Search Results (11,112)

Background: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and end-stage renal disease worldwide. Despite robust evidence-based guidelines, real-world adherence to recommended preventive care remains inadequate. Most prior evaluations have focused on individual care components rather than comprehensive composite care delivery. Methods: A retrospective cross-sectional study of 1010 adult patients with diabetes attending outpatient clinics at King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Jeddah, Saudi Arabia. Full guideline-concordant care (GCC) was defined as composite completion of HbA1c monitoring, albuminuria screening using the urine albumin-to-creatinine ratio (ACR), and renin–angiotensin–aldosterone system inhibitor (RAASi) use among patients with detected albuminuria. Multivariable logistic regression (n = 1007) identified independent predictors of full GCC. Results: Only 22.7% (95% CI: 20.1–25.3%) of patients achieved full GCC. Partial care was the most common pattern (46.2%), followed by no care (20.7%) and near-complete care (10.4%). HbA1c testing was performed in 55.0% and albuminuria screening in 49.3% of patients. Among those with detected albuminuria, RAASi therapy was prescribed in 78.9%. Primary care management (OR 4.79, 95% CI 3.45–6.66; p < 0.001) and hypertension (OR 2.00, 95% CI 1.33–3.00; p = 0.001) were independently associated with full GCC. Age, gender, kidney function, and cardiac disease were not significant predictors. Conclusions: Substantial gaps exist in guideline-recommended DKD care, driven primarily by screening deficiencies rather than treatment failures. Care delivery is influenced more by healthcare setting than by patient characteristics, highlighting the need for system-level interventions targeting detection infrastructure across all care settings. Full article

Background/Objectives: Children with cancer admitted to the pediatric intensive care unit (PICU) are at increased risk for post-intensive care syndrome (PICS-p) due to prolonged immobility, deep sedation, and severe illness. The ABCDEF bundle offers a framework for enhancing ICU care and patient recovery, but implementing all components in pediatric oncology patients is challenging. This study assesses the development and implementation of the BRAVE (Beginning Restorative Activities Very Early) initiative, specifically BRAVE2, to integrate the comprehensive ABCDEF bundle and a nurse-led mobility program, in collaboration with rehabilitation specialists, within a pediatric oncology intensive care unit. Methods: BRAVE2 was a quality improvement project conducted in a single pediatric ICU from 2022 to 2023. We analyzed ICU data to assess patient demographics, frequency of physical and occupational therapy (PT/OT) consultations, time to initial mobilization, and delirium screening rates (CAPD score of 9 or higher) for patients with ICU stays over 48 h. BRAVE2 addressed all elements of the ABCDEF bundle, including regular pain assessments, evaluation of spontaneous breathing readiness, sedation adjustments, delirium screening, early mobilization, and family engagement. Outcomes were monitored using statistical process control methods. Results: Of 140 patients, 117 (84%) remained in the ICU for more than 48 h. The delirium screening rate was 15.5%, consistently below the target of 30%. PT/OT consultations within 72 h occurred in 80.7% of patients, and early mobilization in 49.7% of patients, both below the 80% goal. However, 90.4% of patients with tracked mobility were able to ambulate during their ICU stay. No mobility-related safety incidents were reported. Conclusions: Rolling out a full ICU liberation plan in a pediatric oncology ICU is possible, and implementing a comprehensive one is feasible and sustainable despite challenges. Although therapist-led early mobilization did not meet targets, incorporating nurse-led mobility strategies and routine delirium screening has established a scalable model to enhance ICU care and support long-term recovery for these patients. Full article

Background/Objectives: Migraine is a complex neurovascular disorder with a multifactorial genetic basis and remains a leading cause of neurological disability worldwide. The angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism has been implicated in vascular regulation and neurovascular reactivity; however, its role in migraine susceptibility and clinical expression remains unclear. This study aimed to evaluate the association between ACE I/D polymorphism and migraine susceptibility and clinical phenotypes in a diverse clinical cohort. Methods: A case–control study was conducted including 183 participants, comprising clinically diagnosed migraine patients (n = 82) and age- and sex-matched controls (n = 101). Genomic DNA was extracted from peripheral blood samples, and ACE I/D genotyping was performed using polymerase chain reaction. Genotype distribution was compared using chi-square tests, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Overall genotype frequencies were Deletion/Deletion (DD) 43.7%, ID 38.8%, and Insertion/Insertion (II) 17.5%. Genotype distributions were comparable between migraine patients and controls (χ² ≈ 0.92, p = 0.632). No statistically significant associations were identified between ACE I/D polymorphism and migraine susceptibility, genotype models, or migraine subtypes. However, the II genotype was associated with higher Migraine Disability Assessment (MIDAS) scores among migraine patients. Conclusions: The ACE I/D polymorphism was not associated with migraine susceptibility or clinical phenotypes in this cohort. These findings suggest that ACE I/D polymorphism does not appear to be a major determinant of migraine susceptibility in this cohort. The results highlight the need to investigate broader genetic and molecular mechanisms and support the application of integrative genomic approaches to better understand migraine heterogeneity and inform precision medicine strategies. Full article

