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Navigating the potassium dilemma: a qualitative study of nephrologists’ strategies for renin–angiotensin–aldosterone system inhibitor preservation and hyperkalaemia management in Spain
Background Hyperkalaemia is a common complication among patients with predialysis chronic kidney disease (CKD) and a leading reason for modifying or discontinuing renin–angiotensin–aldosterone system inhibitor (RAASi) therapy despite its proven cardiorenal benefits. Although newer potassium binders may improve potassium control while enabling RAASi use, real clinical practice remains poorly characterised. This study explored how nephrologists in Spain manage hyperkalaemia in patients with predialysis CKD (stages 3–5), with particular emphasis on RAASi continuation. Methods Semi-structured interviews were conducted with 12 practising nephrologists across Spain who routinely manage hyperkalaemia in patients with predialysis CKD. Interviews were transcribed verbatim and analysed using ATLAS.ti. A codebook-based thematic analysis was performed, with codes iteratively refined into 15 sub-themes and grouped into five overarching themes. Results Five themes were identified: (1) hyperkalaemia was managed using a structured clinical algorithm incorporating dietary, metabolic, diuretic, and pharmacological strategies, to preserve RAASi therapy where possible; (2) newer potassium binders (patiromer and sodium zirconium cyclosilicate) were viewed as effective and better tolerated than traditional resins, supporting greater RAASi continuity; (3) system-level barriers, including visado requirements, regional formulary variation, and fragmented communication across specialties, limited timely use of newer binders were perceived to contribute to RAASi discontinuation; (4) patient engagement, underpinned by clear communication, trust, and nursing-led education, facilitated adherence, although clinician-level nutrition expertise varied; and (5) hyperkalaemia management affected patients’ daily functioning and emotional well-being, yet formal assessment of health-related quality of life (HRQoL) was infrequent. Conclusions Nephrologists in Spain prioritised preservation of RAASi therapy when managing hyperkalaemia in predialysis CKD. Although newer potassium binders supported this objective, their use was limited by access and care coordination challenges. Streamlined access pathways, improved multidisciplinary communication, and routine HRQoL assessments may enable more patient-centred and guideline-concordant care. These implications reflect qualitative clinician perspectives rather than evidence of clinical or economic effectiveness.
Environmental footprint of in-center hemodialysis in Türkiye: A national, scenario-based analysis of water, energy, and waste
Background Hemodialysis (HD) is a life-sustaining but resource-intensive therapy, consuming large volumes of water and electricity and generating substantial waste. This hybrid modeling study quantified the environmental footprint of in-center HD in Türkiye using national registry data, published parameters, and measured facility-level data from two Turkish dialysis centers. Methods A hybrid modeling approach combined published per-session resource parameters with measured facility-level data from two Turkish hemodialysis centers (4,000 sessions/month combined). Literature-derived parameters (493 L water/session at 42% RO recovery, 6.2–19.6 kWh electricity/session, 1.5–8.0 kg waste/session) were scaled nationally for 2023 (9.27 million sessions). Measured Turkish data (390 L water, 10.8 kWh electricity, 1.19 kg hazardous waste per session) provided empirical calibration. GHG emissions were calculated using Türkiye-specific (0.494 kg CO 2 e/kWh for electricity) and international conversion factors. Results Using literature parameters, annual national estimates include 4.57 million m³ water, 57.5–181.8 GWh electricity, and 13.9–74.2 kt waste, with total GHG emissions ranging from 45.3 to 171.1 kt CO 2 e/year. Measured Turkish facility data yielded lower per-session water consumption (~390 L vs. 493 L, a 21% reduction) and hazardous waste generation (1.19 vs. 1.5 kg/session under good segregation), while electricity consumption (mean 10.8 kWh/session) aligned with the moderate literature scenario. Electricity was the dominant emission source (63–72%), followed by waste incineration (up to 47% with poor segregation). Conclusion In-center HD in Türkiye imposes a substantial yet modifiable environmental burden. Measured Turkish facility data demonstrated that actual water consumption is meaningfully lower than international estimates, highlighting the importance of locally validated parameters. Waste segregation and electricity decarbonization represent the highest-impact intervention points for reducing the sector’s carbon footprint.
