Search Results (214)

Background: To diagnose prostate cancer, a prostate biopsy is required. Two methods are commonly used for biopsy: transrectal and transperineal. The transperineal approach, particularly the “freehand” technique under local anesthesia, offers better access to the anterior prostate, lower infection risk, and higher detection rates. Methods: This retrospective study examined the records of 1674 patients who underwent ultrasound-guided prostate biopsies between 2015 and 2022. Of these, 1161 patients had transperineal biopsy using the “freehand” method, and 513 had transrectal biopsy. All the biopsies were carried out under local anesthesia, with a combined systematic and targeted approach for patients with MRI-identified lesions. Results: This study demonstrates that the transperineal biopsy approach significantly increased the detection rate of clinically significant prostate cancer compared with the transrectal method, with detection rates of 65.7% and 59.4%, respectively. Notably, the transperineal technique also achieved superior detection of anteriorly located tumors (94.1% vs. 43.1%), supporting its use as the preferred biopsy strategy, particularly in anatomically challenging regions. Moreover, patients who underwent transperineal biopsy demonstrated more favorable diagnostic outcomes, characterized by a higher detection rate for clinically significant cancers and a reduced incidence of clinically insignificant cases. The transperineal method outperformed the transrectal approach, especially among younger patients and those presenting with lower PSA values. These results highlight the diagnostic superiority and broader clinical applicability of the transperineal biopsy technique across various patient subgroups. Full article

Introduction: Despite the key role of healthcare workers (HCWs) in tuberculosis (TB) prevention and control, there is a lack of regional data on their knowledge, attitudes, and practices (KAPs) regarding the disease in Atlantic Canada. Objectives: To assess the KAPs of HCWs and identify targets for educational interventions to enhance TB care and control. Methods: A cross-sectional study was conducted among HCWs in Atlantic Canada aged $\ge$19 years from October 2023 to February 2024. Participants were recruited via multiple channels such as social media, collegiate email lists, and snowball sampling. Survey data were collected using an online platform and analyzed using IBM SPSS Statistics v29. KAPs were assessed using Likert-type scales and internal consistency was evaluated using Cronbach’s alpha. Results: A total of 157 HCWs participated in this study (age range: 19 to 69 years); most were women (n = 145, 92%), born in Canada (n = 134, 85.4%), with nearly three-quarters (n = 115, 73.2%) who had never lived outside of Canada. Study participants demonstrated moderately high knowledge (M = 29.32, SD = 3.25) and positive attitudes (M = 3.87, SD = 0.37) towards TB and strong practices (M = 4.24, SD = 0.69) in TB care; however, gaps were identified in HCW abilities to recognize less common TB symptoms (e.g., rash and nausea), as well as inconsistent practices in ventilation and pre-treatment initiation. Internal consistency analysis indicated suboptimal reliability across all three KAP domains, with Cronbach’s alpha values falling below 0.7, thwarting further planned analyses. Conclusions: This study found overall moderate-to-strong TB-related KAPs among HCWs in Atlantic Canada; however, critical gaps in knowledge and practice were noted. This new information can now guide future educational initiatives and targeted training to enhance TB preparedness and ensure equitable care for patients in the region. Full article

The present essay aims to make an analysis of a widely analyzed theme held very dear to Pope Saint John Paul II, namely, the right to religious freedom as a foundation for all other forms of freedom. From the way this essay tackles this theme, it is not difficult to understand that John Paul II’s metaphysical view with regard to the human being, as well as his view on the subjectivity of the human person and the dignity of the human person, are essential for an accurate understanding of the relation between freedom and truth. Freedom is rooted in the truth, and it can be achieved only in truth. When it is separated from truth, it becomes just an illusion. For Pope John Paul II, it is very clear that freedom and truth either go together or perish together. The truth to which freedom is linked is not just an abstract truth, but is the Absolute Truth, namely God. Therefore, only in the light of this relationship between freedom and truth can the right to religious freedom, which is the heart of human rights, be explained. Religious freedom allows the human person to live in the truth of her/his faith, according to her/his transcendental dignity. Full article

