Search Results (1,180)

Burkholderia is a metabolically versatile genus of Gram-negative bacteria that inhabits niches ranging from soil and water to plants and clinical environments. This review provides an integrated examination of Burkholderia species, focusing on their dual roles as both pathogens and beneficial microorganisms. Key pathogenic species, such as members of the Burkholderia cepacia complex and the Burkholderia pseudomallei group, pose significant threats to human, animal, and plant health due to their intrinsic antibiotic resistance and diverse virulence factors. Conversely, several environmental and plant-associated Burkholderia species promote plant growth, enhance nutrient uptake, and serve as biocontrol agents, supporting sustainable agriculture. We synthesize current knowledge across taxonomy, genomics, pathogenicity, beneficial interactions, and secondary metabolite biosynthesis—including the prolific production of antibiotics, toxins, and volatile organic compounds with pharmaceutical and agricultural potential. Advances in high-throughput genomics are revealing substantial genetic diversity, genome plasticity, and mechanisms underlying both pathogenicity and beneficial traits. Clarifying this dual nature and identifying strategies to mitigate risks will guide the safe and effective exploitation of Burkholderia in medicine, agriculture, and biotechnology. Full article

Long-term exposure of plastics to the environment causes them to disintegrate, resulting in the formation of micro/nanoplastics as well as the release of additives and chemicals into the soil. The micro/nanoplastics are able to readily migrate into the soil, destabilize the soil microbiota, and finally enter crop plants. Endocytosis, apoplastic transport, root adsorption, transpiration pull, stomatal entry, and crack-entry mode are well-known pathways by which microplastics enter into plants. Roots of vegetable crops were able to transfer 0.2 µm–1.0 µm of microplastics through root adsorption and by transpiration pull to the xylem and then further transported them to the plant tissues through apoplastic pathways. Beads of 1000 nm size were also engulfed by BY-2 protoplast cells through endocytosis. Micro and nanoplastics that enter crops affected the physiological and biochemical activities of the plants. Aquaporins were needed to aid the symplastic pathway which made the symplastic pathway difficult for MPs/NPs transport. Microplastics block seed capsules and roots of seedlings, thereby negatively affecting the uptake and efficient use of nutrients supplied. Photosynthesis of plants was affected due to the reduction in chlorophyll contents. Exposing soils to MPs/NPs drastically affected the pH, EC, and bulk density of the soil. This review focused on bridging the knowledge gap with understanding how microplastics prevent nutrient uptake and nutrient use efficiency in plants. This understanding is essential for assessing the broader ecological impacts of plastic contamination and for developing effective mitigation strategies. Further research is needed on microorganisms capable of degrading plastics, as well as on developing analytical methods for detecting plastics in soil and plant tissues. Also, further research on how to replace plastic mulching and still provide the same benefits as plastic mulch is needed. Full article

The enormous applications of various nanoparticles (NPs) have raised the possibility that humans may be simultaneously exposed to mixtures of them in real life. Realistically, this situation may apply to plastic NPs, mainly derived from the breakdown of larger plastics, and to silver NPs, both of which are among the most frequently detected NPs in the envirnment due to their applications in healthcare, consumer products, and water purification. Although numerous studies have examined the toxicity of plastic and silver NPs individually, knowledge of their combined toxicity remains limited. Hence, the main objective of our study was to investigate the toxicity of high-density polyethene nanoparticles (HDPE NPs), thermally isolated from food-cooking bags, in combination with citrate-stabilised silver nanoparticles (AgNPcit) to Caco-2 and HT29MTX cells growing in 2D monoculture or in 3D triple-culture with Raji cells. Cellular uptake of NPs was quantified from the side-scatter (SSC) signal in flow cytometry; toxicity was evaluated by the neutral red assay; apoptosis was evaluated by the Annexin V method; and induction of oxidative stress was evaluated by a fluorescent method using DCFDA and DHR probes. Both cell lines took up both types of NPs; however, HT29MTX cells were more effective in the NPs’ uptake. Interestingly, HDPE NPs and AgNPcit mutually inhibited each other’s uptake, which suggests a similar mechanism of entry. Both types of NPs were toxic to both cell lines growing in monoculture; Caco-2 cells were more susceptible than HT29MTX. The toxicity was attributed to the induction of oxidative stress and associated apoptosis. In line with the mutual inhibition of the NPs’ uptake, the toxic effect of both NPs in the mixture was less than that expected as the sum of individual treatments. The toxic effects of both NPs or their mixture were less pronounced in the triple-culture Caco-2/HT29MTX/Raji, than in Caco-2 and HT29MTX growing in monoculture. Full article

