Multidimensional Care Poverty Among East Asian and Nordic Older Adults.

Background and Objectives: This study uses the care poverty framework, focusing on both individuals and structures. In this context, structures are represented by 2 welfare states: Taiwan, an East Asian welfare system and Finland, a Nordic welfare state. This study explores multidimensional care poverty rates and examines 3 realms of individual factors (health status, sociodemographic factors, and care support availability) among older adults in these long-term care (LTC) models. Research Design and Methods: We analyzed data from the 2019 Taiwan Longitudinal Study on Ageing Survey and the 2020 Daily Life and Care in Old Age Survey in Finland to compare the rates and factors of care poverty in these 2 culturally and structurally different countries. Results: Our analysis revealed different rates of care poverty in personal, practical, and socioemotional care needs in the 2 countries. Under a familistic welfare regime, Taiwanese older adults had higher personal care poverty rates than their Finnish counterparts. Those living alone faced more personal and practical care poverty. Conversely, Finnish older adults, under the Nordic welfare model, experienced more practical and socioemotional care poverty. Those with high care needs and disadvantaged social status and support were more likely to experience personal and practical care poverty. Socioemotional care poverty varied with the availability of support and health status in both countries. Discussion and Implications: The study highlights the impact of 2 LTC policies and cultures on older adults' multidimensional care poverty, identifying disadvantaged older adults under different welfare-transforming LTC models. Taiwan's budget-constrained LTC policies and high family reliance contrast with Finland's inadequate attention to the practical and socioemotional needs of its aging population. This study suggests that holistic LTC policies are needed in both countries to improve the well-being of older adults with limited support and health issues.

[Utilizing ChatGPT in Systematic Reviews and Meta-Analyses].

The current uses, potential risks, and practical recommendations for using chat generative pre-trained transformers (ChatGPT) in systematic reviews (SRs) and meta-analyses (MAs) are reviewed in this article. The findings of prior research suggest that, for tasks such as literature screening and information extraction, ChatGPT can match or exceed the performance of human experts. However, for complex tasks such as risk of bias assessment, its performance remains significantly limited, underscoring the critical role of human expertise. The use of ChatGPT as an adjunct tool in SRs and MAs requires careful planning and the implementation of strict quality control and validation mechanisms to mitigate potential errors such as those arising from artificial intelligence (AI) 'hallucinations'. This paper also provides specific recommendations for optimizing human-AI collaboration in SRs and MAs. Assessing the specific context of each task and implementing the most appropriate strategies are critical when using ChatGPT in support of research goals. Furthermore, transparency regarding the use of ChatGPT in research reports is essential to maintaining research integrity. Close attention to ethical norms, including issues of privacy, bias, and fairness, is also imperative. Finally, from a human-centered perspective, this paper emphasizes the importance of researchers cultivating continuous self-iteration, prompt engineering skills, critical thinking, cross-disciplinary collaboration, and ethical awareness skills with the goals of: continuously optimizing human-AI collaboration models within reasonable and compliant norms, enhancing the complex-task performance of AI tools such as ChatGPT, and, ultimately, achieving greater efficiency through technological innovative while upholding scientific rigor.

Attitude and level of satisfaction on objective structured practical examination and traditional practical examination among undergraduate nursing students.

BACKGROUND: Objective structured practical examination (OSPE) and traditional practical examination (TPE) are two different methods used to evaluate the theoretical and practical skills among students. The present study assessed the attitude and level of satisfaction of undergraduate nursing students toward OSPE and TPE. MATERIALS AND METHODS: A comparative research design study was conducted at Yenepoya Nursing College in 2022. The samples were 4th year B.Sc nursing students who have experienced both types of examination system and are selected by using the non-probability purposive sampling technique. The selected 102 students are further divided into two groups (51 students in each group) by the chit method: one group for assessing the attitude and level of satisfaction toward OSPE and the other group for assessing the attitude and level of satisfaction toward TPE. The tools used were demographic proforma, structured attitude, and satisfaction scale. The collected categorical data were represented as frequency and percentage, and quantitative data are represented in terms of mean and standard deviation. The Mann-Whitney U test was used to compare the attitude and level of satisfaction between the two groups. RESULTS: The majority [32 (65.7%)] of the participants had positive attitude toward the OSPE, and the majority [30 (61.5%)] of the samples had neutral attitude toward TPE. Most of the students [27 (55.3%)] had a good level of satisfaction toward the OSPE. The majority [28 (56.3%)] of the samples had an average level of satisfaction toward TPE. The median of attitude score was 48.32 with 3.35 inter-quartile range (IQR) on OSPE and 44.40 with 3.35 IQR on TPE. The median of level of satisfaction was 50.95 with 1.69 IQR on OSPE and 46.05 with 1.69 IQR on TPE. CONCLUSIONS: The study concluded that the students have positive attitude and a good level of satisfaction toward OSPE and neutral attitude and an average level of satisfaction toward TPE. The results provide important implications for choosing a different examination strategy and increasing the standard for the educational and evaluation systems.

Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association.

Local ablation for hepatocellular carcinoma, a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage hepatocellular carcinoma. The lack of organized evidence and expert opinions regarding patient selection, preprocedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-Guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.

Impact of a Digital Scribe System on Clinical Documentation Time and Quality: Usability Study.

BACKGROUND: Physicians spend approximately half of their time on administrative tasks, which is one of the leading causes of physician burnout and decreased work satisfaction. The implementation of natural language processing-assisted clinical documentation tools may provide a solution. OBJECTIVE: This study investigates the impact of a commercially available Dutch digital scribe system on clinical documentation efficiency and quality. METHODS: Medical students with experience in clinical practice and documentation (n=22) created a total of 430 summaries of mock consultations and recorded the time they spent on this task. The consultations were summarized using 3 methods: manual summaries, fully automated summaries, and automated summaries with manual editing. We then randomly reassigned the summaries and evaluated their quality using a modified version of the Physician Documentation Quality Instrument (PDQI-9). We compared the differences between the 3 methods in descriptive statistics, quantitative text metrics (word count and lexical diversity), the PDQI-9, Recall-Oriented Understudy for Gisting Evaluation scores, and BERTScore. RESULTS: The median time for manual summarization was 202 seconds against 186 seconds for editing an automatic summary. Without editing, the automatic summaries attained a poorer PDQI-9 score than manual summaries (median PDQI-9 score 25 vs 31, P<.001, ANOVA test). Automatic summaries were found to have higher word counts but lower lexical diversity than manual summaries (P<.001, independent t test). The study revealed variable impacts on PDQI-9 scores and summarization time across individuals. Generally, students viewed the digital scribe system as a potentially useful tool, noting its ease of use and time-saving potential, though some criticized the summaries for their greater length and rigid structure. CONCLUSIONS: This study highlights the potential of digital scribes in improving clinical documentation processes by offering a first summary draft for physicians to edit, thereby reducing documentation time without compromising the quality of patient records. Furthermore, digital scribes may be more beneficial to some physicians than to others and could play a role in improving the reusability of clinical documentation. Future studies should focus on the impact and quality of such a system when used by physicians in clinical practice.

Co-catalysis strategy for low-oxidant-consumption Fenton-like chemistry: From theoretical understandings to practical applications and future guiding strategies.

Recently, great effects have been made for the co-catalysis strategy to solve the bottlenecks of Fenton system. A series of co-catalysis strategies using various inorganic metal co-catalysts and organic co-catalysts have been developed in various oxidant (i.e., hydrogen peroxide (H2O2) and persulfate) systems with significantly promotion of catalytic performances and lower oxidant consumption (only 5-10 % of conventional Fenton/Fenton-like systems). However, the developments of these co-catalysis strategies from theoretical understandings to practical applications and future guiding strategies were overlooked, which was an essential problem that must be considered for the future scale-up applications of co-catalysis systems. In this paper, these co-catalysis strategies with low-oxidant-consumption characteristics have been reviewed by the comparison of their co-catalysis mechanisms, as well as their advantages and disadvantages. We also discussed the recent developments of amplifying devices based on the co-catalysis systems. The scale-up performances of co-catalysis strategies based on these amplifying devices have also been assessed. In addition, future guiding strategies for the development of co-catalysis strategy with low-oxidant-consumption characteristics have also been first time outlined by the combination of the technical-economic analysis (TEA), life cycle assessment (LCA) and machine learning (ML). Finally, the paper systematically discusses the development opportunities, technical bottlenecks and future development directions of co-catalysis strategies with the prospect of large-scale applications. Basically, this work provides a systematic review on co-catalysis strategy with low-oxidant-consumption characteristic from theoretical understandings to practical applications and future guiding strategies.

