Several years now, the global scientific community has accepted and recognized the importance of Evidence-based practice (EBP) for Nursing science. The main factor for the implementation of EBP is the competence of undergraduate Nursing students towards EBP, so that they as active nurses be ready for its application in their clinical practice, in order to provide better care for their patients. The aim of the present study is to examine the level of evidence-based practice competency evaluated with the self-reported EBP-COQ questionnaire. A quantitative study based on cross-sectional design was conducted from February to June 2022 in a convenience sample of Greek undergraduate nursing students. The Evidence-Based Practice Competence Questionnaire (EBP-COQ) and a questionnaire on undergraduate students’ gender, age, academic year, and training in the field of research were used. The SPSS 26.0 program was used to perform descriptive, bivariate and multivariate analyses. A total of 175 undergraduate students participated at the Hellenic University Nursing (Greece), specifically from the 2nd and 3rd academic year. The mean score of EBP-COQ for nursing undergraduate students was 3.03 ± 0.26, indicating moderate EBP. Among the EBP-COQ dimensions, the mean scores were obtained 3.03 ± 0.32 for Attitude toward EBP, 3.01 ± 0.49 for Skills in EBP, and 3.03 ± 0.49 for Knowledge in EBP. They were not found significant differences among participants’ mean EBP-COQ scores regarding gender (p = 0.766), age (p = 0.400), academic year (p = 0.153), and training in the field of Research Methodology (p = 0.538). It appears that the level of readiness towards EBP is mediocre between undergraduate nursing students at a university in Greece. Therefore, it is necessary to carry out new studies in the future, so that there is a correct approach of all the elements that contribute to the readiness of Nursing undergraduate students regarding EBP.

Nurses’ competency towards Evidence-based Practice (EBP) has been extensively investigated by several studies worldwide. However, factors affecting the competence of Greek nurses working in the NHS have not been fully investigated in terms of EBP. Thus, this study aimed to explore the impact of individual qualifications of nurses on their competence towards EBP. Data from 473 registered nurses working in 10 hospitals of in the Greek National Health Service (NHS) were collected between October and December 2022 using a convenience-sampling method in a cross-section design. The Greek version of the 35-item (5-point Likert scale) Evidence-Based Practice Competency Questionnaire for Professional Registered Nurses (EBP-COQ Prof) was used to assess the competence level of nurses focusing on the attitudes, skills, and knowledge as well as the utilization of EBP in clinical practice. One-way ANOVA and Pearson coefficient tests were applied to compare possible differences among variables (two or more groups) as appropriate. A multi-factorial regression model was applied to explore participants’ qualifications, including demographics (MSc degree, gender, English language knowledge, etc.) as independent variables, and to control for potential confounding effects toward EBP competency. P-values <0.05 were considered statistically significant. The mean age of 473 participants (402 women and 71 men) was 44.7 ± 9.2 years old. The mean value of competence subscales was found as follows: attitudes 3.9±0.6, knowledge 3.7±0.6, skills 3.1±0.8, and utilization 3.4±0.7. A multivariate regression analysis revealed that associates of “Master's degree” (t=3.039, p=0.003), “Writing an academic article” (3.409, p=0.001), “Working in a University clinic” (2.203, p=0.028) and, “Computer Skills” (2.404, p=0.017) are positively affecting ‘Attitudes’, ‘Knowledge’, ‘Skills’ and ‘Utilization’. Respectively. The research data suggest that nurses working in Greek NHS are limited in competence towards EBP in comparison to other European countries. Therefore, Vocational, Educational and Training programs tailored to EBP enhancement are crucially important.

The implementation and sustainability of evidence-based practice (EBP) is a complex process. Best practice guidelines (BPGs) can facilitate the translation of knowledge from theory into practice, but they require working groups to adapt recommendations and encourage adherence to them. The aim of this study was to identify facilitators and barriers of BPGs in the Registered Nurses’ Association of Ontario®, within the framework of Best Practice Spotlight Organisations® (BPSOs®), in a hospital setting. The study was conducted using the modified Delphi method (two rounds) with a cohort of BPSO® Best Practice Champions. The facilitators and barriers included in the first round were identified through a bibliographic search. The degree of concordance was determined in the second round using the highest mean resulting values. A total of 44 nurses responded, with a mean age of 42.57±8.563. Facilitators included: Work Environment; Working in a hospital that encourages research; and Dedicating time to EBP (p<0.001). Barriers: Excessive workload; Professional mobility (p<0.001); and Lack of time (p=0.002). As such, it is necessary to approach human resource management by implementing new policies that guarantee systemic sustainability. The BPSO® programme is an excellent framework for promoting the translation of theoretical knowledge into practice and effecting institutional change.

Background: Falls in older adults are prevalent and can result in an injury affecting their quality of life. Whether a fall is fatal or not, it has a high financial impact. Older adults with dementia are more likely to fall than their cognitively healthy counterparts, increasing their risk of serious injury or even death. This quality improvement project developed, implemented, and evaluated an evidence-based fall prevention bundle to reduce preventable falls in a long-term memory care unit.; Methods: The interventions that were implemented includes fall risk screening, physical exercise, vitamin D supplementation, purposeful hourly rounds, and post-fall huddles. Kurt Lewin’s force field analysis guided the project’s implementation. Nurses, healthcare providers, certified nursing assistants, restorative aides, and life enrichment staff from all shifts at a long-term memory care unit participated in the project. The participants implemented the evidence-based fall prevention bundle based on their scope of practice. They participated for 12 weeks. The frequency of falls was compared three months before, during, and after implementation. Paired t-test and independent samples t-test were used to analyze statistically significant differences between variables.; Results: Thirty staff members attended educational sessions, and 22 residents received interventions. Fall rates dropped 50% during the project's implementation but increased subsequently. The difference in the number of falls before, during, and after implementation was not statistically significant.; Conclusions: Staff working in a long-term care facility may help reduce fall rates using evidence-based interventions, but measures should be taken to sustain the initiative's implementation.

Decision-making using evidence-based practice (EBP) is generally universally accepted by nurses. Such acceptance may affect the personnel’s behaviour towards patients, which is also demonstrated by taking into consideration the patient’s preferences, including the patient’s spiritual needs, in the care plan. The provision of such care requires the development of an attitude of approval and an adequate level of communicative competence, which will enable the actual implementation of the EBP. The purpose of our study was to assess the perception of spirituality and the nurse’s role in providing spiritual care, as well as the perception of the significance of communication skills in the approval of EBP in professional practice. A multi-centre cross-section study was conducted on a population of 1176 participants (459 undergraduate (Bachelor programme, BP) and 717 postgraduate students (Master programme, MP)) from 10 medical universities in Poland. Three tools were used in the study to evaluate the participants’ approach: Evidence-Based Practice Competence Questionnaire (EBP-COQ), The Spirituality and Spiritual Care Rating Scale (SSCRS), and Communication Skills Attitude Scale (CSAS). Structural equation modelling was used for the analysis. An analysis of structural equations revealed the presence of positive relationships of the attitude to spiritual care and the role of communicative competences with the approach to EBP regardless of the cohort. A significant difference was found related to the influence of age on the attitude toward learning communicative competences. The approval in this respect was observed to decrease with age in the MP group. Increasing approval of EBP requires strengthening the approach to activity-centred spiritual care, with the simultaneous development of a positive attitude towards learning communicative competences. The model reveals the need to integrate a humanistic approach with EBP, which can be achieved by planning different interventions in different groups of recipients: nurses, academic teachers and students.

Quality evidence-based decisions and strategies are critical and valuable tools in strengthening health systems policies, strategic priorities action plans and comprehensive care delivery management. Our finding showed that there is scarcity of local/national and internal effective evidence-based and management strategies for informed decision making based on the disease or health epidemics nature, extend, ecological and geo-location of pandemics and epidemics crises burden and impacts. Evidence-based programs or projects are crucial in evolving pandemics and/or (Ebola, meningitis, Cholera and influenza) epidemics persistent morbidity and mortality/ case fatality reduction or prevention; as well as on poverty and inequity alleviation within the vulnerable population and citizenry over time. This paper assesses implications of evidence-based on health systems surveillance and monitoring systems, preparedness and emergency response gaps and needs in improving care delivery uptake and usefulness, coverage and effectiveness in Africa. Furthermore, the article advocates for quality, access to and uptake of knowledge-based policy-decision making and practice improvements in building efficient and standardized surveillance, preparedness and response approaches. Also, in enriching data sharing and inclusiveness through understanding the links between poverty, poor health and inequited related emerging infectious diseases epidemics in Africa. Leveraging on cumulative lessons learnt experiences and innovations in integrating participatory knowledge-based policies and approaches is paramount in fostering vulnerable population awareness and engagement, skills empowerment collaborative productivity and sustainable healthy solutions and measures. Strengthening new partnerships, alliances, and networks requires collaborative and quality evidence policy decisions, appropriate and reliable monitoring and evaluation systems approaches and strategies in improving local preparedness and emergency response capabilities against future emerging infectious diseases epidemics and fast-tracking poverty alleviation knowledge-based livelihoods and health solutions for impact. Furthermore, integrated, participative partnerships and collaborative responsibilities, cost effective and reliable evidence health financing and budget allocation, and targeted capacity development aiming at reducing and averting the burden of poverty related emerging threats and epidemics preparedness and response programs in African countries.

A bijective analysis is confirming, the expansion of universal space has never been directly observed, and this assumption is unproven thus far. The measurement of the gravitational redshift, which was confirmed using the Mossbauer experiment, proves only the gravitational redshift and nothing more because there is no causality between the gravitational redshift and hypothetical expansion. Thus, even if the universal space is assumed to expand, the gravitational redshift cannot be assumed to be proof of the expansion. In addition, the Doppler effect was never observed in an expanding space; thus, the claim that the cosmological redshift is partially caused by the Doppler effect, which is caused by the expansion of space, is an unproven assumption. Furthermore, the discovery of cosmic microwave background (CMB) radiation simply proves that the radiation is emitted by the entire universal space, but does not prove the existence of a recombination period. In evidence-based cosmology, every element in the model has a corresponding element in physical reality that is observed and measured. The evidence-based cosmology model is related to the real universe by a bijective function of set theory. Supermassive black holes in the centre of galaxies are rejuvenating systems of the universe. They rotate their local superfluid space which is the physical origin of galactic rotation curves.

This paper outlines evidence-based practice in the context of professionalism, and highlights the contribution evidence-based practice can make to the professional practice of higher education course managers. Implications of the changing HE landscape for the status of academics as professionals are reviewed, and evidence-based practice is proposed as a solution for both enhanced course management and to remedy perceived deprofessionalisation. Finally, questions regarding researching professional practice within one’s own institution are addressed.

Tunnel fires are generally detected using various sensors, including measuring temperature, CO concentration, and smoke concentration. To address the ambiguity and inconsistency in multi-sensor data, this paper proposes a tunnel fire detection method based on an improved Dempster-Shafer (DS) evidence theory for multi-sensor data fusion. To solve the problem of evidence conflict in DS theory, a two-level multi-sensor data fusion framework is adopted. The first level of fusion involves feature fusion of the same type of sensor data, removing ambiguous data to obtain characteristic data, and calculating the basic probability assignment (BPA) function through the feature interval. The second level fusion derives basic probability numbers from the BPA, calculates the degree of evidence conflict, normalizes to obtain the relative conflict degree, and optimizes the BPA using the trust coefficient. The classical DS evidence theory is then used to integrate and obtain the probability of tunnel fire occurrence. Different heat release rates, tunnel wind speeds, and fire locations are set, forming four fire scenarios. Sensor monitoring data under each simulation condition are extracted and fused using the improved DS evidence theory. The results show that the proposed improved DS evidence theory method detects the probability of fire occurrence in the four scenarios as 67.5%, 71.0%, 82.8%, and 83.5%, respectively, and identifies fire occurrence in approximately 2.4 seconds, an improvement of 64.7% to 70% over traditional methods. This demonstrates the feasibility and superiority of the proposed method, highlighting its significant importance in ensuring personnel safety.

