Search Results (2,450)

Background: Health literacy plays an important role in medication understanding, self-management, and engagement with healthcare services among older adults. Limited health literacy may contribute to medication-related problems and reduced utilization of pharmacist-led services in geriatric populations. Methods: A cross-sectional, questionnaire-based survey was conducted among geriatric outpatients (≥60 years) attending a tertiary-care teaching hospital in Saudi Arabia. Health literacy was assessed using a four-domain functional tool—covering prescription label comprehension, understanding of healthcare instructions, confidence in completing medical forms, and comprehension of written health information—developed in alignment with established health literacy frameworks, including the Health Literacy Survey—European Union (HLS-EU) model and Baker’s conceptual framework. Participants were classified as having higher health literacy (0–2 domains impaired) or lower health literacy (3–4 domains impaired). Sociodemographic characteristics, clinical burden, medication self-management behaviors, and awareness of clinical pharmacist services were recorded. Multivariable logistic regression was used to identify factors independently associated with lower health literacy. Results: A total of 200 participants were included. Impairment in three or more domains was observed in 55.5% of participants. Lower health literacy was independently associated with older age, lower educational attainment, lower income, female sex, multimorbidity, and polypharmacy. Participants with lower health literacy reported higher rates of missed or incorrect medication dosing and unreported adverse drug reactions and lower use of medication management aids. Awareness of clinical pharmacist services and prior exposure to pharmacist counseling were significantly lower among participants with lower health literacy. Willingness to receive pharmacist counseling was higher among participants with higher health literacy and greater awareness of pharmacist roles. Conclusions: Health-literacy impairment is common among geriatric outpatients and is associated with medication self-management behaviors and engagement with pharmacist-led services. These findings highlight the relevance of functional health literacy in geriatric medication use and support further research on literacy-sensitive pharmacist-led interventions. Full article

This study investigates the phytochemical and pharmacological profiles of Crinum asiaticum L. var. anomalum Baker from Vietnam. Phytochemical screening identified diverse secondary metabolites, including polyphenols, flavonoids, and alkaloids. Gas chromatography–mass spectrometry analysis of the n-hexane fractions revealed 19 major compounds. While all extracts showed moderate antioxidant activity, the chloroform fraction exhibited superior antidiabetic potential via α-amylase inhibition (IC₅₀ = 83.13 ± 6.67 µg/mL). Furthermore, at non-cytotoxic concentrations (3.13 to 50 µg/mL), this fraction effectively rescued mouse β-TC6 insulinoma cells from thapsigargin. In anti-inflammatory assays, the n-hexane fraction significantly suppressed nitric oxide production in RAW 264.7 macrophages (IC₅₀ = 53.12 ± 1.63 µg/mL). Notably, the extracts displayed remarkable selective anticancer activity, particularly the chloroform fraction against HeLa cervical and HepG2/Huh-7 hepatoma cell lines. In silico ADMET and Lipinski’s Rule of Five analyses confirmed that the key bioactive constituents possess favorable pharmacokinetic profiles and drug-likeness. These findings demonstrate C. asiaticum L. var. anomalum Baker as a promising natural source for developing multitarget therapeutic agents against inflammation, diabetes, and cancer. Full article

Wildlife rehabilitation can alter host-associated microbial communities, yet the effects of temporary managed care on the gut microbiome of insectivorous bats remain poorly understood. We used shotgun metagenomic sequencing to investigate gut microbiome composition in wild and rehabilitated bats from Yorkshire, United Kingdom. A total of 25 faecal metagenomes were analysed from four bat species (Myotis daubentonii, Pipistrellus pipistrellus, Nyctalus noctula, and Nyctalus leisleri), including wild baseline individuals and bats undergoing temporary managed care for 1–49 days. Microbial community structure clustered primarily according to host species and roost location, with no significant separation associated with rehabilitation status. Among bats in managed care, bacterial alpha diversity did not differ significantly with time in care (H = 2.30, p = 0.32). Archaeal communities displayed markedly lower interindividual variation than bacterial communities (coefficient of variation: 12.2% vs. 41.8%), indicating a highly conserved archaeal microbiome across hosts. Rehabilitated bats exhibited modest compositional shifts in bacterial communities, including increased relative abundances of Yersiniaceae and Lactobacillaceae and reduced abundances of environmentally associated taxa such as Pseudomonadaceae and Erwiniaceae. These changes may reflect controlled dietary provision and reduced environmental exposure during care. Overall, no marked rehabilitation-associated differences in gut microbiome diversity or community structure were detected under the current sampling design. These findings are consistent with microbiome stability during temporary managed care, although longitudinal studies are required to confirm microbiome dynamics within individual bats. Nonetheless, this study provides an initial baseline for future microbiome-informed wildlife rehabilitation studies. Full article