Background and Objectives: The aim of our study was to evaluate in an ex vivo setting the impact of the holmium laser lithotripsy over the temperature of the irrigation fluid. Materials and Methods: We recorded temperature changes in an ex vivo porcine model during laser activation using dusting (18 Hz, 0.6 J, 10.8 W) and fragmenting settings (8 Hz, 2 J, 16 W). The temperature was recorded for each of these modes in three settings: without irrigation or access sheath, with irrigation but no access sheath, and with irrigation and a 10/12 F access sheath in place. Results: Using dusting settings, the maximum recorded temperatures were 42.3 degrees Celsius (no irrigation, no sheath), 37.3 degrees Celsius (with irrigation but no access sheath) and 36.2 degrees Celsius (with irrigation and access sheath). In fragmenting mode, the maximum recorded temperatures were 52 degrees Celsius (no irrigation, no sheath), 43.1 degrees Celsius (with irrigation but no access sheath), and 42.9 degrees Celsius (with irrigation and access sheath). Conclusions: In certain conditions (no irrigation, more watts) the temperature may rise to dangerous levels. However, in closer to real-life settings (with irrigation and especially when ureteral access sheaths are employed) the magnitude of this effect is limited, making flexible intrarenal laser lithotripsy a reasonably safe procedure. Full article

The various forms of Airy’s differential equation are discussed in this work, together with the special functions that arise in the processes of their solutions. Further properties of the arising integral functions are discussed, and their connections to existing special functions are derived. A generalized form of the Scorer function is obtained and expressed in terms of the generalized Airy and Nield–Kuznetsov functions. Higher derivatives of all generalized functions arising in this work are obtained together with their associated generalized Airy polynomials. A computational procedure for the generalized Scorer function is introduced and applied to computing and graphing it for different values of its index. The solution of an initial value problem involving the generalized Scorer function is obtained. Full article

When nurses encounter people in institutional settings who are living with dementia and self-neglecting their hygiene, they are challenged to provide care that respects autonomy while upholding the ethical principles of beneficence and non-maleficence. This study aimed to understand how nurses respond when confronted with patients who decline assistance with personal hygiene and then became physically aggressive. Methods: A qualitative descriptive study employing think-aloud interviewing to explore nurses’ clinical reasoning about how they would proceed with the care of a patient living with dementia who self-neglects their hygiene. Results: Nurses describe many creative ways that they would work with patients to accomplish personal hygiene care in an ideal world. Participants also share the many barriers they experience to providing desired care and instances where they would force care with people who self-neglect their hygiene. Thematic analysis revealed six key themes: non-preferred approaches to care; preferred approaches to care; barriers to actualizing preferred approaches; responding to continued resistance to care; justified use of force; and efforts to minimize harm. Conclusions: This study highlights that ethical nursing practice in dementia care is not simply a matter of following through with best practices. It is an ongoing negotiation, carried out in environments that are often misaligned with nurses’ values. Full article

We report the development of a procedure for ultrasound-assisted microscale extraction of metabolites from the flowers of Saint John’s wort (Hypericum perforatum L.), designed for comparative metabolite analysis of plants from genetic resource collections and natural and segregating populations. The procedure involves high-throughput methanol extraction of metabolites from ground-frozen flowers at a selected stage of flower development, which is carried out in a standard 2 mL Eppendorf tube. A total of 18 compounds, including chlorogenic acid, catechins, glycosylated flavonoids, hypericins, and hyperforin, were identified based on LC/DAD/QTOF analysis, of which 16 could be detected in the UV-Vis spectrum. Two alternative versions of the procedure were evaluated: the “single-flower” procedure, including repeated collection and analysis of single flowers from the tested plant, and the “bulk-flower” procedure, employing the collection of a bulk flower sample from the tested plant and analysis of a portion of the ground sample. The results showed excellent technical reproducibility of the “single-flower” procedure when used with the suggested combination of the peak areas for the proto- and stable forms of pseudohypericin and hypericin. Application of the developed “single-flower” procedure for comparison of the plants derived from seed progeny of the apomictic line Hp93 revealed significantly lower metabolite variation among the apomictic progeny plants compared to the variation observed among plants belonging to different genotypes. Full article