Exploratory identification of candidate SNP markers associated with recurrent clinical mastitis in Holstein cattle
Mastitis remains one of the most prevalent and economically significant diseases in dairy cattle worldwide. Although somatic cell count (SCC) is widely used as an indicator for mastitis diagnosis, its physiological variability limits its utility for predicting individual susceptibility. In this study, we aimed to identify genomic markers associated with recurrent clinical mastitis by defining mastitis-susceptible cows as those experiencing three or more episodes within a single lactation. Whole-genome resequencing was conducted on 50 Holstein cows (25 mastitis-susceptible and 25 healthy controls), yielding 536,184 high-quality SNPs after stringent quality control. A genome-wide association analysis identified 86 SNPs surpassing the significance threshold (–log₁₀P > 5.0), and seven candidate SNPs were evaluated in an independent cohort of 100 cows. Notably, the majority of candidate SNPs were localized on the X chromosome, suggesting a potential role for X-linked variation in mastitis immune response and disease resistance. While the candidate marker panel combining SNP1, SNP2, and SNP7 demonstrated moderate sensitivity (47%), its high specificity (98%) highlights its potential utility as a preliminary screening tool for identifying individuals at increased risk of recurrent mastitis. These findings provide a foundation for further functional validation and large-scale replication studies, which are essential for implementing effective genomic selection strategies to mitigate mastitis incidence in dairy herds.
Structural analysis of recombinant AAV vector genomes at single-molecule resolution
Recombinant adeno-associated virus vectors are essential tools for in vivo gene therapy, yet heterogeneity in their packaged genomes remains an important safety consideration. To systematically evaluate this heterogeneity, we developed a long-read, read-level analysis pipeline that directly classifies individual AAV genomes and their structural variants from PacBio sequencing data. The workflow combines two components: a tiling step that aligns each read to reference sequences to generate positional patterns, and a parsing step that applies a formal grammar to categorize reads into five structural classes: expected, truncated, snapback, truncated snapback, and others. Each molecule is annotated with strand orientation, breakpoint coordinates, and structural arrangement, enabling precise classification of genome heterogeneity at single-vector resolution. Applied to both single-stranded and self-complementary vector genome preparations, the pipeline achieved high classification accuracy and revealed distinct patterns of genome structure between different vector constructs. In both cases, the majority of genomes were classified as expected full-length species, consistent with the dominant full peaks observed by orthogonal methods. For snapback genomes, breakpoints frequently clustered at discrete sites, with some coinciding with regions predicted to form stable secondary structures and others occurring in less structured regions. This distribution suggests contributions from both sequence-driven folding and additional replication- or processing-related mechanisms. Together, these read-level insights highlight sequence and structural features that shape AAV genome heterogeneity. Importantly, the pipeline demonstrated strong performance in structural classification, maintaining high accuracy even in the presence of sequencing error profiles such as homopolymer-associated indels (insertion or deletion). By integrating structural classification, sequence context, and secondary-structure predictions, our pipeline provides a comprehensive framework for evaluating recombinant adeno-associated virus genome diversity. This approach not only improves resolution of vector genome architecture but also offers actionable insights to guide vector design and production processes for safer and more efficacious recombinant adeno-associated virus therapeutics.
Effectiveness of MyKidEye in improving parents’ knowledge, attitude, and practice on children eye health care
Background Vision problem among children is the most common health concern worldwide. Parental involvement plays an important role in addressing these issues especially through their Knowledge, Attitude, and Practice (KAP) regarding vision care. MyKidEye is an innovative smartphone application that contain information on common vision problem in children, early signs and symptoms, and treatment options to enhance parent’s KAP. This study aims to assess the effectiveness of MyKidEye application in improving parental KAP related to children’s eye health care. Methods This is a quasi-experimental study conducted from January to February 2023. The MyKidEye smartphone application was developed, and efficacy testing was performed. Parents from two schools who met the study criteria were selected and divided into two groups: the control group and the study group. Both groups completed the Parental Knowledge, Attitude, and Practice in Eye Problem among Children Questionnaire (PEPC-KAPQ) and their responses were recorded as pre-intervention data. Parents in the study group were given the MyKidEye application to be used for 4 weeks. Following a four weeks period, the PEPC-KAPQ was re-administered to both groups, and their responses were recorded as post-intervention data. Result A total of 178 parents were enrolled in this study, with 89 parents in the control group and 89 in the study group. Statistical analysis was performed using two-way mixed ANOVA to evaluate changes in parental knowledge, attitude, and practice score between groups over time. The practice scores of parents in the study group showed significant improvement after using MyKidEye, compared to the control group (F (1,176) = 34.27, p < 0.01). However, no significant changes were observed in knowledge (F (1,176) = 0.02, p = 0.88) or attitude score (F (1,176) = 2.82, p = 0.10). Conclusion MyKidEye application effectively improved parental practices related to children’s eye health care. It can serve as a valuable tool for improving and sustaining parents’ knowledge, attitudes, and practices regarding children’s eye health over a prolonged period, ultimately promoting better long-term eye care and awareness.