This study conducts a comparative analysis of surgical outcomes in patients who underwent FSF repair by a plastic surgeon versus an ENT using a national database. A retrospective analysis was conducted on patients who underwent surgical treatment of FSFs by a plastic or ENT surgeon using the de-identified American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patients were identified based on surgical CPT codes. Data extracted included primary surgeon specialty and patient demographics, comorbidities, and surgical outcomes. Statistical analysis was performed using Fisher’s Exact test and the Wilcoxon Rank-Sum test, with a p-value < 0.05 representing statistical significance. A total of 111 patients were analyzed, of which 85.6% were male. The mean age was 30.0 years [22.0, 48.0]. There were 70 patients (63.1%) treated by an ENT and 41 (36.9%) by a plastic surgeon. The median operative time was 131.0 min for ENT and 115.0 min for plastic surgery (p = 0.19). The median length of postoperative stay was 1.0 day for both groups. Postoperative complications included surgical site infection (SSI), wound disruption, and sepsis in five patients (4.5%). There was no statistically significant difference in the rate of complications between patients who underwent surgery with an ENT surgeon versus a plastic surgeon (p = 0.16). There were no statistically significant differences in operative time, length of stay, or complications between patients who underwent FSF repair by an ENT or by a plastic surgeon. Surgeon specialty training does not appear to influence intraoperative or postoperative outcomes. Studies with larger sample sizes may demonstrate statistically significant differences in outcomes. Full article

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects. Full article

Background: The paediatric dentistry domain requires effective management of pain in children during invasive procedures such as the inferior alveolar nerve block (IANB). This study aimed to evaluate the effectiveness of Buzzy BEE^TM in reducing pain perception during IANB in children. Methods: This crossover study recruited 38 children aged 6–10 years scheduled for bilateral dental procedures requiring IANB. The washout period was 7 days, and two visits were scheduled for procedures on either side. Two randomly allocated groups received the study intervention, with each group receiving it alternately at each visit. Outcomes measured were pulse rate; subjective pain assessment using the Wong–Baker FACES Rating Scale (WBS); objective pain assessment using the Sound, Eyes and Motor (SEM) scale; and parental rating of observed pain on a scale of 1–10. Results: A statistically significant reduction in pulse rate after IANB was observed in the Buzzy BEE group at the first (p = 0.02) and second (p = 0.002) visits. At the second visit, the WBS scores (p < 0.001) and ‘eye’ (p = 0.004) and ‘motor’ (p = 0.002) scores on the SEM scale were significantly reduced in the Buzzy BEE group. The crossover analysis identified a significant treatment effect on pulse rate (p < 0.001) and significant carryover effects on WBS and SEM scores (p < 0.001). Conclusions: The use of Buzzy BEE reduced pulse rates during IANB, suggesting a positive impact on children’s anxiety. The carryover effects in the current study limit the consistency of improvements in subjective and objective pain perceptions. Further studies with a larger sample size and an extended washout period are recommended to evaluate the effectiveness of Buzzy BEE in reducing pain perception during IANB. Full article

Flavonols are an important class of flavonoids widely distributed across various plant species. They have garnered significant attention from synthetic chemists due to their extensive biological activities and medicinal value. This review provides a systematic overview of five classical synthetic methods, including the Auwers reaction, the Allan–Robinson reaction, the Baker–Venkataraman rearrangement, the Algar–Flynn–Oyamada (AFO) reaction, and DMDO-mediated oxidation. Each methodology is comprehensively discussed in terms of its advantages, limitations, and potential optimization strategies. Additionally, the biological activities, including antioxidant, anticancer, anti-inflammatory, and antiviral properties, are summarized and discussed in the context of structure–activity relationships (SARs). Full article