Background: Clínica Esperanza/Hope Clinic (CEHC), a free clinic for low-income, uninsured, Spanish-speaking patients, located in Providence, RI, piloted an intervention to improve vaccination rates. This program, named “Oportuna Vacuna” (OV) aimed to assess vaccine hesitancy in the post-pandemic period and measure improvements to vaccine uptake after integrating healthcare provider (HCP) and patient education with vaccine workflow adjustments. Methods: OV was initiated in January 2023. Culturally attuned and linguistically appropriate vaccine-focused educational programs were developed and provided to patients and HCPs, while workflow modifications to streamline vaccine administration were implemented during clinic visits. Structured pre- and post-intervention chart reviews were conducted and (oral- and) paper-based knowledge, attitudes, and practices surveys were administered to selected staff and patients to assess knowledge, attitudes, and vaccine confidence before and after the interventions. A total of 816 charts were reviewed prior to the intervention; 709 charts were reviewed post-intervention. A total of 72 patient and 10 HCP pre- and post- intervention surveys were completed. Vaccine uptake was compared to the uptake in 2022. Results: Overall vaccination rates at the clinic increased by more than 400% compared to the prior year. Patients and HCPs demonstrated increased vaccine knowledge and confidence, particularly with respect to COVID-19 and HPV vaccines. In contrast, chart reviews of individual patients revealed only a slight improvement in vaccination completion rates for patients over the 1-year period. Conclusion: Substantial increases in vaccine administration rates across multiple vaccine types highlight the effectiveness of OV, mainly for first time patients, at CEHC. Clinic workflow modifications improved vaccination efficiency and increased vaccine uptake. Educational sessions on vaccines were well received by patients and staff. Overall knowledge about vaccines improved during the intervention among staff and HCPs. Patients reported higher trust in HCPs compared to other sources for vaccine information. Full article

Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the “Caregiver Decision Support” (mySupport) study (2019–2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes. Full article

Background: Socioeconomic disparities may affect COVID-19 booster vaccination uptake, potentially undermining public health efforts. This study assessed the association between first booster dose coverage and municipal socioeconomic deprivation in the Apulia region of southern Italy. A secondary objective was to evaluate whether SARS-CoV-2 incidence modified this relationship. Methods: We conducted a retrospective observational study including Apulian residents aged ≥5 years from 1 January 2021, to 31 December 2022. First booster doses were identified using an algorithm based on dose chronology and national guidelines. Vaccination and infection data were retrieved from regional databases. Socioeconomic deprivation was measured using the Social and Material Vulnerability Index (SMVI) developed by the Italian National Institute of Statistics (ISTAT). Booster coverage was calculated at the municipal level. A multivariable Poisson’s regression model was used to estimate the association between SMVI and booster uptake, adjusting for age group, primary vaccine type, SARS-CoV-2 incidence, and municipal vaccination rates. Analyses were stratified by sex. Results: A total of 2,732,258 individuals received a first booster dose. Booster coverage decreased with increasing SMVI. Among females, a significant reduction was observed in the highest deprivation category (RR > 102 vs. <99: 0.95; 95% CI: 0.94–0.97) and it was similar in males (RR: 0.95; 95% CI: 0.93–0.96). A significant interaction between age and deprivation was found in both sexes, with a sharper decline in younger individuals. Municipal vaccination rates were positively associated with booster uptake. SARS-CoV-2 incidence was positively associated with uptake only in males. Conclusions: The analysis revealed a significant association between lower socio-cultural level and lower adherence to the first booster dose of the COVID-19 vaccine. The decline is more pronounced among subjects younger than 50 years with high levels of vulnerability. The findings of this study suggest that to overthrow vaccine hesitancy, knowledge of the social setting allows for targeted communications to the different groups in the population. Further research is needed to define different approaches in the different social groups. Full article