Directional drift in biologically meaningful vector planes: A proposed geometric framework for early detection of subthreshold disease
Background Most conventional diagnostic systems rely on fixed thresholds to differentiate disease states from normal. However, early pathological changes may begin before these thresholds are crossed. Therefore, a system that works in this pre-threshold state can potentially lead to earlier diagnosis. Objective To propose and evaluate a geometric framework that models early disease as a directional drift from a physiological plane to a pathological plane, allowing for pre-threshold detection using biologically interpretable variables. Methods In this modeling study on synthetic data derived from published clinical trends, two clinically meaningful variables were used to define a 2D feature space. The model was applied to a synthetic dataset of 4000 eyes divided into four phenotypes: normal stable (NS), early disease stable (ED_S), early disease progressive (ED_P), and pre-threshold progressive (PT_P). A physiological plane was constructed using range-normalized values from the NS group. A canonical disease vector was derived from the ED_P group. Each subject's follow-up data was transformed into a subject-specific drift vector, and the Composite Drift Score (CDS) was calculated as the product of directional alignment (Directional Emphasis Multiplier, DEM) and a Magnitude-to-Noise Ratio (MNR). Results CDS increased significantly over follow-ups in both ED_P and PT_P, distinguishing them from the two stable cohorts (p < 0.001). DEM and MNR components showed consistent trends, with progressive cases exhibiting higher alignment with the disease vector and supra-noise magnitude of change. Visual and statistical analyses confirmed early drift detection even within numerically normal ranges. Conclusion In this early modeling study based on simulation data, we could quantify the directional drift with a unitless, interpretable metric (CDS) and its derivatives. It showed similar trends in pre-threshold groups as early disease groups, showing potential for further evaluation.
Design and validation of an immersive virtual rehabilitation system for individuals with vestibular disorders: A feasibility study
Background Vestibular rehabilitation is an essential part of managing balance disorders, but traditional exercises can often be repetitive and demotivating for patients. This can reduce adherence and limit treatment outcomes. Objective This study aimed to assess the feasibility, usability, patient satisfaction, and safety of DizzyVR, an immersive virtual reality system designed to support vestibular rehabilitation. Preliminary data on its potential effects on clinical outcomes were also collected. Methods A prospective, single-arm feasibility study was conducted with ten participants diagnosed with various vestibular disorders. Each participant completed eight weekly sessions using DizzyVR. Feasibility was assessed through session attendance and completion rates. Usability, satisfaction, and safety were measured using the System Usability Scale, the User Satisfaction Evaluation Questionnaire, and the Simulator Sickness Questionnaire. Clinical measures included the Dizziness Handicap Inventory (DHI), Timed Up and Go (TUG) test, Activities-specific Balance Confidence (ABC) scale, and Functional Gait Assessment (FGA). Results Ten participants completed the training, with a high adherence rate (91.25%). Usability scores indicated good ease of use, and satisfaction scores were high. Mild adverse events such as nausea or disorientation were reported by three participants, but improved over time. Exploratory pre–post changes were observed in gait speed (TUG: p = 0.002), balance confidence (ABC: p = 0.007), and gait stability (FGA: p = 0.012). While DHI scores demonstrated a trend toward improvement, the change did not reach statistical significance (p = 0.081). Overall, participants reported feeling safe and expressed willingness to recommend and reuse the system. Conclusions The findings suggest that DizzyVR is a feasible, usable, and well-accepted tool that may complement conventional vestibular rehabilitation. The system appears to support patient motivation and safe participation while showing promising exploratory changes in balance and gait. Further studies with larger samples, control groups, and longer follow-up are recommended to confirm and expand on these promising preliminary results.
Retailer’s inventory-based financing with bounded advance rates: Interplay between wholesale price contract and loan menu
We examine a supply chain comprising a capital-constrained retailer, a supplier, and a bank. The retailer adopts inventory-based financing with bounded advance rates (IBF-B) to procure products through wholesale price contracts offered by the supplier. The bank is viewed as a strategic decision-maker with market power over the retailer when designing a loan menu that includes interest rates and inventory advance rates. By analyzing how inventory advance rates influence the retailer’s financing decisions, we derive upper and lower bounds for these rates to balance profitability and credit risk. Furthermore, we explore the interplay between the loan menu and wholesale price contracts. For the retailer intending to borrow up to the loan limit, the highest feasible wholesale price is offered if the supplier can obtain more profits, while the bank consistently charges the highest feasible interest rate. The upper bound of inventory advance rates is offered only when it yields a positive margin; otherwise, the interior advance rate within medium range is preferred. Numerical results illustrate the value of IBF-B, the motivations of all participants, and the impact of key economic parameters on financing decisions and supply chain performance.
