of 5.0 times for county hospitals and 2.0 times for township hospitals. Of the 6,323 patient medication surveys, after excluding 152 patients not involved in medication use, 945 (15.3%) indicated medicine shortages, with half of these attributable to institutions lacking required medicines (52.8%). On average, the prescription qualified rate of 37 township hospitals was 72.2%. Four final themes emerged during the qualitative data analysis: (1) Supply of PHC medicines; (2) Solutions to the shortage of off-list medicines; (3) Appropriateness of PHC medicines list; (4) Pharmacist workforce development and pharmacy services. CONCLUSIONS: The discrepancy between patients' need for PHC medicine and present medicine supply is noteworthy. It is suggested that governments should optimize the existing lists to adequately meet patient medicine needs and prioritize medicines for chronic diseases, which is also particularly important for developing countries. Integrated health care may be a novel strategy to establish unified medicines list and achieve uniform pharmaceutical services in PHC.

What preferences do potential obstetrics-gynecology specialists have regarding their working environment? Results of a questionnaire survey of participants in the Summer School 2023 of the Japanese Society of Obstetrics and Gynecology.

AIM: The chronic lack of obstetrics-gynecology (Ob/Gyn) doctors is a serious problem to be tackled in Japan. To address this issue, it is necessary for medical students to be interested in working as an Ob/Gyn doctor and more junior residents need to specialize in Ob/Gyn. This study aims to identify the preferences concerning working conditions among students and discusses what information should be provided and what conditions should be changed. METHODS: A questionnaire survey was conducted among participants in the Summer School 2023 of the Japanese Society of Obstetrics and Gynecology. The respondents were medical students and junior residents interested in Ob/Gyn. Ob/Gyn specialists contributing to the summer school were also asked the same questions for comparison. The resulting data focused on important working conditions, concerns about future work, and expected future working conditions. RESULTS: Responses from 132 medical students (97.8%, N = 135), 122 residents (99.2%, N = 123), and 76 specialists (95.0%, N = 80) were obtained. There were three main findings. First, large gaps between students/residents and specialists were observed in terms of preferences. Second, differences between male and female students/residents were not negligible, although the difference was relatively small in specialists. Third, students/residents were more concerned about risks related to medical malpractice than specialists. CONCLUSIONS: Gaps in preferences and perceptions regarding working conditions between students/residents and specialists should be narrowed through sufficient information provision. Working conditions should become gender-inclusive rather than focus on female persons.

State Policy Strategies for the Workforce Emergency in Behavioral Health.

The United States is experiencing a behavioral health workforce emergency of unparalleled magnitude. After decades of inaction, selected states have launched significant efforts to strengthen the mental health and substance use disorder workforce. Seven state policy strategies in frequent use for addressing the current emergency are described, with examples for each. Links to more than 140 additional examples are also provided. States can draw on these strategies as they consider actions to strengthen their behavioral health workforce. There is a compelling need to act quickly while executive and legislative branches have a strong interest in solving this problem and federal support to the states is abundant.

Benzathine Penicillin G Shortage and Secondary Syphilis.

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. This disease is characterized by four different stages, each presenting with a variety of manifestations or asymptomatic disease. These stages can be further broken down into early-stage syphilis, which includes primary and secondary syphilis, and late-stage syphilis, which includes tertiary syphilis. It is crucial to recognize and treat syphilis early because the later stages of the disease are marked by irreversible damage to the central nervous system (CNS) and cardiovascular system, and can even increase mortality risk. The primary recommended treatment for early-stage syphilis is intramuscular (IM) benzathine penicillin G (BPG). In this case report, we present a patient with secondary syphilis who exhibited red papules and nonspecific skin eruptions. Due to the unavailability of BPG, the patient initially received doxycycline as an alternative treatment. After eight days of searching multiple facilities and pharmacies, a dose of BPG was finally located and administered to the patient. We highlight crucial information about the BPG shortage, including supply and demand challenges, infrastructure issues, and the broader impact on numerous other antimicrobials. We emphasize the importance of recognizing this issue and provide alternatives for managing the disease in resource-limited settings.

The growth and development of a novel distance accelerated bachelor of science in nursing program.