Background/Objectives: Delirium, an acute cognitive disturbance, is often unrecognized by family or friend care partners, contributing to delayed interventions and negative health outcomes. UnderstandingDelirium.ca is an e-learning lesson developed to address this gap by improving delirium knowledge among the public, patients, and family/friend care partners. Our objective was to evaluate the acceptability, intention to use, and perceived impact of Understanding Delirium e-learning among public users. Methods: A convergent mixed-methods observational evaluation combining survey-based quantitative data and thematic analysis was conducted. The survey included the Net Promoter Score (NPS), the short-form Information Assessment Method for patients and consumers (IAM4all-SF), and an open-text feedback item. Descriptive statistics were used to summarize IAM4all-SF responses, assessing perceived relevance, understandability, intended use, and anticipated benefit. Open-text comments were analyzed thematically by two independent reviewers who reached consensus through discussion. Subgroup analysis of qualitative themes was performed by age, gender, and NPS category. Results: Among 629 survey respondents, over 90% of respondents agreed that the lesson was relevant, understandable, likely to be used, and beneficial. The NPS was rated ‘excellent’ (score of 71), and lesson uptake included over 7000 unique users with a 35% completion rate. Qualitative analysis revealed themes of high educational value, emotional resonance, and perceived gaps in prior healthcare communication. Respondents emphasized the lesson’s clarity, intent to share, and potential for wider dissemination. Conclusions: UnderstandingDelirium.ca is a promising, guideline-aligned digital intervention that has potential to enhance delirium literacy and reduce care partner distress. Findings suggest that the Understanding Delirium e-learning can effectively improve public delirium literacy and should be integrated into care partner and clinical workflows. Full article

Background: Many biological drugs have a rival version produced from different cell lines by other manufacturers; these drugs are referred to as biosimilars. By providing accurate information, encouraging patient and medical community acceptance, and advocating for their appropriate usage, pharmacists can play a crucial role in supporting the uptake of biosimilar medicines. Aim: This study aimed to assess pharmacists’ knowledge and attitudes toward biosimilar medicines in the Aseer region in Saudi Arabia. Methods: The study employed a descriptive, cross-sectional design using an anonymous online self-administered questionnaire. The questionnaire was developed by adapting a previously validated instrument and consisted of three sections: demographic data, knowledge about biosimilars, and attitudes toward biosimilars. Two non-probability sampling approaches, i.e., convenience and snowball sampling, were using for data collection. Results: A total of 298 pharmacists participated in the current study. Overall, a total of 135 (45.3%) demonstrated good knowledge of biosimilar medicines, while 163 (54.7%) exhibited poor knowledge. The median knowledge score among the study participants was 5 (5–6). Only 26.2% of pharmacists in the current study correctly identified that biosimilars were not generics and not interchangeable with reference biologics. More experienced pharmacists and those working in industry-related sectors demonstrated greater knowledge of biosimilars (p < 0.05). Pharmacists in the current study demonstrated generally favorable attitudes toward biosimilar medicines. Conclusions: The current study revealed knowledge gaps regarding biosimilar medicines among pharmacists. Targeted educational initiatives, continuing professional development opportunities, and enhanced curricular content could be implemented to address these gaps. Full article