Effects of TBL teaching on nursing students' knowledge, practical skills and core ability: A systematic review and meta-analysis.

AIM: This study aims to investigate the comparative effects of the team-based learning methodology against conventional teaching practices on the educational outcomes of nursing students. BACKGROUND: The team-based learning instructional strategy represents a significant pedagogical innovation in nursing education. This approach initiates with foundational knowledge, uses predetermined questions for guidance and adopts both intra-group and inter-group dialogues as mechanisms of learning. It accentuates the creativity and pragmatism of students, thereby enhancing their communicative and collaborative competencies. Although this methodology has garnered recognition among nursing education practitioners in recent years, consensus on its pedagogical efficacy remains elusive. DESIGN: The investigation was structured as a systematic review and meta-analysis. METHODS: In August 2024, a comprehensive search was executed across several databases, including PubMed, Embase, The Cochrane Library, Web of Science, OVID, Scoups and CNKI, to identify studies that satisfied predetermined criteria for inclusion and exclusion. The process entailed screening studies against the criteria, extracting pertinent data and assessing the quality of the studies prior to performing a meta-analysis. The review protocol of this study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024513238). RESULTS: From an initial pool of 3191 articles, 29 were selected for meta-analysis following a meticulous screening process. Findings indicated that the team-based learning methodology significantly outperformed traditional teaching approaches in enhancing nursing students' final examination scores and practical skills. Moreover, it was observed to bolster self-directed learning and critical thinking capabilities among students. Nonetheless, the impact of team-based learning on improving problem-solving skills and communication skills warrants additional verification. CONCLUSION: The investigation concludes that the team-based learning approach is efficacious in enriching nursing students' theoretical and practical proficiencies, alongside promoting self-directed learning and critical thinking. However, given the constrained number and quality of the studies included, these findings necessitate corroboration through further high-caliber research.

A Machine Learning Approach for Predicting Biochemical Outcome After PSMA-PET-Guided Salvage Radiotherapy in Recurrent Prostate Cancer After Radical Prostatectomy: Retrospective Study.

BACKGROUND: Salvage radiation therapy (sRT) is often the sole curative option in patients with biochemical recurrence after radical prostatectomy. After sRT, we developed and validated a nomogram to predict freedom from biochemical failure. OBJECTIVE: This study aims to evaluate prostate-specific membrane antigen-positron emission tomography (PSMA-PET)-based sRT efficacy for postprostatectomy prostate-specific antigen (PSA) persistence or recurrence. Objectives include developing a random survival forest (RSF) model for predicting biochemical failure, comparing it with a Cox model, and assessing predictive accuracy over time. Multinational cohort data will validate the model's performance, aiming to improve clinical management of recurrent prostate cancer. METHODS: This multicenter retrospective study collected data from 13 medical facilities across 5 countries: Germany, Cyprus, Australia, Italy, and Switzerland. A total of 1029 patients who underwent sRT following PSMA-PET-based assessment for PSA persistence or recurrence were included. Patients were treated between July 2013 and June 2020, with clinical decisions guided by PSMA-PET results and contemporary standards. The primary end point was freedom from biochemical failure, defined as 2 consecutive PSA rises >0.2 ng/mL after treatment. Data were divided into training (708 patients), testing (271 patients), and external validation (50 patients) sets for machine learning algorithm development and validation. RSF models were used, with 1000 trees per model, optimizing predictive performance using the Harrell concordance index and Brier score. Statistical analysis used R Statistical Software (R Foundation for Statistical Computing), and ethical approval was obtained from participating institutions. RESULTS: Baseline characteristics of 1029 patients undergoing sRT PSMA-PET-based assessment were analyzed. The median age at sRT was 70 (IQR 64-74) years. PSMA-PET scans revealed local recurrences in 43.9% (430/979) and nodal recurrences in 27.2% (266/979) of patients. Treatment included dose-escalated sRT to pelvic lymphatics in 35.6% (349/979) of cases. The external outlier validation set showed distinct features, including higher rates of positive lymph nodes (47/50, 94% vs 266/979, 27.2% in the learning cohort) and lower delivered sRT doses (<66 Gy in 57/979, 5.8% vs 46/50, 92% of patients; P<.001). The RSF model, validated internally and externally, demonstrated robust predictive performance (Harrell C-index range: 0.54-0.91) across training and validation datasets, outperforming a previously published nomogram. CONCLUSIONS: The developed RSF model demonstrates enhanced predictive accuracy, potentially improving patient outcomes and assisting clinicians in making treatment decisions.

