Search Results (5,034)

Petroglyph motifs from 23 sites and 37 panels in northern Georgia and western North Carolina foothills and mountains are analyzed within their archaeological, ethnographic, and landscape contexts. The Track Rock Tradition comprises 10 chronologically sequenced marking categories: (1) Cupules/Meanders/Open Circles; (2) Soapstone Extraction cars; (3) Vulva Shapes; (4) Figures; (5) Feet/Hands/Tracks; (6) Nested Circles; (7) Cross-in-Circles; (8) Spirals; (9) Straight Lines; and (10) Thin Incised Lines. Dating spans approximately 3800 years. Early cupules and meanders predate 3000 years ago, truncated by Late Archaic soapstone extraction. Woodland period (3000–1050 years ago) motifs include vulva shapes, figures, feet, tracks, and hands. Early Mississippian concentric circles date to 1050–600 years ago, while Middle Mississippian cross-in-circles span 600–350 years ago. Late Mississippian spirals (350–200 years ago) and post-contact metal tool incisions represent the most recent phases. The Track Rock Tradition differs from western Trapp and eastern Hagood Mill traditions. Given the spatial overlap with Iroquoian-speaking Cherokee territory, motifs are interpreted through Cherokee beliefs, supplemented by related Muskogean Creek ethnography. In Cherokee cosmology, the matrilocal Thunderers hierarchy includes the Female Sun/Male Moon, Selu (Corn Mother)/Kanati (Lucky Hunter), Medicine Woman/Judaculla (Master of Game), and Little People families. Ritual practitioners served as intermediaries between physical and spirit realms through purification, fasting, body scratching, and rock pecking. Meanders represent trails, rivers, and lightning. Cupules and lines emphasize the turtle appearance of certain rocks. Vulva shapes relate to fertility, while tracks connect to life-giving abilities. Concentric circles denote townhouses; cross-in-circles and spirals represent central fires. The tradition shows continuity in core beliefs despite shifting emphases from hunting (Woodland) to corn cultivation (Mississippian), with petroglyphs serving as necessary waypoints for spiritual supplicants. Full article

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients’ views, wishes and preferences are in the heart of these plans. Full article

Millions of puppies are welcomed into the homes of families around the world each year. However, understanding the ways in which puppies are bred and raised by their breeders, as well as the perspectives and perceptions underpinning these practices, is still in its infancy. The current study administered an online survey to 200 Australian dog breeders to investigate their breeding program characteristics, breeding dog selection, understanding of the importance of early experiences in puppyhood, and the extent and diversity of their puppy rearing and socialisation practices. Results indicated that breeders were motivated by breed improvement and producing dogs for themselves rather than providing companion dogs, despite most of their puppies being placed in companionship roles. The participating breeders also acknowledged the important role they play in shaping puppies’ behaviour and temperament, which was reflected in both their breeding dog selection and in their rearing and socialisation practices. The majority of breeders housed their litters within their residence for the initial weeks of life but the socialisation experiences they provided were variable in type and frequency. Longer-term breeders and those with larger, more intensive programs reported providing human-focused socialisation experiences less frequently, though the correlational nature of these findings require cautious interpretation. Whilst future research should endeavor to explore these results more comprehensively among a more diverse sample, these findings provide valuable insight into the breeding, rearing, and socialisation process undertaken by dog breeders in Australia. Full article

The agony of medical negligence for all involved is well documented. Health practitioners involved in harm events are described in the literature as “second victims”. Injured patients report that clinical negligence litigation is traumatic, slow, expensive, and does not meet their needs. Clinical negligence lawyers have complained that healthcare injury cases are so complex and expensive that many firms do not accept these cases. This article uses a qualitative case study research design to analyse two cases from the United States of America (US) to explore the promise of an alternative resolution process: the communication-and-resolution program (CRP). CRPs involve the hospital disclosing the healthcare injury, investigating and explaining what happened, apologising and, sometimes, offering compensation to injured patients and families. In the US, CRPs have not replaced tort law. The two case studies analysed in this article offer a rare insight into the accounts of those who have experienced clinical negligence and an alternative non-litigation approach. The case study approach delves into the detail, providing an in-depth glimpse into the complexity of healthcare injuries in their real-life context. The case studies provide valuable lessons for reshaping resolution processes to better meet injured patients’ needs. Full article

