Search Results (11,022)

Background/Objective: Nurse educators are central to consolidating nursing as a discipline and shaping professional identity, yet their preparation is heterogeneous. This study aimed to identify profiles of nurse educators based on the value they assign to teaching competencies and to analyze factors influencing these profiles. Methods: A cross-sectional, descriptive research design was applied, using convenience sampling to recruit 326 nurse educators from Spanish universities. Data were collected through a self-administered online questionnaire distributed to nursing faculty from public, private, and affiliated (semi-private) universities across Spain. The instrument included sociodemographic and academic variables, along with nine teaching competencies. Descriptive statistics, cluster analysis, ANOVA, chi-square tests, and multinomial logistic regression were conducted using SPSS. Results: Three distinct profiles of nursing faculty were identified. The academic–pedagogical profile assigned the highest importance to all competencies (means 4.78–4.91), the clinical–pragmatic profile assigned the lowest (3.61–4.04), and the intermediate–researcher profile showed moderate values (4.26–4.50). Doctoral degree (χ² = 65.36, p < 0.001) and pedagogical training (χ² = 33.89, p < 0.001) were the strongest predictors of membership in the academic–pedagogical group, confirmed in multivariate regression (OR for doctorate = 0.07; OR for pedagogical training = 0.13, both p < 0.001). Conclusion: This study delineates three coherent and statistically robust profiles of nursing faculty based on their appraisal of teaching competencies. Academic qualifications and pedagogical training emerged as key determinants of these profiles. Tailored faculty development strategies that reinforce doctoral-level preparation and pedagogical expertise are critical to advancing the quality and consistency of nursing education. Full article

In the saline, cold, and arid regions of Western China, the adhesive performance at the carbon fiber-reinforced polymer (CFRP)–concrete interface critically affects the long-term reliability of CFRP-strengthened structures. Replacing the organic epoxy resin (EP) with inorganic magnesium phosphate cement (MPC) has been proposed as an alternative. However, comparative studies on the deterioration of MPC- and EP-bonded CFRP–concrete under sulfate freeze–thaw cycles are limited. This study employed double-shear tests to systematically compare the failure modes, ductility, and bond performance of the CFRP–concrete interface bonded with MPC and EP after 25, 50, and 75 sulfate freeze–thaw cycles. The results indicate that, as the number of cycles increased, MPC-bonded specimens exhibited progressive interfacial peeling, whereas EP-bonded specimens underwent abrupt brittle fracture. At 0, 25, 50, and 75 cycles, the peak strains of MPC specimens exceeded those of EP specimens by 9.28%, 10.13%, 5.99%, and 0.86%, respectively, indicating greater ductility. Bond performance declined markedly for both groups as cycles increased, with MPC specimens showing greater deterioration. After 75 cycles, compared with EP-bonded specimens, MPC-bonded specimens showed a 16.56% lower interfacial load capacity, a 21.53% reduction in peak bond stress, and a 6.03% shorter effective bond length. This systematic comparison of MPC- and EP-bonded CFRP–concrete under sulfate freeze–thaw exposure provides guidance for adhesive selection and strengthening practices in saline, cold, and arid regions. Full article

Early childhood education is a demanding profession. Understanding how early childhood (EC) professionals’ draw on internal assets and external resources to sustain well-being is critical, as their well-being is linked to the quality of the care and education they provide. This phenomenological study examined professionals’ strengths and assets, how they used them to manage workplace demands to sustain well-being, and how they engaged with broader systems to enhance the quality of care and education they provide. Thirteen focus groups were conducted with 98 English-speaking (n = 87 female, 3 male, 8 missing gender) and 23 Spanish-speaking (n = 22 female, 1 missing gender) EC professionals. Analysis identified three interdependent themes: (1) holistic well-being; (2) centrality of relationships; and (3) interactions with systems. Participants reported well-being ranging from struggling to sustaining. Relationships with children, families, and co-workers were a source of motivation, commitment, and satisfaction with their work. Participants emphasized the importance of caring for their own well-being to effectively care for others. Systems both supported and hindered well-being. Participants used support-seeking, problem-focused, proactive, and restorative strategies to cope with stressors. Findings underscore the relational and systemic dimensions of EC professionals’ well-being and the strategies they employ to sustain it. Full article