Throughout the COVID-19 pandemic, masks have been promoted as an important tool for reducing SARS-CoV-2 transmission. However, even though masks are plausible experimental interventions, their mechanistic effectiveness has not been validated by randomized clinical trials (RCTs), with reduction risks of just 1.1-fold (11%) or less. Several meta-analyses have suggested that masks effectively reduce viral transmission, but all of them rely heavily or exclusively on observational data. Indeed, there is a strong inverse correlation between the effectiveness of masks and the number of RCTs included in the meta-analysis. RCTs on alternative therapies often show similar low levels of effectiveness. Thus, masks can be compared with potential new drugs or therapies that failed clinical trials despite showing mechanistic evidence.

Background: It is clear that breastfeeding is the gold standard of infant feeding because of the many advantages it offers to both the child and the mother. Objective: to identity the main reasons for cessation breastfeeding declares by the mother themselves during the first year. Design: A prospective cohort study was conducted, recruiting 969 newborns in a third level hospital in Spain. The main maternal variables studied were: maternal age, parity, educational level, work occupation, smoking habit, gestational age, birth, weigh, feeding type, and duration of breastfeeding. All the participants were followed for a year to determinate the duration of breastfeeding and to know the reason of the abandonment. Results: At 6 months, the percentage of maternal lactation was cut in half and only 24.6% of these mothers maintain. Mainly 15.80% of the mothers decide to give up the exclusive maternal lactation of their own free desire, and 15.41% because they suspect hypogalactia. The work cause is the third reason of abandonment in both cases. Conclusions: Our results show the need to improve the health policies of promotion, protection and support the initiation of breastfeeding. In particular, our results show the importance of the work factor with particular emphasis on improving conciliation measures.

Background: This practice guideline was developed by the Chronic Kidney Disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its Health Holding Company commissioned this guideline project to support the realization of the Vision 2030's healthcare transformation pillar. Methods: The guideline synthesis was guided by the GRADE-ADOLOPMENT methodology. Results: The final adoloped guideline addressed 12 clinical questions on blood pressure management in patients with CKD through a set of recommendations and performance measures. The recommendations included antihypertensive agents in children, non-renin angiotensin system inhibition (Non-RASi) vs RASi in adults, intensive vs standard blood pressure targets, early vs late assessment for kidney replacement therapy (KRT), late vs early preparation strategy for KRT, CKD symptoms during assessment for KRT or conservative management, initiation of KRT in patients with deteriorating CKD, choice of KRT modality or conservative management in certain CKD patient groups, changing or discontinuing KRT modalities, review frequency for KRT or conservative management, and Information, education and support. Conclusions: These conditional recommendations were based on low to very low certainty of evidence that highlights the need for high-quality randomized trials comparing different antihypertensive agents in patients with CKD.

The adoption of technology and digital tools across various user groups has brought about a heightened risk of cyber-attacks targeting devices and shared data. These elevated levels of cybercrime necessitate thorough investigations to address victims’ inquiries about the nature, causes, affected data, and impacted resources of the attack. Digital forensics serves as a crucial means to answer these queries. Additionally, it enables the formulation of strategies and delineation of roles essential for fortifying future defenses against such attacks. Within digital forensics, digital evidence holds pivotal importance in the investigative process as it serves as a cornerstone in legal proceedings to identify perpetrators. Numerous research endeavors focus on devising solutions to safeguard evidence, including centralized storage centers or cloud computing. These efforts aim to create frameworks integrating diverse security levels for sharing and preserving evidence effectively. In this paper, a new framework is proposed that seeks to amalgamate novel technologies with forensic practices to address challenges in the preservation phase of digital forensics. Strategies include segmenting evidence into smaller components, leveraging steganography to support preservation, and employing blockchain technology to ensure the integrity of collected evidence.

We assessed the use of Evidence-Based Practice (EBP) among pharmacists working in community pharmacies in France, and the factors linked to this practice. During 3 months in 2018 an online survey was sent to over 7,000 active pharmacists, and posted on pharmacist social media sites. The 40-item questionnaire described four clinical cases reflecting typical situations (conventional med-icine and Complementary and Alternative Medicine) encountered daily by community pharma-cists. Multiple-choice responses were proposed and scored according to whether they reflected EBP. A high total score indicated behavior in line with EBP. Univariate and multivariate analyses were used to evaluate factors that might explain adherence to EPB (pharmacy’s characteristics, the pharmacist’s status, mode of continuing education and sources of information). 595 pharmacists completed the questionnaire. The majority relied on pharmaceutical industry and other biased and/or non-evidence-based sources, particularly concerning information on homeopathic products. The consultation of independent reviews, health agency recommendations, and peer-reviewed scientific journals, was associated with evidence-based decisions. In contrast, reliance on phar-maceutical industry documents, personal experience and informal handbooks was linked to lower EBP scores. The level of EBP use by French community pharmacists needs to be improved to ensure that good quality scientifically-based advice is given to customers.

BACKGROUND Epidemiological sciences have been evolving at an exponential rate paralleled only by the comparable growth within the discipline of data science. Digital epidemiological studies are playing a vital role in medical science analytics for the past few decades. To date, there are no published attempts at deploying the use of real-time analytics in connection with the disciplines of Dentistry or Medicine. AIMS AND OBJECTIVES We deployed a real-time statistical analysis in connection with topics in Dental Anatomy and Dental Pathology represented by the maxillary sinus, posterior maxillary teeth, related oral pathology. The purpose is to infer the digital epidemiology based on a continuous stream of raw data retrieved from Google Trends database. MATERIALS AND METHODS Statistical analysis was carried out via Microsoft Excel 2016 and SPSS version 24. Google Trends database was used to retrieve data for digital epidemiology. Real-time analytics and the statistical inference were based on encoding a programming script using Python high-level programming language. A systematic review of the literature was carried out via PubMed-NCBI, the Cochrane Library, and Elsevier databases. RESULTS The comprehensive review of databases of the literature, based on specific keywords search, yielded 491813 published studies. These were distributed as 488884 (PubMed-NCBI), 1611 (the Cochrane Library), and 1318 (Elsevier). However, there was no single study attempting real-time analytics. Nevertheless, we succeeded in achieving an automated real-time stream of data accompanied by a statistical inference based on data extrapolated from Google Trends. CONCLUSION Real-time analytics are of considerable impact when implemented in biological and life sciences as they will tremendously reduce the required resources for research. Predictive analytics, based on artificial neural networks and machine learning algorithms, can be the next step to be deployed in continuation of the real-time systems to prognosticate changes in the temporal trends and the digital epidemiology of phenomena of interest.

Population growth, climate change, changes to land use, and the advent of emerging infectious disease agents has put our abilities to feed the growing global population at risk, which is of particular concern in low- or middle-income countries. Research to improve the profitability and sustainability of common livestock production systems is key to tackling this issue. However, despite considerable research investment to address this concern, there has been no attention to development of robust methodologies for the synthesis of existing research evidence and its re-use. Syntheses of evidence are critical for fostering best practices, minimising wastage of valuable research resources, and enabling informed decision and policy making. Whilst the use of evidence syntheses is well entrenched in human healthcare, their use within animal sciences is limited and specific methodologies for performing them are underdeveloped. In this call to action, we propose some methodological development activities that should be undertaken within this field of research to increase the potential of evidence syntheses to contribute to tackling pressing societal issues relating to livestock agriculture.

Dementia is recognized as a disability under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). People with disabilities like dementia have the right to access specialized health and social care services, including interventions that support independence and community participation. Cognitive Stimulation Therapy (CST) is an evidence-based psychosocial intervention that improves cognition, communication, confidence and quality of life for people living with dementia (PLwD), but an implementation gap means that CST is often not available. We recruited trained CST practitioners (n=62; 91.9% female) to a mixed methods study to examine facilitators and barriers to the implementation of CST in Ireland. Statistical analysis showed that 54.8% of practitioners had run CST following training; ratings of intervention efficacy predicted the likelihood of running CST groups (p=0.006); and seeing the benefits of CST first-hand predicted that practitioners would run a greater number of CST groups (p=0.01). Thematic analysis of qualitative data identified three key themes of ‘resources’, ‘awareness and education’, and ‘acceptability of CST’. Overall, the results show that while CST is acceptable and deemed highly effective, resources and staffing often impede implementation. The results are discussed in the context of prioritising the rights of people with disabilities and recommendations are made around improving access to evidence-based supports.

This article explores the profound implications of Dr. Anthony Fauci's testimony before the U.S. House Select Subcommittee on the Coronavirus Pandemic, where he admitted that key COVID-19 policies lacked scientific backing. By analyzing the foundation of these decisions, the piece delves into the broader issues of scientific evidence, hypothesis validation, and the societal consequences of implementing unverified measures. It raises critical questions about the role of scientific rigor and accountability in policy-making, urging a reflection on our approach to scientific inquiry and decision-making in public health.

Abstract: Background: Dental fear and uncooperative behavior can hinder dental treatment quality. Pediatric Procedural Sedation and Analgesia (PPSA) is used to facilitate treatment when coping capacity is exceeded. Out-of-hospital PPSA has been associated with more adverse outcomes compared to hospital-based settings. Updated Dutch PPSA guidelines recommending two anesthesiologists and a ventilator during out-of-hospital PPSA have increased costs and raised concerns about the accessibility to specialized high quality dental care for children in the Netherlands. Aim: This study aims to investigate the impact of the updated 2017 guideline on the occurrence rate of adverse events during PPSA, as recorded in the anesthesia complication database of twelve participating Dutch dental clinics, with adjustments made for age, weight, and duration of treatment. Method: Data of 25,872 children treated at 12 dental clinics performing out-of-hospital PPSA between 1997 and 2019 were analyzed. Eligible children were aged 2-18 with ASA classification I and II. A logistic two-level mixed-effects model is used to estimate the updated guideline’s impact on adverse events. Results: In the final model we analyzed the data of 21,759 children in nine dental clinics. The OR of the occurrence rate of an adverse event adjusted for age, weight, and duration of treatment was 0.75 (95% CI 0.64 – 0.89) after the implementation of the updated guideline, compared to before the updated guideline. This outcome was significant with a P=0.001, indicating a protective effect. The average odds per clinic of having an adverse event was 0.04 with a 3.81% chance. Conclusion: Our findings demonstrate a significant reduction in adverse events after the implementation of the updated guideline and highlight the importance of adherence to evidence-based guidelines in improving patient safety and the quality of care provided during pediatric procedural sedation and analgesia in out-of-hospital dental clinics. Our study underlines the necessity of considering the complex underlying mechanisms that play a role in the development and implementation of evidence-based practice and safety initiatives on the occurrence of adverse events.

This paper examines the marketing mix of rattan canes businesses, with a focus on small and medium enterprises (SMEs). Rattan cane enterprises rely on both domestic and international sources for raw materials, and the market is largely unorganized, with individual-level operations dominating the industry. The primary aim of this study is to evaluate the marketing mix in relation to the 7Ps framework, which includes price, product, place, promotion, people, process, and physical evidence. A simple random sampling method was employed to select participants from rattan processing enterprises. A questionnaire survey was then conducted among 46 rattan entrepreneurs, representing a total of 66 enterprises, including rattan processing industries, rattan traders, and Community Forest User Groups. The findings of the study indicate that, among the seven Ps, place and process are relatively stronger aspects of service delivery, while price and people are considered moderate. However, product, promotion, and physical evidence are identified as weak areas in terms of service delivery within the rattan business. It is concluded that rattan processing industries continue to rely on traditional tools and technologies, which has resulted in a lack of competitiveness in penetrating both national and international markets. Furthermore, poorly segmented distribution channels have hindered their sales efforts, while limited promotional activities have restricted awareness of their products among potential customers. In conclusion, the study highlights the need for rattan businesses to modernize their operations and adopt more effective marketing strategies in order to enhance their competitiveness and expand their market reach.