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

Black gay and bisexual older men face numerous barriers across the life course that can contribute to negative health and well-being as they age. Drawing on strengths-based social determinants discussed in the health literature and literature on intersectionality, justice, and critical consciousness, this study examines qualitative data from seventeen Black gay and bisexual older men about sources and strategies of resilience and thriving amidst intersecting systems of power and oppression that shape health inequities. The findings revealed an evolution of positive support networks across their life courses, including biological family and families of choice such as “houses” and support groups. Early and ongoing negative experiences relating to intersecting positionalities (e.g., race, gender, sexual orientation) also provided sources of strength and resilience. Participants identified three strategies for building resilience and thriving: naming external ignorance, acknowledging common struggles, and reconciling contradictions. These strategies reflected various levels of critical consciousness that helped them navigate complex and intersecting systems of power that they encountered as Black gay men across the life course. Overall, the findings underscore the importance of considering intersecting systems of power and critical consciousness when examining resilience and social determinants of health and contribute new insights on a vastly understudied population. Full article

Background: Neurogenic bladder (NB) in children may lead to recurrent urinary tract infections (UTIs), renal deterioration, and a reduced quality of life. Clean intermittent catheterization (CIC) is the standard of care, but in some patients, CIC may be unfeasible due to anatomical, sensory, or compliance issues. Button cystostomy (BC) has emerged as a minimally invasive, bladder-preserving alternative. This study aimed to assess the feasibility, safety, and outcomes in the long-term of BC in pediatric NB patients. Methods: Retrospective analysis was conducted on children with NB who underwent endoscopic BC placement between January 2020 and December 2024 in a tertiary pediatric center. Demographic data, operative time, complications, and follow-up outcomes were collected. All procedures used an endoscopic approach with cystoscopic guidance for safe device placement. Results: Thirty-three patients (25 males; median age 7.96 years) underwent BC placement. Most had spinal dysraphism (63.6%). The mean operative time was 48.5 ± 6 min. During a mean follow-up of 2.1 ± 1.4 years, five patients (15.2%) had febrile UTIs and two had minor leakage. No major complications occurred. Four buttons were removed due to clinical improvement (N = 1), the fashioning of a continent derivation (N = 1) and implantation of a sacral neuromodulator (N = 2); two patients accepted CIC. Satisfaction was reported by 93.9% of families. Conclusions: BC is an effective, minimally invasive alternative for urinary drainage in children with NB, even when compared to continent diversion techniques such as the Mitrofanoff, due to its lower invasiveness, greater feasibility, and lower complication rate. Broader adoption may be warranted, but prospective studies are needed to confirm long-term outcomes. Full article

The COVID-19 pandemic precipitated unprecedented social isolation measures, profoundly disrupting daily life, educational routines, and mental health worldwide. University students, already susceptible to psychological distress, encountered intensified challenges under remote learning and prolonged confinement. This longitudinal study examined fluctuations in anxiety and mood among 102 Brazilian university students during the pandemic, distinguishing between those solely engaged in academic pursuits and those simultaneously balancing work and study. Data collected via the Brunel Mood Scale and State-Trait Anxiety Inventory in April and July 2021 revealed that students exclusively focused on studies exhibited significant increases in depressive symptoms, anger, confusion, and anxiety, alongside diminished vigor. Conversely, participants who combined work and study reported reduced tension, fatigue, confusion, and overall mood disturbance, coupled with heightened vigor across the same period. Notably, women demonstrated greater vulnerability to anxiety and mood fluctuations, with socioeconomic disparities particularly pronounced among females managing dual roles, who reported lower family income. These findings suggest that occupational engagement may serve as a protective factor against psychological distress during crises, underscoring the urgent need for tailored mental health interventions and institutional support to mitigate the enduring impacts of pandemic-related adversities on the student population. Full article

If God cares and is present, can God use pain and suffering in my life? Absolutely. Does this mean that God planned, ordained, or designed the pain (or cancer) to be instrumental in my life for some sort of higher spiritual purpose? If so, why? Why does God allow cancer to invade and interrupt one’s life? There are no theologically sound or definitive answers to these questions. Although asking such questions is basic to our humanity, as we will observe in various passages of Scripture, the answers will always remain elusive. Instead of seeking to answer the question “why?”, I will suggest two areas for theological and pastoral reflection with respect to those facing cancer: humility and hope. Enduring cancer, from diagnosis through treatment, requires humility in mind and body before our Creator and before our caregivers. Cancer also provides an opportunity for Christians to embed themselves in the hope of resurrection and new creation. Resurrection hope is also not reduced to hope beyond death but hope that is manifested now through embodied resurrection “signs” and actions of human sacrificial love, both received and practiced by the patient undergoing illness and by the patient’s caregivers, family, and friends. Full article