Urban park areas mitigate urbanization’s negative impacts by integrating environmental, social and cultural benefits. Development strategies should enable participation and consider all user groups’ needs, following sustainability principles. However, ensuring multifunctionality often generates conflicting decisions. While the universal necessity for safety is widely acknowledged, its implementation frequently results in the diminution of a crucial sense of privacy. For example, the universally recognized need for safety may compromise the willingness sense of privacy or intimacy. This can discourage those for whom this need is important and prevent urban parks from fully utilizing their social potential. This study examines how spatial configurations of plant forms within urban parks shape personal experiences. We used an intra-group design to evaluate photographs of park spaces, manipulated using Photoshop AI algorithms to examine safety, privacy, preference, and willingness to spend time. Variables included space size and shape. The study used Computer-Assisted Web Interviewing (CAWI) with 300 participants. Regression and mediation analyses showed willingness to visit derives from space attractiveness, influenced by perceived safety and privacy. Analyses revealed the following: open areas were safest but the least private, corridor spaces were the least safe but the most private; curtain screens enhanced perception better than corridor screens; small spaces with corridor screens were least attractive; space size mattered less for open spaces than screened spaces; and spatial configuration was critical in assessing small spaces. The findings of this research enhance our comprehension of the perception of park spaces. They hold potential practical implications for sustainable design, facilitating the development of plant forms that are more socially effective, particularly those with substantial environmental value, such as dense vegetation that serves as visual screens. Neglecting these preferences may result in inappropriate design decisions that fail to accommodate users’ needs and behaviors, thereby not fully capitalizing on the potential of urban green spaces. Full article

Background/Objectives: Antimicrobial resistance (AMR) has increased significantly over the years, contributing to a real challenge in the intensive care unit (ICU). The emergence of metallo-beta-lactamases (MBLs) has contributed to the protection of pathogens against all current beta-lactam/beta-lactamase inhibitors (BL/BLIs), including the newer ceftazidime–avibactam (CAZ-AVI), meropenem–vaborbactam, and imipenem–relebactam. Treatment of such infections is challenging. In vitro and clinical data suggest that combinations of CAZ-AVI with aztreonam (ATM) and the use of two different carbapenems (double carbapenem therapy, DCT) may be an option for MBL-producing pathogens. The aim of our study was to evaluate the effectiveness of the combination CAZ-AVI + ATM and the effectiveness of DCT against MBL-producing K. pneumoniae infections in the critically ill, mechanically ventilated patients. Methods: This is a retrospective study conducted in the two ICUs of hospitals in central Greece. Mechanically ventilated patients admitted to the ICU were included in the study if they developed an infection by MBL-producing K. pneumoniae. Patients were divided into three groups: the first one consisted of patients who were treated with CAZ-AVI plus ATM (CAZ-AVI + ATM group), and the second group consisted of patients who received DCT (DCT group). The third group included patients who received appropriate antibiotic therapy other than CAZ-AVI + ATM and DCT (control group). The primary outcome of the study was the evolution of the sequential organ failure assessment (SOFA) score, and secondary outcomes were duration of mechanical ventilation (MV), ICU length of stay (LOS), and, finally, ICU mortality. Results: 108 patients were included in the study. 35 (32%) in the CAZ-AVI + ATM group, 31 (29%) in the DCT group, and the remaining 42 (39%) patients in the control group. The SOFA score was not statistically different on day 1, day 4, and day 7 of the infection among the three groups (p > 0.05). Duration of MV and ICU LOS were also similar. Finally, mortality did not differ between the groups [20 patients (57.1%) vs. 18 (58.1%) vs. 25 (59.5%) for CAZ-AVI + ATM, DCT and control group, respectively, p = 0.98]. Comparison between survivors and non-survivors revealed that independent risk factors for mortality were SOFA score at day 1 of infection and medical cause of admission (p < 0.05). Conclusions: Treatment with CAZ-AVI + ATM or DCT presented similar efficacy with appropriate antibiotic therapy for infections caused by MBL-producing K. pneumoniae strains. Larger studies are required to confirm the findings. Full article