Severe nursing shortages threaten the sustainability of US health systems. Rural and underserved communities are disproportionately affected by staffing crises and associated facility closures, as well as health disparities. A major factor contributing to geographic gaps in care is the absence of nursing schools, nursing faculty, and locations for clinical rotations in many rural and underserved areas. Emory School of Nursing is helping to solve for these issues through the Distance Accelerated Bachelor of Science in Nursing (DABSN) program. The DABSN is establishing accelerated pipelines of nursing students into practice in locations where nursing education has historically been difficult or impossible to access. This innovative nursing education model allows students to enroll in a top-ranked nursing school while remaining in their home communities. Students complete synchronous didactic coursework with peers in every US time zone while performing clinical rotations in local healthcare facilities. This paper details the growth and development of the DABSN. It describes the challenges and opportunities we have navigated in implementing the program, along with information about its pedagogy, clinical placement practices, and student/faculty characteristics. We share program outcomes and conclude with recommendations for the future.

Collaborative nursing education between advanced practice registered nurses.

The surge in healthcare demands due to the explosion of growth in the aging adult population demands that academic institutions address enhanced education of Advanced Practice Registered Nurses (APRNs). This is particularly challenging amidst nurse faculty shortages in specialty areas, stemming from factors such as lack of pay competitiveness with clinical positions, and doctoral-prepared nurses seeking faculty positions. Despite efforts to address the shortages, recruitment challenges persist, necessitating innovative approaches. This article explores the interprofessional collaborative teaching between Nurse Anesthesia (NA) and Adult Gerontology Nurse Practitioner (NP) programs, focusing on airway management, sedation techniques, chest X-ray interpretation, and ultrasound skills. To date, this collaboration between NA and NP faculty has proven effective. Both synchronous and online asynchronous teaching have received overwhelmingly positive student feedback. Ongoing communication and collaborations between NA and NP faculty facilitate teaching and educational strategies across programs, sharing faculty expertise, and mitigating reduced faculty numbers. This innovative model benefits faculty and students and provides a platform for firsthand interprofessional collaboration, fostering mutual respect and preparing students for effective interdisciplinary healthcare teamwork.

Leased clinical faculty model: Bridging gaps in nursing education.

In response to the critical Registered Nursing (RN) shortage, John Carroll University, a not-for-profit, private, faith-based university in the Midwest, has developed an academic-practice partnership to bolster its new Bachelor of Science in Nursing (BSN) program. This initiative addresses the challenge of limited clinical faculty. Central to this strategy is a "leased employee agreement" with healthcare partners, which allows the university to employ practicing RNs as part-time clinical instructors. Formulated in collaboration with healthcare Chief Nurse Executives (CNEs), this model enables the seamless integration of hospital-employed RNs into the academic framework as clinical faculty. This model streamlines the onboarding process and enriches student learning experiences by leveraging the practical expertise of active nurses. Initial feedback following its launch in August 2023 has been positive, with students and clinical faculty reporting high levels of satisfaction and quality educational experiences. This approach presents a viable strategy to mitigate faculty shortages in nursing education and underscores the importance of inventive academic-practice partnerships in adapting to the dynamic demands of healthcare training.

Prescription for crisis: the compounding effect of community drug shortages on Lebanon's healthcare system.

The multifaceted crises that Lebanon is facing have led to a shortage of medications in the country's community pharmacies. This shortage has triggered a cascade of adverse effects, rippling throughout the nation's healthcare system. In this report, we examine the causes, which range from economic turmoil to inadequate resource distribution, along with the profound impacts on public health, such as increased length of hospital stays and compromised patient care. The paper also proposes a suite of solutions aimed at mitigating the immediate challenges and paving the way for a more resilient healthcare framework.

A new business paradigm to make coronary CT angiography (CCTA) accessible to all.

Recently, the Centers for Medicare and Medicaid proposed a classification change that, if enacted, could double reimbursement for coronary CT angiography (CCTA) in the U.S. [1]. With this comes the potential to realistically build an economically viable and sustainable model to deliver cardiac CT outside of major urban (hospital and private practice) and academic centers. The value of CCTA in reducing cardiovascular morbidity and mortality has been demonstrated in large, randomized control trials and real-world studies, but access to CCTA in rural, socially deprived, and low-resource settings (including poorer urban areas with a lack of specialist equipment and specialty-based services) remains a significant challenge. This paper discusses the end-to-end business aspects required to deliver a sustainable cardiac CT service in these areas, exploring technologist-delivered services, with remote support from physicians, and the potential to leverage developing artificial intelligence (AI) decision aid tools and mobile scanners.

