Search Results (925)

Background/Objectives: This study compared overall survival (OS) associated with common real-world treatment sequences in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in the United States. Methods: Utilizing the nationwide Flatiron Health electronic health record-derived de-identified database, adult CLL/SLL patients who initiated systemic therapy (JAN2016-NOV2023) and received at least two lines of therapy (LoTs) were analyzed. Treatment regimens were categorized based on drug class, and most frequent (n ≥ 50) sequences (first LoT followed by [→] second LoT) were compared. OS from initiation of the first LoT was compared using multivariable Cox proportional hazard models, and adjusted hazard ratios with 95% CIs were reported. Results: Among 2354 eligible patients, n = 1711 (73%) received the 16 most frequent treatment sequences. Sequencing chemoimmunotherapy (CIT) → CIT (HR: 2.29 [1.23–4.28]), anti-CD20 monoclonal antibody (anti-CD20mab) monotherapy → CIT (1.95 [1.03–3.69]), and covalent Bruton tyrosine kinase inhibitor (cBTKi) monotherapy → anti-CD20mab monotherapy (2.00 [1.07–3.74]) were associated with worse OS compared to patients treated with cBTKi monotherapy → B-cell lymphoma 2 inhibitors (BCL2i) + anti-CD20mab (reference). Conclusions: OS associated with other sequences were not significantly different from the reference sequence in adjusted analyses, suggesting a lack of evidence for the optimal standard of care for sequencing the first two LoTs in real-world settings. Future research should reassess sequencing outcomes as novel treatments become adopted into clinical practice. Full article

Background: There is growing evidence suggesting that SARS-CoV-2 may contribute to metabolic dysfunction. SARS-CoV-2 infection is associated with systemic inflammation, oxidative stress, and metabolic dysregulation, all of which may impair liver function and promote glucose intolerance. This study investigated the role of SARS-CoV-2, specifically its Main Protease (M^pro), in accelerating insulin resistance and metabolic dysfunction in HepG2 cells in vitro. Methods: HepG2 cells were treated with varying concentrations of M^pro (2.5, 5, 10, 20, 40, 80, and 160 nmol/mL) for 24 h to assess cytotoxicity and glucose uptake. Based on initial findings, subsequent assays focused on higher concentrations (40, 80, and 160 nmol/mL). The effects of M^pro on cell viability, protein kinase B (AKT) expression, matrix metallopeptidase-1 (MMP1), dipeptidyl peptidase 4 (DPP4), interleukin-6 (IL-6) expression, and lipid peroxidation were investigated. Results: Our findings reveal that the SARS-CoV-2 M^pro treatment led to a concentration-dependent reduction in glucose uptake in HepG2 cells. Additionally, the M^pro treatment was associated with reduced insulin-stimulated AKT activation, particularly at higher concentrations. Inflammatory markers such as IL-6 were elevated in the extracellular medium, while DPP4 expression was decreased. However, extracellular soluble DPP4 (sDPP4) levels did not show a significant change. Despite these changes, cell viability remained relatively unaffected, suggesting that the HepG2 cells were able to maintain overall metabolic functions under M^pro exposure. Conclusions: This study demonstrated the concentration-dependent impairment of hepatic glucose metabolism, insulin signaling, and inflammatory pathways in HepG2 cells acutely exposed to the SARS-CoV-2 M^pro. These findings warrant further investigation to explore the long-term metabolic effects of SARS-CoV-2 and its proteases in the liver and to develop potential therapeutic approaches for post-viral metabolic complications. Full article