Red blood cell (RBC) deformability is a critical biophysical property that enables effective passage of RBCs through microvasculature and ensures proper oxygen delivery. Impairment of this property is associated with various pathological conditions, including type 2 diabetes mellitus (T2DM). In this study, we developed an automated microfluidic platform for high-throughput and real-time assessment of RBC deformability under controlled flow conditions. The device features a structured microchannel design and integrated imaging to quantify individual cell deformation responses. Comparative analyses of RBCs from healthy individuals and T2DM patients revealed significant reductions in deformability in the diabetic group. In vivo validation using a diabetic mouse model further confirmed the progressive decline in RBC deformability under chronic hyperglycemia. This microfluidic approach provides a robust and efficient tool for characterizing RBC mechanical properties, offering potential for disease monitoring and clinical diagnostic applications. Full article

With the rapid increase in solid waste generated worldwide, sustainable approaches for the recovery of resources considering environmental protection are required. As one of the emerging strategies in recent years, biochar has shown great potential due to its high carbon stabilization, adjustable porosity and tunability. This review focuses on the critical assessment of the available technologies for biochar upgrading, with a specific objective of biochar physicochemical functionality improvement and critical materials recovery in line with circular economy targets. We systematically review physicochemical activation methodologies, functionalizations and leaching approaches, accounting for their effects on surface area, porosity and functional group chemistry. Particular attention is paid to the dual functionality of upgraded biochar (i) as a catalyst support for thermochemical processes and (ii) as a medium for the recycling of essential nutrients (e.g., phosphorus, potassium, magnesium, calcium). It is evidenced that customized activation can further improve its adsorption and catalytic efficiency as well as promote near-total nutrition extraction. This review positions advanced biochar as an enabling multipurpose technology across sustainable material production, nutrient cycling and waste valorization in the circular bioeconomy. Full article

Intelligent crack detection and displacement measurement are critical for evaluating the health status of dams. Earth-fill dams, composed of fragmented independent material particles, are particularly vulnerable to climate changes that can exacerbate cracking and displacement. Existing crack segmentation methods often suffer from discontinuous crack segmentation and misidentification due to complex background noise. Furthermore, current skeleton line-based width measurement techniques demonstrate limited accuracy in processing complex crack patterns. To address these limitations, this study introduces a novel three-step approach for crack detection in earth-fill dams. Firstly, an enhanced YOLOv8-CGA crack segmentation method is proposed, incorporating a Cascaded Group Attention (CGA) mechanism into YOLOv8 to improve feature diversity and computational efficiency. Secondly, image processing techniques are applied to extract sub-pixel crack edges and skeletons from the segmented regions. Finally, an adaptive skeleton fitting algorithm is developed to achieve high-precision crack width estimation. This approach effectively integrates the pattern recognition capabilities of deep learning with the detailed delineation strengths of traditional image processing. Additionally, dam crest displacements and crack zone strain field are measured via the digital image correlation (DIC) method. The efficacy and robustness of the proposed method are validated through laboratory experiments on an earth-fill dam model, demonstrating its potential for practical structural health monitoring (SHM) applications in a changing climate. Full article