Background: TROP2 (TACSTD2) is a therapeutic target of antibody–drug conjugates and is broadly expressed in epithelial malignancies. Data on TROP2 protein expression in large, clinically annotated prostate cancer cohorts, particularly in recurrent disease, remain limited. Methods: TROP2 immunohistochemistry was performed on a prostate cancer tissue microarray comprising 17,747 primary radical prostatectomy specimens and 258 recurrent prostate cancer samples. TROP2 staining data were compared with clinicopathological parameters, biochemical recurrence and ERG status. Results: Among 12,807 interpretable primary prostate cancers, TROP2 staining was detectable in all cases and considered strong in 94.5%, moderate in 3.5%, and weak in 2.0%. Reduced TROP2 was statistically associated with high pT stage (p = 0.0011) and high Gleason grade (p < 0.0001), but absolute differences were small. Reduced TROP2 expression levels were unrelated to PSA recurrence in the entire cohort (p = 0.0787) but statistically linked to early PSA recurrence in ERG positive cancers (p = 0.0165). In four different scenarios of multivariate analyses, reduced TROP2 expression did not show an unequivocal independent prognostic role. As compared to primary tumors, TROP2 was markedly reduced among 250 evaluable recurrent cancers (strong 57.6%, moderate 31.6%, weak 8.4%, negative 2.4%; p < 0.0001 vs. primary cancers). Reduced TROP2 was also significantly more frequent in recurrent cancers than in the subgroup of high-grade primary tumors (Gleason ≥ 4+4; strong 57.6% vs. 90.2%; p < 0.0001). Conclusions: TROP2 is consistently expressed at high levels in primary prostate cancer but often reduced in recurrent disease. While uniform expression in primary tumors supports TROP2 as a therapeutic target in prostate cancer, reduced expression in many recurrent cancers highlights the potential need for TROP2 expression measurement as a predictive test in this subgroup. Full article

Chronic chikungunya arthritis is a debilitating post-viral inflammatory arthritis with no established evidence-based therapy. Regulatory T cell (Treg) dysfunction may contribute to persistent inflammation, and low-dose interleukin-2 (IL-2) may restore immune regulation. We evaluated the immunomodulatory effects of low-dose IL-2 using peripheral blood mononuclear cells from adults with laboratory-confirmed chronic chikungunya arthritis in Atlántico, Colombia. Cells were treated ex vivo with recombinant IL-2 or an IL-2/anti-IL-2 monoclonal antibody complex in the presence of CD2/CD3/CD28 stimulation beads, followed by flow cytometric assessment of effector T cells and Tregs. Low-dose IL-2 treatments ex vivo did not increase total Treg frequency but selectively increased activated suppressor Tregs while decreasing activated T effector cells, enhancing Treg CTLA-4 and HLA-DR expression, and reducing Ki67 expression in effector T cells. IL-2 complex treatment decreased cytokine-secreting Tregs, and IL-10 and TGF-β were not associated with IL-2 treatment status or with Teff/Treg balance, suggesting limited utility as pharmacodynamic biomarkers of low-dose IL-2 treatments. These findings support the use of activated suppressor Tregs, Treg CTLA-4, and HLA-DR expression as candidate biologic endpoints for evaluation in future trials of low-dose IL-2 in chikungunya arthritis. Full article