Seaweeds, classified as non-vascular plants, have definite advantages over terrestrial plants as they grow rapidly, can be cultivated in coastal environments, and are dependable and non-endangered sources of biomass. Algal bioproducts, which include a wide range of bioactive compounds, have drawn much interest because of their applications in nutraceuticals, pharmaceuticals, agriculture, and cosmetics. Particularly in the pharmaceutical and nutraceutical fields, algal bioproducts have shown tremendous activity in regulating enzymes involved in human diseases. However, the drawbacks of conventional extraction methods impede the complete exploitation of seaweed biomass. These include low efficiency, high cost, and potential harm to the environment. Enzyme technology developments in recent years present a viable way to overcome these challenges. Enzymatic processes improve product yields and reduce the environmental impact of processing, while facilitating the more effective extraction of valuable bioactive compounds as part of an integrated biorefinery approach. Enzyme-assisted biorefinery techniques can greatly advance the creation of a circular bioeconomy and increase the yield of extracted seaweed bioproducts, thus improving their value. With the potential to scale up to industrial levels, these biotechnological developments in enzymatic extraction are developing rapidly and can advance the sustainable exploitation of seaweed resources. This review emphasises the increasing importance of enzyme technologies in the seaweed biorefinery and their contribution to developing more environmentally friendly, economically feasible, and sustainable methods for valorising products derived from seaweed. In the biorefinery industry, enzyme-assisted methods have enormous potential for large-scale industrial applications with further development, opening the door to a more sustainable, circular bioeconomy. Full article

This article presents a theological framework of a Theology of Living, which seeks to reimagine the task of theology as a lived, communal and practical enterprise. Departing from purely systematic or disembodied approaches, this theology emphasises the relational and contextual dimensions of Christian faith. The embedded nature of theology acknowledges that theological reflection is always situated within particular histories, cultures and communities. The deliberative dimension foregrounds the necessity of intentional, dialogical discernment in response to complex moral and spiritual challenges. The embodied aspect affirms that theology is not merely spoken or written, but enacted through the rhythms of everyday life, worship and service. Drawing upon pastoral experience, biblical reflection and theological discourse, this article proposes that such an integrated approach to theology not only bridges the gap between doctrine and practice but also reclaims theology’s vocational role in forming individuals and communities shaped by love, justice and hope. Full article

The present study focuses on investigating the contribution of puppetry as a pedagogical and psychosocial tool in special education, addressing the literature gap in the systematic documentation of the experiences of special education teachers, concerning its use in daily teaching practice. The main objective is to capture the way in which puppetry enhances the learning, social and therapeutic support of students with complex educational and psychosocial needs. The study employs a qualitative phenomenological approach, conducting semi-structured interviews with eleven special education teachers who integrate puppetry into their teaching. Qualitative data were analyzed using thematic analysis. The findings highlight that puppetry significantly enhances cognitive function, concentration, memory and language development, while promoting the active participation, cooperation, social inclusion and self-expression of students. In addition, the use of the puppet acts as a means of psycho-emotional empowerment, supporting positive behavior and helping students cope with stress and behavioral difficulties. Participants identified peer support, material adequacy and training as key factors for effective implementation, while conversely, a lack of resources and time is cited as a key obstacle. The integration of puppetry in everyday school life seems to ameliorate a more personalized, supportive and experiential learning environment, responding to the diverse and complex profiles of students attending special schools. Continuous training for teachers, along with strengthening the collaboration between the arts and special education, is essential for the effective use of puppetry in the classroom. Full article

Substance use is a critical public health issue in the U.S., with Black communities, particularly those with criminal justice contact, disproportionately affected. Chronic exposure to stressors can lead to substance use as a coping strategy. This study used data from 1476 Black adults with criminal justice involvement from the National Survey of American Life to examine how psychosocial stress and sleep disturbances relate to lifetime substance use and to determine if there are any sex differences. Sex-separate generalized linear models for a Poisson distribution with a log-link function estimated prevalence ratios and adjusted prevalence ratios (APRs) for lifetime alcohol abuse, lifetime cigarette, and marijuana use. Independent variables include stressors (family, person, neighborhood, financial, and work-related) and sleep problems, with covariates such as age, SES, and marital status. Lifetime alcohol abuse was associated with family stressors (APR = 2.72) and sleep problems (APR = 3.36) for males, and financial stressors (APR = 2.75) and sleep problems (APR = 2.24) for females. Cigarette use was linked to family stressors (APR = 1.73) for males and work stressors (APR = 1.78) for females. Marijuana use was associated with family stressors (APR = 2.31) and sleep problems (APR = 2.07) for males, and neighborhood stressors (APR = 1.72) for females. Lifetime alcohol abuse, as well as lifetime cigarette and marijuana use, was uniquely associated with various psychosocial stressors among Black adult males and females with criminal justice contact. These findings highlight the role of structural inequities in shaping substance use and support using a Social Determinants of Health framework to address addiction in this population. Full article