Background: Uncontrolled donation after circulatory death (uDCD) remains underutilized globally, despite critical organ shortages. We report outcomes from Israel’s uDCD kidney transplant program compared with the matched donation after brain death (DBD) recipients. Methods: This retrospective cohort study analyzed all uDCD kidney transplants performed at the Rabin Medical Center between January 2018 and December 2024, compared with DBD transplants during the same period. Propensity score matching (1:3 ratio) was performed using recipient demographics, comorbidities, and donor characteristics. Primary outcomes included delayed graft function (DGF), graft failure, and patient survival. Results: Among 92 kidney transplants, 21 (22.8%) were from uDCD donors. After propensity-matching (21 uDCD, 63 DBD), significant baseline differences persisted: uDCD recipients were younger (47.2 ± 11.8 vs. 57.5 ± 10.9 years, p < 0.001) despite a similar dialysis vintage (7.2 ± 3.2 vs. 7.7 ± 3.7 years, p = 0.569). Warm ischemia time was 58.5 ± 12.3 vs. 3.0 ± 0.0 min (p < 0.001), and cold ischemia time was longer in uDCD (13.7 ± 5.9 vs. 8.4 ± 2.5 h, p < 0.001). DGF occurred in 90.5% of uDCD versus 54.1% of DBD recipients (p = 0.006). Graft failure was markedly higher in uDCD (28.6% vs. 1.6%, p = 0.001), yet mortality was lower (14.3% vs. 27.9%, p = 0.339). After a median follow-up of 60 months (IQR 48–72) for both groups, the death-censored 5 year graft survival rate was 71.4% for uDCD versus 98.4% for DBD (p < 0.001). Conclusions: Despite higher rates of DGF and graft failure, uDCD kidney transplantation demonstrated an acceptable 5 year patient survival rate in carefully selected younger recipients. These findings support cautious expansion of uDCD programs with rigorous recipient selection criteria and realistic outcome expectations. Full article

Interstitial lung diseases (ILDs) represent a group of lung disorders that primarily affect the lung parenchyma. These disorders are usually progressive, may be debilitating and life threatening, and often pose diagnostic and therapeutic challenges. Exhaled breath analyses offer opportunity for diagnosis, differential diagnosis, and to predict prognosis and treatment outcomes. Numerous studies have been published using various exhaled biomarker analyses, including exhaled nitric oxide, exhaled breath condensate, and exhaled volatile organic compounds. This review summarises and critically appraises the literature and offers suggestions for further research to apply exhaled biomarker analyses in clinical practice. Full article

Background/Objectives: Stress during pregnancy critically impacts maternal and fetal health. While prior research has linked sociodemographic and biological factors to stress levels, the role of specific biomarkers, such as vitamin D (VD), remains unexplored. This study examined the relationships among sociodemographic factors, VD status (as measured by serum 25-hydroxyvitamin D [25(OH)D] concentration), and perceived stress in pregnant women. We hypothesized that 25(OH)D concentration would be associated with perceived stress levels during pregnancy. Methods: A post hoc analysis of the Kellogg Pregnancy VD study was conducted on a cohort of 232 pregnant women with Perceived Stress Scale (PSS-10) scores at months 2, 5, and 7 with corresponding 25(OH)D concentrations. PSS-10 scores were classified into two groups: patients with scores of 0–13 were considered to have low stress, while those with scores of 14–40 were considered to have moderate-to-high stress. Logistic regression models identified factors associated with moderate-to-high stress. Results: At month 2, univariate analyses showed that being married (p = 0.002), having a college education (p = 0.0013), and lower BMI (p = 0.018) were associated with lower perceived stress, whereas Black race was associated with higher perceived stress (p = 0.027). By month 7, higher serum 25(OH)D concentration was the only significant predictor of perceived stress in univariate analysis (p = 0.002). In multivariate models at month 7, 25(OH)D approached significance (p = 0.053). Conclusions: Early in pregnancy, race, marital status, college education, and BMI were significantly associated with PSS-10 score. By month 7, 25(OH)D concentration over time emerged as a factor that was significantly associated in univariate analysis and showed a trend toward significance in multivariate models. VD status, as measured by 25(OH)D concentration, may act as a biomarker of stress during pregnancy. Results warrant further study in prospective intervention trials. Full article