Mosquito control programs rely on larvicides such as S-methoprene to suppress vector populations and prevent mosquito-borne diseases including West Nile virus (WNV). Resistance surveillance is essential for maintaining the long-term effectiveness of larvicide active ingredients and is typically conducted using cup bioassays to evaluate larval susceptibility. Disposable Styrofoam cups are commonly used for these assays because they minimize adsorption of S-methoprene under standard testing conditions. However, recent restrictions on expanded polystyrene products in California necessitated the identification and evaluation of suitable replacement cup materials for larval resistance bioassays. Four alternative cup materials, high-density polyethylene (HDPE), polyethylene terephthalate (PET), polypropylene (PP), and paper cups, were compared to Styrofoam cups. Cup bioassays were conducted using a laboratory colony of Culex quinquefasciatus exposed to S-methoprene concentrations of 1–40 ppb. Emergence inhibition data were analyzed using probit regression to estimate the concentrations causing 50% and 90% emergence inhibition (LC₅₀ and LC₉₀, respectively) for each cup type. Cup material significantly affected concentration-response relationships. HDPE and paper cups produced significantly higher LC₅₀ and LC₉₀ estimates than Styrofoam, whereas PET and PP produced responses more comparable to the Styrofoam reference. Concentration-response slopes were similar among cup materials, indicating that cup material primarily shifted the concentration required to achieve a given level of emergence inhibition. These findings demonstrate that cup material can significantly influence estimated S-methoprene LC values. Replacement assay cups should therefore be validated before implementation in larval resistance monitoring programs. Full article

Background: In 2022, we adapted the World Health Organization Digital Adaptation Kit (DAK) for antenatal care (ANC) into the BornFyne digital health platform. Because ANC services in many facilities relied on fragmented paper-based guidance, the DAK represented the first exposure for many providers to a structured, comprehensive ANC guideline framework integrated into a digital system. Understanding providers’ motivation, capabilities, and readiness to adopt guideline-driven digital care was essential to inform implementation strategies. We therefore conducted a workshop to explore healthcare providers’ expectations, perceived challenges, and readiness to integrate a comprehensive digital ANC system into routine practice. Methods: A prospective mixed-methods pre–post implementation pilot workshop was conducted between June and August 2023 across four districts. The 5-h workshop targeted ANC providers and included exposure to the WHO ANC DAK and demonstration of its integration into the BornFyne platform. Survey tools assessed perceived knowledge, attitudes, perceived behavioural control, intention, and social norms using Likert scales. Constructs were mapped to the COM-B framework. Paired student’s t-tests assessed pre–post changes (p < 0.05), and Cohen’s d estimated effect sizes. Qualitative responses were thematically analysed. Results: Nineteen participants, including doctors, nurses, midwives, and data managers from public, private, and faith-based facilities, completed the surveys. Most participants were women (90%). Following the workshop, perceived knowledge of behaviour change and digital guideline use significantly increased (t(19) = 3.22, p = 0.004, d = 0.78). Although no statistically significant changes were observed in attitudes, perceived behavioural control, intentions, or social norms, descriptive trends suggested improved confidence and openness toward digital ANC systems. Qualitative findings identified increased knowledge as the most important outcome, with 80% of participants emphasizing its role in strengthening capability. Participants also reported greater confidence in integrating digital tools into routine care but highlighted contextual and motivational barriers as ongoing challenges. Acceptability was high: 90% expressed satisfaction, and all participants rated the workshop as useful, relevant, engaging, and worth their time. Conclusions: The workshop improved providers’ perceived knowledge and demonstrated high acceptability of DAK-aligned digital ANC systems. While changes in attitudes and behavioural control were not statistically significant, the findings support the feasibility of behaviour change-based digital ANC interventions. Addressing contextual and motivational barriers will be essential for sustained adoption in resource-limited settings. Full article

Physical activity is an important determinant of sleep health; however, its relationship with sleep quality may differ depending on the domain in which it occurs. This study examined the differential associations of occupational physical activity (OPA) and total physical activity (TPA) with sleep quality among adults in the United Arab Emirates. Data were collected from 1310 adults (February–April 2024) using the International Physical Activity Questionnaire, the Occupational Sitting and Physical Activity Questionnaire, and the Sleep Quality Scale, in an analytical cross-sectional design. Higher TPA was associated with better sleep quality at the bivariate level (r = −0.104, p < 0.001) but not independently after adjustment (β = −0.042, p = 0.246); this null adjusted finding was sensitive to how skewness in the activity data was handled. Occupational sitting was associated with poorer sleep quality only at the bivariate level, whereas occupational heavy labor remained independently associated with better sleep quality after adjustment (β = −0.080, p = 0.022). Standing, walking, and the TPA × sitting interaction were not significant. These findings indicate that the physical activity–sleep quality association depends on domain and support promoting overall activity alongside attention to occupational demands; however, given the small effect sizes, cross-sectional design, and unmeasured confounders, these implications should be regarded as preliminary rather than a basis for policy recommendations. Full article