This article evaluates the reliability and consistency of nutrition- and supplementation-related advice for pregnant women provided by ten selected health-related Internet portals. The portals were chosen based on their perceived reliability and prominence in Google searches, with representation from both English and Polish language sources. The evaluation criteria included the adherence of the presented information to official recommendations and its evidence-based character based on specific items representing dietary aspects important in pregnancy. While the overall reliability was deemed acceptable, significant variations existed both among the portals and specific evaluated items. Notably, HealthLine, Medline Plus, and NCEZ emerged as the most evidence-based, while WebMD and Medycyna Praktyczna were identified as less reliable. Despite a number of issues, the analysed portals remain valuable sources of nutritional information for pregnant women, offering user-friendly accessibility superior to alternatives such as social media, on the one hand, and scientific articles, on the other. Improved consistency and attention to detail, especially in relation to vitamin intake and supplementation, would improve the overall quality of health portals.

Taiwan’s auditors have suffered from processing excessive audit data, including drawing audit evidence. This study advances sampling techniques by integrating machine learning with sampling. This machine learning integration helps avoid sampling bias, keep randomness and variability, and target the risker samples. We first apply a Naive Bayes classifier to classify data into some classes. Next, a user-based, item-based, or hybrid approach is employed to draw audit evidence. The representativeness index is the primary metric for measuring the representativeness of audit evidence. The user-based approach denotes the selection of samples between two percentiles in a class as audit evidence. It may be equivalent to a combination of monetary and variable sampling methods. The item-based approach represents the choice of risky samples as audit evidence. It may be identical to a combination of non-statistical and monetary sampling methods. Auditors can hybridize those user-based and item-based approaches to balance representativeness and riskiness in selecting audit evidence. Three experiments show that sampling using machine learning integration has the benefits of drawing unbiased samples, handling complex patterns, correlations, and unstructured data, and improving efficiency in sampling big data. However, the limitations are the classification accuracy output by machine learning algorithms and the range of prior probabilities.

Forensic assessments may involve the sampling of textile fibers when examining crime scenes. The need to characterize and identify those fibers is crucial as they can provide extensive information relating to a crime, linking a suspect to a location. Fibers in particular may contain issues in terms of both size and quantity of sample, and micro Fourier transform Infrared in attenuated total reflectance mode (micro FTIR-ATR) spectroscopy presents a non-destructive method to identify those fibers. In this study we carried out a rapid forensic assessment via micro FTIR-ATR of sixty textile fibers recovered from twenty white fabrics relying on tape lifting method, in order to discriminate those materials. Two dimensional principal component analysis and radar chart were applied to enhance the visual comparison of the fibers. Results of infrared spectra revealed that the technique allows the discrimination of textile fibers according to their spectral composition (cellulose, polyamide, polyester, or mixture of these composites) and to some characteristics, as number and width of peaks, peak position according to the wavenumber, absorbance index related to peak sharpness, etc. The technique was deemed useful in the forensic assessment of the fibers, presenting rapid and enlightening results.

Background: Gram-negative bacteremia, especially from Klebsiella spp., Escherichia coli, and Pseudomonas aeruginosa, poses a significant public health threat due to multidrug resistance and high mortality rates. Cost-effective treatments are essential in low-middle income countries as Colombia. Methods: This descriptive, phase IV study was conducted in a tertiary care hospital in Colombia. Adult patients with Gram-negative bacteremia treated with generic piperacillin/tazobactam (Penibactam®) were evaluated. Clinical and microbiological responses were assessed over 12 months. Results: The study included 30 critically ill patients with an average APACHE II score of 22.12. The clinical response at day 7 was 66% (n = 20), and the microbiological response was 56.7% (n = 17). By the end of follow-up, clinical improvement was observed in 63.3% (n = 19), with a mortality rate of 23% (n = 7). The cardiovascular system was the most common infection site. Conclusions: Generic piperacillin/tazobactam demonstrated effectiveness and safety comparable to existing literature in treating Gram-negative bacteremia, offering a viable, cost-effective alternative for critically ill patients in real-world settings.

This study addresses the importance of conducting mass movement susceptibility mapping and hazard assessment using quantitative techniques, including machine learning, in the Northern Lima Commonwealth (NLC). Previous exploration of the topographic variables revealed high correlation and multicollinearity among some of them, which led to dimensionality reduction through principal component analysis (PCA). Six susceptibility models were generated using weights of evidence, logistic regression, multilayer perceptron, support vector machine, random forest, and naive Bayes methods to produce quantitative susceptibility maps and assess the hazard associated with two scenarios: the first being an El Niño phenomenon and the second being an earthquake exceeding 8.8Mw. The main findings indicate that machine learning models exhibit excellent predictive performance for the presence and absence of mass movement events, as all models surpassed an AUC value of >0.9, with the random forest model standing out. In terms of hazard levels, in the event of an El Niño phenomenon or an earthquake exceeding 8.8Mw, approximately 40% of the NLC area would be exposed to the highest hazard levels. It also highlights the importance of integrating methodologies to reduce model uncertainty, such as comprehensive analysis of variables supported by high quality data and organized workflows. The findings of this research are expected to serve as a supportive tool for land managers in formulating effective disaster prevention and risk reduction strategies.

Smart local energy systems (SLES) have been promoted in policy as a solution to decarbonisation challenges which also bring wider benefits, such as community prosperity and energy affordability. But the combination of conditions required to enable their successful emergence and operation are still to be elaborated. This paper reports on the development of a Theory of Change (ToC) for the “societal project” of emergence of SLES with benefits. ToC is a process of making explicit the causal links by which activities lead to outcomes, surfacing assumptions, and recognising possible unintended consequences. We describe the ToC development process, involving consultation and collaboration across a research consortium. It consists of layers (e.g. users, skills, data and digital), and shows conditions considered necessary to deliver SLES, and for these to deliver wider benefits. It also provides interactive links to evidence emerging from the consortium, as well as policy/governance conditions and metrics. We reflect on potential uses of the ToC – internally to the consortium and externally – along with challenges we encountered in pursuing this approach. Policy implications relate to the importance of enabling conditions across multiple sectors, the absence of any of which could inhibit delivery of either SLES or their ensuing benefits.

The latest World Atlas of Desertification represents a turning point in the diagnosis of desertification. While it forgoes desertification mapping due to the intrinsic complexity of the phenomenon and the impossibility of measuring it using a single indicator, it introduces the Convergence of Evidence paradigm, which identifies socioeconomic and biophysical variables whose behavior allows pointing out those areas prone to desertification. The Spanish National Action Program Against Desertification (PAND), back to 2008, already implemented a similar approach to identify five “desertification landscapes” within Spain using both socio-economic and climatic information. The PAND was not only pioneering but also, unfortunately, accurate. Desertification in Spain has continued to worsen and the first two decades of the 21st century have consolidated an agri-food model whose dynamics have exacerbated the desertification processes identified in the PAND. Despite its scientific value, the PAND lacked a proper action plan and was completely detached from the diagnosis. As a result the diagnosis it provided was not followed by effective actions to halt desertification in Spain. The Spanish Government's recent declaration of climate and environmental emergency requires a new strategy to combat desertification. This commitment is an excellent opportunity to update the diagnosis of the situation and, more crucially, to unify the different desertification sectoral policies and actions under a single front. We provide here elements for a roadmap to be designed around the pressures, impacts, and drivers that define today's Spanish desertification landscapes to manage them effectively and avoid their further degradation.

For most of its history, archaeology has taken an indulgent attitude toward looting and antiquities trafficking. The primary response to these dangers has been to publish the main findings made outside of academia. As a result of this approach and the prominent role played by police techniques in investigating such crimes, investigations are primarily based on documentary research. This approach makes it harder to determine such essential factors in this field as an object’s collecting history or discovery date. This paper offers an overview of the state of the research on the fight against antiquities trafficking. It then proposes new ways of studying collecting history, drawing on research projects on the use of archaeometry to shed light on cases of looting or trafficking involving police, court, or government intervention; hence, its qualification as “forensic.” Although the current state of knowledge does not enable the presentation of novel research, we believe that researchers and interested institutions should be made aware of the advisability of using archaeometry more directly in the fight against these scourges.

The therapeutic management of acquired thrombotic thrombocytopenic purpura (aTTP) has recently benefited from the introduction of caplacizumab, an agent directed to inhibition of platelet aggregation. This real-world analysis investigated the epidemiology, the demographic and clinical characteristics of aTTP patients in Italy before and after caplacizumab introduction in 2020. Hospitalized adults with aTTP were included using the administrative databases of healthcare entities covering 17 million residents. Epidemiological estimates of aTTP considered the 3-year period before and after caplacizumab introduction. After stratification by treatment or not with caplacizumab, aTTP patients were characterized for their demographic and clinical features. The annual incidence before and after 2020 was estimated in the range 4.3-5.8 cases/million and 3.6-4.6/million, respectively. From 2018 to 2022, 393 patients with aTTP were included, 42 of them treated with caplacizumab. Caplacizumab-treated patients were aged on average 46.8 years, 31% were males, and showed tendentially better clinical outcomes: no treated patients died at either 1 month or 3 months after caplacizumab treatment initiation, compared to 10.5% (1 month) and 11.1% (3 months) mortality among the untreated. Caplacizumab treatment was associated with a trend towards shorter hospital stays. These findings suggest that caplacizumab advent provided clinical and survival benefits for patients with aTTP.

Dietary guidance to recommend food patterns to deliver nutrients has been well accepted for the past century. Foods to deliver essential nutrients and energy are needed across the life cycle and are dependent upon local industries and accepted cultural practices to deliver essential nutrients to prevent nutrient deficiency diseases. Since the 1980s, dietary guidelines to prevent chronic diseases have relied on epidemiological research to predict what dietary patterns are linked to reduced risk of chronic disease or links to health outcomes. Dietary guidelines have been broad, typically recommending avoiding “too much sugar”, “too much saturated fat”, and “too much sodium”. Efforts to fine tune these recommendations have met with limited scientific data to support more specific recommendations across the life cycle. Consumers have become skeptical of dietary guidelines as media coverage of new studies is often in conflict with accepted nutrition dogma. We discuss whether we really have a science-based databank to support dietary guidelines, based on a scientific session at the 10th International Conference on Nutrition and Growth.