The genus Tulipa L. is a common group of ornamental plants, characterized by high morphological variability and a complex taxonomy. Despite considerable interest in this group, assessments of its species composition remain inconclusive, as evidenced by discrepancies between contemporary taxonomic sources. The number of recognized taxa varies across major taxonomic databases, including Plants of the World Online, World Flora Online, and Euro+Med PlantBase, reflecting ongoing taxonomic revisions and differences in species concepts. In terms of distribution patterns, 7.6% are widely distributed taxa across transcontinental regions, 28.0% occur across multiple countries within a continent, and 66.9% are range-restricted taxa. The latter group includes 4.2% transnational endemics, 44.1% single-country endemics, 8.5% single-region endemics, and 10.2% single-site endemics. Recent taxonomic and evolutionary studies of Tulipa increasingly rely on molecular approaches, particularly DNA barcoding and chloroplast genome analyses, which have improved phylogenetic resolution and species delimitation in several cases. However, truly comprehensive studies combining morphological, cytogenetic, and molecular datasets remain limited and are typically restricted to individual taxa or species complexes rather than the genus as a whole. Modern molecular genetic studies demonstrate the high informativeness of both nuclear and plastid markers for studying the phylogeny, systematics, and genetic diversity of Tulipa species. Natural populations of Tulipa are under pressure from anthropogenic factors and climate change, resulting in reduced range and habitat degradation. According to the International Union for Conservation of Nature Red List of Threatened Species, among 118 taxa of the genus Tulipa, T. sprengeri Baker is classified as Extinct in the Wild, 5.9% as Critically Endangered, 5.9% as Endangered, 8.5% as Vulnerable, 11.9% as Near Threatened, and 11.0% as Least Concern. The use of exclusively national assessments to determine species extinction risk may be insufficiently objective, whereas global assessments provide a more informative and reliable approach for evaluating conservation status. In this review, we combine investigations of the morphology, taxonomy, and geographic diversity; population genetic structure and molecular diversity; and molecular phylogenetics and plastome-based genomics of the genus Tulipa. Furthermore, the review examines current challenges and future research prospects, emphasizing that studies of the genus Tulipa should integrate morphological, genomic, and ecological approaches to refine taxonomy and conserve genetic resources. Full article

Taking spot samples at hydrogen refuelling stations (HRSs) and performing offline analysis in laboratories is currently the only way to achieve hydrogen fuel compliance at HRS (meet the ISO 14687:2025 standard or EN 17124:2022 in Europe). Currently, different sampling strategies are defined in ISO 19880-9:2024 (Annex A–C) and implemented in different parts of the world (EU, Japan, USA). The differences in conducting the sampling potentially influence the hydrogen samples; therefore, there is a need to compare the different sampling strategies. Comparative sampling studies are required to evaluate the equivalence of sampling methodologies and support the standardisation of hydrogen fuel sampling. This study provides a systematic comparison of five European sampling systems with different sampling strategies under real and defined HRS operation conditions. The results show that the issue of representative sampling is more complex than initially assumed and that there is an interdependence of sampling device and HRS configuration, respectively. Full article

This study developed a two-step statistically integrated optimization framework to identify the effects of key fermentation medium components controlling hyaluronic acid (HA) biosynthesis by Streptococcus zooepidemicus. As an initial phase, the Plackett–Burman design was employed to identify the most influential components among yeast extract, casein, peptone, beef extract, MgSO₄·7H₂O, K₂HPO₄, KH₂PO₄, and (NH₄)₂SO₄ by conducting 12 fermentation runs, and 30 g/L of glucose was used as the carbon source. Among the eight ingredients, yeast extract, MgSO₄·7H₂O, and KH₂PO₄ were identified as the most significant factors in enhancing HA production. The following steps were based on the selection of the best carbon and yeast extract sources. Sucrose was selected as the optimal carbon source among glucose and lactose, and Tastone 900-Baker’s yeast extract was selected as the optimal nitrogen source among various yeast extract sources. The final phase of the optimization procedure employed the Box–Behnken design to determine the optimal concentrations of three ingredients: yeast extract (10–30 g/L), MgSO₄·7H₂O (0.2–2.0 g/L), and KH₂PO₄ (1–4 g/L). The results depicted that the optimized media formulation, composed of 30.0 g/L of yeast extract, 1.16 g/L of MgSO₄·7H₂O, and 4.0 g/L of KH₂PO₄, enhanced HA production and biomass OD600 to 545.9 mg/L with 1250–1500 kDa and 2.53 OD600 in a 250 mL shake flask scale, which was around a 10-fold increase in HA production compared with run #10 of Plackett–Burman (57.42 mg/L). This study provided preliminary results for future process conditions optimization, scale-up studies, and techno-economic evaluation. Full article