Bayesian hierarchical mixture modelling to derive probabilistic iELISA thresholds for bovine brucellosis in endemic dairy systems
Background In endemic dairy systems, the interpretation of serological tests for bovine brucellosis is compromised using fixed diagnostic cut-offs, which fail to account for continuous antibody distributions and population heterogeneity. This study aimed to apply a Bayesian hierarchical Gaussian mixture model (BHGMM) to resolve diagnostic uncertainty by deriving probabilistic, biologically informed thresholds for indirect ELISA (iELISA). Methods A cross-sectional dataset comprising 2,696 milk samples from large-scale dairy herds was analysed. Log-transformed and standardised antibody values were modelled using a three-component hierarchical mixture representing healthy, latent, and diseased populations. Posterior class distributions, herd-specific cut-offs, and prevalence were estimated, and model performance was evaluated using convergence diagnostics, posterior predictive checks, and ROC analysis. Results Three distinct serological populations were identified. Mean antibody levels (S/P%) were 5.29 in healthy, 17.07 in latent, and 299.84 in diseased animals. Dual diagnostic thresholds were estimated at 10.7 S/P% and 82.2 S/P%. Estimated class proportions were 23.5% healthy, 43.6% latent, and 32.9% diseased. Substantial between-herd heterogeneity was observed, with confirmatory cut-offs ranging from approximately 68–133 S/P% and herd-level true prevalence varying from about 1% to 67%. The model demonstrated high diagnostic accuracy (AUC = 84.5%) and stability across prior specifications. Conclusions Bayesian modelling captures intermediate serological “gray zones” and herd-level variability overlooked by standard binary interpretations. This probabilistic approach supports targeted control strategies in complex endemic environments.
Association of troponin-defined myocardial injury with adverse long-term survival among patients with chronic kidney disease
Objective Chronic kidney disease (CKD) is associated with increased mortality, however, the impact of troponin-defined myocardial injury within this population remains poorly understood. This study aimed to investigate the associations between troponin-defined myocardial injury and long-term mortality in CKD patients. Methods This observational study analyzed 22,772,953 weighted records of adult CKD patients from National Health and Nutrition Examination Survey (1999–2004) databases. Myocardial injury was defined by at least one elevated high-sensitivity troponin (hs-cTn) assay, present in 26.6% of the cohort. Cox regression models adjusted for baseline characteristics and comorbidities were used to assess the associations between troponin-defined myocardial injury and all-cause and cardiovascular mortality. Sensitivity analyses excluding patients with known cardiovascular disease (CVD) were performed to evaluate the robustness of the findings. Results Patients with troponin-defined myocardial injury were older and had a higher prevalence of CVD, hypertension, diabetes, as well as a lower estimated glomerular filtration rate (eGFR), compared with those without troponin-defined myocardial injury. Over a median follow-up of 11.6 years, survival was significantly worse among patients with troponin-defined myocardial injury at 1, 5, 10, and 15 years. The adjusted hazard ratios (aHR) for all-cause mortality and cardiovascular mortality in patients with troponin-defined myocardial injury were 1.81 (95% CI 1.51–2.17) and 2.03 (95% CI 1.47–2.79), respectively. Sensitivity analysis excluding records with pre-existing CVD showed similar trends, with an aHR of 1.86 (95% CI 1.56–2.21) for all-cause mortality and 2.44 (95% CI 1.83–3.24) for cardiovascular mortality. Conclusion As a marker for troponin-defined myocardial injury, hs-cTns were independently associated with worse long-term survival among CKD patients. However, the observational design precludes causal inference, and single time-point troponin measurements limit the assessment of dynamic changes in myocardial injury.