Resilience for working in Ontario home and community care: registered practical nurses need the support of themselves, family and clients, and employers.

BACKGROUND: The context of practice is often not explicit in the discourse around the personal and professional resilience of nurses. The unique factors related to providing nursing care in home and community care may provide novel insight into the resilience of this health workforce. Therefore, this research addressed how nurses build and maintain resilience working in the home and community care sector. METHOD: A qualitative study was conducted between November 2022 to August 2023 using 36 in-depth interviews (29 registered practical nurses [RPNs], five supervisors of RPNs, two family/care partners (FCPs) of clients receiving home and community care services). Analysis was consistent with a grounded theory approach including coding and comparative methods. RESULTS: The factors of personal and professional resilience were not distinct but rather mixed together in the experience of nurses having resilience working in the home and community care sector. The process of building and maintaining resilience as home and community care nurses was informed by three categories: (1) The conditions of working in HCC; (2) The rapport RPNs held with FCPs; and (3) The nurses' ability for supporting the 'self'. Multiple components to inform these categories were identified and illustrated by the words of the nurse participants. CONCLUSION: The process of building and maintaining resilience by RPNs working in the home and community care sector was guided by the day-to-day experiences of providing care for clients and the conditions of being a mobile health care provider. However, nurses may sense when they need to support their 'self' and must be empowered to request and receive support to do so.

Reframing Social and Emotional Development of the Gifted.

This essay questions the framing of socioemotional development as a separate concomitant of cognitive development in gifted individuals. Rather, it argues, first, that socioemotional development of the gifted is not separate from giftedness. Second, socioemotional development is not even cleanly and clearly separable from cognitive development. Third, giftedness and even intelligence do not reside inside the person-they are not personal properties but rather interactions of persons with tasks and situations. In sum, giftedness needs to be viewed in a holistic context that encompasses integrated cognitive, socio-emotional, task, and situational contextual elements.

Study on Prestressed Concrete Beams Strengthened with External Unbonded CFRP Tendons.

This study builds a refined finite element (FE) model to research the flexural behavior of a reinforced beam with prestressed CFRP tendons. The precision of the FE model is validated through a comparison with the experimental outcomes. The numerical findings align well with the experimental outcomes, encompassing the failure mode, load-deflection curve, load-strain curves of concrete, steel reinforcements and CFRP tendons. The variances between predicted values and experimental results are within 10%. Leveraging the verified FE model, an extensive parametric study has been carried out to examine the effects of various parameters, including the CFRP tendon prestress, the CFRP tendon diameter, the deviator layout, the anchorage height and the prestressing strand prestress. Leveraging the findings from the parametric study, some refined design recommendations are proposed for practical reinforcement applications: Increasing the CFRP tendon prestress in practical reinforcement designs is recommended; CFRP tendons with larger diameters are recommended for use in practical reinforcement designs; Employing a linear CFRP tendon profile for reinforcement is not considered optimal in practical applications; The prestress loss in the prestressing strands of PC beams should be considered in practice.

Investigating Acoustic and Psycholinguistic Predictors of Cognitive Impairment in Older Adults: Modeling Study.

BACKGROUND: About one-third of older adults aged 65 years and older often have mild cognitive impairment or dementia. Acoustic and psycho-linguistic features derived from conversation may be of great diagnostic value because speech involves verbal memory and cognitive and neuromuscular processes. The relative decline in these processes, however, may not be linear and remains understudied. OBJECTIVE: This study aims to establish associations between cognitive abilities and various attributes of speech and natural language production. To date, the majority of research has been cross-sectional, relying mostly on data from structured interactions and restricted to textual versus acoustic analyses. METHODS: In a sample of 71 older (mean age 83.3, SD 7.0 years) community-dwelling adults who completed qualitative interviews and cognitive testing, we investigated the performance of both acoustic and psycholinguistic features associated with cognitive deficits contemporaneously and at a 1-2 years follow up (mean follow-up time 512.3, SD 84.5 days). RESULTS: Combined acoustic and psycholinguistic features achieved high performance (F1-scores 0.73-0.86) and sensitivity (up to 0.90) in estimating cognitive deficits across multiple domains. Performance remained high when acoustic and psycholinguistic features were used to predict follow-up cognitive performance. The psycholinguistic features that were most successful at classifying high cognitive impairment reflected vocabulary richness, the quantity of speech produced, and the fragmentation of speech, whereas the analogous top-ranked acoustic features reflected breathing and nonverbal vocalizations such as giggles or laughter. CONCLUSIONS: These results suggest that both acoustic and psycholinguistic features extracted from qualitative interviews may be reliable markers of cognitive deficits in late life.

