Search Results (12,770)

Background: Intensive care units (ICUs) are high-acuity environments that require respiratory therapists (RTs) to maintain vigilance, manage emotions, and make rapid clinical decisions. In such settings, performance stability is critical for patient safety. Although emotional intelligence (EI) and work–life balance (WLB) have been linked to professional outcomes in health care, their independent and direction-specific associations with job performance among ICU respiratory therapists remain underexamined. Methods: A national cross-sectional survey was conducted among respiratory therapists working in ICUs across Saudi Arabia (June 2025–January 2026). EI was measured using the Wong and Law Emotional Intelligence Scale. WLB was assessed using the work interference with personal life (WIPL), personal life interference with work (PLIW), and work–personal life enhancement (WPLE) scales. Job performance was evaluated using the Individual Work Performance Questionnaire. Correlation and multivariable linear regression analyses were performed to estimate independent associations. Results: A total of 392 RTs were included in the final analysis. Higher EI was independently associated with greater task performance (B = 0.21, p < 0.01) and contextual performance (B = 0.30, p < 0.001), and with lower counterproductive work behaviours (B = −0.24, p < 0.001). Among WLB dimensions, PLIW showed the strongest adverse association, predicting lower task performance (B = −0.20, p < 0.05) and higher counterproductive behaviours (B = 0.39, p < 0.001), but was not significantly associated with contextual performance in the fully adjusted model. WPLE demonstrated modest positive associations with performance, whereas WIPL was not significant in adjusted models. Conclusions: Job performance among ICU respiratory therapists is shaped by both emotional regulatory capacity and cross-domain strain. Personal life interference with work emerged as the most influential adverse predictor, whereas EI was associated with constructive performance patterns. Findings should be interpreted in light of the cross-sectional design and self-reported data. Sustaining performance in high-acuity settings requires attention to emotional competencies and structural sources of role conflict alongside clinical expertise. These findings inform workforce strategies to support performance and sustainability in critical care settings. Full article

Background/Objectives: Japan’s mental healthcare system is characterized by the world’s highest number of psychiatric beds, widespread “social hospitalization,” and a structurally entrenched managerial support model that frequently undermines patient autonomy. Joint Crisis Plans (JCPs)—collaboratively developed crisis management documents—have been increasingly adopted as a care coordination tool; however, their role in transforming professional practice towards recovery-oriented support remains underexplored. This study aimed to elucidate the experiences of professionals utilizing JCPs across diverse facility types and to develop a theoretical understanding of the process by which they redefine their role from ‘manager’ to ‘recovery companion’. Methods: A qualitative design using the Modified Grounded Theory Approach (M-GTA), grounded in symbolic interactionism, was employed. Semi-structured interviews were conducted with 13 professionals (7 nurses, 6 mental health and welfare workers) across nine facilities (psychiatric hospitals, 24-h residential facilities, outpatient facilities) in the Kanto region of Japan. Theoretical sampling continued until saturation. Data were analyzed using the constant comparative method, with validity ensured through team checking. Results: Nine categories and 23 subcategories were extracted. A three-stage support transformation process emerged: (1) Stage of Motivation and Initial Support, in which professionals confronted the limitations of managerial practice; (2) Stage of Collaborative Role Redefinition and Practice, involving joint crisis management, strength-based support, and network building; and (3) Stage of Integration of Support Perspectives and Recovery-Oriented Practice, in which professionals witnessed individual recovery and integrated new support values into their practice. Negative cases revealed that JCP effectiveness is contingent on the co-construction of shared meaning rather than procedural compliance. Conclusions: JCP was suggested to function as a potential tool to facilitate navigating and reframing structural managerial barriers in Japanese mental healthcare. The creation of a shared language through JCP was associated with supporting conditions for individual self-determination, alleviating professional conflicts, and contributing to shifts in organizational culture. Full article