Talisia esculenta Radlk (Sapindaceae) is a tropical tree species native to Brazil, whose leaves are traditionally consumed as herbal infusions. However, the secondary metabolite composition of its foliage remains poorly characterised. In this study, the phytochemical profile of T. esculenta leaf infusions was investigated using HPLC–ESI–QTOF–MS/MS, leading to the annotation of 20 compounds. Subsequent liquid–liquid partitioning and high-speed counter-current chromatography (HSCCC) enabled the targeted isolation of two major constituents. The analysis revealed a flavonoid-rich profile dominated by glycosylated flavonols, with rutin and quercitrin identified as the principal compounds and structurally confirmed by NMR spectroscopy. They were both quantified in the aqueous infusion of the leaves, being 1.42 ± 0.02% (w/w) and 1.54 ± 0.01% (w/w) for rutin and quercitrin, respectively. The metabolite pattern found is consistent with that reported in other members of the Sapindaceae family and contributes to the chemotaxonomic characterisation of the genus. Fractionation enhanced the enrichment of phenolic constituents and allowed assessment of their functional properties such as antioxidant activity (including DPPH assay: from 43.4% for the aqueous infusion to 92.9% for the ethyl acetate fraction) and inhibition of microbial biofilm formation (from 37.4% for the aqueous infusion to 83.4% for the butanolic fraction at 6.25 µg/mL against Staphylococcus aureus). The MIC and MBC were also calculated for the aqueous infusion (12.5 mg/mL for both), its partitions as well as rutin and quercitrin. Anti-inflammatory effects were also observed, with inhibition of NF-κB activity reaching 56.9% for the aqueous infusion and 47.7% for the butanolic fraction. These findings expand current knowledge of secondary metabolite diversity in T. esculenta and demonstrate the applicability of HSCCC as an efficient technique for flavonoid isolation from complex plant extracts. Overall, this study provides new insights into the phytochemical composition of an underexplored tropical species within the Sapindaceae family. Full article

This pilot study examined the effects of parent-delivered training and coaching in the Speak, Play and Listen intervention, implemented with neurotypical (NT) siblings to support the social communication development of children with autism spectrum disorder (ASD). Three families, each consisting of a parent, an NT child, and a child with ASD aged 5–12 years, participated in the study. A single-case multiple-probe design was employed to evaluate changes in sibling social interactions. Results showed increases in positive social communication behaviors across all three sibling dyads. Semi-structured interviews indicated that family members perceived the intervention goals, procedures, and outcomes as acceptable, feasible, and socially meaningful. The study highlights the importance of considering family-wide participation, implementation fidelity, and family capacity when designing and delivering interventions for children with ASD. Full article

Purpose: The purpose of this study is to conduct a qualitative study of perceptions of active commuting to school (ACS) amongst middle school girls. Methods: Twelve adolescent girls (M = 13.1 ± 0.7 years old) who participated in the Safe TRavel Environment Evaluation of Texas Schools (STREETS) natural experiment were recruited to participate in semi-structured interviews. The semi-structured interview guide was grounded in Social Cognitive Theory, the Theory of Planned Behavior, and the existing literature. All interviews were transcribed by WebEx and thematic analysis was conducted via NVivo 12. Results: Participants had generally neutral to positive views of ACS. Main themes included social support of peers and the convenience of active commuting. Commonly reported barriers were distance to school, safety, and concerns about lack of sleep because of an early commuting time. Areas for future intervention included reducing perceived barriers of distance, time management, and safety, increasing girls’ motivation to actively commute, and improving skills and self-efficacy related to ACS through education, social support, guided practice, and incentives. Conclusions: This study provides evidence for schools and communities to include support programs for those who want to actively commute and suggestions for school policy changes to encourage active commuting to school (ACS). When developing ACS infrastructure or programs for middle school girls, concomitant programs that address strategies to address student perceptions and psychosocial barriers should be included. Full article

Respiratory medicine is transitioning from symptom-driven, standardized care to a more precise, patient-specific approach guided by molecular profiling. This evolution is being enabled by advances in liquid biopsy, multiomics, and artificial intelligence (AI) analytics. Fractional exhaled nitric oxide (FeNO) and blood eosinophils, the two commonly used markers in asthma, are now being joined by more precise airway markers such as galectin-10, which could aid clinicians in making more informed decisions for biological treatments. In chronic obstructive pulmonary disease (COPD) similar progress is underway, with treatment now emphasizing inflammation endotypes, especially eosinophilic patterns, to direct therapeutic choices. Alongside these developments, routine blood-based ratios (e.g., platelet-to-lymphocyte and neutrophil-to-lymphocyte) are being explored as predictors of exacerbation risk, and forced oscillation testing (FOT) is proving useful for picking up early disease shifts. In more severe conditions, biomarkers are linked to an early and better prognosis, enabling timely intervention. Markers like Matrix metalloproteinase-7 (MMP-7) and CC chemokine ligand 18 (CCL18) have proven to be reliable indicators of mortality and disease progression in idiopathic pulmonary fibrosis. Meanwhile, in lung cancer, liquid biopsies, especially those measuring circulating tumor DNA and micro-RNA (miRNA) panels, are enhancing screening accuracy while helping to cut down on the high false-positive rates seen with low-dose computerised tomography (CT). Other respiratory conditions such as bronchiectasis, pulmonary embolism, pneumonia, and acute respiratory distress syndrome (ARDS) are also benefiting from biomarker advances. At the same time there is a growing push to standardize how these biomarkers are measured. AI-based clinical decision support systems are also playing an increasingly important role in the translation of all these complicated data into actionable clinical insights. Together these developments pave the way for improved respiratory care that is precise and responsive to individual patient needs. Full article