Background: The progression of Alzheimer’s Disease (AD) deeply affects not only the diagnosed person but also their close relatives, who are often called to take on the role of informal caregivers. This transition is frequently unplanned and emotionally complex, yet poorly understood in its deeper processual dimensions. This study aims to explore and theorize the transition experienced by a family member becoming the primary informal caregiver for a person with advanced AD. Methods: A qualitative study based on the Constructivist Grounded Theory according to Charmaz’s approach (2006) was conducted. In-depth interviews were carried out with 10 participants who had become informal caregivers for a loved one with advanced AD. Data were analyzed using initial coding, focused coding, the constant comparative method, and theoretical coding. Results: Ten caregivers (mean age 39 years, range 35–54; nine females) of patients with advanced AD participated in the study. The analysis revealed a complex, emotionally intense caregiving experience marked by sacrifice, feelings of powerlessness, identity loss, and the necessity of sharing caregiving responsibilities. A core category emerged: A Silent and Certain Willingness to Care, representing the caregivers’ deep, often unconscious commitment to prioritize the care of their loved ones above their own needs. Four interconnected phases characterized the caregiving process: (1) The Changing Daily Life—involving significant sacrifices in personal and social life; (2) Feeling Powerless—confronting the inevitable decline without means to alter the course; (3) Losing Oneself—experiencing physical and psychological exhaustion and a sense of identity loss; and (4) Sharing with Others—seeking external support to sustain caregiving. These findings highlight the evolving nature of becoming a caregiver and the enduring dedication that sustains this role despite the challenges. Conclusions: The progression of AD deeply transforms the lives of caregivers, who become co-sufferers and active participants in the disease’s management. The results underscore the urgency of designing integrative care strategies—including psychological, social, and potentially technological support—that can enhance both patient outcomes and caregiver resilience. Grounded in real-world experiences, this study contributes to the broader neurodegeneration discourse by emphasizing caregiving as a critical factor in long-term disease management and therapeutic success. Full article

Background: The long-term clinical and laboratory results of a 33-year follow-up of a Greek family with abetalipoproteinemia (ABL) are described. Case Report: The patients (two brothers and their sister, aged 57, 49, and 62 years, respectively) are still alive, being under close surveillance. In two of the three patients, diarrhea appeared in early infancy, while in the third, it appeared during adolescence. CNS symptomatology worsened after the second decade of life. At the same time, night blindness appeared in the advanced stages of the disease, resulting in almost complete loss of vision in one of the male patients and severe impairment in the other. The diagnosis was based on the clinical picture, ophthalmological findings, serum lipid estimations, and presence of peripheral acanthocytosis. All patients exhibited typical serum lipidemic profile, ophthalmological findings, and acanthocytes in the peripheral blood. During the follow-up period, strict dietary modifications were applied, including the substitution of fat with medium-chain triglycerides (MCT oil). After 33 years since the initial diagnosis, all patients are alive without any sign of liver dysfunction despite continuous use of MCT oil. However, symptoms from the central nervous system and vision impairment worsened. Conclusion: The course of these patients suggests that the application of a modified diet, including MCT oil, along with close surveillance, could prolong the survival of patients without significant side effects from the liver. Full article

Background/Objectives: Senior nurses in Taiwan shoulder layered responsibilities shaped by professional roles, gendered expectations, and family duty. Although Taiwan faces a persistent shortage of experienced clinical nurses, limited research has explored how long-serving nurses sustain identity and commitment across decades of caregiving. This study examines how senior staff nurses understand their journeys of becoming—and remaining—nurses within a culturally and emotionally complex landscape. Methods: Interviews were conducted between May 2019 and September 2023 in locations chosen by participants, with most sessions face-to-face and others undertaken via video conferencing during COVID-19. This narrative inquiry involved in-depth, multi-session interviews with five female senior staff nurses born in the 1970s to early 1980s. Each participant reflected on her life and career, supported by co-constructed “nursing life lines.” Thematic narrative analysis was conducted using McCormack’s five-lens framework and Riessman’s model, with ethical rigor ensured through reflexive journaling and participant validation. Results: Three overarching themes emerged: (1) inner strength and endurance, highlighting silent resilience and the ethical weight of caregiving; (2) support and responsibility in relationships, revealing the influence of family, faith, and relational duty; and (3) role navigation and professional identity, showing how nurses revisit meaning, self-understanding, and tensions across time. Participants described emotionally powerful moments, identity re-connection, and cultural values that shaped their paths. Conclusions: These narratives offer a relational and culturally embedded understanding of what it means to sustain a career in nursing. Narrative inquiry created space for reflection, meaning-making, and voice in a system where such voices are often unheard. Identity was not static—it was lived, reshaped, and held in story. Full article