Diabetes mellitus, a metabolic disorder that is persistent in nature, is identified by an elevated concentration of glucose in the bloodstream. The disease has become a major public health problem, affecting millions of people globally, and is associated with significant morbidity and mortality. The increasing prevalence of diabetes and the lack of effective therapeutic interventions have led to the exploration of alternative and complementary forms of therapy, including ethnomedicine. Ethnomedicine is the study of traditional medical systems and the medicinal plants used by Indigenous communities. In other words, Ethnomedicine refers to the traditional medical practices and beliefs of a particular cultural or ethnic group. The most popular example of traditional medicine is the use of Aloe vera for the treatment of various diseases such as sunburn, cuts, burns, hypertension, diabetes, and jaundice for thousands of years [1]. In recent years, there has been increasing interest in the potential role of ethnomedicine in the management of diabetes, given its widespread use in many communities and its potential to offer cost-effective and culturally acceptable treatment options. It encompasses a range of traditional healing practices, including herbalism, acupuncture, and massage therapy. Despite the inconsistencies, there is growing evidence to suggest that certain ethnomedical practices may be effective in the management of diabetes [2,3]. For example, several studies have shown that certain herbal remedies, such as cinnamon, ginseng, and bitter melon, may have potential benefits in terms of improving glucose control and reducing the risk of complications associated with diabetes. Evidence-based ethnomedicine is an approach that applies scientific principles and methods to evaluate the efficacy and safety of traditional medical practices. This approach is crucial in the development of effective and safe ways to treat diabetes. To date, there have been numerous studies conducted to examine the efficacy and safety of various ethnomedical interventions for diabetes, including herbal remedies, dietary changes, and physical activity [4]. However, it is important to note that not all ethnomedical interventions for diabetes have been thoroughly evaluated, and many remain unproven. Furthermore, some interventions may be associated with significant risks, particularly in terms of drug interactions and adverse effects. As such, it is crucial that any ethnomedical interventions for diabetes be carefully evaluated using rigorous scientific methods and that patients be advised to consult with their healthcare provider before using any such interventions. It is important to note that the results of these studies have been mixed, with some showing promising results, while others have failed to demonstrate significant benefits. In this chapter, the evidence-based current state of ethnomedicine for diabetes was reviewed. We first provide an overview of diabetes and its pathophysiology, followed by a discussion of traditional medicinal practices used to treat the disease. We then present a systematic review of the scientific literature on the use of ethnomedicine for diabetes, focusing on herbal remedies and dietary interventions. Our review found that several medicinal plants offered promising results to treat all types of diabetes. For example, Gymnema sylvestre, a traditional Indian herb, has been shown to reduce blood glucose levels and improve insulin sensitivity [5]. Additionally, the use of bitter melon (Momordica charantia) has been shown to reduce fasting blood glucose levels and improve glucose tolerance in individuals with type 2 diabetes [6]. Another important aspect of ethnomedicine for diabetes is the use of dietary interventions [7]. Traditional diets, such as the Mediterranean diet, have been shown to have beneficial particularly in terms of improving glycaemic control, reducing the risk of cardiovascular disease, and insulin sensitivity [8]. Additionally, the use of low-carbohydrate diets, such as the ketogenic diet, has been shown to improve glycaemic control in individuals with type 2 diabetes [9]. Traditional medicine has a long history of treating the symptoms and managing the condition. However, the efficacy and safety of these traditional practices have not always been scientifically tested, and there is a lack of standardization and regulation in the production and use of traditional remedies for diabetes. This creates a challenge for healthcare providers and patients, who need to ensure that the treatments they use are safe and effective. Additionally, there is a need for further research to understand the mechanisms by which traditional remedies may be effective in managing diabetes and to determine the optimal dosage and administration methods [9]. Finally, it is also important to understand that the use of traditional remedies may interact with conventional medications, leading to adverse effects; for example, the use of Chinese traditional medicine, known as “herb ginseng,” for the treatment of various health conditions, including diabetes sometimes cause the side effect such as dizziness, confusion, and fainting while interacting with the anti-diabetic medications [10]. Therefore, it is important to approach the use of ethnomedicine for diabetes with caution and under the guidance of a qualified healthcare professional. In conclusion, evidence-based ethnomedicine offers a promising approach to the treatment of diabetes. While further research is needed to fully understand the mechanisms and safety of these interventions, the results to date suggest that traditional remedies and dietary interventions have the potential to be effective in the management of this disease. However, it is important to approach the use of ethnomedicine for diabetes with caution and under the guidance of a qualified healthcare professional and to continue to conduct rigorous scientific research to fully understand the benefits and risks associated with these interventions.

Systematic reviews of 591 primary studies of the modes of transmission for SARS-CoV-2 show significant methodological shortcomings and heterogeneity in the design, conduct, testing and reporting of SARS-CoV-2 transmission. While this is partly understandable at the outset of a pandemic, evidence rules of proof for assessing the transmission of this virus are needed for pre-sent and future pandemics of viral respiratory pathogens. We review the history of causality as-sessment related to microbial etiologies with a focus on respiratory viruses and suggest a hierar-chy of evidence to integrate clinical, epidemiologic, molecular and laboratory perspectives on transmission. The hierarchy, if applied to future studies, should narrow the uncertainty over the twin concepts of causality and transmission of human respiratory viruses. We attempt to address the translational gap between the current research evidence and the assessment of causality in the transmission of respiratory viruses with a focus on SARS-CoV-2. Experimentation, consistency and independent replication of research alongside our proposed framework provide a chain of evidence that can reduce the uncertainty over the transmission of respiratory viruses and increase the level of confidence in specific modes of transmission, informing the measures that should be undertaken to prevent transmission.

Introduction: Dementia is a cognitive decline with patients often exhibit behavioural and psychological symptoms, severely affecting the quality of life and placing a heavy burden on caregivers. Acupressure has reported benefits for dementia. This study aims to critically review the available evidence for its use as a non-pharmacological therapy. Methods: Systematic search of major research databases for human clinical trials using acupressure as an intervention for dementia patients was conducted. Results were synthesised for the effects of acupressure on various outcome measures of interest for dementia.Results: Twelve clinical trials (N=973), including eight randomised control studies, were included in this review. The study sample was predominantly institutionalised residents with moderate to severe dementia. Baihui (GV20), Shenmen (HT7), Fengchi (GB20), Neiguan (PC6), Sanyinjiao (SP6), and Yingtang (EX-HN3) were the most used acupoints for intervention. Acupressure techniques employed in these clinical trials vary greatly with no standardised approach. This review finds inconsistent evidence in the effectiveness of acupressure in reducing agitation and behavioural disturbances. However, the treatment appears to improve their ease of care and reduce physical stress. Affixing acupressure devices on selected acupoints can also potentially improve psychiatric pain, anxiety, and depression. Long-term (6 months) treatment can potentially improve the cognitive function, activities of daily living, and quality of life of patients with mild to moderate dementia. The effect of acupressure on sleep disturbances remains unclear. Conclusion: More high-quality research on acupressure is needed to fill the gaps in knowledge and inform better care for dementia patients in the future.

This survey paper discusses the Cointegrated VAR methodology and how it has evolved over the last 30 years. The first section is a description of major steps in the econometric development of the CVAR model that facilitated serious real world applications. The next three sections are primarily methodological and discuss (i) difficulties and puzzles when confronting theory with the data, (ii) the formulation of a viable link between theory and the data, a so called theory-consistent CVAR scenario, and (iii) how all this was inspired by Trygve Haavelmo and his Nobel prize winning monograph "The Probability Approach to Economics". The next two sections discuss early applications of the Cointegrated VAR model to monetary transmission mechanisms, international transmission mechanisms and wage, price and unemployment dynamics. They report puzzling evidence, discuss the need for new theory, and propose a method for combining partial CVAR analyses into a larger macroeconomic model. The following sections propose a new, empirically-based, approach to macroeconomics in which imperfect knowledge based expectations replace so called rational expectations and in which the financial sector plays a key role for understanding the long persistent movements in the data. The last section argues that the CVAR can act as a "design of experiment for passive observations" and illustrates with several applications including unemployment dynamics under crises periods and aid effectiveness in South Saharan African countries.

This study evaluates the impact of a Project-Based Learning (PBL) intervention on post-pandemic educational recovery in rural Colombia, focusing on student competencies in mathematics, language, science, and 21st-century skills. Conducted in rural schools, the intervention aimed to address significant learning gaps exacerbated by the COVID-19 pandemic by providing teacher training and direct student support. A pretest-posttest single-group design was used to assess the effectiveness of the intervention, with standardized tests measuring academic competencies and an analytical rubric evaluating 21st-century skills. The results indicate significant improvements in math, language, and science test scores, with notable gains in problem-solving, collaborative work, communication, and critical thinking. However, a decline in creativity scores highlights the need for a stronger emphasis on fostering creativity within the PBL framework. Gender differences were observed, with female students generally outperforming males, suggesting the need for tailored instructional approaches. The study's limitations, including the absence of a control group, non-random sampling, and the use of subjective assessment methods, are acknowledged, with recommendations for future research to address these issues. Despite these limitations, the findings underscore the potential of PBL to enhance student learning outcomes in rural settings, offering valuable insights for educators and policymakers aiming to support educational recovery and development in similar contexts. Further research is recommended to explore the long-term effects of PBL and to refine the intervention for broader implementation.

Canada is known to have a complex pathway for new drug approval and reimbursement resulting in delayed access to patients with serious and life-threatening diseases such as cancer. Several recent publications from key stakeholders including patients, physicians and policymakers highlight patient helplessness, physician frustrations and policymakers entangled in a massive network of bureaucracy unable to make headway. Several quantitative assessments using time from regulatory approvals to successful reimbursements confirm long review times and high rejection rates for oncology drugs especially those receiving conditional approvals. A consensus forum of 18 Canadian oncology clinicians recently voiced frustration with the process and inability to deliver guideline-supported efficacious therapies to their patients. This manuscript compares data extracted from publicly available data sources from 2019 to June 2024 to previous publications. Methods: Public databases from Health Canada, the Canadian Agency for Drugs and Technologies in Health (CADTH), which is in the process of changing to Canada’s Drug Agency, and the pan-Canadian Pharmaceutical Alliance (pCPA) were reviewed and data collected were analyzed with descriptive statistics. Results: From the data, three trends emerge, i) an increasing number of oncology drugs are receiving conditional approvals from Health Canada, ii) the percentage of conditionally approved oncology drugs receiving positive reimbursement recommendations from CADTH is still low but appears to be improving, but delays in access are now contingent upon pCPA deciding whether to negotiate price and then the duration of any negotiation, and iii) real-world evidence is no longer part of decision-making for conditional approvals. A slight increase in positive endorsement of RWE used to support CADTH recommendations was observed. Conclusion: Lack of timely access to oncology drugs hurts Canadian patients. While a small trend of improvement appears to be emerging, longer-term data collection is required to ensure sustained patient benefits.

Lung cancer, globally recognized as the leading cause of cancer-related mortality, presents a pressing need for innovative treatment strategies. Increasing evidence points towards the potential of monoamine oxidase (MAO) inhibitors in modulating cancer progression, primarily due to their role in regulating cellular metabolism and apoptotic pathways. This extraordinary study delves into the multifaceted therapeutic implications of MAO inhibitors in lung cancer management, elucidating their ability to pave the way for clinical advancement via novel targets and pathways. Capitalizing on recent advances in molecular biology, this research explores the molecular mechanisms underlying the anticancer actions of MAO inhibitors. By examining their impact on cell proliferation, migration, invasion, and apoptosis in lung cancer cell lines, we provide insight into the intricate signaling pathways and biochemical processes modulated by these compounds. The study also investigates the synergistic effects of MAO inhibitors in combination with established chemotherapeutic agents, elucidating their potential to enhance treatment efficacy and reduce cytotoxicity. Furthermore, we delve into the implications of MAO inhibitors on the tumor microenvironment, evaluating their influence on angiogenesis, immune regulation, and the epithelial-mesenchymal transition. This comprehensive analysis enables the identification of novel molecular targets, which hold promise for the development of advanced therapeutics tailored for specific lung cancer subtypes. To substantiate our findings, in this review, we thoroughly analyze the existing literature using state-of-the-art bioinformatics tools." in vivo orthotopic lung cancer models, and clinical patient cohorts. This robust and multidisciplinary approach permits the generation of clinical evidence supporting the integration of MAO inhibitors in lung cancer management. Conclusion: This ground-breaking study establishes the therapeutic potential of monoamine oxidase inhibitors in lung cancer management by unearthing novel pathways and targets for clinical advancement. The outcomes open doors for the development of innovative treatment strategies and inspire continued research efforts to combat the global burden of lung cancer.