Background/Objectives: This study aimed to evaluate the usability and comprehension of at-home respiratory diagnostic tests for COVID-19 and influenza among rural and urban populations in Georgia. It sought to identify disparities in test interpretation and outcomes that could inform public health interventions tailored to underserved communities. Methods: Participants with respiratory symptoms (N = 592) were enrolled through community events in three rural Georgia counties (N = 188) and urban clinics in Atlanta (N = 404). Structured usability assessments and RT-PCR-confirmed diagnostic testing were conducted. Demographic, clinical, and survey data were analyzed using t-tests, z-tests, and Fisher’s exact tests to compare rural and urban participants. Results: Rural participants were older and more likely to be White. Urban participants had significantly higher infection positivity rates for COVID-19 (18.5% vs. 10.2%) and Flu A (29.2% vs. 1.8%). While overall usability ratings were high across both groups (>94%), rural participants had significantly lower odds of identifying invalid test results and were more likely to continue using tests after procedural errors. Conclusions: Despite strong usability ratings, diagnostic test comprehension differed by geography. Rural participants demonstrated notable gaps in recognizing invalid results, underscoring the need for targeted educational strategies and simplified instructions to ensure equitable test interpretation and public health response. Full article

Accurate and scalable extraction of geomorphic features from LiDAR-derived terrain data is important for environmental monitoring, land use planning, and geohazard assessment. Recent deep learning advances have introduced state-space models, such as Mamba, which can capture broad spatial dependencies with linear complexity and offer an alternative to conventional convolutional neural network (CNN)- or Transformer-based approaches. This study evaluates Mamba-based architectures for geomorphic segmentation across three landform types: agricultural terraces, mine benches, and valley fill faces. Using high spatial resolution terrain derivatives, or land surface parameters (LSPs), as an input feature space, we compare a pure Mamba–UNet, a hybrid architecture with a Mamba-based encoder and CNN decoder, and a baseline CNN-based UNet with a ResNet-34 encoder, each trained with frozen and unfrozen encoders. Results indicate that no single architecture was best across all tasks; however, the hybrid Mamba-CNN architecture provided the most consistent performance overall, improving spatial continuity and interior feature recovery for tasks requiring broad spatial context, although its advantage over the baseline UNet was modest and task-dependent, and boundary-level analysis indicated that CNN-based configurations delineated feature edges most precisely, while the randomly initialized UNet remained highly competitive and achieved the strongest results for some tasks. Further, Mamba-based encoders converge quickly and maintain strong performance when frozen, whereas CNN-based UNets benefit more from encoder fine-tuning. Full article

Background: The widespread use of digital technologies is beneficial to society but has also contributed to the growing prevalence of Technology-Facilitated Sexual Violence (TFSV) among youth. This study aimed to co-design youth-informed recommendations for preventing and responding to TFSV and its mental health consequences among racialized youth in Canada. Methods: Guided by the participatory research approach, 33 participants from Alberta and British Columbia, who were 15–24 years old and self-identified as racialized, participated in two virtual interactive workshops. Participants engaged in facilitated breakout group discussions using case studies and semi-structured prompts. Data were collected via Padlet and analyzed using content analysis. Results: Participants identified several gaps in existing support systems and recommended culturally responsive, multi-sectoral strategies to address and prevent TFSV. The key recommendations included awareness of families and educators about TFSV, training of healthcare and community service providers for trauma-informed care, integrated mental health support, and increasing youth awareness about legal support. Conclusions: Participants collectively designed recommendations to address TFSV and its related mental health outcomes. This study highlights perspectives of racialized youth for collaborative efforts across family, education, health, community, and legal systems to foster safer digital environments and equitable mental health support for youth affected by TFSV. Full article