Background: This narrative review introduces the “From Plaque to Perfusion” framework, a clinically pragmatic approach that maps multimodality imaging technologies to critical decision points in the acute coronary syndrome (ACS) patient journey. By integrating non-invasive assessment, invasive procedural guidance, and post-event tissue characterisation, this framework provides a structured pathway for deep phenotyping of ACS. Artificial intelligence (AI) is highlighted as an essential enabling layer that enhances diagnostic precision, automates quantification, and supports scalable, data-driven care. Contemporary ACS management pathways, while effective, often leave residual clinical uncertainty. The diagnostic objective has evolved beyond confirming myocardial injury to comprehensively phenotyping the entire ACS cascade: defining the plaque substrate, identifying the culprit mechanism, and quantifying the myocardial consequence. This requires a systematic integration of advanced imaging modalities. Methods: This narrative review is based on a comprehensive literature search of major medical databases (PubMed/MEDLINE, Scopus, Embase, Google Scholar) for high-level evidence, including randomized controlled trials, meta-analyses, and international expert consensus documents published between January 2010 and February 2026. Results: The “From Plaque to Perfusion” framework consists of three core stages. First, non-invasive assessment with coronary computed tomography angiography (CCTA), fractional flow reserve (FFR-CT), and PET-CT defines plaque substrate and vascular inflammation. Second, invasive precision in the catheterization laboratory, guided by optical coherence tomography (OCT) and intravascular ultrasound (IVUS), resolves the culprit mechanism and optimizes percutaneous coronary intervention (PCI). Third, post-event tissue characterization with cardiac magnetic resonance (CMR) quantifies myocardial injury and refines prognosis. AI-driven platforms are shown to enhance each stage by automating analysis, standardizing interpretation, and providing actionable metrics for clinical decisions, including complex scenarios like Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). Conclusions: The “From Plaque to Perfusion” framework, enabled by AI, reframes ACS imaging as an integrated, mechanism-driven pathway. This approach moves beyond isolated test interpretation toward a scalable model of precision, phenotype-led care that promises to improve diagnostic certainty and personalize patient management. Full article

Background and Objectives: The prioritization of intensive care unit (ICU) admission following surgery for cancer is controversial. There is an urgent need to develop an appropriate clinical predictive model to aid in making ICU admission decisions after surgery. Materials and Methods: Four model strategies were used to build post−operative ICU admission predictive models: SVM, Catboost, ANN, and KNN. Internal verification was used for model evaluation at a ratio of 7:3. The area under the curve (AUC) value, calibration plots, and decision curve analysis were employed to assess the performance and clinical usefulness of the model. Results: The ICU group of patients with cancer who underwent surgery showed better prognosis for disease−free survival (DFS, p = 0.0008) and overall survival (OS, p < 0.0001). Cox multivariate analyses validated that lower baseline RBC, LDH, and CRP; higher baseline ALB, LCR, and lower post−operative LDH; higher post−operative HCT and ApoA−I; and higher fluctuating MCH independently predicted better DFS and OS (all p < 0.05). The AUC of the Catboost model was superior to that of the other models in the training cohort and internal validation cohort. Calibration plot and decision curve analysis indicated that the Catboost model possessed the best performance, with higher clinical utility, compared with other models. Conclusions: ICU admission after surgery was associated with superior survival in patients with cancer. The cost−effective Catboost model has promising clinical application but requires further clinical evaluation. Unravelling the cellular and molecular foundation of ICU admission might enable the development of more practical life−support strategies. Full article