Social Determinant of Unconventional Resilience: Tactical Engagement in Medical-Martial Creativity.

Building on our strategic framework and operational model, we will discuss findings from our ethnographic study entitled, "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams (SOST)." Our goal is to establish that medical-martial creativity supports Special Operation Forces (SOF) medics' ability to fluidly modulate pressure amid real-time military medical decision-making in austere environments. We will use qualitative quotes to explore how SOST medics express medical-martial creativity in support of unconventional resilience. We continue to highlight tactical engagement by using bag sets as a metaphor for understanding the practical performance of this social determinant. To achieve our goals, we will: 1) define the social determinant of medical-martial creativity and provide a brief background on creativity; 2) thematize various ways in which medical-martial creativity is optimized or degraded; and 3) relate tactical engagement with medical-martial creativity to our metaphor of bag sets. We conclude by gesturing to how medical-martial creativity enables SOF medics' ingenuity, which allows them to freely maneuver complex real-time decision-making to support SOF mission success.

Early Diagnosis of Hereditary Angioedema in Japan Based on a US Medical Dataset: Algorithm Development and Validation.

BACKGROUND: Hereditary angioedema (HAE), a rare genetic disease, induces acute attacks of swelling in various regions of the body. Its prevalence is estimated to be 1 in 50,000 people, with no reported bias among different ethnic groups. However, considering the estimated prevalence, the number of patients in Japan diagnosed with HAE remains approximately 1 in 250,000, which means that only 20% of potential HAE cases are identified. OBJECTIVE: This study aimed to develop an artificial intelligence (AI) model that can detect patients with suspected HAE using medical history data (medical claims, prescriptions, and electronic medical records [EMRs]) in the United States. We also aimed to validate the detection performance of the model for HAE cases using the Japanese dataset. METHODS: The HAE patient and control groups were identified using the US claims and EMR datasets. We analyzed the characteristics of the diagnostic history of patients with HAE and developed an AI model to predict the probability of HAE based on a generalized linear model and bootstrap method. The model was then applied to the EMR data of the Kyoto University Hospital to verify its applicability to the Japanese dataset. RESULTS: Precision and sensitivity were measured to validate the model performance. Using the comprehensive US dataset, the precision score was 2% in the initial model development step. Our model can screen out suspected patients, where 1 in 50 of these patients have HAE. In addition, in the validation step with Japanese EMR data, the precision score was 23.6%, which exceeded our expectations. We achieved a sensitivity score of 61.5% for the US dataset and 37.6% for the validation exercise using data from a single Japanese hospital. Overall, our model could predict patients with typical HAE symptoms. CONCLUSIONS: This study indicates that our AI model can detect HAE in patients with typical symptoms and is effective in Japanese data. However, further prospective clinical studies are required to investigate whether this model can be used to diagnose HAE.

The development and evaluation of the Designing for Dissemination and Implementation Learning Hub.