Objective: Existing studies on short-chain fatty acids (SCFAs) and colorectal cancer (CRC) yield contradictory conclusions and are limited to single ethnic groups or sample types. This study aimed to (1) quantify associations between total SCFAs/subtypes (acetate, propionate, butyrate) and CRC/advanced colorectal adenoma (A-CRA) risks; (2) identify modifiers (ethnicity, sample type, intervention); and (3) clarify SCFA–gut microbiota interaction mechanisms via integrative Bayesian meta-analysis and multi-ancestry data integration. Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science (inception to September 2025) using keywords: “Short-chain fatty acids”, “SCFAs”, “Colorectal cancer”, “CRC”, “Gut microbiota”, “Dietary fiber”, and “High-amylose maize starch butyrate”. Eligible studies included 14 peer-reviewed original studies (7 observational, cohort/case–control/cross-sectional; 7 RCTs) covering Europeans, Asians, and African Americans. Inclusion criteria: Quantitative SCFA data (total/≥3 subtypes), clear ethnic grouping, reported CRC/A-CRA risks or intervention outcomes. Exclusion criteria: Reviews, animal/in vitro studies, incomplete data, low-quality studies (Newcastle–Ottawa Scale [NOS] <6 for observational; high Cochrane risk for RCTs), or limited populations (single gender/rare genetics). A Bayesian hierarchical random-effects model quantified effect sizes (Odds Ratio [OR]/Mean Difference [MD], 95% credible intervals [CrI]), with heterogeneity analyzed via multi-ancestry stratification, intervention efficacy, and microbiota interaction analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] 2020; International Prospective Register of Systematic Reviews [PROSPERO]: CRD420251157250). Results: Total SCFAs were negatively associated with CRC (OR = 0.78, 95% CrI: 0.65–0.92) and A-CRA (OR = 0.72, 95% CrI: 0.59–0.87), with butyrate showing the strongest protective effect (CRC: OR = 0.63, 95% CrI: 0.51–0.77). Ethnic heterogeneity was significant: Europeans had the strongest protection (OR = 0.71), Asians had weaker protection (OR = 0.86), and African Americans had the lowest fecal SCFA levels and the highest CRC risk. Fecal SCFAs showed a stronger CRC association than serum/plasma SCFAs (OR = 0.73 vs. 0.85). High-Amylose Maize Starch Butyrate (HAMSB) outperformed traditional fiber in increasing fecal butyrate (MD = 4.2 mmol/L vs. 2.8 mmol/L), and high butyrate-producing bacteria (Clostridium, Roseburia) enhanced SCFA protection (OR = 0.52 in high-abundance groups). Conclusions: SCFAs (especially butyrate) protect against CRC and precancerous lesions, with effects modulated by ethnicity, sample type, and gut microbiota. High-Amylose Maize Starch Butyrate is a priority intervention for high-risk populations (e.g., familial adenomatous polyposis, FAP), and differentiated strategies are needed: 25–30 g/d dietary fiber for Europeans, 20–25 g/d for Asians, and probiotics (Clostridium) for African Americans. Future Perspectives: Expand data on underrepresented groups (African Americans, Latinos), unify SCFA detection methods, and conduct long-term RCTs to validate intervention efficacy and “genetics-microbiota-metabolism” crosstalk—critical for CRC precision prevention. Full article