Background: Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYAs: 16–24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as ‘joint care’ with designated hospitals (DHs). Central to this is the TYA multidisciplinary team (MDT) and an outreach model coordinating care between hospitals. We previously reported similar outcomes regardless of care location. Aims: To compare TYA experiences of care with healthcare professionals’ perspectives of the service they deliver. Methods: Mixed methods across England and Wales were used. The TYA-MDT identified TYAs who then received a postal invite to a cross-sectional survey capturing experiences of places of care, treatment, healthcare professional support (HCP), mental health, sexuality/fertility, clinical trials and care coordination. Comparisons were made based on exposure to care in a specialist TYA environment within 6 months of diagnosis: all-TYA-PTC (all care in the TYA-PTC, n = 70, 28%), no-TYA-PTC (no care in the TYA-PTC (n = 87, 35%): care delivered in a children/adult unit only), and joint care (care in a TYA-PTC and in a children’s/adult unit, n = 91, 36%). HCP perspectives were captured by rapid ethnography. Results: A total of 250/1056 (24%) TYAs participated. Overall, 200 (80%) rated their teams as excellent/good for helping them prepare for treatment. No evidence of significant differences existed between categories of care for proportions receiving support from key TYA-related professionals: TYA cancer nurse specialists (all-TYA-PTC n = 58, 91%; joint care n = 71, 88%; no-TYA-PTC n = 64, 82%) and social workers (all-TYA-PTC n = 30, 55%; joint care n = 36, 48%; no-TYA-PTC n = 28, 38%). A trend of diminishing support from youth support co-coordinators existed (all-TYA-PTC 63%; joint care 49%; no-TYA-PTC 40%, p = 0.069). This may explain why few differences in patient experiences existed across categories of care. Forty-nine HCPs participated. They were more critical in their interpretation of care, highlighting inequity in resources and challenges in some pathways and coordination. Conclusions: Similar access to age-appropriate support across care settings is likely to reflect recruitment methods. When TYAs are known to the MDT, age-appropriate care can be mobilized beyond TYA units, which could explain the equitable outcomes observed across different care locations in young people who responded to the survey. Nevertheless, gaps persist in communication and coordination, particularly within joint care models, and in the involvement of allied health professionals such as dieticians and physiotherapists, whose input is essential for rehabilitation and return to normal life. Strengthening these areas will require continued investment in workforce capacity and digital infrastructure to support genuinely coordinated, developmentally appropriate TYA cancer care. Full article

Large-scale surface subsidence induced by extra-thick seam longwall top-coal caving (LTCC) is strongly amplified by thick unconsolidated overburden, posing serious serviceability risks to overlying linear infrastructure. Taking the S103 Provincial Highway above Panel 6118 in Inner Mongolia, China, as the engineering background, this study integrates theoretical analysis, numerical simulation, and in situ monitoring to investigate the subsidence-control mechanism of directional presplitting roof cutting. The results show that roof cutting mitigates surface subsidence by reconstructing the overburden structural system and weakening the stress-transfer chain, thereby transforming key-stratum deformation from integral bending to segmented block movement and narrowing the subsidence-affected zone. An equivalent mining-depth model for subsidence-boundary convergence is proposed to characterize the inward migration of the subsidence-basin boundary under thick unconsolidated cover, and a segmented probability-integral model is developed to explain the kink-like high-gradient feature in the post-cut subsidence profile. Parametric simulations of roof-cutting positions (p = 0, 2, 4, …, 32 m) show that the most effective mitigation occurs in the range p = 4–12 m; using minimum–maximum highway subsidence together with profile flattening as the optimization criteria, the representative optimum is identified at p ≈ 10 m, for which the maximum highway subsidence is approximately 57 mm, about 76% lower than that in the non-cutting case. The results further indicate that, although roof cutting significantly reduces subsidence and deformation gradients, fissure localization and possible discontinuous deformation near the pre-split weak plane still require careful field monitoring. Full article