There is a growing emphasis on reducing the gap between research and routine practice. Dissemination and Implementation (D&I) science offers theories, models, and frameworks to enhance the implementation, impact, and sustainment of new programs and interventions. Few training opportunities are available that help leaders, researchers, clinicians, and staff (implementers) translate original research into practice settings in a more timely and effective manner without requiring significant time away from their primary clinical duties. To address these needs, we designed a virtual Designing for Dissemination and Implementation (D4D&I) Learning Hub that offered foundational D&I knowledge and opportunities for skill building. We developed the D4D&I Learning Hub curricula to train novice participants in the multicomponent D4D&I implementation strategy bundle when implementing new programs or innovations. The components of the D4D&I strategy bundle include (i) Pre-implementation assessment for proactive planning and multilevel contextual assessment, (ii) Multilevel partner engagement to learn what is important to end-users and obtain buy-in, (iii) Implementation and adaptations guided by a pre-implementation assessment while retaining program fidelity, and (iv) Program evaluation. We utilized a virtual e-learning platform, expert trainers, mentorship, and a Virtual Learning Collaborative to deliver the six-module curricula to support participants' growth and success. We used quantitative and qualitative methods informed by the Kirkpatrick Evaluation Model to evaluate the D4D&I Learning Hub. Thirty-one participants completed the D4D&I Learning Hub across four cohorts. Participants found the D4D&I curricula relevant and favorable, indicating they acquired the intended knowledge and skills. In presentations of their key takeaways, participants cited a greater understanding of how to apply various D&I theories, models, and frameworks to their research, engage multilevel partners during all phases of implementation and evaluation, and assess fidelity and adaptations. Participants planned to incorporate the acquired D&I knowledge and skills in future publications, grant applications, and when implementing new programs and projects in clinical settings. The D4D&I Learning Hub provides foundational education for novice participants of D&I science. It promotes designing, disseminating, implementing, and evaluating effective programs in clinical settings. This article discusses the development and implementation of the D4D&I Learning Hub. In addition, we evaluated the first four cohorts using the Kirkpatrick Evaluation Model.

This article describes the design, delivery, and evaluation of an online educational course about the multicomponent Designing for Dissemination and Implementation strategy bundle to mitigate barriers when implementing new programs in real-world settings. This is important because many healthcare programs often never reach patients due to a lack of training for researchers and clinicians. This online Learning Hub provides an opportunity for healthcare leaders, researchers, clinicians, and staff to gain D&I knowledge, and practice skills that will help them offer new innovations in healthcare to patients. Further benefits of this Learning Hub are the emphasis on learning the foundations of D&I, practicing skills together, and creating healthcare partners who can work together to improve healthcare for patients.

NursPainPrevent: A Prospective Observational Study on Pain During a Bed Bath.

BACKGROUND: Although bed baths are known to cause pain, the engendered pain frequency and intensity remain poorly studied. This prospective, observational study was undertaken to examine prospectively, on a given day, patients' bed bath-associated pain in the general in-hospital population. METHODS: Eight external investigators observed 166 bed baths given in 23 units in 5 hospitals. Using validated assessment scales specific to the patients' clinical situations, they established pain scores. RESULTS: Expert observers rated bed bath-induced pain as moderate-to-severe for 48% of the patients, among whom 51.9% had not received prophylactic analgesia prior to the procedure. Only 7.2% benefited from evaluation with a validated pain scale. Astute attention-distraction techniques were applied to shift attention during 16.8% of the bed baths. Caregivers used verbal guidance for 85% of the procedures, and adapted touch and rhythm of the gestures for 84.3%. CONCLUSION: Bed baths generate moderate-to-severe pain intensity. Evaluation and recourse to analgesia remain insufficient despite caregivers' attention accorded to patient comfort and positioning. CLINICAL IMPLICATIONS: The results of this study could contribute to sensitizing professionals to preventing pain linked with routine nursing care. Four axes for improvement were highlighted: evaluation improvement, analgesia, nonpharmacological approaches, and adapted mobilization techniques.

Oncology Early-Phase Clinical Trials in the Middle East and North Africa: A Review of the Current Status, Challenges, Opportunities, and Future Directions.