In 2016, the South African government approved free oral PrEP distribution among high-risk groups like female sex workers (FSWs) to reduce new HIV infections. Despite the availability, unique barriers exist that challenge PrEP persistence, including limited knowledge, side effects, stigma, and mobility that hinder adherence. As such, engaging FSWs in the design of an FSW-led intervention program is crucial to promote PrEP uptake, adherence, and retention. Processes of an intervention mapping approach were applied to design and develop the program in KwaZulu-Natal, South Africa. A needs analysis was completed through existing literature and through engagements with FSWs, FSW peer educators, and a healthcare provider. The working group, comprising eight FSW peer educators and a researcher, co-created the intervention following a six-step mapping process. A total of six meetings took place, during which intervention determinants, change objectives, theory-based methods, and the intervention program were discussed and formulated, as well as implementing partners and the evaluation plan identified. The program focuses on the development of agency, self-efficacy, and hope among FSWs and aims to destigmatize PrEP through positive messaging, equipping FSWs with the ability to differentiate PrEP from ARVs given to people living with HIV. Through role-playing, participants will practice discussing PrEP with their intimate partners and friends, receive suggestions on managing pill supply and side effects, and be equipped to become PrEP ambassadors. The introduction of PrEP as a pill for high-risk groups can be stigmatizing. Therefore, it is crucial to involve marginalized groups in the design and implementation of their interventions to foster acceptance and develop a sense of ownership, ensuring the programs’ sustainability. Full article

Background: Artificial intelligence (AI) emerges as a powerful tool to assist breast cancer screening; however, its integration into different mammographic modalities remains insufficiently explored. Digital Mammography (DM) is widely accessible but presents limitations in dense breast tissue, whereas Contrast-Enhanced Spectral Mammography (CESM) provides functional information that enhances lesion visualization. Understanding how deep learning models behave across these modalities, and determining whether their decision-making patterns remain consistent, is essential for equitable clinical adoption. Methods: This study evaluates three convolutional neural network (CNN) architectures, ResNet-18, DenseNet-121, and EfficientNet-B0, for binary classification of breast lesions using DM and CESM images from the public CDD-CESM dataset (2006 images, three diagnostic classes). The models are trained separately on DM and CESM using three classification tasks: Normal vs. Benign, Benign vs. Malignant, and Normal vs. Malignant. A 3-fold cross-validation scheme and an independent test set are employed. Training uses transfer learning with ImageNet weights, weighted binary cross-entropy (BCE) loss, and SHapley Additive exPlanations (SHAP) analysis to visualize pixel-level relevance of model decisions. Results: CESM yields higher performance in the Normal vs. Benign and Benign vs. Malignant tasks, whereas DM achieves the highest discriminative ability in the Normal vs. Malignant comparison (EfficientNet-B0: AUC = 97%, Accuracy = 93.15%), surpassing the corresponding CESM results (AUC = 93%, Accuracy = 85.66%). SHAP attribution maps reveal anatomically coherent decision patterns in both modalities, with CESM producing sharper and more localized relevance regions due to contrast uptake, while DM exhibits broader yet spatially aligned attention. Across architectures, EfficientNet-B0 demonstrates the most stable performance and interpretability. Conclusions: CESM enhances subtle lesion discrimination through functional contrast, whereas DM, despite its simpler acquisition and wider availability, provides highly accurate and explainable outcomes when combined with modern CNNs. The consistent SHAP-based relevance observed across modalities indicates that both preserve clinically meaningful information. To the best of our knowledge, this study is the first to directly compare DM and CESM under identical preprocessing, training, and evaluation conditions using explainable deep learning models. Full article