Background: Digitalization and artificial intelligence-supported clinical decision support systems (AI-DSS), defined here as tools that generate patient-specific alerts, risk estimates, prioritization prompts, documentation suggestions, or related recommendation outputs intended to support rather than replace professional nursing judgment, can improve clinical decision-making, yet they may also amplify technostress and burnout, with downstream effects on missed nursing care and implementation readiness. Methods: We surveyed 239 registered nurses from a tertiary-care hospital in Timișoara, Romania (January–March 2025), including critical care (n = 60) and general wards (n = 179). Measures included a 15-item technostress scale, eHEALS, Maslach Burnout Inventory–Human Services Survey (MBI-HSS), Safety Attitudes Questionnaire (SAQ) teamwork and safety climate subscales, a 10-item missed nursing care inventory, and a six-item AI-DSS acceptance scale reflecting perceived usefulness, trust, and stated willingness to use such tools if available as an attitudinal readiness outcome rather than as routine observed use. Multivariable regression, exploratory mediation models, cluster analysis, and exploratory ROC analysis were performed. Results: Higher technostress was associated with higher emotional exhaustion (r = 0.52) and more missed care (r = 0.41), whereas eHealth literacy correlated with higher AI-DSS acceptance (r = 0.35) and lower technostress (r = −0.34). In adjusted models, technostress (per 10 points) was associated with higher missed care (β = 0.28, p < 0.001) (equivalent to 0.14 points per 5-point increase) and higher odds of low AI-DSS acceptance (OR = 1.38, p = 0.001), while eHealth literacy was associated with lower odds of low acceptance (OR = 0.71 per 5 points, p < 0.001). Burnout and the safety climate statistically accounted for approximately 35% of the technostress–missed care association. Three workflow phenotypes were identified, with the high-strain/low-literacy cluster showing the most missed care (3.5 ± 1.8) and the lowest AI acceptance (19.7 ± 5.2). An exploratory in-sample ROC model for intention to leave achieved an AUC of 0.82. Conclusions: Higher technostress clustered with worse nurse well-being, more care omissions, and lower AI-DSS acceptance, whereas eHealth literacy appeared protective. Interventions combining digital skills support, usability-focused redesign, and a stronger safety climate may reduce missed care and support safer AI implementation. Full article

Background: Outdoor time in early childhood education and care (ECEC) settings provides important opportunities for children’s physical activity. Evidence is limited on whether different organizational outdoor conditions influence not only activity intensity but also the contextual characteristics of children’s movement. Methods: An observational study was conducted using the Observational System for Recording Physical Activity in Children—Preschool Version (OSRAC-P). The study was conducted in two public ECEC centers. Not all children were observed across all three conditions due to the field-based design. A total of 7440 observation intervals were analyzed from preschool children across three outdoor conditions (structured educator-led physical activity, outdoor free play, and outdoor free play with additional portable equipment) using a momentary time-sampling protocol (10 s observation + 50 s recording), resulting in one interval per minute. Physical activity intensity, activity type, equipment use, and social context were coded. Contextual differences were analyzed using chi-square tests with standardized residuals, and activity intensity using linear mixed-effects models. Results: No significant differences were found between outdoor conditions in physical activity intensity, sedentary behavior, and moderate-to-vigorous physical activity (all p > 0.05). About one-third of the variance in activity intensity was attributable to individual differences between children (ICC ≈ 33%). Differences were observed in contextual characteristics. Structured activity involved more locomotor activities and greater adult involvement, with 49.4% of intervals occurring in groups with an educator present. Free play with portable equipment showed more manipulative activities, greater equipment use, and mostly peer interactions without adult presence (55.5%), while free play without additional equipment involved more stationary behavior and activities without equipment (46.9%). Conclusions: Although physical activity intensity did not differ across conditions, the structure, material context, and social organization of children’s activity varied, highlighting the practical importance of intentionally combining different outdoor activity formats to support diverse movement patterns in ECEC settings. Full article