Transmembrane protein 43 (TMEM43 or LUMA) encodes a highly conserved protein found in the nuclear and endoplasmic reticulum membranes of many cell types and the intercalated discs and adherens junctions of cardiac myocytes. TMEM43 is involved in facilitating intra/extracellular signal transduction to the nucleus via the linker of the nucleoskeleton and cytoskeleton complex. Genetic mutations may result in reduced TMEM43 expression and altered TMEM43 protein cellular localization, resulting in impaired cell polarization, intracellular force transmission, and cell–cell connections. The p.S358L mutation causes arrhythmogenic right ventricular cardiomyopathy type-5 and is associated with increased absorption of lipids, fatty acids, and cholesterol in the mouse small intestine, which may promote fibro-fatty replacement of cardiac myocytes. Mutations (p.E85K and p.I91V) have been identified in patients with Emery–Dreifuss Muscular Dystrophy-related myopathies. Other mutations also lead to auditory neuropathy spectrum disorder-associated hearing loss and have a negative association with cancer progression and tumor cell survival. This review explores the pathogenesis of TMEM43 mutation-associated diseases in humans, highlighting animal and in vitro studies that describe the molecular details of disease processes and clinical, histologic, and molecular manifestations. Additionally, we discuss TMEM43 expression-related conditions and how each disease may progress to severe and life-threatening states. Full article

(1) Background: The integration of digital technologies such as electronic health records (EHRs), telepsychiatry, and communication platforms has transformed the mental health sector a lot compared to in previous years. While these tools enhance service delivery, they also introduce unique stressors. Despite growing concerns, there is no validated instrument specifically designed to measure the digital stress experienced by mental health professionals. (2) Methods: This study involved the development and psychometric validation of the Digital Stress Scale (DSC). The process included item generation through a literature review and qualitative interviews, expert panel validation, and a two-phase statistical evaluation. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted on responses from 423 licensed mental health professionals using EHRs and digital communication tools. The scale’s reliability and convergent validity were assessed via internal consistency and correlations with established mental health measures. (3) Results: The final DSC included four subscales: digital fatigue, technostress, digital disengagement, and work–life digital boundaries. CFA supported the factor structure (CFI = 0.965, RMSEA = 0.038), and the overall reliability was acceptable (Cronbach’s Alpha = 0.87). Descriptive analysis showed moderate-to-high levels of digital stress (M = 11.94, SD = 2.72). Digital fatigue was the strongest predictor of total stress (β = 1.00, p < 0.001), followed by technostress and work–life boundary violations. All subscales were significantly correlated with burnout (r = 0.72), job dissatisfaction (r = −0.61), and perceived stress (r = 0.68), all with a p < 0.001. (4) Conclusions: The DSC is a valid and reliable tool for assessing digital stress among mental health professionals. Findings point out the urgent need for policy-level interventions to mitigate digital overload, promote healthy work–life boundaries, and enhance digital competency in mental health settings. Full article

Bicycle use has been increasing in many countries for active, sustainable transportation and recreation. Bicycling can benefit an individual’s mental and physical health and contribute to a community’s well-being and desirability, and it is more environmentally sustainable than automobiles. Nonprofit organizations lead bicycle advocacy efforts in the USA, both for bicycling as recreation and as part of local transportation systems. Outride is one of the larger advocacy organizations, and it sponsors a unique grant system targeting grassroots bicycling organizations dedicated to increasing bicycling. Using the Bicycle Community Development Framework (BCDF) as a lens, this study aims to evaluate Outride’s efforts through an interpretative phenomenological approach (IPA) using semi-structured interviews to gather data regarding grant recipients’ experiences using Outride funds. Findings suggest fund recipients are increasing bicycling through programs and infrastructure development, but with more intentionality, could better support building bicycle communities. Regarding the BCDF, the recipients strongly promoted education, engineering, and equity & accessibility while fostering a sense of community, belonging, and empowerment in their participants. Full article