Background/Objectives: Cervical cancer is one of the most common cancers among women of reproductive age, with 80% of the cases occurring in developing countries. Cervical cancer is largely preventable by effective screening programs. This study assessed the knowledge, attitudes, cultural beliefs, and screening practices related to cervical cancer among women in the rural community of Lutubeni, Eastern Cape Province. Methods: A descriptive cross-sectional study was conducted among 95 women aged 25 years or older attending Lutubeni Clinic. Data was collected using a structured, validated questionnaire covering demographics, reproductive health, knowledge of cervical cancer, attitudes, cultural perceptions, and screening practices. Statistical analysis involved descriptive summaries, chi-square tests, and binary logistic regression. Results: Most participants exhibited poor knowledge of cervical cancer symptoms (47.4%) and risk factors (61.1%), with only 3.2% demonstrating good overall knowledge. Vaginal bleeding (60.0%) and foul-smelling discharge (50.5%) were the most recognized symptoms. Only 40.0% were aware of human papillomavirus (HPV) vaccination. While 87.4% knew about cervical cancer screening, only 55.8% had ever been screened. Of these, 43.2% had screened only once, primarily at the clinic (33.7%), mostly initiated by health professionals (41.1%). Positive attitudes toward screening were observed in 52.6%, while 88.4% held cultural beliefs that hindered open discussion about sexual health. Statistically significant factors associated with screening uptake included educational level (p = 0.047), knowledge of symptoms (p = 0.04), risk factors (p < 0.0001), prevention (p < 0.0001), treatment (p = 0.001), and attitudes (p < 0.0001). Independent predictors of poor screening practice were holding an associate degree (OR = 0.04, p = 0.042), having good preventive knowledge (OR = 0.02, p = 0.012), and having negative attitudes (OR = 36.22, p = 0.005). Conclusions: High awareness alone does not guarantee participation in cervical cancer screening in rural South Africa. Interventions must address cultural barriers, stigma, and negative perceptions while strengthening health education that links HPV vaccination with screening awareness. The unexpected association between associate degree attainment and poor screening underscores the complexity of behavioral determinants and warrants further investigation in larger cohorts. Full article

Background/Objectives: Health literacy and vaccine literacy influence vaccine uptake behavior. Ensuring that people in rural communities are knowledgeable about vaccines can be an important tool in increasing influenza vaccination rates. The goal of this research was to evaluate rural community member knowledge of influenza and influenza vaccine. Methods: A cross-sectional survey was conducted with residents of a rural a medically underserved community in Washington State. Three thousand rural residents were contacted up to five times by a survey research center with a request to participate, with the goal of receiving 500 returned surveys based on the current population size, a z-score of 95, and an error rate of 5%. The survey evaluated rural resident knowledge and opinions about influenza and influenza vaccine. Results: Participants who were vaccinated against influenza in the last five years were more likely to know that influenza vaccine does not cause influenza (χ² = 13.44, p < 0.01) and that antibiotics cannot be used to treat influenza (χ² = 19.36, p < 0.01) than people who were not vaccinated. There was no statistical difference between people who are vaccinated and unvaccinated regarding knowing that influenza is viral rather than bacterial with the majority in both groups responding correctly (χ² = 0.05, p < 0.82), or that people who have influenza are at higher risk for contracting pneumonia (χ² = 0.78, p = 0.08) or COVID-19 (χ² = 1.54, p = 0.21). Unvaccinated people were more likely to have had their opinion about vaccines changed in recent years (p < 0.01) and feel that COVID-19 impacted their ability to trust public health officials (p < 0.01). Conclusions: Understanding gaps that exist in rural resident knowledge about influenza could be valuable in developing future educational outreach efforts in these communities. Full article

Despite HIV/AIDS disproportionately impacting Black women in the United States, HIV knowledge, awareness, and uptake of prevention efforts like pre-exposure prophylaxis (PrEP) have been limited for this community. Since campus leaders can maintain the attention of Black college women for a sustained period, they are an ideal demographic for PrEP interventions. Accordingly, the purpose of this study was to assess the awareness and knowledge of PrEP among Black Historically Black Colleges and University (HBCU) women, informing future possibilities and strategies for PrEP interventions and uptake. The lead author employed a descriptive, qualitative approach to collect data from five focus groups of Black HBCU women. Within this, the authors examined Black HBCU women’s PrEP knowledge and awareness in their own words and on their own terms. The results revealed that Black HBCU women have notable gaps in knowledge and limited awareness about PrEP and sexual health, with some assuming PrEP is only for men who have sex with men (MSM). Others believed it was used to manage an existing HIV diagnosis. Given that these participants perceived PrEP as primarily for MSMs, there is a clear gap in public health practice. Therefore, it is essential to focus future HIV prevention efforts on college-aged Black women by exploring their perspectives and considering how institutions like student activities, Greek Life, and campus health services can contribute to PrEP education for HIV prevention. Full article