Evidence-based data for endometriosis management are limited. Experiments are excluded without adequate animal models. Data are limited to symptomatic women and occasional observations. Hormonal medical therapy cannot be blinded if recognised by the patient. Randomised controlled trials are not realistic for surgery since a variable disease with low numbers. Each diagnosis and treatment is an experiment with an outcome and experience is Bayesian updating from the past. If the experience of many is similar, this has more value than an opinion. The combined experience of a group of endometriosis surgeons was used to discuss problems in the management of endometriosis. Considering endometriosis as several genetically/epigenetically different diseases is important for medical therapy. Imaging cannot exclude endometriosis and diagnostic accuracy is limited for superficial lesions, deep lesions, and cystic corpora lutea. Surgery should not be avoided for emotional reasons. Shifting infertility treatment to IVF without considering fertility surgery is questionable. The concept of complete excision should be reconsidered. Surgeons should introduce quality control and teaching should move to explain why it is done. The perception of information has a personal bias. These are the major problems in the management of endometriosis identified by the combined experience of endometriosis surgeons.

Acute myeloid leukemia (AML) is a hematological malignancy that predominantly affects the elderly. Prognosis declines with age. For those who cannot tolerate intensive chemotherapy, historically established treatment options have been hypomethylating agents (HMAs), low dose cytarabine (LDAC), and best supportive care (BSC). As the standard of care evolves for those unfit for intensive chemotherapy, there is a need to understand established treatment pathways, clinical outcomes and healthcare resource utilization in Canada. The CURRENT study was a retrospective chart review of AML patients not eligible for intensive chemotherapy who initiated first-line treatment between 1 January 2015 and 31 December 2018. Data were collected from 170 Canadian patients treated at six hematology centers, of whom 118 received systemic therapy and 52 received BSC as first-line treatment. Median overall survival was 8.58 months and varied from 2.96 months for BSC to 13.31 months for HMAs. Over 80% of patients had at least one outpatient visit, and 67% of patients receiving systemic therapy and 71% of those receiving BSC had at least one admission to hospital, during their first line of therapy. A total of 96 (81.4%) patients receiving first line systemic therapy and 39 (75.0%) of those receiving first line BSC had at least one red blood cell or platelet transfusion. These findings highlight the unmet need for novel therapies for patients ineligible for intensive chemotherapy.

Significant efforts in the past decades to teach evidence-based practice (EBP) implementation has emphasized increasing knowledge of EBP and developing interventions to support adoption to practice. These efforts have resulted in only limited sustained improvements in the daily use of evidence-based interventions in clinical practice in most health professions. Many new interven-tions with limited evidence of effectiveness are readily adopted each year - indicating openness to change is not the problem. The selection of an intervention is the outcome of an elaborate and complex cognitive process which is shaped by how they represent the problem in their mind and is mostly invisible processes to others. Therefore, the complex thinking process which support appropriate adoption of interventions should be taught more explicitly. Making the process visible to clinicians increases the acquisition of the skills required to judiciously select one in-tervention over others. The purpose of this paper is to provide a review of the selection process and the critical analysis that is required to appropriately decide to trial or not trial new intervention strategies with patients.

Introduction: The academic landscape is increasingly recognizing the complex interplay of personal and professional responsibilities on scholarly productivity. For women scholars, particularly those with significant parenting duties, this balance is even more precarious. This study aims to explore how family responsibilities, personal vulnerabilities, and motivational theories such as Imposter Syndrome and Self-Determination Theory (SDT) influence the motivation to publish scholarly work. Understanding these dynamics is crucial for developing supportive mechanisms that can enhance academic productivity and personal fulfilment. Methods: Utilizing a Qualitative Evidence Synthesis (QES) framework, this study will systematically review and synthesize qualitative research on women scholars' experiences in academia, focusing on the challenges and motivators related to publishing. Data sources will include academic databases, grey literature, and first-hand narratives. Thematic analysis will be employed to identify key themes and patterns across the collected data. Results/Findings: Preliminary findings suggest that the dual demands of parenting—especially in extreme cases such as assuming responsibility for seven children—and academic work significantly impact women scholars' publishing activities. Personal vulnerabilities, including imposter syndrome and low self-efficacy, further exacerbate these challenges. However, the data also highlight resilience strategies and the potential for intrinsic and extrinsic motivational factors to mitigate these effects. Discussion: The study underscores the nuanced impact of familial and personal factors on academic motivation. The preliminary findings suggest that addressing imposter syndrome and enhancing self-determination could be pivotal in supporting women scholars. The role of institutional policies and academic culture in either exacerbating or alleviating these challenges is also discussed. Significance: By elucidating the specific challenges and motivators for women scholars in publishing, this study will contribute to the development of targeted interventions and policies that support work-life integration and promote academic productivity. The insights that will be gained could inform mentorship programs, institutional support systems, and policy reforms aimed at fostering a more inclusive and supportive academic environment.

Background: Citicoline, a medical food, lacks proven efficacy for ischemic stroke and has uncertainties around its harms. The continued prescription should be reevaluated given the more robust, high-quality Evidence against that medical food. This essay is based on a recent Cochrane review and uses only one all-cause mortality as the primary outcome. Therefore, the essay should be considered as something other than an updated Cochrane review but like a reflection based on Evidence-based Medicine and Philosophy of Science analysis. Question Research: Why citicoline (a medical food) should not be prescribed to treat people with acute ischemic stroke: The certainty of the Evidence.? Objective: Demonstrate from evidence-based medicine and philosophy of science perspective that citicoline should not be prescribed for acute ischemic stroke due to lack of efficacy and harm uncertainties. Search publications: We searched in PubMed and Cochrane Library from 2020 until 30 October 2023. We, furthermore, used engineering machines Bing and Google Scholar to detect additional papers. Additionally, we also reviewed reference lists of the retrieved publications and review articles and searched the websites of the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA). Selection criteria: We included systematic reviews, meta-analyses, randomized clinical trials, clinical guidelines focused on acute ischemic stroke and comparing citicoline versus placebo or no intervention. We excluded narrative reviews, observational studies and ongoing trials. Data collection and analysis: We identified only new randomized clinical trials and assessed the risk of bias in seven domains. The other eight trials were already included in the mentioned Cochrane review. The systematic reviews with or without meta-analyses were assessed using McMaster University guidelines. We estimated risk ratios (RRs) for that outcome. We measured statistical heterogeneity using the I² statistic. We conducted our analyses using the fixed effect model. We did not use the GRADE approach due to what is shown in a Cochrane review published in 2020 by Martí-Carvajal et al. We used the RevMan 5.4 software from Cochrane Collaboration to conduct the forest plot. We used a Trial Sequential Analysis with Copenhagen Trial Unit Software. We estimated a Bayes factor from the relative risk and 95% confidence interval. Results: We identified only one new RCT (N = 99) reported mortality data and three clinical guidelines. We conducted a new meta-analysis with nine trials (N = 4461) having a high risk of bias and showing little to no difference in mortality between citicoline and placebo (17.1% vs 18.4%; RR 0.94, 95% CI 0.82 to 1.06; I2 = 0%). The Bayes factor was 0.7, indicating weak Evidence for the null over the alternative hypothesis. Trial sequential analysis suggested sufficiency of Evidence for mortality. No guidelines recommend citicoline. Conclusions: This essay reassessed citicoline for acute ischemic stroke after the 2020 Cochrane review. Adding a new RCT further supported the lack of mortality benefit with citicoline. The overall evidence quality could be better. Analyses using evidence-based medicine and philosophy of science approaches do not support prescribing citicoline due to a lack of efficacy substantiation and potential harms.

Genomic medicine is moving from research to the clinic. There is a lack of evidence about the impact of genomic medicine interventions on health outcomes. This is due in part to a lack of standardized outcome measures that can be used across different programs to evaluate the impact of interventions targeted to specific genetic conditions. The eMERGE Outcomes working group (OWG) developed measures to collect information on outcomes following the return of genomic results to participants for several genetic disorders. These outcomes were compared to outcome intervention pairs for genetic disorders developed independently by the ClinGen Actionability working group (AWG). In general, there was concordance between the defined outcomes between the two groups. The ClinGen outcomes tended to be higher level and the AWG scored outcomes represented a subset of outcomes referenced in the accompanying AWG evidence review. eMERGE OWG outcomes were more detailed and discrete, facilitating collection of relevant information from health records. This paper demonstrates that common outcomes for genomic medicine interventions can be identified. Further work is needed to standardize outcomes across genomic medicine implementation projects and make these publicly available to enhance dissemination and assist in making precision public health a reality.

Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effec-tiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influ-enza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; ap-plied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, pub-lication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed us-ing a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season and risk of bias. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017-2018 influenza season. The arVE was 3% (-01 to 7%) in the 2018-2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.

Background: Potential calcium-related adverse events of vitamin D supplement use have not been addressed in large-scale, real-world data so far. Methods: Leveraging data from the UK Biobank, encompassing 445,493 individuals aged 40-69, we examined associations of high 25-hydroxyvitamin (25[OH]D) levels ≥100 nmol/L and vitamin D supplementation with hypercalcemia (plasma calcium >2.6 mmol/L), kidney stones, and atherosclerosis assessments (pulse wave arterial stiffness index and carotid intima-medial thickness). Regression models were comprehensively adjusted for 49 covariates. Results: Approximately 1.5% of the participants had high 25(OH)D levels, 4.3% regularly used vitamin D supplements, and 20.4% reported regular multivitamin use. At baseline, the hypercalcemia prevalence was 1.6%, and 1.1% were diagnosed with kidney stones during follow-up. High 25(OH)D levels were neither associated with calcium-related adverse events nor atherosclerosis assessments. Vitamin D and multivitamin supplementation were associated with an increased prevalence of hypercalcemia (odds ratios and 95% confidence intervals: 1.46[1.32-1.62] and 1.11[1.04-1.18], respectively) but were neither associated with atherosclerosis nor future kidney stones. Conclusion: High 25(OH)D levels observable in routine care were not associated with any adverse outcome. Vitamin D users have a slightly higher prevalence of hypercalcemia, possibly due to co-supplementation with calcium, but without higher atherosclerosis prevalence or risk of kidney stones.

Carbapenem-resistant Acinetobacter baumannii (CRAB) infections represent the fourth-leading cause of death attributable to antimicrobial resistance globally, but a standardized therapy is still lacking. In this narrative review we focused the antibiotic treatment of CRAB infections in view of newly β-lactam agents (NBLs) like sulbactam/durlobactam and cefiderocol, discussing the main hot points such as the superiority of combination treatment over monotherapy and the best antibiotic partner to use in combination. Sulbactam/durlobactam seems to be the best candi-date to replace current back-bone agents. Cefiderocol, could play a crucial role in combina-tion-regimen. Due to toxicity and the PK/PD limitations, colistin (or polymyxin B) should be used as an alternative agent (when no other options are available). Tigecycline (or minocycline) and fosfomycin could represent suitable partners for both NBLs. Randomized clinical trials (RCTs) are needed to better evaluate the role of NBLs in CRAB infection treatment and to compare the ef-ficacy of tigecycline and fosfomycin as partner antibiotics. Synergism should be tested between NBLs and “old” drugs (rifampicin and trimethoprim/sulfamethoxazole). Huge efforts should be made to accelerate pre-clinical and clinical studies on safer polymyxin candidates with lung im-proved activity, as well as on the i.v. rifabutin formulation.

Although traditional automotive development has mainly focused on functional safety, as the number of automotive hacking cases has increased due to the growing Internet connectivity of automotive control systems, security is also becoming more important. Accordingly, various international organizations are preparing cybersecurity regulations or standards to ensure security in automotive development by emphasizing the concept of security-by-design(i.e. security engineering) which emphasizes trustworthiness from the beginning of development. The problem, however, is that no specific methodology has been suggested. In this paper, we propose a specific security-by-design methodology for automotive development based on Secure System Development Life Cycle (secure SDLC) standards and evidence-based standards. Our methodology could be easily used in the actual field as it is more general and detailed than existing secure SDLC standards and research. Also, since it satisfies all requirements of United Nations Economic Commission for Europe (UNECE) regulation, automobile manufacturers could respond to the upcoming cybersecurity regulation with our methodology.