Evaluation of semen quality is crucial for predicting fertility success in artificial insemination and eventual rooster selection within poultry breeding programs. However, the multitude of parameters obtained in semen quality analysis makes it challenging for breeders to make informed selection decisions. This study evaluated semen samples from 210 roosters in seven chicken breeds, using a computer-aided sperm analysis (CASA) system. A multivariate approach utilizing factor analysis (FA) was applied to simplify the data. The FA condensed 14 semen quality traits into 3 factors, linearity factor, velocity factor, and quantitative factor, explaining 75.82% of the original variations. The Beijing-You breed was selected to analyze the association between fertility and these semen quality factors, and we found high correlation between fertility and quantitative (r = 0.84) and linearity (r = 0.63) factors, and low correlation with the velocity factor (r = 0.19). Based on individual factor scores, breed clustering revealed distinct profiles with Houdan, Tibetan, and White Leghorn demonstrating lower sperm counts and poor linearity. Columbian Plymouth Rock exhibited high speed with poor linearity while Beijing-You, Rhode Island Red, and Barred Plymouth Rock displayed higher sperm counts with compromised speed and linearity. This study demonstrates that FA effectively consolidates multiple semen quality traits into fewer, biologically relevant factors. These findings provide valuable insights into breed-specific reproductive characteristics and offer actionable information for optimizing breeding in poultry production. Full article

Rivers are recognized as significant pathways and transportation for microplastics (MPs), an emerging contaminant, to aquatic environments. However, there is limited evidence on how riverine reservoirs influence MPs transport. To fill this gap and provide baseline empirical data and insights to South African context, the current study assessed the seasonal variation in MP densities from sediments collected upstream, within the reservoir, and downstream of the Vondo Reservoir along the Mutshindudi River. We hypothesised that MP densities would be highest within the reservoir, due to the lack of constant flow that would otherwise transport accumulated particles downriver. Additionally, we expected the cool–dry season to be associated with the highest MP densities. As expected, high MP densities were observed within the reservoir (117.38–277.46 particles kg⁻¹ dwt) when compared to the downstream (72.63–141.50 particles kg⁻¹ dwt) and upstream (28.81–91.63 particles kg⁻¹ dwt) sites of the reservoir. The cool–dry season (91.63–277.46 particles kg⁻¹ dwt) exhibited the highest MP densities compared to the hot–wet season (28.81–141.50 particles kg⁻¹ dwt). However, MP densities downstream the reservoir were higher during the hot–wet season (141.50 ± 24.34 particles kg⁻¹ dwt) compared to the cool–dry season (72.63 ± 48.85 particles kg⁻¹ dwt). The most dominant MP particles identified were white, transparent, and black fibres/filaments composed primarily of polypropylene (PP) and polyethylene (PE). This suggests diverse sources of MP particles. No significant correlations were found between water parameters and MP densities across sampling sites and seasons, indicating a widespread and context-independent presence of MPs. These findings contribute to MP studies in freshwater environments and further reinforce the role of sediments as sink for MPs and suggest that riverine reservoirs similar to dams can trap MPs, which may then be remobilized downstream during high-flow periods. Importantly, the results of this study can support local municipalities in implementing targeted plastic pollution mitigation strategies and public awareness campaigns, particularly because the Vondo Reservoir serves as a critical water resource for surrounding communities. Full article

A dysregulated hypothalamic–pituitary–adrenal (HPA) axis in patients with type 2 diabetes (T2D), a condition preceded by prediabetes, has been shown to exacerbate the hyperglycaemic state, increasing the risk of depression. However, HPA axis activity in a prediabetic state—as well as whether the prediabetic state affects HPA axis regulation—is not fully understood. This study investigated the activity of the HPA axis in selected biomarkers and hormones related to HPA axis regulation in individuals with prediabetes. The study used samples obtained from adults aged between 25 and 45 of all ethnicities from the King Edward VIII Hospital. The samples were divided into three groups—non-prediabetic (NPD) (n = 40), prediabetic (PD) (n = 40), and T2D (n = 40)—based on the participant’s glycated haemoglobin percentage. The cortisol (CORT), adrenocorticotropic hormone (ACTH), insulin, epinephrine (EPI), and norepinephrine (NE) concentrations of the samples were measured. The plasma CORT and ACTH concentrations in the PD group were higher compared to the NPD group. Plasma insulin concentration was increased only in the T2D group. There was also an increase in the plasma epinephrine concentration in the T2D group as compared to the NPD and PD groups. These observations collectively suggest that prediabetes is associated with heightened HPA axis activity and may alter HPA axis regulation, which may cause an altered stress response. Full article