Compact urban form can reduce road transportation GHG emissions and mitigate resource supply bottlenecks associated with mass EV adoption. Global databases from Climate TRACE and the Global Human Settlement Layer are utilized to develop the Compact Urban Form Estimation Tool or CUFET for calculating the reduction in VKT and road transportation GHGs from shifting toward CUF. The CUFET does not explicitly account for mechanistic changes in driving (e.g., modal shift) but rather uses settlement density as a coarse proxy for walking and transit urban fabrics. VKT was modeled using weighted least squares regression from the independent variables settlement population, settlement population density, and country fixed effects. Population size banding was introduced to the model to improve explanatory power. The model was developed using 10,495 settlements in the 2021 Climate TRACE dataset. The CUFET VKT model was able to explain 78% (p < 0.001) of the variation in the VKT of test settlements and improved with the addition of a country fixed effect. The CUFET on average gave estimates of VKT within 24% of Climate TRACE-calculated VKT for countries with a GDP per capita between $20,000 and $45,000 and average estimates within 20% for countries with a GDP per capita above $45,000. Increased settlement density was associated with more substantial reductions in VKT in small (50,000 to 88,335) and medium (88,335 to 329,480) sized settlements relative to large (>329,480) settlements. Higher variability was observed in VKT estimates of small settlements. The CUFET VKT was validated by backcasting historical VKT data from 1960 to 2000. The backcasting exercise used historical administrative boundaries and only included high economic output nations (GDP per capita above $20,000 in 2021 USD). Despite these limitations, backcasting achieved a % difference of ~20% for settlements after 1990, suggesting the model can make useful estimates within 30 years of the model calibration year for high economic output nations. The VKT model was used to calculate emissions using a settlement-specific emissions factor. Settlements with annual road transportation emissions per capita greater than 2 t CO₂eq have the lowest population densities relative to their populations and are mostly located in the United States, Japan, Canada, and Australia. The nations with the highest transportation emissions are also nations where the CUFET provides the most accurate VKT estimates. The CUFET aims to bridge the gap between academic consensus and local decision-making practice by reducing the barriers to estimate VKT and transportation GHG reduction from shifting to compact urban form. Full article

Background: Rifaximin is widely used in the management of small intestinal bacterial overgrowth (SIBO), but concerns remain regarding the potential risk of Clostridioides difficile infection (CDI), particularly with repeated antibiotic exposure. Aim: To evaluate the short-term risk of CDI following Rifaximin therapy in patients with SIBO. Materials and Methods: We conducted a retrospective cohort study using the TriNetX Collaborative Research Network. Adult patients with SIBO were identified and categorized based on Rifaximin exposure within 60 days of diagnosis. The primary analysis compared patients with SIBO treated with Rifaximin to those with SIBO who did not receive Rifaximin. Secondary analyses included comparisons between SIBO patients treated with Rifaximin and irritable bowel syndrome (IBS) patients receiving Rifaximin, as well as patients with SIBO receiving a single versus multiple Rifaximin courses. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary outcome was CDI within 60 days of the index event. Secondary outcomes included hospitalization and emergency department (ED) visits. Results: After propensity score matching, 19,597 patients were included in each cohort in the primary comparison of SIBO treated with Rifaximin versus SIBO without Rifaximin. CDI occurred in 0.21% of Rifaximin-treated patients and 0.15% of untreated patients (p = 0.152). In the contextual comparison, CDI incidence was similar between SIBO patients receiving Rifaximin and IBS patients receiving Rifaximin (0.21% vs. 0.15%, p = 0.168). Among patients with SIBO receiving Rifaximin, CDI risk did not differ between single and multiple treatment courses (0.20% vs. 0.21%, p = 0.850). Conclusions: In this large real-world cohort, Rifaximin therapy for SIBO was not associated with a statistically significant increase in short-term CDI risk. However, given the low event rate, wide confidence intervals, and risk of type II error, these findings should be interpreted with caution. Full article