Amaranthus is appointed as a common weed associated with crops. The research was designed to survey the Amaranth existence pattern throughout the Fayoum Depression, Egypt, accompanied with a community vegetation analysis. The study was extended to collect and analyze associated soil samples. The obtained results figured out the prevalence of dicot families, herb growth forms, therophyte followed by phanerophyte life forms, the Pantropical monoregional chorotype, and the Mediterranean and Sudano-Zambezian followed by the Irano-Turanian pluri-regional chorotype. Multilevel pattern analysis stated that Gossypium barbadense, Corchorus olitorius, Sorghum bicolor, Sesamum indicum, and Zea mays are indicator species most related to Amaranth occurrence and prediction. NMDS analysis denoting that the Ibshaway, Youssef Al Seddik, Itsa, and Fayoum districts are the most representative districts for Amaranth existence on the basis of edaphic resources. Itsa and Youssef Al Seddik, in addition to Itsa and Fayoum, resemble each other in species composition. High pH and CaCO₃ percentages were discriminatory in Ibshaway, Itsa, and Youssef Al Seddik. Ni was the cornerstone for districts partitioning in pruned trees. Finally, Amaranth was flourishing in both comfortable and harsh habitats with cultivated crops and orchards, as well as on the outskirts. The findings are considered to be valorized by decision makers in arable land management. Full article

Introduction: Cystic fibrosis (CF) is a genetic condition affecting several organs and systems, including the pancreas, colon, respiratory system, and reproductive system. The detection of a growing number of CFTR variants and genotypes has contributed to an increase in the CF population which, in turn, has had an impact on the overall statistics regarding the prognosis and outcome of the condition. Given the increase in life expectancy, it is critical to better predict outcomes and prognosticate in CF. Thus, each person’s choice to aggressively treat specific disease components can be more appropriate and tailored, further increasing survival. The objective of our narrative review is to summarize the most recent information concerning the value and significance of clinical parameters in predicting outcomes, such as gender, diabetes, liver and pancreatic status, lung function, radiography, bacteriology, and blood and sputum biomarkers of inflammation and disease, and how variations in these parameters affect prognosis from the prenatal stage to maturity. Materials and methods: A methodological search of the available data was performed with regard to prognostic factors in the evolution of CF in children and young adults. We evaluated articles from the PubMed academic search engine using the following search terms: prognostic factors AND children AND cystic fibrosis OR mucoviscidosis. Results: We found that it is crucial to customize CF patients’ care based on their unique clinical and biological parameters, genetics, and related comorbidities. Conclusions: The predictive significance of more dynamic clinical condition markers provides more realistic future objectives to center treatment and targets for each patient. Over the past ten years, improvements in care, diagnostics, and treatment have impacted the prognosis for CF. Although genotyping offers a way to categorize CF to direct research and treatment, it is crucial to understand that a variety of other factors, such as epigenetics, genetic modifiers, environmental factors, and socioeconomic status, can affect CF outcomes. The long-term management of this complicated multisystem condition has been made easier for patients, their families, and physicians by earlier and more accurate identification techniques, evidence-based research, and centralized expert multidisciplinary care. Full article

Tunisia faces significant challenges related to climate change, which deeply affect its natural and agricultural resources. This reality threatens not only food security but also the economic stability of rural communities and mainly rural women. This research aims to assess the impact of climate change on rural women in the agricultural development group in Sidi Bouzid, focusing on the strategies adopted and the support provided by various stakeholders to mitigate this impact. To achieve this, we developed a rigorous methodology that includes structured questionnaires, focus group discussions, and topological analysis through Multiple Correspondence Analysis (MCA). The results revealed that rural women were categorized into three groups based on their vulnerability to climate change: severely vulnerable, vulnerable, and adaptive. The findings highlighted the significant impact of climate change on water resources, which has increased family tensions and reduced agricultural incomes, making daily life more challenging for rural women. Furthermore, a deeper analysis of interactions with external stakeholders emphasized the important role of civil society, public organizations, and research institutions in strengthening the climate resilience of rural women. Given these findings, strategic recommendations aim to enhance stakeholder coordination, expand partnerships, and improve access to essential technologies and resources for women in agricultural development groups. Full article