Background: Spinal cord stimulators can offer an effective treatment in chronic pain refractory to conventional medical management. However, with a failure rate of up to 44% and an annual explantation rate of 6–9%, there is a need to better identify patients at high risk for therapeutic failure. The objective of this retrospective cohort study was to determine predictors of early SCS explantation following device placement. Methods: The Medical Informatics Operating room Vitals and Events Repository database was queried for patients with a spinal cord stimulator and at least two years of follow-up (n = 56). A multivariate logistic regression was fitted. Recursive factor elimination with cross-validation and L1 penalization were used to reduce the number of predictors and minimize the risk of overfitting. The model was used to predict risk factors for explantation, odds ratio (OR), 95% confidence interval (CI), and false discovery rate-adjusted p-value. Results: The final model displayed adequate performance with an average precision of 0.769. Sleep disorders were identified as a statistically significant predictor of SCS explantation (OR: 3.88, CI: 1.36–11.04, FDR p-value: 0.0497). Conclusions: While further prospective studies are needed, our study indicates that sleep disorders are a risk factor for spinal cord stimulator explantation and should be considered during pre-operative evaluation. Full article

Background: Postoperative hypoparathyroidism is a common complication of thyroid surgery. Sunlight is a natural source of ultraviolet B (UVB) radiation, which facilitates the synthesis of vitamin D3 in the skin. Inadequate sunlight exposure has been linked to vitamin D deficiency, potentially exacerbating the risk of hypocalcemia in patients undergoing thyroid surgery. The aim of the present study is to evaluate the effect of sunshine levels on postoperative hypoparathyroidism. Method: We retrospectively evaluated patients that underwent total thyroidectomies at two different centers (Thessaloniki and Rhodes) by the same surgical team from 2021 to 2023 in terms of postoperative hypoparathyroidism. We compared the sunshine levels at each center the year before surgery and correlated them with postoperative levels of parathyroid hormone, serum ionized calcium, and phosphorus. Results: One-hundred twenty patients (Group Thessaloniki = 60 patients, Group Rhodes = 60 patients) who were matched for demographic characteristics and type of thyroid disease and surgery were enrolled in our study. The sunshine levels were different between the two centers (Rhodes > Thessaloniki, p < 0.001). It was found that sunshine levels affect preoperative serum ionized calcium (p = 0.002) and postoperative parathyroid hormone levels (p = 0.025). Conclusions: Sunlight exposure levels may play a crucial role in preventing postoperative hypoparathyroidism. Patients living in locations with higher sunshine levels may have lower rates of postoperative hypoparathyroidism. Full article

Background: Nutrition literacy, defined as “the skills to comprehend and implement nutrition information into everyday practice”, is a new area of study. Preschool teachers affect children’s perception of nutrition and health and contribute to their nutrition literacy skills. Objective: This cross-sectional study aimed to assess the level of nutrition literacy (NLS-Gr) of preschool teachers. Methods: The research included two stages of cluster sampling in a sample of kindergarten teachers in Greece (Rhodes Island). Nutrition literacy was assessed with the NLS-Gr, the Greek version of the NLS, and adherence to a Mediterranean diet with the MedDiet score. Results: The mean NLS-Gr score was 25.87 (SD ± 2.2) and is considered adequate. The correct answers range from 65.1% to 100%. The MedDiet score was calculated at 33.94 (SD ± 3.8), and no correlation was found between the MedDiet score and the NLS-Gr. The NLS-Gr score of kindergarten teachers was adequate, higher than that of previous research on different populations. Conclusions: The study concluded that adherence to the Mediterranean diet requires improvement, and food waste needs to be reduced. Educators should be empowered through targeted educational interventions to improve their dietary habits and, therefore, enhance students’ health and nutritional behaviors. Further research is needed to contribute to formulating nutrition strategies and policies in kindergarten. Full article