Urinary tract infections (UTIs) are a global health concern, with over 150 million cases annually, primarily caused by Escherichia coli. Due to anatomical differences, females, especially children and postmenopausal women, are four times more susceptible. Crucially, E. coli has developed widespread antimicrobial resistance (AMR), including resistance to broad-spectrum agents and the emergence of Extended-Spectrum Beta-Lactamase (ESBL)-producing strains. This retrospective study analyzed hospital records from 95 female patients with positive urine cultures at Siblin Governmental Hospital in 2024. Patients were stratified into three age categories: children (≤18 years), adults (18–64 years) and elderly patients (>64 years). Statistical analysis using SPSS focused on descriptive resistance patterns and differences across age groups. Overall, cephalothin (85.7%) and cefaclor (78.49%) exhibited the highest resistance rates. Conversely, tigecycline (97.22%) and ertapenem (91.67%) showed the highest susceptibility. Resistance patterns varied significantly by age. For instance, elderly patients showed high resistance to agents like Augmentin (52.5%) and cefixime (66.1%), while the pediatric group (≤18 years) displayed exceptionally high resistance to cefixime (90.0%). E. coli isolates show high resistance to conventionally used antibiotics, complicating UTI treatment. These findings highlight the need for continuous local surveillance, particularly focusing on third-generation cephalosporins and beta-lactamase production. Ultimately, age is a critical factor that must be considered when determining empirical antibiotic therapy for UTIs. Full article

Alzheimer’s disease (AD) is the leading cause of dementia and is often prefaced by mild cognitive impairment (MCI). Detection of AD-related changes via blood-based biomarkers would enable critical therapeutic interventions early in disease progression. Neuronal enriched extracellular vesicle (NEEV) miRNAs regulate peripheral genes as a response to early AD brain changes and hence may have biomarker potential. Plasma NEEVs were captured from plasma samples of Mexican Americans (MAs) and Non-Hispanic Whites (NHWs) using an antibody against the neuronal surface marker CD171. miRNAs isolated from NEEVs were sequenced and analyzed using miRDeep2/DEseq2 and QIAGEN RNA-seq portal for differential expression between cognitively impaired (CI) and cognitively unimpaired controls. hsa-miR-122-5p was significantly underrepresented in the CI group in both MAs and NHWs compared to the healthy control. Other population-specific miRNAs (MAs: hsa-miR-26a-5p, hsa-let-7f-5p, and hsa-miR-139-5p, NHWs: hsa-miR-133a-3p, hsa-miR-125b-5p, and hsa-miR-100-5p) identified may have biomarker potential in AD precision medicine. Some of these differentially expressed miRNAs were associated with key AD-related comorbidities such as APOE genotype, age, and metabolic burden and were predicted to target genes within NF-κB -regulated inflammatory pathways. Together, these findings suggest that dysregulated miRNA networks may serve as a mechanistic link between comorbidity burden and AD-related neuroinflammation and neurodegeneration. Full article

This study establishes a structured framework to identify and evaluate risk factors that may hinder the achievement of sustainable development goals in green buildings and sustainable infrastructure projects. Fifty-six risk factors are identified and categorized into four risk groups, including stakeholder and management, financial and economic, technological and resource, and process and regulatory risks. The risk factors are evaluated across four risk indices related to probability of occurrence, manageability, impact on building performance, and project cost. Further, the severity of risks based on combining the four indices’ effects is quantified using a new Green Risk Index (GRI), while the relationships among all risk indices are determined. The strongest positive correlation is observed between the probability and the impact on cost, whereas a negative relationship is found between the probability and manageability. The analysis demonstrates that a risk factor related to the lack of knowledge about energy-saving procedures and environmental concerns during the design phase is the most critical, as it has the highest severity based on the GRI. “Non-compliance with environmental standards in project design” is also identified as a critical risk factor due to its high effect on building performance. Additionally, the risk factor associated with unstable funds from investors shows the highest effect on manageability. Process and regulatory is identified as the most critical risk group, encompassing the maximum number of key risk factors, and has the highest average weight related to the GRI. These findings reveal crucial vulnerabilities and underline the importance of targeted strategies to strengthen the use of nature-based solution frameworks for mitigating the risk effects in green buildings and sustainable infrastructures. Full article