Background: In the emergency setting, many diagnostic pathways incorporate change in high-sensitivity cardiac troponin (hs-cTn) concentrations (i.e., the delta) to classify patients as low-risk (rule-out) or high-risk (rule-in) for possible myocardial infarction (MI). However, the impact of analytical variation on the delta for correct classification is unknown, especially at concentrations below and around the 99th percentile. Our objective was to assess the impact of delta variation for correct risk classification across the European Society of Cardiology (ESC 0/1 h and 0/2 h), the High-STEACS, and the common change criteria (3C) pathways. Methods: A yearlong accuracy study for hs-cTnT was performed where laboratories across Canada tested three patient-based samples (level 1 target value = 6 ng/L, level 2 target value = 9 ng/L, level 3 target value = 12 ng/L) monthly across 41 different analyzers. The assigned low-delta between levels 1 and 2 was 3 ng/L (i.e., 9 − 6 = 3 ng/L) and the assigned high-delta between levels 1 and 3 was 6 ng/L (i.e., 12 − 6 = 6 ng/L). The low- and high-deltas for each analyzer were determined monthly from the measured values, with the difference calculated from the assigned deltas. The obtained deltas were then assessed via the different pathways on correct classification (i.e., percent correct with 95% confidence intervals, CI) and using non-parametric analyses. Results: The median (interquartile range) difference between the measured versus assigned low-delta (n = 436) and high-delta (n = 439) was −1 ng/L (−1 to 0). The correct classification differed among the pathways. The ESC 0/1 h pathway yielded the lowest percentage of correct classification at 35.3% (95% CI: 30.8 to 40.0) for the low-delta and 90.0% (95% CI: 86.8 to 92.6) for the high-delta. The 3C and ESC 0/2 h pathways yielded higher and equivalent estimates on correct classification: 95.2% (95% CI: 92.7 to 97.0) for the low-delta and 98.2% (95% CI: 96.4 to 99.2) for the high-delta. The High-STEACS pathway yielded 99.5% (95% CI: 98.4 to 99.9) of correct classifications for the high-delta but only 36.2% (95% CI: 31.7 to 40.9) for the low-delta. Conclusions: Analytical variation will impact risk classification for MI when using hs-cTn deltas alone per the pathways. The 3C and ESC 0/2 h pathways have <5% misclassification when using deltas for hs-cTnT in this dataset. Additional studies with different hs-cTnI assays at concentrations below and near the 99th percentile are warranted to confirm these findings. Full article

This article offers a Thomist response to Brian Leiter’s Why Tolerate Religion?, challenging his claim that religion does not merit distinct legal protection. While Leiter assumes religion to be epistemically irrational—defined by existential consolation, categorical demands, and insulation from evidence—this article draws on John Finnis’s interpretation of Saint Thomas Aquinas (d. 1274) to reconstruct religion as a basic good of practical reason. It proposes a three-tiered model of religion—as human quest, natural religion, and revealed religion—which clarifies religion’s internal structure and civic relevance. Developing this model against Leiter’s critique, this article shows that religion, so understood, can be legally protected even on Leiter’s liberal terms, through both Rawlsian and Millian frameworks. The article also extends its argument to “second-wave” law-and-religion controversies, illustrating how a Thomist framework illuminates debates about ideological establishments, identity politics, and public reason. Through original syntheses and rigorous normative analysis, this article advances a conceptually fresh and publicly accessible model of religion for law and public policy. It also speaks to pressing constitutional debates in the U.S. and Europe, thus contributing to transatlantic jurisprudence on religious freedom and the moral purposes of law. Religion still matters—and must be understood—not as conscience, but qua religion. Full article

Background/Objectives: Ureteral stents are indispensable tools in contemporary urological practice; however, their prolonged indwelling is frequently associated with a spectrum of complications. This study aims to evaluate the correlation between indwelling duration and the extent of stent encrustation, as well as the impact on extraction difficulty. Methods: A retrospective analysis was conducted on 33 patients treated at Clinical County Emergency Hospital of Brașov between December 2023 and December 2024. All patients had polyurethane double-J ureteral stents placed. Parameters assessed included the degree of stent encrustation, discoloration, incidence of urinary tract infections (UTIs), and extraction difficulty. These were analyzed in relation to indwelling time and patient comorbidities. Statistical processing was performed using SPSS 23.0 software, with significance set at p < 0.05. Results: A statistically significant association was observed between longer stent indwelling times and higher grades of encrustation, particularly for the intervals of 45–90 days and over 90 days (p = 0.008 and p = 0.01, respectively). Low encrustation demonstrated correlations with certain comorbidities, whereas no statistically relevant associations were found for moderate and severe encrustation. Black coloration of the stents was strongly associated with UTIs caused by Escherichia coli, Klebsiella spp., and Enterococcus spp. (p < 0.001), as well as with extended indwelling durations (p < 0.001). No significant correlation was identified between the presence of UTIs and the degree of stent encrustation. Conclusions: Indwelling time is a critical determinant of both ureteral stent encrustation and discoloration, with direct implications for clinical decision-making regarding stent management and extraction planning. Timely removal and close monitoring are essential to reduce the risk of complications associated with long-term stent placement. Full article