The objective of the study was to investigate the gap between data and evidence-based decisions among healthcare professionals considering the enormous amount of individual and aggregate data collected. Our study assessed the capacity, skills, and knowledge of the Ministry of Health leadership staff to understand data management, analysis, utilization, and dissemination. Three key components were assessed: 1) Knowledge through true/false questions, 2) Level of Skill (and Competency) using a Likert scale, and 3) Understanding of Key Concepts and Tools based on a Likert scale. The 183 study respondents were diverse healthcare professionals from Kenya, Tanzania, and Rwanda. Majority of respondents had not received any training on data management, analysis, interpretation, and utilization techniques, further there was a significant difference between those who had received training versus those who had not(p=0.005). The respondents were competent in work-related experiences but lacked skills and knowledge on: data concepts and tools, study designs, and types of data analysis. These findings explain the gap between data management, analysis, utilization, and dissemination among health professional’s cadre. To enhance service delivery and optimal provision of health care, it is imperative to have all health care professionals receive a well-designed training on data management, analysis, interpretation, and utilization.

Serum neurofilament light chain (sNfL) levels have been proposed as a biomarker of the clinical activity, disability progression, and response to treatment of people with multiple sclerosis (PwMS); however, questions remain about its implementation in clinical practice. Ocrelizumab (OCR) has proven effective to improve clinical and radiological outcomes and to reduce sNfL levels. This real-life study followed the sNfL levels of 30 PwMS treated for 12 months with OCR and evaluated the usefulness of this biomarker for the short-term prognosis, considering expanded disability status scale (EDSS), annualized relapse rate (ARR), radiological activity, and NEDA-3 values. OCR reduced the ARR in 83% of PwMS and the radiological activity in 80%. Their EDSS was maintained, while NEDA-3 was achieved in 70% at 12 months. OCR produced an early reduction in sNfL levels (at 3 months). At baseline, greater MRI-evaluated radiological activity was associated with higher sNfL levels. sNFL levels over the first 12 months of treatment did not predict a suboptimal response or sustained control of the disease. Longer-term studies are needed to explore the predictive usefulness of sNfL levels in PwMS treated with high-efficacy drugs

N-of-1 data are unavoidable in zoological medicine. Accordingly, zoological medicine clinicians and investigators need research techniques that can make use of these data. This article reviews two methodologies for using both observational and experimental N-of-1 data: 1) systematic reviews and meta-analyses of case reports and 2) prospective N-of-1 trials. Systematic reviews of case reports and other observational evidence are formal, unbiased summaries of clinical characteristics of a particular disease-taxon combination. They offer advantages to narrative reviews by minimizing omission of relevant articles, thereby reducing the potential for mischaracterization of the literature. Meta-analyses are extensions of systematic reviews that quantitatively synthesize the data from the included articles. While valuable, systematic reviews and meta-analyses of case reports can have limited interpretations due to publication bias and confounding present in their source materials. In contrast to case reports, N-of-1 trials are prospective study designs that allow clinicians to make strong inferences about the effect of an intervention in a particular patient. They are double-blinded, single patient, multi-crossover studies that are of particular value in fields where it is difficult to recruit sufficient patients for conventional randomized control trials (RCTs), such as zoological medicine. Because they require multiple crossover periods, N-of-1 trials are ideal for evaluating short-acting interventions in patients with somewhat stable chronic diseases, such as osteoarthritis. More complex than conventional therapeutic trials, N-of-1 trials require prior consideration of how to achieve blinding, appropriate placebo controls, quantitative primary outcomes, analysis methods, and ethical approval. Aggregation of N-of-1 trials allows estimation of the average treatment effect across the population with fewer participants than a conventional RCT. While systematic reviews and meta-analyses of case reports can be used to synthesize the observational N-of-1 data already in existence, N-of-1 trials offer an exciting way to prospectively generate strong evidence that will be useful for evidence-based decision-making.

General Linear Modelling (GLM) has been widely employed to estimate the hemodynamic changes evoked by cognitive processing, which are more likely to be nonlinear than linear. First, this study re-analyzed the fNIRS data (N = 38, Mage = 5.0 years, SD = 0.69 years, 17 girls) collected in the Mixed-Order Design Dimensional Change Card Sort (DCCS) task. The results indicated that the quadratic equation was better than GLM to model HbO changes in this task. Second, analysis of a new set of data indicated that the Habit-DisHabit design of DCCS was more effective in identifying the neural correlates of cognitive shifting than the Mixed-Order Design. Third, this study found that the Non-users were more attentive and engaged than the Heavy-users, with a slower but more steady increase of brain activation in BA8 and BA9.

This study aims to examine the impact of tablet use on preschoolers’ executive function during the Dimensional Change Card Sort Task (DCCS) task using the functional near-infrared spectroscopy (fNIRS). Altogether 38 Chinese preschoolers (Mage = 5.0 years, SD = 0.69 years, 17 girls) completed the tasks before the COVID-19 lockdown. Eight children never used tablets, while 16 children were diagnosed as the ‘heavy-user'. The results indicated that: (1) the 'Non-user' outperformed the 'Heavy-user' with a significantly higher correct rate in the DCCS task; (2) the two groups differed significantly in the activation of the prefrontal cortex (BA 9): the 'Non-user' pattern is normal and healthy, whereas the 'Heavy-user' pattern is not normal and needs further exploration.

Bovine tuberculosis (bTB) outbreaks, caused by Mycobacterium bovis infection, are a costly animal health challenge. Understanding factors associated with the duration of outbreaks, known as breakdowns, could lead to better disease management policy development. We undertook a retrospective observational study (2012-2018) and employed Finite Mixture Models (FMM) to model the outcome parameter, and to investigate how factors were associated with duration for differing subpopulations identified. In addition to traditional risk factors (e.g. herd size, bTB history), we also explored farm geographic area, parcels/farm fragmentation, metrics of intensity via nitrogen loading, and whether herds were designated controlled beef finishing units (CBFU) as potential risk factors for increased duration. The final model fitted log-normal distributions, with two latent classes (k) which partitioned the population into a subpopulation around the central tendency of the distribution, and a second around the tails of the distribution. The latter subpopulation included longer breakdowns of policy interest. Increasing duration was positively associated with recent (<3 yrs) TB history and the number of reactors disclosed, (log) herd size, beef herd-type relative to other herd types, number of land parcels, area, and being designated a controlled finishing unit (“feedlot”), and having high annual inward cattle movements within the “tails” subpopulation. Breakdown length was negatively associated with year of commencement of breakdown (i.e. a decreasing trend) and non-significantly with the organic nitrogen produced on the farm (N kg/hectare), a measure of stocking density. The latter finding may be due to confounding effects with herd size and area. Most variables contributed only moderately to explaining variation in breakdown duration, that is, they had moderate size effects on duration. Herd-size and CBFU had greater effect sizes on the outcome. The findings contribute to evidence-based policy formation in Ireland.

More than 179,000 individuals have fallen ill of the Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus, which first emerged in China less than four months ago in December 2019. As of today, there exist no approved treatments against COVID-19. Vaccines are being developed, but they will take time, at least one year, to reach the population. Drug repositioning represents a fast track because already approved medicines have been broadly tested through multiple trials. We developed a repositioning strategy that mostly leads to candidates that are commonly used. The advantages are that they will facilitate proof of concept in humans through a “real-world evidence” approach and should be rapidly available to the population. We focus on the established research results that the unfolded protein response (UPR) and autophagy pathways of the host cells are essential to the life cycle of previously known coronaviruses. We performed the relevant bioinformatics analysis to understand and confirm if SARS-CoV-2 may interact with these druggable pathways. Based on these considerations, we prioritized two additional druggable pathways, which are important to the viral life cycle and tightly connected to UPR/autophagy signaling: the mitochondrial permeability transition pores (MPTP) and NLRP-3 inflammasome pathways. These four important pathways are perturbed in most major common diseases and have therefore been targeted by numerous broadly prescribed drugs. We have identified 97 approved drugs that are known to modulate these four identified pathways, and which represent, therefore, interesting repositioning candidates. Although it is indisputable that these drugs should never be used for immediate self-medication against COVID-19, we notice that some of them could also be prescribed to individuals who have COVID-19 comorbidities (e.g., hypertension). It is debated if these comorbidities are linked to the pathology itself (e.g., hypertension) or the drugs used to treat the pathology (e.g., sartans). Therefore, relevant preclinical tests and massive electronic health records (i.e., real-world evidence) must be used to pre-screen them and check the COVID-19 prognosis of individuals taking these drugs.

Motivation is essential in education, with highly motivated learners engaging more deeply with content and more ably transferring knowledge to new contexts. However, the validity of scales to measure motivation has been underexplored in pre-clerkship medical education. This study evaluates the validity of the Situational Motivation Scale (SIMS) for measuring motivation among pre-clerkship medical students in post-situational and short-term contexts. Using a sample of n = 156 students from the Frank H. Netter MD School of Medicine at Quinnipiac University, SIMS was tested for construct validity with attention paid to content, response process, internal structure, relationships to other variables, and consequences of use evidence. Small modifications from present to past tense in English were made for clarity following focus group feedback, and content validity was ensured via expert consultation. SIMS demonstrated strong internal consistency with a satisfactory Cronbach’s alpha for all subscales and anticipated patterns of correlations. Factor analysis confirmed appropriate factor loadings, with a stronger model fit for the short-term context, and no observed adverse effects on student engagement. These findings support the robustness of SIMS in capturing intrinsic, extrinsic, and amotivation in pre-clerkship medical students, highlighting its applicability for short-term and situational motivational assessment.

Artificial intelligence (AI), deep learning (DL) or machine learning (ML) is the ability of computer systems, machines and enginery to work devise procedures like humans. These technologies provide opportunities and possibilities to advance diagnostics and in planning also in the field of human medicine and dentistry. The purpose of this literature review was to ascertain the applicability and significance of AI, as well as to highlight its uses in maxillofacial surgery. The primary inclusion criterion for this publication was an original paper written in English focusing on the use of AI, DL or ML in maxillofacial surgery. The sources of information were PubMed, Scopus and Web of Science, and the queries were made on 31st of December 2023. The search strings used were “artificial intelligence maxillofacial surgery”, “machine learning maxillofacial surgery” and “deep learning maxillofacial surgery”. Following the removal of duplicates, all remaining publications that were returned by the searches and were screened by three independent operators to minimize the risk of bias. The analysis of publications from 1992 to 2023 identified certain records, of which 324 were finally selected. These were calculated according to the year of publication with a continuous increase (excluding 2012 and 2013) of R2 = 0.9295. Generally, in orthognathic dentistry and maxillofacial surgery, artificial intelligence and machine learning have gained popularity over the past few decades. When we included the keywords "planning in maxillofacial surgery" and "planning in orthognathic surgery", the set of published papers significantly increased to the number of 7535 publications. The first publication appeared in 1965, with an increasing trend (excluding 2014-2018), with an R2 value of 0.8642. These tools have been found useful for diagnosis, treatment planning in head and neck surgical oncology, cosmetic and aesthetic surgery, and in oral pathology. In orthognathic surgery, they have been utilised for diagnosis, treatment planning, assessment of treatment needs, cephalometric analyses, and orthognathic surgeries, among other applications. The review confirms that the current use of artificial intelligence and machine learning in maxillofacial surgery is focused mainly on the evaluation of digital diagnostic methods especially radiology, treatment plans and postoperative results. However, as these technologies are integrated in maxillofacial surgery and robotic surgery in head and neck region, it is expected that in the future they will be gradually utilized to plan and comprehensively evaluate the success of maxillofacial surgeries.