Background: Interactive, narrative-based digital health interventions may positively influence vaccination-related attitudes, intentions, and uptake. However, evidence on their implementation and evaluation for vaccine communication has not yet been comprehensively synthesized. Our research questions (RQs) were to describe the use of interactive, narrative-based digital health interventions for vaccine communication (RQ1), their impact on individuals’ vaccine intention or uptake (RQ2), and factors associated with their implementation (RQ3). Methods: A scoping review was conducted using Arksey and O’Malley’s 5-stage framework and the PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, Web of Science, CINAHL, and PsycINFO from inception to 18 April 2023. To be included in the review, studies had to include empirical findings from primary data collection, address vaccine communication, use narrative communication that enabled audience engagement (i.e., interactivity), and deliver the narrative through a digital health device or modality. Results: The search identified 6834 records, with 25 studies meeting the inclusion criteria. For RQ1, the interventions most often focused on HPV vaccination (12 studies). Communication objectives included addressing vaccine hesitancy and increasing vaccination confidence or knowledge. Intervention delivery formats included multi-device compatibility (utilizing more than one device type, 7 studies) and incorporated interactive features, such as gamification and push notifications. Invented narratives were the most frequent narrative approach (8 studies). For RQ2, vaccination outcomes were reported in nearly half the studies (12 studies), with vaccination intention assessed in 8 studies and both vaccination intention and uptake assessed in 4 studies. For RQ3, implementation factors were reported in nearly half the studies (12 studies), with the most frequently reported outcome being acceptability (6 studies). Conclusions: Evidence supporting interactive, narrative-based digital health interventions for vaccine communication can be strengthened by diversifying narrative strategies, expanding the range of interactivity modalities tested, and focusing on a broader range of vaccines. Further research is needed to assess the effectiveness of these interventions, particularly of vaccine uptake. The insights from this scoping review may inform the development of novel future interventions for vaccine communication. The generalizability of these findings may be limited by the small number of studies in some categories and the preponderance of studies from high-income settings. Full article

Background/Objectives: New vaccines designed to combat infections such as Group B Streptococcus and respiratory syncytial virus will soon be accessible in Africa. While outbreak response vaccines are given to pregnant women, safety data for maternal vaccines in low- and middle-income countries (LMICs) are limited. This study explored Ugandan pregnant women’s knowledge, attitudes, and engagement in adverse event reporting and vaccine decision-making. Methods: This nested qualitative study was part of a national gap analysis of pharmacovigilance systems for maternal vaccines. Five Focus Group Discussions (FGDs), each involving eight participants, were held with pregnant and or breastfeeding women at four healthcare facilities and one research center. The data collected from these discussions were analyzed thematically using a manifest content analysis, conducted in Atlas.ti software version 9 for qualitative data analysis. Results: Women valued maternal vaccines, particularly tetanus, but reported confusion about schedules and hesitancy when informed of potential side effects. Many adverse events were normalized, therefore not reported, and most participants were unaware of national reporting mechanisms beyond informing healthcare providers. Barriers included inadequate information, dismissive or rushed provider interactions and reliance on family, peers, and informal care networks to manage side effects. Women expressed a strong desire to be informed and actively involved in decisions about pregnancy vaccines, including the introduction of new vaccines. Conclusions: Strengthening maternal vaccine safety monitoring requires clearer, balanced communication; simplified and well-publicized reporting tools; supportive provider–patient interactions; and integration of community and informal networks. Pregnant women should be engaged as active partners in pharmacovigilance and maternal vaccine introduction to build trust, improve adverse event reporting, and support vaccine uptake. Full article