[Surgeon well-being and mindfulness-A narrative review on how come, for what reason, why in times of surgeon shortage]. / "Surgeon well-being" und "mindfulness" ­ ein narratives Review zum Wieso, Weshalb, Warum in Zeiten des Chirurg:innenmangels.

In the Anglo-American world the field of surgeon well-being is already very prominent, while in Germany it is still underrepresented. In this article, we aim to analyze the challenges and factors that affect the well-being of surgeons, including stress, burnout, workload, job satisfaction, autonomy, leadership, teamwork and work-life integration. Additionally, we discuss the connection between surgeon well-being and the shortage of new talent in surgery, which is currently being exacerbated by increasing treatment and physician demands, the age development of specialists and an overall high turnover. Finally, we propose several solutions that can be implemented at individual, institutional and systemic levels to promote and maintain the well-being of surgeons. These include improving working conditions, providing resources and support, promoting resilience and mindfulness and recognizing and appreciating achievements.

The Role of Negative Age Stereotypes and Sociodemographic Factors in the Intention to Leave Among German University Hospital Nursing Staff.

Staff shortages are a global problem in the nursing profession. Negative beliefs about older workers may have detrimental effects on the development and performance capacity of an aging workforce. To date, little is known about the impact of age stereotypes and potential factors on nurses' intent to leave (ITL). Therefore, the aim of our study was to assess intention to leave and potential predictors (eg, sociodemographic characteristics and age stereotypes) in a large representative sample of nurses in a German university hospital setting. A total of 423 nurses at the University Hospital of Heidelberg participated in a cross-sectional questionnaire study assessing sociodemographic data, age stereotypes using the "Beliefs About Older Workers" questionnaire, and participants' intentions to leave and give up their profession. Questionnaires were returned by 423 nurses (13.7% response rate). The results revealed that negative age stereotypes were highly prevalent. Significant correlations between age and negative age stereotypes were found, indicating that the younger the nurses were, the more negative their age stereotypes were. Most nurses with negative age stereotypes had no intention to leave their profession; however, the majority of nurses could not imagine working in the profession until they retired. Despite the low response rate, the results of the current study suggest that organizational and societal measures to reduce age stereotypes should be directed at newcomers and young nurses to retain them in the profession in the long term.

Consensus document on the implications of standardization of BCG supply in the management of patients with non-muscle-invasive bladder cancer.

Patients with non-muscle-invasive bladder cancer (NMIBC) in the intermediate and high-risk groups must receive adjuvant treatment with intravesical Bacillus Calmette-Guérin (BCG) following transurethral resection (TUR), as it reduces the risk of recurrence and presumably the risk of progression as well. Optimization of BCG efficacy is achieved by administering maintenance therapy. However, since many immunological aspects of the mechanism of action of BCG in the bladder remain unknown, the implementation of the optimal dose, number of instillations, strains and adequate maintenance regimen over the last decades has been heterogeneous. Additionally, this has hindered the interpretation of efficacy in terms of oncologic outcomes. This, together with the shortages of BCG in recent years, have forced scientific societies to adapt their clinical practice guidelines and modify their protocols of adjuvant treatment with BCG. This includes changes to strains, doses, and maintenance during this period of time. This consensus document evaluates the current status of adjuvant BCG treatment and the implications of BCG supply availability in the treatment of patients with NMIBC. It also addresses the implementation of novel therapies that will improve cancer prognosis and the quality of life of patients with NMIBC in the future.

"Figure it out or starve": The Impact of an Infant-Formula Shortage on Prenatal Infant Feeding Intentions.

OBJECTIVES: Beginning in February 2022, the United States faced an infant formula shortage that severely impacted access and affordability. Little is known about how this shortage impacted infant feeding intentions among expectant mothers. Our study sought to determine the impact of the formula shortage on prenatal feeding intentions and to understand expectant mothers' feelings and perceived stress related to the shortage. METHODS: This cross-sectional, exploratory, observational study of pregnant women (n = 57) residing in New York City utilized a self-administered online survey in May-July 2022. RESULTS: The results indicate that ten (17.5%) respondents changed their feeding intentions during the infant formula shortage for months 0-3 or 3-6 of infancy to include more breastfeeding than originally intended. These mothers also reported significantly higher stress levels related to the shortage than their non-changing peers. CONCLUSIONS FOR PRACTICE: Our results suggest that the formula shortage influenced feeding intentions among a subset of surveyed expectant mothers. The stress associated with the shortage influenced prenatal feeding intentions to include more breastfeeding than intended prior to the shortage. Prenatal healthcare providers should consider the availability of infant formula as one of myriad factors that influence infant feeding intentions, and that the stress associated with whether infant formula is readily available may influence these intentions as well.