An innovative quantum–fuzzy paradigm for time- and context-sensitive membership: Quantive logic
Uncertainty in real-world decision problems is rarely static or one-dimensional: the relevance of evidence changes over time, depends on context, and is shaped by interactions between multiple criteria. Classical fuzzy logic provides a flexible scalar notion of membership, but it typically treats each criterion in isolation and does not natively encode temporal or contextual dynamics. Quantum-inspired models, on the other hand, offer rich Hilbert-space representations but are often difficult to integrate with everyday decision-making tasks. This paper proposes Quantive Logic (QL), a quantum-inspired fuzzy framework for time- and context-sensitive membership. In QL, each element is assigned a quantive membership state, represented as a vector in a complex Hilbert space. Conventional fuzzy degrees are recovered as suitable projections of this state, while phase and superposition capture interactions and context effects between criteria. We formalize how quantive membership states are initialized from classical information and updated through linear operators that model temporal evolution and contextual shifts. To illustrate the framework, we outline a multi-criteria credit-risk assessment scenario in which applicant profiles are encoded as quantive membership states and updated under changing economic conditions. This example shows how QL can refine risk judgments when interactions between criteria and scenario-dependent effects are important. Rather than competing with existing fuzzy or probabilistic models, QL is intended as a complementary layer that enriches membership representation wherever time, context, and interaction effects cannot be ignored.
Assessing the effects of virtual reality-based positive psychotherapy on emotion, life satisfaction, and suicidal ideation in major depression: A mixed-methods randomized controlled trial
Background Positive psychotherapy (PPT) targets the enhancement of well‑being in individuals with major depressive disorder (MDD), and virtual reality (VR) offers an immersive medium for delivering such experiential interventions. However, most VR-based approaches for depression are grounded in cognitive‑behavioral frameworks, leaving the application of PPT within VR environments largely unexplored. This study examined the effects of VR-based PPT on emotional experiences, life satisfaction, and suicidal ideation in individuals with MDD. Methods In this sequential explanatory mixed‑methods study, 78 patients were randomly assigned to VR-based positive psychotherapy (intervention; n = 39) or an equivalent face-to-face format (control; n = 39). Both groups received three sessions of positive psychotherapy, differing only in delivery mode. The quantitative phase assessed changes in affect, life satisfaction, and suicidal cognitions before and after each session using the PANAS, SWLS, and B-SCS. A subsequent qualitative analysis of the intervention group was conducted to contextualize and further interpret the quantitative findings. Results The results demonstrated a significant multivariate effect over time (Wilks’ Lambda = 0.316, F(20,57) = 6.176, ɳ² = 0.684, P < 0.001), indicating significant improvements in the outcome measures across sessions. Within‑group effect sizes ranged from small to moderate (d = 0.02–0.53), with comparable improvements observed in both the VR-supported and face-to-face formats. Qualitative findings further enriched the interpretation of these patterns, yielding two overarching themes: “user-friendly program” and “efficient psychotherapy program.” Conclusion Both VR-based and face-to-face positive psychotherapy were associated with improvements in emotional experiences, life satisfaction, and suicidal ideation in individuals with major depressive disorder. VR-based delivery appeared feasible and acceptable, with outcomes comparable to the traditional face-to-face format in this preliminary trial. Further studies with larger samples and longer follow-up are needed to confirm these findings and clarify their clinical implications. Trial registration: This trial was prospectively registered in the Iranian Registry of Clinical Trials (IRCT20201001048893N7, registration date: 16 November 2022, URL: https://irct.behdasht.gov.ir/trial/66424 ) prior to the enrollment of the first participant.
Overexpression of CD97 in intestinal epithelial cells attenuates LPS-induced pro-inflammatory cytokine induction via stabilization of β-catenin early in life
Acute inflammatory conditions in the intestine of preterm infants are linked to increased susceptibility due to the immature degree of the gut’s epithelial barrier, microbiota, and pattern recognition receptors. Toll-like receptor 4 (TLR4) plays a pivotal role in recognizing lipopolysaccharides (LPS) from gram-negative bacteria, triggering pro-inflammatory cytokine responses (TNF-α, IL-1β, CXCL1) via nuclear factor kappa B (NF-κB) signaling. These processes are implicated in necrotizing enterocolitis (NEC), a severe gastrointestinal condition in premature infants. CD97, an adhesion G-protein coupled receptor (aGPCR), has emerged as a modulator of immune responses influencing inflammatory signaling pathways. CD97 expression is typically low in intestinal epithelial cells (IECs); however, protective effects of increased CD97 levels have been described in experimentally induced colitis. In this study, we examined the role of CD97 in modulating the inflammatory response in the immature gut, utilizing wild-type (WT) and transgenic CD97-overexpressing mice (TgCD97) with epithelial-specific expression in the intestinal epithelium. LPS was administered to IECs and organ segments isolated from the small intestine of mice of specific ages, modeling certain stages of human perinatal/postnatal gut development. CD97 overexpression attenuated LPS-induced TNF-α expression in IECs during early intestinal development while IECs from adult mice remained unaffected. This effect was attributed specifically to ileal tissue. Attenuation was mediated by β-catenin stabilization, leading to suppressed LPS/NF-κB signaling. Inhibition of β-catenin in TgCD97 IECs reversed the anti-inflammatory phenotype restoring pro-inflammatory gene expression. These findings suggest that CD97 overexpression modulates the inflammatory response in the developing gut by stabilizing β-catenin and interacting with the LPS/NF-κB axis. This effect was restricted to early developmental stages and ileal tissue, highlighting a previously unrecognized role of CD97 in age-dependent endotoxin tolerance. These findings identify a novel CD97-β-catenin-NF-κB regulatory axis in the immature small intestine and highlight its potential as a therapeutic target to protect the immature neonatal gut from inflammatory damage.