A generalized model of the variable permeability in the transition layer is introduced in this work. This model can handle flows with a small Darcy number and might be useful in controlling permeability amplifications. A solution method for the resulting inhomogeneous, generalized Airy equation is presented, together with a computational procedure for evaluating the generalized Airy functions and the generalized Nield–Kuznetsov function of the first kind. A complete solution is then provided for the tri-layer flow problem that involves flow over a porous layer with an embedded transition layer. Full article

Background/Objectives: Insomnia is associated with immune function. This study evaluated the association between insomnia and febrile neutropenia in women treated with adjuvant chemotherapy for breast cancer. Methods: This secondary analysis used data from the Canadian Cancer Trial Group MA.21 trial, which compared three chemotherapy regimens (CEF, EC/T dose-dense, or AC/T) in 2104 women with high-risk locoregional breast cancer. A total of 1731 patients completed the EORTC QLQ-C30 questionnaire. We compared “insomnia patients” with patients considered “good sleepers” based on the sleep item of this questionnaire. The primary endpoint was the occurrence of febrile neutropenia. Secondary endpoints were the occurrences of leucopenia and infection. Chemotherapy dose reduction was added as a secondary outcome in an unplanned analysis. Results: Patients with insomnia (16.3%) had a significantly higher rate of febrile neutropenia than good sleepers (12.2%; p = 0.01). After controlling for various confounders, the contribution of insomnia in explaining febrile neutropenia remained statistically significant (OR 1.45, 95% CI 1.07–1.97, p = 0.02). Chemotherapy dose reductions were significantly more frequent in patients with insomnia (30.6%) than in good sleepers (21.8%; p < 0.0001). The relationship remained significant in the multivariate analysis (OR 1.67, 95% CI 1.30–2.15, p < 0.0001). Conclusions: In the MA21 trial, insomnia was associated with febrile neutropenia. Furthermore, chemotherapy dose reductions were more common in women with insomnia. These results suggest that the role of insomnia in potential cancer outcomes needs to be confirmed in other studies, given the possible implication of dose reductions on the prognosis of women receiving chemotherapy for breast cancer. Full article

The polemics of idol worship in John Capgrave’s Life of Saint Katherine of Alexandria have been interpreted by previous scholars as either the author’s engagement with the Lollard image controversy or a political critique of Henry VI. This essay, however, shifts the focus from Katherine and her iconoclasm to the concept of divine iconoclasm, defined here not only as the divinely sanctioned or divinely motivated destruction of religious images but also as God’s direct intervention to dismantle false representations and correct human perceptions of the divine. It further argues that Capgrave’s Life redefines sacred space as primarily constructed through light, emphasizing its immateriality and exposing the saint’s physical limitations. In these scenarios, divine iconoclasm emerges as a constructive force that resolves the tension between the secular and the sacred. Moreover, Christ’s celestial manipulation of the vision of sacred space and the relationship between body and space—encouraging confidence while discouraging self-inflation—serves as a model for how a monarch should inspire both love and fear. In this way, Capgrave’s Mirrors for Princes is embedded within his hagiography, where the image debate features prominently, addressing the heated political and theological controversies of his time. By combining these elements, the essay bridges two strands of criticism that have previously treated the political and theological dimensions of the text separately. Full article

This study addresses the need for effective, real-time monitoring of indoor air quality, a critical factor for health and environmental well-being. The aim is to develop an affordable, Arduino-based IoT sensor system capable of continuous measurement of key air pollutants, including CO₂, PM_2.5, NO₂, and VOCs. The system integrates multiple sensors and transmits data to an online server, where it is stored in a MySQL database for analysis and visualization. Validation studies conducted at Concordia University and Qatar University confirm the system’s accuracy and reliability, with discrepancies reduced to under 15% through calibration and adjustment techniques. Comparative analysis with commercial monitoring instruments reveals strong correlations and negligible deviations, supporting the system’s validity for real-time air quality monitoring. The system also includes a user-friendly interface that displays real-time data through intuitive charts and tables, along with an indoor air quality index to help users assess and address air pollution levels. The system demonstrates a 90% cost reduction versus commercial tools while maintaining a mean deviation of <15% across climatic extremes. Its combination of comprehensive sensors, data visualization tools, and an air quality index makes it an effective tool for environmental monitoring and decision-making. Full article