Training a rural oral health workforce: Effects of rural background on dentist practice choice.

PURPOSE: The Regional Initiatives in Dental Education (RIDE) program is an educational track of the University of Washington School of Dentistry that aims to produce leaders who practice in rural areas of the Pacific Northwest. This study assesses outcomes of the first 10 years of the RIDE program. The hypothesis tested is that rural background is the most important predictor of long-term rural dental practice. METHODS: This descriptive study assessed existing data including graduates' location of practice, demographics, rurality of origin, parental occupation, and practice type over time. Subjects are all graduates of the RIDE program from 2012 to 2021 (N = 80), and range in age from 25 to 50 years. Statistical analyses were utilized to explore associations. RESULTS: Within the study sample 78% of graduates practiced in a rural and/or underserved area, 32.5% of graduates pursued post-graduate dental training, 40% participated in Medicaid, and 78% practiced in the Pacific Northwest at the time of analysis (March 2023). Statistical analysis demonstrated a strong association and medium to large effect sizes between both rural upbringing and training sites and established dental practice in a rural region. CONCLUSIONS: Graduates of the RIDE program practice in rural areas in greater proportion compared to the general population of practicing dentists. RIDE graduates from the study period tended to be male, and white, and practice in a health professional shortage area or rural site. The rurality of origin analysis was confounded by the substantial number of graduates from Spokane, Washington, an urban area surrounded by extensive rural territory.

Using an Academic-Practice Partnership to Address the Perioperative Nursing Shortage.

The nursing shortage continues to affect perioperative nursing negatively. Multiple factors, including a lack of exposure to the perioperative nursing specialty during baccalaureate nursing programs, influence the number of applicants for open perioperative positions. In 2018, we formed a collaborative academic-practice partnership to address this critical gap at our facility. We created an interactive learning program that included a scenario in a fully equipped OR simulation suite to provide nursing students with exposure to the perioperative setting. Students who participated in the experience reported that they appreciated exposure to an OR environment and engaging with perioperative personnel. Additionally, there was an increase in the number of nurse externship applications and students who were interested in completing their capstone experience in perioperative settings at our health care system. These positive outcomes illustrate that an effective collaboration between academic and clinical practice leaders can increase nursing students' interest in perioperative nursing.

Blood Bonds: Transforming Blood Donation Through Innovation, Inclusion, and Engagement.

The journey of receiving blood as a patient with transfusion-dependent beta thalassemia has profoundly shaped my understanding of the life-saving power of blood donation. This personal experience underscores the critical importance of blood donors, not just for individual recipients but for the broader community, enhancing public health, productivity, and well-being. There are several challenges to securing a blood donor pool in current health care climate. Solutions that focus on the engagement of donors, clinicians, and patients are key to improving the donor pool and utilizing the blood supply in a judicious manner.

Community Health Workers as Mental Health Paraprofessionals: Protocol for a Mixed-Methods Pilot Feasibility Study.

BACKGROUND: Community health workers (CHWs) are effective in delivering behavioral activation (BA), especially in low-resource settings. In an area with a lack of Spanish-speaking mental health counselors, such as southwest Montana, CHWs can provide needed care. OBJECTIVE: The goal of this pilot study protocol is to test the feasibility, acceptability, and preliminary efficacy of a model of care that engages CHWs as providers of BA. METHODS: We will train 2 CHWs in BA methodology. We will enroll 20 participants who screen positive for depression in a 12-week telephone intervention for BA. Preliminary efficacy will be tested in pre- and postscores of the Beck Depression Inventory and semistructured interviews. Feasibility and acceptability will be measured through participant retention and treatment adherence. The Therapeutic Alliance with Clinician Scale will be used to measure the strength of the therapeutic relationship. Descriptive statistics will measure alliances and repeated measures ANOVA will measure trends and changes in depression scores. RESULTS: Enrollment began in October 2023. A total of 12 participants completed at least 10 BA sessions and all study measures by the time the study concluded in May 2024. In August 2024, data analysis occurred with an anticipated manuscript to be submitted for publication in October 2024. CONCLUSIONS: Results from this study will inform future studies into the implementation of an evidence-based mental health intervention in a limited resource setting for Latino people with limited English proficiency. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57343.