The promise of deep urine proteomics for diagnosis of cancer, neurologic, and metabolic diseases
Introduction Urine offers a noninvasive and low-cost source of disease biomarkers, yet most proteomic studies have targeted single conditions. Using deep proteomic profiling and machine learning, we evaluated whether urinary protein signatures distinguish early-stage cancer, neurologic, and metabolic diseases from healthy controls. Methods This case–control diagnostic accuracy study analyzed urine samples from the Ukraine Association of Biobank (UAB), collected during routine medical check-ups. The study included 22 patients each with kidney, bladder, melanoma, prostate, ovarian, endometrial, and cervical cancers; 22 with multiple sclerosis (MS); 22 with metabolic dysfunction–associated steatohepatitis (MASH); and 66 healthy controls, yielding 264 samples analyzed in September 2023. Proteomic assays were performed using the Olink Explore 3072 platform, with laboratory personnel blinded to disease status. Urine proteomes were profiled to identify disease-specific protein signatures. The primary outcome was diagnostic accuracy of multiprotein urine panels for each disease compared with healthy controls, expressed as the area under the receiver operating characteristic curve (AUC), along with sensitivity and specificity calculated at a prespecified threshold. Results Expected sex‑specific differences (KLK3, MSMB higher in males; KLK8, KLK13 higher in females) supported assay validity. Three expression patterns were observed: (1) few strong, symmetric signals in melanoma and endometrial cancer; (2) asymmetry with many up‑regulated proteins in cervical, ovarian, and prostate cancers and in MS; and (3) broad up‑regulation in kidney and bladder cancers and in MASH. Multiprotein models outperformed single proteins, plateauing at five to seven. Maximum AUCs ranged from 0.88 (MS) to 0.98 0.97 (ovarian cancer), with AUCs ≥ 0.95 for seven of nine diseases. Some proteins (e.g., C9orf40, PPY) showed cross‑disease importance. Conclusions Urine proteomics identified disease‑related signals across cancer and metabolic conditions and may enable accurate, noninvasive classification using multiprotein panels, but given the exploratory design and its limitations, the reported accuracies should be regarded as upper-bound estimates requiring prospective validation.
Explaining the reasons for the divorce of young couples in Western Iran: A qualitative Study from the Beneficiary's point of view
Divorce is an important social issue that has destructive consequences for both the individual and the family. It is a multi-dimensional and complex phenomenon that occurs under the influence of various factors, so this research was conducted to explain the reasons for divorce among young couples in the West of Iran with a qualitative approach. This research was carried out with a qualitative approach and conventional content analysis. Purposeful and snowball sampling were used to identify the participants. Semi-structured interviews were used to collect data and continued until theoretical saturation was reached. In this research, 16 key informants and 32 main participants were present. For data analysis, Graneheim and Lundman method was used. Also, to increase the quality of the research, Guba and Lincoln's four criteria were observed. 212 primary codes, 24 subcategories, and 3 categories came from the analysis of the interviews. Categories and sub-categories include 1- individual factors (sexual problems, mental-psychological disorders, spouse's behavioral characteristics, individualism, physical appearance problems, Formation of a positive understanding of divorce consequences, having defective relationships before marriage, drug use), 2- socio-cultural factors (de-tabooing of divorce, women-oriented social changes, media and social networks, lack of a suitable support system, inappropriate spouse choosing, economic challenges, modeling of divorce), 3- family factors (job's impact on family life, improper communication with spouse's family, accumulation of negative feelings in marital life, issues related to children, cheating on spouse, inefficient relationships, heterogeneity of lifestyle, violence, inability to manage challenges). The results indicate that divorce is a complex, multi-dimensional phenomenon influenced by individual, social, cultural, and family factors. Prevention requires multi-level interventions, including educating couples on sexual issues and communication skills, promoting responsible marital roles, preventing superficial marriages, reducing stigma around seeking psychological help, managing personality and lifestyle differences, guiding families on conflict resolution, and providing access to counseling and mental health services before and after marriage.