The enteric nervous system (ENS) is a neural network referred to as "the brain in the gut" because of its similarities to the central nervous system (CNS). The ENS consists of numerous types of neurons and glial cells distributed in two intramuscular plexuses that span the length of the intestine and control coordinated smooth muscle contractile activity and other intestinal functions. It is well-established that reciprocal communication exists between the brain and the gastrointestinal tract. Although the ENS can function independently, it is connected to the CNS through the afferent and efferent pathways of the parasympathetic and sympathetic nervous systems. In addition to regulating ENS function by the CNS, these connections are likely to be critically involved in the pathophysiology of Parkinson's disease (PD). PD is a common neurodegenerative disorder that presents with non-motor and motor symptoms. Surprisingly, ENS lesions have been shown to occur very early in the disease, even before CNS involvement. This has led to the postulation that the ENS may be central to the pathophysiology of PD. Autopsy studies have shown that α-synuclein (αS) aggregates in PD patients are found both in the substantia nigra (SN) and the ENS. Therefore, it has been hypothesized that the pathological process leading to PD may initially occur in the ENS years before the appearance of motor features. This process induces misfolding and aggregation of αS in specific subtypes of neurons in the CNS. Finally, it spreads retrogradely in the CNS through preganglionic vagal fibers to the dorsal motor nucleus of this nerve and to other central nervous structures. In addition to the presumed role in the spread of the disease process, it has also been suggested that pathological changes in the ENS might be involved in the gastrointestinal dysfunction frequently seen in Pd patients. Starting from the evidence in animal models and using a translational point of view, in this review, we aim to summarize the role of the ENS in the pathogenesis of PD and how this system could be modulated for a novel therapeutic approach. While acknowledging the presumed role of the microbiome in the gut-brain axis, we will shift the focus from this point of view to focus more on the neurons of the ENS.

The nine plateau lake watersheds in Yunnan are important ecological security barriers for southwest China, and the prevention and control of landslides are important considerations in the management of these watersheds. Taking Dianchi Lake watershed as a typical study area, this paper puts forward an improved comprehensive process of landslide susceptibility evalua-tion, and discusses the model’s sensitivity regarding susceptibility to landslides. The compre-hensive process is based on the weight of evidence method (WoE) and integrates many analyti-cal techniques, such as cross-validation, multi-quantile cumulative Student’s comprehensive weight analysis, independence tests, step-by-step modeling, ROC analysis and ROC-based sus-ceptibility zoning. This paper established fourteen models, with high accuracy and validity AUC, reaching 0.83-0.87 and 0.85-0.88, respectively. Moreover, according to the susceptibility zoning map compiled using the optimal model, 80% of landslides can be predicted in the very high and high susceptibility zones, which only account for 19.58% of the study area. Finally, the strategies for geological disaster prevention and ecological restoration deployment were put forward, providing great guiding significance for deeply understanding the landslide susceptibility of lake watersheds (Dianchi Lake) in Yunnan Plateau and guiding the planning and deployment of landslide prevention and mitigation activities and ecological restoration in the watershed.

Young people living with perinatal infections of Human Immunodeficiency Virus (YLPHIV) face a chronic disease, with treatment including adherence to life-long antiretroviral treatment (ART). The aim of this QES was to explore adherence to ART for YLPHIV as an assemblage within the framework of the BPS model with a new materialist perspective. We searched up to November 2021 and followed the ENTREQ and Cochrane guidelines for QES. All screening, data extraction and critical appraisal was done in duplicate. We analysed and interpreted the findings innovatively, by creating images of meaning, a storyboard, and storylines. We then reported the findings in a narrative first person story. We included 47 studies and identified 9 storylines. We found that treatment adherence has less to do with humans’ preferences, motivations, needs and dispositions, and more to do with how bodies, viruses, things, ideas, institutions, environments, social processes, and social structures assemble. This QES highlights that adherence to ART for YLPHIV is a multisensorial experience in a multi agentic world. Future research into rethinking the linear and casual inferences we are accustomed too in evidence-based health care is needed if we are to adopt multidisciplinary approaches to address pressing issues such as adherence to ART.

Epistemological naturalism dismisses the notion that epistemology is a basis for the empirical sciences. In particular, it rejects the demand for a general justification of induction. Making inductive generalisations is a basic habit among humans. There is no such thing as a logic of inductive inference. The role of induction in science is heuristic; it is our way of inventing new theoretical predicates and developing theories. We discover new laws by applying inductive thinking; but this is not any kind of inference which can be evaluated as more or less rational.

Increasingly large numbers of people are using digital weight-loss services (DWLSs) to treat overweight or obesity. Although it is widely agreed that digital modalities improve access to care in general, obesity stakeholders remain concerned that many DWLSs are not comprehensive or sustainable enough to deliver meaningful health outcomes. This study adopted a mixed-methods approach to assess why and after how long patients tend to discontinue Austral-ia’s largest DWLS, a program that combines behavioural and pharmacological therapy under the guidance of a multidisciplinary care team. We found that in a cohort of patients who commenced the Eucalyptus DWLS between January and June 2022 (n=5604), mean program adherence was 171.2 (±158.2). Inadequate supply of a patient’s desired Glucose-like peptide-1 receptor agonist medication was the most common reason for discontinuation (43.7%), followed by program cost (26.2%), result dissatisfaction (9.9%), and service dissatisfaction (7.2%). Statistical tests revealed that ethnicity and age both had a significant effect on patient adherence. These findings suggest that DWLSs have the potential to improve access to comprehensive, continuous obesity care, but that care models need to improve upon the one observed in the Eucalyptus Australia DWLS to maximise program adherence.

This article presents the development and validation of a new instrument measuring social, cultural, and behavioral factors influencing exposure to occupational zoonoses in agricultural settings. The Social Ecological Model (SEM) and the Standards for Educational and Psychological Testing were used as guiding frameworks to ensure the instrument's validity. The instrument's content was compiled by combining the results of a scoping literature review and an expert qualitative study. The instrument items were drafted, organized, and underwent a meticulous process of revision and adjustment. It was translated into Spanish and tested in one-to-one cognitive interviews with five volunteer agricultural workers. Exploratory factor analysis was conducted for construct discrimination, and bivariate regression analyses were conducted to explore the association with exposure indicators. Evidence of validity was obtained from four out of five sources of validity evidence according to the AERA/APA’s Standards of Educational and Psychological Testing. The Social Ecology of Occupational Zoonoses (SEOZ) was successfully used to determine social and behavioral factors associated with a higher risk of exposure to occupational zoonoses. Further use of the SEOZ can provide valuable insights into developing effective interventions to improve the health and well-being of agricultural workers.

Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain whose management is particularly challenging and for which the most effective pharmacological therapy is still controversial. Current guideline treatment recommendations vary and are mostly driven by expertise with opinion differing across different interventions. Thus, it is difficult to formulate evidence-based guidance when relatively few randomized clinical trials did explore the diagnosis and management of LBP while employing different selection criteria, statistical analyses, and outcome measurements. This narrative review aims to provide a critical appraisal of current acute LBP management by discussing the unmet needs and areas of improvement from bench-to-bedside and proposes multimodal analgesia as the way forward to attain an effective and prolonged pain relief and functional recovery in patients with acute LBP.

Real-world evidence (RWE) is increasingly involved in the early benefit assessment of medicinal drugs. It is expected that RWE will help to speed up approval processes comparable to RWE developments in vaccine research during the COVID-19 pandemic. Definitions of RWE are diverse marking the highly fluid status in this field. So far, RWE comprises information produced from data routinely collected on patient’s health status and/or delivery of health care from various sources other than traditional clinical trials. These sources can include electronic health records, claims, patient-generated data including in home-use settings, data from mobile devices as well as patient, product and disease registries. The aim of the present update was to review the current RWE developments and guidelines mainly in the U.S., the UK, Europe and Germany field during the last decade. RWE has already been included in various approval procedures of regulatory authorities reflecting its actual acceptance and growing importance in evaluating and accelerating new therapies. However, since the RWE research is still in a transition process and since a number of gaps in this field have been explored, more guidance and a consented definition are necessary to increase the implementation of real-world data.

The popularity of electronic cigarettes in the United States and around the world has led to a startling rise in youth nicotine use. The Juul e-cigarette was introduced in the U.S. market in 2015 and had captured approximately 13% of the U.S. market by 2017. Unlike many other contemporary electronic cigarette companies, the founders behind the Juul® e-cigarette approached their product launch like a traditional high-tech start-up company, not like a tobacco company. This article presents a case study of Juul’s corporate and product development history in the context of US regulatory actions. The objective of this article is to demonstrate the value of government-curated archives as leading indicators which can (a) provide insight into emergent technologies and (b) inform emergent regulatory science research questions. A variety of sources were used to gather data about the Juul e-cigarette and the corporations that surround it. Sources included government agencies, published academic literature, non-profit organizations, corporate and retail websites, and the popular press. Data was disambiguated, authenticated, and categorized prior to being placed on a timeline of events. A timeline of four significant milestones, nineteen corporate filings and events, twelve US regulatory actions, sixty four patent applications, eighty seven trademark applications, twenty three design patents and thirty two utility patents related to Juul Labs and its associates is presented spanning the years 2004 thought 2020. This work demonstrates the probative value of findings from patent, trademark, and SEC filing literature in establishing a premise for emergent regulatory science research questions which may not yet be supported by traditional archival research literature. The methods presented here can be used to identify key aspects of emerging technologies before products actually enter the market, this shifting policy formulation and problem identification from a paradigm of being reactive in favor of becoming proactive. Such a proactive approach may permit anticipatory regulatory science research and ultimately shorten the elapsed time between market technology innovation and regulatory response.

Conventional cancer clinical trials can be time-consuming and expensive, often yielding results with limited applicability to real-world scenarios and presenting challenges for patient participation. Real-world data (RWD) studies offer a promising solution to address evidence gaps and provide essential information about the effects of cancer treatments in real-world settings. Defining RWD based on its original intent, which is the collection of data at the point of care for clinical purposes, can distinguish it from conventional clinical trial data. RWD can be generated using experimental designs that resemble those used in conventional clinical trials, but with several advantages, such as improved efficiency and a better balance between internal and external validity. RWD can support pharmacovigilance, insights into disease progression, and the development of external control groups. Prospective RWD collection enables evidence generation based on pragmatic clinical trials (PCTs) that support randomized study designs and expand clinical research to the point of care. To ensure the quality of real-world studies, it is crucial to implement auditable data abstraction methods and develop new incentives to capture clinically relevant data electronically at the point of care. The treatment landscape is constantly evolving, with the integration of front-line immune checkpoint inhibitors (ICIs), either alone or in combination with chemotherapy, affecting subsequent treatment lines. Real-world effectiveness and safety in underrepresented populations, such as the elderly, patients with poor performance status (PS), hepatitis, or human immunodeficiency virus-infected patients, are still largely unexplored. Similarly, the cost-effectiveness and sustainability of these innovative agents are important considerations in the real world.

It is widely recognized that public health interventions benefit from community engagement and leadership, yet there are challenges to evaluating complex, community-led interventions assuming hierarchies of evidence derived from laboratory experimentation and clinical trials. Particular challenges include, first, inconsistency of the intervention across sites; and second, absence of researcher control over the sampling frame and methodology. This report highlights these challenges as they played out in the evaluation of a community-organized health project in South London. The project aimed to benefit maternal mental health, health literacy and social capital, and especially to engage local populations known to have reduced contact with statutory services. We evaluated the project using two studies with different designs, sampling frames and methodologies. In one the sampling frame and methodology were under community control, permitting comparison of change in outcomes from before to after participation in the project. In the other, the sampling frame and methodology were under researcher control, permitting a case-control design. The two evaluations led to different results however: participants in the community-controlled study showed benefits, while participants in the researcher-controlled study did not. The principal conclusions are that while there are severe challenges to evaluating a community-led health intervention using a controlled design, measurement of pre-/post-participation changes in well-defined health outcomes should typically be a minimum evaluation requirement, and confidence in attributing causation of any positive changes to participation can be increased by use of interventions in the project and in the engagement process itself that have a credible theoretical and empirical basis.