Clinical trials, the empirical discipline of medical experimentation conducted on human subjects, have engendered a paradigm shift in medical research. The need for new clinical studies is paramount in the Middle East and North Africa (MENA) region, with its rising cancer incidence and demand for efficient oncology treatments. This paper comprehensively reviews the challenges, opportunities, and future directions of phase I oncology clinical trials in the MENA region. Early-phase trials are vital in determining drug dosage and assessing toxicity, bridging the gap between preclinical research and clinical practice. Considering the unique landscape of MENA, this review explores regulatory aspects, specific hurdles faced, potential advantages, and areas for improvement in conducting these trials. Various future directions can be pursued to maximize the potential of phase I oncology trials in MENA. While regulatory bodies like the Ministry of Health adhere to the International Conference on Harmonization-Good Clinical Practice guidelines, a unified system meeting high standards would yield better results. Strengthening research infrastructure, establishing research centers, incorporating clinical trial education into the curriculum, and improving access to medical facilities are crucial. Enhancing consumer understanding of research would facilitate increased participation and promote sustainability in trial recruitment. Navigating various funding sources would open the door for more funding opportunities. Collaborations between academia, industry, and regulatory bodies, both international and local, should be fostered to promote knowledge sharing, resource pooling, and harmonization of standards. Such collaborations would contribute to the sustainability of clinical trial activities by leveraging collective expertise, sharing research infrastructure, and distributing the burden of regulatory compliance. By adopting these strategies, the MENA region can advance its capacity to conduct early phases of oncology trials and contribute significantly to the global medical research landscape.

Übersichtsarbeiten / Review Articles. Was wollen wir (diagnostizieren) und was sollten wir diagnostizieren. Ein systemischer Überblick und Ausblick / What Would we Like to (Diagnose) and what do we have to Diagnose. A Systemic Overview and Perspective.

What Would we Like to (Diagnose) and what do we have to Diagnose. A Systemic Overview and Perspective Behavioral problems in children and young people are currently quickly suspected of being a sign of a psychological problem or a psychiatric disorder. In many cases, the caregivers agree on this, but in others there are clearly different perspectives from obvious to possible diagnoses. Whether a diagnosis makes sense and whether appropriate diagnostics are effective depends on various factors. From a systemic perspective, the common process, the symptomatic patients and their environment benefit from a solution- and resource-oriented view, which should have a greater impact on the future design of classifications of health and illness.

Extended lactations in dairy cows and the effects on fertility and production.

Extending lactation length reduces the frequency of critical calving events for the cow and herewith reduces the frequency of periods with increased risk for health problems. Moreover, breeding is postponed until a moment later in lactation, which is associated with better conception rates and less days open after start of the breeding period in most studies. Potential risks of an extended lactation are that milk yield of cows at the end of the lactation may be too low which may lead to cows being overconditioned at the end of the extended lactation. Therefore, extending lactation length might not fit every cow. Individual cow characteristics like parity, milk yield level, or body condition determine the response of the cow to an extended lactation. These individual cow characteristics can be used in customized management strategies to optimize lactation length for individual cows. Customized lactation length for individual cows could limit the impact at herd level of disadvantages concerning milk losses and overconditioning and maintain benefits for improved cow health and fertility, reduced number of surplus calves and increased work satisfaction for the farmer. In conclusion, extending lactation length has interesting perspectives for health and fertility of high-producing dairy cows, although questions remain concerning management approaches to support lactation persistency of cows with an extended lactation, and consequences for calf health and development. Moreover, ongoing studies aim to develop decision support tools to select individual cows for a specific lactation length.

In Situ Inorganic/Organic Protective Layer on Carbon Paper as Advanced Current Collector for Robust Li Metal Anode.

Lithium (Li) metal is regarded as the most promising anode for next-generation batteries with high energy density. However, the uncontrolled dendrite growth and infinite volume expansion during cycling seriously hinder the application of Li metal batteries (LMBs). Herein, an inorganic/organic protective layer (labeled as BPH), composed of in situ formed inorganic constituents and PVDF-HFP, is designed on the 3D carbon paper (CP) surface by hot-dipping method. The BPH layer can effectively improve the mechanical strength and ionic conductivity of the SEI layer, which is beneficial to expedite the Li-ion transfer of the entire framework and achieve stable Li plating/stripping behavior. As a result, the modified 3D CP (BPH-CP) exhibits an ultrahigh average Coulombic efficiency (CE) of ≈99.7% over 400 cycles. Further, the Li||LiFePO4 (LFP) cell exhibits an extremely long-term cycle life of over 3000 cycles at 5 C. Importantly, the full cell with high mass loading LiFePO4 (20 mg cm-2) or LiNi0.8Co0.1Mn0.1O2 (NCM, 16 mg cm-2) cathode exhibits stable cycling for 100 or 150 cycles at 0.5 C with high-capacity retention of 86.5% or 82.0% even at extremely low N/P ratio of 0.88 or 0.94. believe that this work enlightens a simple and effective strategy for the application of high-energy-density and high-rate-C LMBs.