Depressive symptoms among older adults in Turkey: Evidence from a nationally representative ageing survey
Background Late-life depression is a growing public health issue in ageing societies, influenced by health, functional, socioeconomic, and psychosocial factors. Evidence integrating health, functional, psychosocial, and healthcare-access determinants using nationally representative data in Turkey remains limited. This study examined determinants of depressive symptoms among adults aged ≥65 years. Methods This study analyzed data from 10,348 participants aged ≥65 years from the nationally representative Turkey Older Persons Profile Survey (TYPA 2023). All analyses incorporated survey sampling weights. Depressive symptoms were defined using the Geriatric Depression Scale-30 (GDS-30) (cut-off ≥10). Hierarchical logistic regression models were constructed in sequential blocks (sociodemographic; health and functional status; psychosocial and healthcare-related factors) to identify independent correlates. Results The weighted mean age was 72.8 years; 55.1% were women, and 46.2% screened positive for depressive symptoms according to the applied screening threshold. In the fully adjusted model, depressive symptoms were associated with female sex, lower education, unmarried status, poorer self-rated health, sensory and functional limitations, perceived age-related restriction, perceived exclusion, and difficulties accessing or communicating with healthcare services. Conclusions Depressive symptoms among older adults in Turkey reflect the combined influence of health decline, functional limitations, negative psychosocial perceptions of ageing, and barriers to healthcare access. Interventions addressing functional decline, financial strain, ageism, and access barriers may support better mental health in later life and inform public health and ageing-related policies.
Walking the tightrope of justifiable decision‑making: An exploratory qualitative study identifying barriers and solutions to efficient safety reporting
Background Safety reporting is integral to clinical trial conduct, aiming to protect the rights and safety of trial participants and future patients. Over time, reporting safety events has become increasingly complex, leading to inefficiencies which place extra burden on trial staff and potentially impact patient safety. Attempts have been made to streamline these processes. However, effecting change in practice is challenging. Changes to UK trial regulations introduced in 2025 may reduce inefficiencies. To incorporate these changes effectively, we need to understand what barriers exist for their implementation. This study aimed to identify barriers and solutions to efficient safety reporting processes from the perspective of staff working at registered academic trials units in the UK, with a view to developing recommendations to enable the delivery of more efficient safety reporting practices. Method This was an exploratory, observational, qualitative focus group study of trials unit staff across the UK. Verbatim transcripts of the focus group discussions were analysed using Reflexive Thematic Analysis. Results Twenty-three CTU staff participated in four focus groups. One over-arching theme was generated from the analysis, “ Walking on a tightrope: Making justifiable decisions”. Participants felt that they were performing a balancing act between efficient, risk-proportionate safety reporting and risk-aversion. Possible solutions included clarification of expectations and improved transparency, and improved training and knowledge building. Discussion Despite efforts to streamline safety reporting processes, problems persist with the implementation of risk-proportionate approaches. Concerns that decisions will be deemed inadequate and impact patient safety and well-being make decision-making a difficult balancing-act. Confident decision-making by trial practitioners can be facilitated through access to resources and training provided by regulators, supported by tools and case studies. Trials unit level actions, such as mentoring schemes or platforms to share knowledge and learning, can support knowledge building and confidence development.