Background: Evidence shows that simulation-based education for nurses and midwives contributes to strengthening patient safety and quality of care in healthcare settings. Nevertheless, it is implemented to a limited degree in Sub-Saharan African (SSA) higher education institutions, including Tanzania. This demands that Tanzania shift from a traditional model of teaching to incorporate simulation-based education to produce a skilled workforce. Objective: To explore perceptions and experiences of nurse educators (lecturers) and midwives on simulation-based education in Tanzania. Methods: The study employed a generic qualitative descriptive study design with purposive sampling. The data were collected through individual semi-structured interview guides with nurse educators and midwives (nine nurse educators and 11 midwife graduates) from two selected universities in the School of Nursing and their respective teaching hospitals. Qualitative inductive content analysis was used to analyze the data. Results: The data analysis revealed three themes and nine sub-themes: 1. Knowledge and skills in simulation-based education. 2. Challenges in the implementation of simulation-based education. 3. Ensuring patients’ safety. Conclusions: Students were indeed experienced, but not trained in how to use simulation-based education, and nurse educators had inadequate skills. A high number of students with inadequate infrastructure and resources is the major challenge experienced by participants. Simulation-based education is at an early stage of adoption in Tanzania and will require ongoing development, support and resources to fulfilll its potential in promoting patient safety. Full article

Patients undergoing hemodialysis often experience reduced quality of life, with psychological symptoms and nutritional risk representing important determinants of patient functioning. This study aimed to examine the relationships between depression, anxiety, stress, nutritional risk, mental health, and physical functioning in patients undergoing hemodialysis, with particular emphasis on the mediating role of mental health. A cross-sectional study was conducted among 199 patients receiving hemodialysis in five Croatian hospitals. Depression, anxiety, and stress were assessed using the DASS-42, quality of life using the SF-36, and nutritional risk using the NRS-2002. Associations between variables were examined using Spearman’s correlation coefficient, while structural equation modeling was used to analyze direct and indirect relationships among psychological symptoms, nutritional risk, mental health, and physical functioning. Depression and stress showed significant negative effects on mental health, while mental health showed a significant positive effect on physical functioning. Nutritional risk had a significant direct negative effect on physical functioning. Mental health significantly mediated the relationship between depression and stress and physical functioning. These findings indicate that psychological symptoms and nutritional risk are important determinants of functioning and quality of life in hemodialysis patients and support the need for an integrated care approach that includes regular psychological and nutritional screening. Full article

The well-being of university students is deteriorating, highlighting the need for accessible, non-stigmatizing supports beyond clinical care. Positive psychology (PP) interventions have shown strong potential for improving mental well-being, yet they remain largely underutilized in Nigerian universities. This pilot study evaluated the impact of an eight-week education and intervention incorporating acts of kindness, gratitude, positive reframing, and character strengths in improving subjective well-being among university students in Nigeria. Students were assigned randomly to an education + PP group or an education-only control group and assessed at baseline and post-intervention. Independent-samples t-tests were used to examine group differences in outcomes, while mixed-design ANOVA models assessed the effects of group and time. Compared with controls, the intervention group showed significantly higher mental well-being, positive affect, and resilience, with moderate to large effects. While significant main effects emerged across outcomes, time-by-group interactions were observed only for positive affect and resilience. Given rising psychological distress among Nigerian university students, these preliminary results showed that brief, strengths-based PP exercises can meaningfully improve students’ subjective well-being. They can serve as low-cost, non-stigmatizing additions to university mental health services and a scalable complement to traditional care in low-resource settings. Full article

Background: Women with atrial fibrillation experience a higher lifetime risk of ischemic stroke, greater stroke severity, and worse functional outcomes than men. Preventive strategies focused on AF detection may therefore miss critical opportunities for early intervention in women. Methods: We developed a decision-analytic Markov model using real-world primary care data from Catalonia (Spain) to evaluate an artificial intelligence (AI) enabled strategy for upstream thromboembolic risk detection. The intervention combined electronic health record–based risk prediction, targeted digital rhythm screening, and individualized anticoagulation. Lifetime clinical and economic outcomes were estimated for adults aged ≥65 years, with pre-specified sex-stratified analysis. Results: Compared with usual care, the AI-enabled strategy reduced ischemic stroke, major adverse cardiovascular events, and long-term disability. Absolute reductions in stroke and disability were greater in women, reflecting higher baseline thromboembolic risk. Per 1000 high-risk women, the strategy prevented more strokes and generated larger quality-adjusted life-year gains than in men. From both healthcare payer and societal perspectives, the intervention was cost-saving in women, driven by reductions in stroke-related disability and long-term care. Conclusions: AI-enabled upstream thromboembolic risk detection may deliver particularly important benefits for older women and represents a promising approach to reduce sex-based inequities in stroke prevention. Full article