This study evaluates the incidence and characteristics of adverse events (AEs) following the second COVID-19 booster dose, leveraging Taiwan's distinctive approach of extending booster vaccinations to all citizens, unlike the targeted high-risk group strategies in other countries. Utilizing data from Taipei Veterans General Hospital's Vaccine Adverse Event Reporting System (VAERS) from October 27, 2022, to January 19, 2023, the research examines AEs in 441 out of 1711 second booster recipients, considering factors like age, vaccine brands, and booster combinations. The findings reveal incidence rates (IR) of 25.6% (95% CI: 21.1-30.8) after the first booster and 24.9% (95% CI: 20.5-30.0) after the second, mostly non-serious, with those having AEs post-first booster 5 times more likely to report them again (Incidence rat rato, 5.02, P&lt;0.001). Significantly, switching from the mRNA1273 vaccine to another brand reduced AE risk by 18%. The study underscores that AEs are more repetitive than cumulative with additional booster doses, advocating for personalized vaccination strategies based on individual medical histories and previous vaccine reactions. These insights are valuable for healthcare providers in discussing potential AEs with patients, thereby improving vaccine compliance and public trust, and for policymakers in planning future booster vaccination strategies.

This paper aims to contribute to refining the e-values for testing precise hypotheses, especially when dealing with nuisance parameters, leveraging the effectiveness of asymptotic expansions of the posterior. The proposed approach offers the advantage of bypassing the need for elicitation of priors and reference functions for the nuisance parameters and the multidimensional integration step. For this purpose, starting from a Laplace approximation, a posterior distribution for the parameter of interest only is considered and then a suitable objective matching prior is introduced, ensuring that the posterior mode aligns with an equivariant frequentist estimator. Consequently, both Highest Probability Density credible sets and the e-value remain invariant. Some targeted and challenging examples are discussed.

Today, numerous studies have shown that the physical environment in hospitals can significantly influence patients' well-being, comfort, and recovery. However, this is currently neglected in hospitals in the Global South. Therefore, there is an urgent need to increase the awareness to make it more applicable worldwide. Thus, this study focuses on improving the healing environment standards, by exploring the impact of evidence-based design and patient-centred care in hospitals for cancer patients; particularly the architectural space quality, on patient health outcomes as well as hospital staff health and wellbeing. In Global North countries, such as the UK, the Achieving Excellence Design Evaluation Toolkit (AEDET), is used by its National Health Services, to assess the effectiveness of various environmental attributes. However, these toolkits have not been designed for and do not work well within Global South countries, such as Northern Cyprus. To examine and compare the effectiveness of different physical environmental attributes and to evaluate user responses, the Post-Occupancy Evaluation Method and the AEDET toolkit have been used in the study. These were applied to both public and private hospitals in Northern Cyprus, involving cancer patients, staff, and professionals (n=220). The findings reveal the strength and weaknesses in terms of environmental comfort based on the aspects of evidence-based design of the hospitals such as natural light, air quality, noise, view, infection control, etc., to create a more optimal physical environment for better psychological outcomes. This is the first study to propose an adaptation of the AEDET toolkit to assist architects in designing healthcare facilities that are responsive to the requirements of hospital patients and staff; and to promote the quality of healing environment for improved health and well-being outcomes.

There is a systematic exclusion of gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI’s other than HIV in essential health packages in LMICs. To accelerate progress on sexual reproductive health (SRH), the Guttmacher–Lancet Commission proposed the adoption of these interventions into an essential health package of SRH services that should be universally available. In this commentary, we use a healthcare priority-setting processes lens to review the importance of these services for universal health coverage. We isolate inherent challenges in social value judgments for terminal, process and content evidence for their healthcare priority-setting. We then advance promising emerging practical examples from low to middle-income countries on evidence-informed decision-making processes. We recommend capacity development through regional support, generating equity and efficiency evidence and strengthening political and publicly acceptable processes to institutionalise and operationalise evidence-informed decision-making.

Aymaraism, as a socio-cultural phenomenon, has given rise to components and elements of representativeness in the population of the Andes. However, the dialectic component of the Aymara as a nation is annulled by fundamental historiographical elements that underlie this process of identification. The empirical analysis of the historical data leads us to conclude that the Aymara language and culture contain ambiguous elements that cannot be defined according to the dialectical interpretation and the current narrative. Thus, the analysis of the cultural, linguistic and social elements of this population from the Early Horizon period to the present confirms the historical distortion towards a narrative component of origin and presence in the territory of the Qullasuyu, in the current geographical area of the Collao. In order to understand this phenomenon, this work promotes the complementarity of the analysis through the use of ethnoarchaeological and documentary elements in order to clarify the origin, synthesis and development of the Aymara from a historical perspective, leaving aside the dialectical component of the present.

The city administration of China planned numerous metro projects and more metros can hardly avoid undercrossing a bridge. While metro shield construction when undercrossing a bridge (MSCUB) is frequently located in complicated natural and social context, which made the construction process more susceptible to safety accidents. Therefore, it is crucial to look into safety risk of MSCUB. The paper identified the safety risk factors during SSCUR by using literature review and experts’ evaluation, proposed a novel safety risk assessment model by integrating CFA and FER, and then selected a project case to test the validity of the suggested model. Research results show that (a) a safety risk factors list of MSCUB was identified, including 4 first-level safety risks and 37 second-level safety risk factors; (b) the proposed safety risk assessment model can be used to measure the risk values of the overall worksite safety risk, the first-level safety risks and the safety risk factors of MSCUB; (c) environment-type safety risk and personnel-type safety risk have higher risk values when shield construction undercrossing a bridge; (d) when compared to worker-type safety risk, manager-type safety risk is the higher risk value. The research can enrich the theoretic knowledge of MSCUB safety risk assessment and provide references to safety managers for conducting scientific and effective safety management on the construction site when subway undercrossing a river.

The shift towards Personalized Cancer Medicine (PCM) represents a significant transformation in cancer care, emphasizing tailored treatments based on genetic understanding of cancer at the cellular level. This review draws on recent literature to explore key factors influencing PCM implementation, highlighting the role of innovative leadership, interdisciplinary collaboration, and coordinated funding and regulatory strategies. Success in PCM relies on overcoming challenges such as integrating diverse medical disciplines, securing sustainable investment for shared infrastructures, and navigating complex regulatory landscapes. Effective leadership is crucial for fostering a culture of innovation and teamwork, essential for translating complex biological insights into personalized treatment strategies. The transition to PCM necessitates not only organizational adaptation but also the development of new professional roles and training programs, underscoring the need for a multidisciplinary approach and the importance of team science in overcoming the limitations of traditional medical paradigms. The conclusion underscores that PCM's success hinges on creating collaborative environments that support innovation, adaptability, and shared vision among all stakeholders involved in cancer care.

Based upon 30-years of research by the author a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 population is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem a new approach to bed modelling has been developed which plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence for over-utilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the current most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.

The urgency to develop vaccines against Covid-19 is putting pressure on the long and expensive development timelines which are normally required for development of lifesaving vaccines. There is a unique opportunity to take advantage of new technologies, smart and flexible design of clinical trials, and evolving regulatory science to speed up vaccine development against Covid-19 and transform vaccine development altogether.

This literature review aims to gain a deeper understanding of Spinosaurus aegyptiacus’s dorsal sail regarding its function as thermoregulation, display, or hydrodynamic. The function of S. aegyptiacus’s dorsal sail has been widely debated for many years. The three most popular hypotheses are that it was used as a biological mechanism of thermoregulation, display, or hydrodynamic. The display hypothesis includes attracting mates, intimidating rivals, and social communication with other members. This literature review delves into each of the three hypotheses using past studies and excavation sites to analyze their validity. For the hydrodynamic aspect, the lifestyle of S. aegyptiacus must first be established. Based on existing research, we cannot conclude that there is a definitive primary function of Spinosaurus aegyptiacus’s dorsal sail. However, it is likely that its sail served the crucial function of display, since it would have a large surface area and could thus be a distinguishable characteristic of S. aegyptiacus that could determine mating success. Additionally, it is probable that the sail had supplementary roles in thermoregulation and hydrodynamics.

This literature review provides a comprehensive analysis of the functional morphology and paleoecology of Pteranodon, a prominent genus of Pterosaur from the Late Cretaceous period. By synthesizing recent research findings with classic studies, this paper elucidates the aerodynamic and ecological adaptations of Pteranodon, which was one of the largest pterosaurs to ever soar the skies. The review examines the distinctive cranial features, including its elongated cranial crest and its implications for sexual dimorphism and species identification. Detailed analysis of wing morphology and limb proportions reveals insights into its flight mechanics, suggesting that Pteranodon was adapted for dynamic soaring, leveraging its expansive wingspan for efficient long-distance travel. Additionally, the paper explores Pteranodon's feeding habits and dietary preferences based on dental and jaw structure, indicating a diet primarily consisting of fish and other aquatic prey. The review also integrates fossil evidence with ecological models to reconstruct the paleoenvironment of the Late Cretaceous, highlighting the role of Pteranodon in its ecosystem as both a predator and a competitor. This synthesis not only enhances our understanding of Pteranodon’s physiological and ecological roles but also contributes to broader discussions on pterosaur evolution and behavior.

Therizinosaurs, a unique clade of theropod dinosaurs, are characterized by their distinct morphological features and enigmatic ecological role. This review provides a comprehensive analysis of the functional morphology and ecological significance of these remarkable dinosaurs. Therizinosaurs are distinguished by their elongated, often curved claws, robust postcranial skeletons, and herbivorous diet, which starkly contrasts with their carnivorous theropod relatives. We explore the evolutionary implications of their morphology, focusing on adaptations such as their specialized feeding apparatus and limb structure. These features suggest a complex interplay between their herbivorous lifestyle and ecological niche. The review synthesizes recent findings from fossil evidence, including detailed studies of cranial and postcranial anatomy, to elucidate the functional mechanisms behind their unique adaptations. Additionally, we discuss the broader ecological role of therizinosaurs within their Mesozoic ecosystems, highlighting their interactions with contemporaneous flora and fauna. By integrating paleontological data with comparative anatomy and ecological modeling, this review aims to shed light on the evolutionary trajectory of therizinosaurs and their impact on our understanding of theropod diversity and adaptation. This focused review contributes to a more nuanced appreciation of therizinosaurs' place in dinosaur evolution and their adaptive strategies in prehistoric environments.

Neurodegeneration is a major problem in neuroscience and medicine as it causes and worsens many neurological and psychiatric disorders. It involves gradual loss of neurons at different levels of the brain, affecting cognition, emotion, behavior, consciousness, and attention. Understanding the causes and consequences of neurodegeneration is crucial for identifying the risk factors, biomarkers, and treatments. However, the current therapies are mostly symptomatic and ineffective. Therefore, new and innovative methods, such as noninvasive brain stimulation (NIBS), are needed to modulate brain activity and plasticity in a safe and reversible manner. This field is rapidly developing, with a focus on exploring new clinical applications, mechanisms, and combinations of NIBS and drugs. This special issue covers the latest progress and challenges in the study of neurodegeneration in cognitive impairment and mood disorders from the experimental, clinical, and translational perspectives. It addresses the complexity and diversity of these conditions, the lack of disease-modifying treatments, the ethical and practical issues of conducting research in vulnerable and diverse populations, the integration and interpretation of data from multiple sources and modalities, and the development and validation of novel methods such as NIBS, artificial intelligence, and drug repurposing. Collaborative efforts among various stakeholders are needed to improve our knowledge and treatment of neurodegeneration underlying cognitive impairment and mood disorders.