Educational strategies to improve health literacy for people with type 2 diabetes in low socio-economic communities: A realist review protocol
Introduction Type 2 diabetes (T2D) has emerged among the top ten causes of disability and mortality worldwide. Health literacy is crucial for effective self-management to reduce the burden associated with T2D. Studies have reported the effectiveness of educational strategies for improving health literacy to promote good health and well-being. However, contextual factors influence the effectiveness of these strategies. Therefore, this paper intends to explain how and why context shapes the mechanisms through which educational strategies work to improve health literacy for adults with type 2 diabetes in low socioeconomic communities. Methods and analysis Theory-driven realist review methods will explain how and why contexts activate different mechanisms through which educational strategies work to produce intended or unintended outcomes in low socioeconomic communities. The following five steps of realist review, which are non-linear and iterative, will be undertaken: (i) Define the scope of the review and locate existing theories on educational strategies to improve health literacy, (ii) Develop the initial programme theories, (iii) Search for evidence, (iv) Select papers and appraise, and (v) Extract data and synthesis. The following databases will be searched, but not limited to, PubMed, Education Resource Information Centre (ERIC), and PsycINFO. Papers will be selected based on relevance, richness, and rigour. Data extraction will follow both inductive and deductive approaches. The Intervention-Context-Actor-Mechanism Outcome (ICAMO) configurations will be utilised to analyse and synthesise data using retroductive reasoning. Finally, the revised programme theories, which explain how the educational strategies are expected to work across different contexts in low socioeconomic communities, will be prepared and disseminated. Conclusion The findings may inform practice, influence policy, and contribute to the design of health literacy programmes in similar settings. The realist review is registered with the Open Science Framework: ( https://osf.io/9w867 )
Development of a scale for measuring the perception of artificial intelligence among mental health consumers
Background Artificial Intelligence (AI) has emerged as a transformative force revolutionizing various sectors, including healthcare, particularly the mental health field. However, the acceptance and integration of AI technologies in different healthcare systems can be influenced by various factors, including cultural, social, and individual aspects. Nevertheless, there is a need for a valid and reliable tool for assessing AI’s perception among healthcare consumers. Aim To develop and validate a tool for the perception of AI among healthcare consumers and apply the tool to assess AI’s perception among mental health consumers in the Jordanian healthcare system. Method A cross‐sectional descriptive correlational design was utilized in the study. Data was collected from a convenience sample of 431 mental health consumers visiting mental health clinics of the International Medical Corps and university hospitals in Jordan. Structured interviews were conducted using an AI Perception (AIP) questionnaire developed by the authors. The questionnaire’s content validity was assessed by an expert panel. Using Principal Component Analysis (PCA), the construct validity of the tool was evaluated, and its internal consistency was examined using Cronbach’s alpha. Descriptive statistics were used to assess the levels of AI perception among participants. Results The final AIP tool consisted of 20 items across 4 domains and has demonstrated strong internal consistency across its four domains: AI acceptance and readiness (α = 0.92), AI perceived importance (α = 0.92), AI perceived risk (α = 0.9), and AI perceived challenges (α = 0.85). The construct validity of the four-domain structure of the tool was supported by PCA. Additionally, the mean scores for each domain indicated the average level of agreement with AI perception items among participants. Specifically, the mean score for AI acceptance and readiness was ( 2 . 7 ± 0 . 96 ). AI perceived importance was (2.18 ± 0.83), AI perceived risk was (2.58 ± 0.92), and AI perceived challenge was (2.78 ± 0.87). Conclusion The findings of this study resulted in developing a valid and reliable 20-item tool to assess AI’s perception among mental health consumers. The tool can be used to assess the predictors of AI’s readiness among mental health consumers. Therefore, aiding policymakers and other stakeholders in understanding the AI adoption barriers from the perspective of end-users. In addition, this study developed the AIP tool that can be validated and used among other populations in future research.
Rational Design of the Composite Perfluoro-Sulfonic Ionomer for High-Performance Proton Exchange Membrane Fuel Cells
Abstract Scaling proton exchange membrane fuel cells (PEMFCs) is constrained by high cathodic overpotential and platinum usage for the oxygen reduction reaction, challenges exacerbated by catalyst poisoning from perfluorosulfonic acid (PFSA) ionomers. Though compositing PFSA with additives can mitigate this poisoning, progress has remained largely empirical due to the lack of quantitative assessment tools. Here, we introduce an electrochemical probe leveraging ionomer-coated single-crystal Pt(111) to quantify the coverage and strength of PFSA adsorption, elucidating how cationic additives suppress Pt poisoning. We identify an inverse correlation between cation hydration energy and PFSA adsorption, guiding the rational design of a poorly hydrated tetramethylammonium-anchored covalent organic framework (TMA+-COFs) as an ionomer additive. Electrochemical and spectroscopic analyses reveal that the composite TMA+-COFs/PFSA layer significantly inhibits sulfonate adsorption and poisoning onto Pt(111) through robust electrostatic interactions, which translates to a 1.7- and 4-fold activity enhancement for industrial Pt/C in rotating-disk and gas-diffusion electrodes, respectively. We also demonstrated a high mass activity of 1.08 A mgPt–1 in a PEMFC cathode with TMA+-COFs. Our work provides an alternative avenue to conventional catalyst engineering through the rational design of advanced composite ionomers for high-performance, low-Pt PEMFCs.