Background: In clinical practice, LDL-dominant familial hypercholesterolemia (FH) may overlap phenotypically with triglyceride-dominant or mixed familial dyslipidemia. Rule-based diagnostic approaches like the Dutch Lipid Clinic Network (DLCN) and Simon Broome (SB) criteria are frequently used in countries with limited genetic testing, but their concordance with molecular confirmation is inconsistent. In a large Turkish tertiary-care cohort, we studied phenotype-related discordance between clinical criteria and molecular data and tested whether machine learning (ML) models could improve the prediction of reportable pathogenic/likely pathogenic variant positivity among patients with a clinical FH phenotype. Methods: Patients referred for suspected familial hyperlipidemia underwent targeted next-generation sequencing with a 9-gene panel. For the ML analysis, we focused on FH cases with a definitive molecular status (pathogenic/likely pathogenic vs. no reportable variant; variants of uncertain significance were excluded) and applied an 80/20 stratified split (n = 200; 82 molecular-positive cases). Elastic-net logistic regression, random forest, and XGBoost models trained on routinely available clinical variables were compared with dichotomized SB and DLCN classifications. Results: SB positivity was significantly more frequent in triglyceride-dominant phenotypes than in FH (68.4% vs. 52.3%, p = 0.041), despite the substantially lower molecular positivity (14.0% vs. 36.9%, p = 0.002), indicating FH-like false-positive clinical classification in mixed dyslipidemia. In the FH test set, the ML models showed higher discrimination for reportable pathogenic/likely pathogenic variant positivity than dichotomized rule-based criteria (AUC: XGBoost 0.808; random forest 0.769; elastic-net 0.747 vs. SB 0.639; and DLCN 0.598). Thirteen novel variants absent from gnomAD were identified, predominantly in LDLR. Conclusions: In this real-world Turkish cohort, within clinically defined FH cases, ML models performed better at predicting LP/P variant positivity than dichotomized DLCN and Simon Broome criteria. ML-based risk stratification may support prioritization for genetic testing; however, external validation is warranted. Full article

Hemostatic biomaterial agents are widely used during surgery and trauma care to control bleeding, yet their effects on wound healing remain incompletely understood. This study evaluated the impact of oxidized non-regenerated cellulose (ONRC), oxidized regenerated cellulose (ORC), and a gelatin-based hemostat (GELA) on wound healing at 14 and 30 days in a mouse model. Full-thickness wounds were created in C57BL/6J mice (n = 192) and compared to sham controls. Tissue samples were analyzed histologically, supported by immunohistochemistry for Ki-67 and α-SMA and qPCR for VEGF, TGF-β, and FGF-2. Histology demonstrated preserved tissue architecture across groups with progressive resorption of cellulose-based materials, whereas GELA showed localized fibrous structures and enhanced extracellular matrix formation. At day 14, no significant differences were observed in proliferation, contraction, VEGF, or FGF-2 expression; however, TGF-β was significantly reduced in the ORC group. By day 30, GELA significantly increased epidermal proliferation, while contraction markers were elevated in both GELA and ORC. VEGF expression was reduced in GELA and ORC, whereas ONRC showed increased TGF-β expression. FGF-2 remained unchanged across groups. All investigated hemostatic materials were well tolerated during the early postoperative phase (up to day 14), indicating short-term biocompatibility within the scope of this model. In contrast, material-specific differences in cellular activity and growth factor expression became apparent during the later remodeling phase (day 30). These findings suggest differential effects on cellular and molecular aspects of tissue remodeling; however, no conclusions can be drawn regarding overall healing quality or clinical safety, as no quantitative macroscopic or functional outcome measures were assessed. Full article