Genetically encoded voltage indicators (GEVIs) have long promised optical access to membrane potential, yet their adoption has lagged significantly behind genetically encoded calcium indicators. A central but underappreciated reason is that the metrics used to evaluate and compare GEVIs—fractional fluorescence change (ΔF/F), kinetics, and signal-to-noise ratio—rest on an assumption that is frequently violated: that GEVI fluorescence reflects a single underlying process. In this perspective, we argue that GEVI signals are composite optical measurements, arising from the superposition of voltage-dependent fluorescence, intracellular and nonresponsive signal, background, and contributions from neighboring cells. Under these conditions, ΔF/F is not a measure of sensor sensitivity but a contrast metric whose value depends on baseline fluorescence composition, optical sampling, and imaging configuration. This reinterpretation has two key consequences. First, it explains a substantial source of variability in GEVI performance that is currently attributed to noise or experimental inconsistency. Second, and more importantly, it reveals that the complexity of GEVI signals is not a limitation to be minimized but a resource to be exploited. By resolving composite signal components, GEVIs can report multiplexed physiological variables, expose hidden conformational states of voltage-sensing domains, probe membrane organization, and reveal intracellular and intercellular electrical coupling. We propose that realizing the full potential of GEVIs requires treating ΔF/F not as a gold standard for sensor performance, but as one interpretable component of a richer optical measurement whose structure encodes multiple layers of cellular physiology. Full article

Flat and profile-modulated permalloy films have been studied by the electron magnetic resonance (EMR) method. In addition to ferromagnetic and spin-wave resonances, the structures demonstrate low-field EMR signals of an unusual shape, which form a hysteresis loop in sweeping fields. The low-field signals are attributed to a fast reorientation of magnetic domains. The low-field EMR behavior is comparable to the behavior in magneto-dependent photovoltage previously observed in the optical experiments. The shapes of the loops and typical values of the switching fields depend on the profile modulation parameters confirming the possibility of controlling magnetic properties and the coupling of magnetic and optical effects with nanoscale geometry. Full article

Objective: This study aimed to investigate the impact of elevated CRP on survival outcomes in small renal masses (SRM). Methods: This was a multi-institutional retrospective analysis of SRM (≤3 cm) managed surgically. The cohort was divided into elevated CRP (≥0.5 mg/dL) vs. non-elevated CRP groups (<0.5). The primary outcome was all-cause mortality (ACM). The secondary outcomes were non-cancer (NCM) and cancer-specific mortality (CSM). Cox-regression analysis was used to elucidate predictive factors for mortality outcomes. Kaplan–Meier Analysis (KMA) was performed to analyze 10-year overall (OS), cancer-specific (CSS) and non-cancer-specific survival (NCS). Results: A total of 1001 patients were analyzed (309 non-elevated CRP/692 elevated CRP; median follow-up 70 months). Elevated CRP was an independent predictor for ACM (HR = 2.60, p < 0.001) NCM (HR = 2.90, p = 0.002), and CSM (HR = 1.20, p = 0.011). KMA comparing elevated vs. non-elevated groups revealed greater 10-year OS (p < 0.001) and NCS (p < 0.001) for non-elevated CRP, but no significant difference in 10-year CSS (p = 0.295). A total of 83 deaths were observed in elevated CRP (71 NCM/12 CSM—all clear-cell histology). The sensitivity/specificity of elevated CRP was 0.87/0.33, 0.75/0.81, and 0.90/0.33 for ACM, CSM, and NCM. By utilizing CRP for a decision-making algorithm prioritizing biopsy in CRP elevation and offering surveillance in benign or indolent histology, surgery may be avoided in 218 patients, in whom there were 38 fatalities, all NCM. Conclusions: Elevated CRP was an independent predictor of survival outcomes in SRM ≤ 3 cm. From a competing mortality standpoint, patients with elevated CRP had significantly worsened NCM compared to CSM. In such patients, upfront oncologic risk stratification through biopsy may be considered, and indolent/low-grade neoplasms should be strongly considered for non-surgical management. Full article