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Video-based dual-task Four-Square Step Test for fall risk assessment in Parkinson’s disease

Correction: Severity-dependent metabolic rewiring in COVID-19 based on untargeted metabolomic profiling of patient plasma

Piriformospora indica and grafting mitigate drought-induced oxidative stress and enhance fruit quality and bioactive compound accumulation in tomato

Developing person-centred leadership practices: Health and social care leaders’ experiences following an educational programme

Objective Educational programmes aimed at nurturing person-centred leadership are requested to advance the implementation of person-centred care, however there is a scarcity of evaluations. This study aimed to explore health and social care leaders’ experiences of changes in leadership practices following participation in an educational programme on person-centred leadership. Design A qualitative exploratory research approach, with individual interviews analysed using conventional content analysis, including an interpretative step linking categories to an overarching theme using three leadership concepts. Setting Health and social care services in Sweden. Participants Thirteen leaders were purposefully selected according to sampling criteria. Results The programme did, according to the participants, contribute to the development of person-centred leadership practices by enhancing self-leadership, team leadership, and workforce development aligned with person-centred principles. Three categories unfolded this process: Live as you learn , Strive for equal relations , and Enable co-creation , which were further detailed into nine sub-categories. The results were influenced by various preconditions for continuous learning. Conclusion The findings emphasise the necessity of establishing preconditions promoting person-centred leadership (e.g., continuous support from other leaders, time to coach teams and establishing empowering working methods) for continuous development during and after the educational programme. When these preconditions were met, the programme was experienced to effectively influence self-leadership, enhance team leadership, and promote workforce development in line with person-centred principles. Implications It is crucial to integrate practical assignments into workplace settings, address daily challenges, and involve leaders, employees, patients, and their relatives early on. This approach supports the continuous development of leadership practices and ensures the sustainable transformation of health and social care practices towards person-centred care. The programme’s theoretical foundation was considered applicable in supporting leadership development, but more research is needed to evaluate the impact and effect of person-centred leadership programmes over time from leaders’, employees’, and patients’ perspectives.

The impact of artificial intelligence-based tutoring systems on student engagement and long-term retention in math education

Pragmatic cardiovascular-kidney-metabolic burden categories and 5-year all-cause mortality in Vietnamese outpatients: A retrospective cohort study

Background The American Heart Association introduced cardiovascular-kidney-metabolic (CKM) health as an integrated framework for metabolic, kidney, and cardiovascular risk. However, full AHA CKM staging requires variables that are often unavailable in retrospective outpatient datasets, and outcome data from Southeast Asia remain limited. Objective To evaluate whether pragmatic CKM burden categories derived from routinely available baseline diagnoses identify Vietnamese outpatients at higher risk of 5-year all-cause mortality. Methods We performed a retrospective cohort analysis of 480 adult outpatients recruited from 01 January 2016–31 December 2016 in Ho Chi Minh City, Vietnam. The de-identified dataset for this secondary analysis was accessed on 31 March 2024. Participants were classified into four mutually exclusive pragmatic CKM burden categories: Category A, no documented metabolic-risk diagnosis, chronic kidney disease (CKD), or coronary artery disease (CAD); Category B, documented metabolic-risk diagnosis only; Category C, CKD or CAD, but not both; and Category D, concomitant CKD and CAD. These categories are AHA-informed but are not official AHA CKM stages. The primary endpoint was 5-year all-cause mortality, with administrative censoring at 5 years. Logistic regression was the primary inferential model; Kaplan-Meier, log-rank, and Cox models were used as complementary time-to-event analyses. To support privacy-preserving data sharing, adjusted models used prespecified age groups (<40, 40–60, and >60 years) and sex rather than exact individual ages. Results Most participants were aged 40–60 years (331/480, 69.0%) and 204 (42.5%) participants were men. The category distribution was as follows: Category A, 24 (5.0%), Category B, 252 (52.5%), Category C, 180 (37.5%), Category D, 24 (5.0%). Over 2243.1 person-years of follow-up within the 5-year analysis horizon, 64 deaths occurred (13.3%). Five-year mortality was 0/24 (0.0%) in Category A, 33/252 (13.1%) in Category B, 24/180 (13.3%) in Category C, 7/24 (29.2%) in Category D. Kaplan-Meier curves differed across the four categories (log-rank p = 0.036). Compared with Categories A + B, Category D had higher unadjusted odds of 5-year mortality (OR 3.03, 95% CI 1.17–7.86; p = 0.022) and remained elevated after age-group and sex adjustment (OR 2.87, 95% CI 1.04–7.94; p = 0.042). Category C was not associated with higher adjusted 5-year mortality. Conclusions In this Vietnamese outpatient cohort, pragmatic CKM burden categories identified a subgroup with combined CKD and CAD that had the highest absolute 5-year mortality. The age-group- and sex-adjusted estimate remained elevated for this small subgroup, although confidence intervals were wide. These categories should not be interpreted as official AHA CKM stages, and prospective validation with complete CKM phenotyping is needed.

Weighted estimation of multiple regions in CT-derived images of the pubic symphysis for age estimation using a deep learning framework with R-Mixup augmentation

Cocoa by-products extracts suppress viral replication and oxidative stress in chikungunya virus-infected cells

Context Studies have demonstrated a correlation between oxidative stress and Chikungunya virus (CHIKV) replication, underscoring the potential of these biochemical interactions for developing novel antiviral therapies. Since cocoa ( Theobroma cacao L. ) by-products have exhibited potent antiviral and antioxidant properties, they may represent a promising source for new therapeutic alternatives. Objective To assess the potential of cocoa pod husk (CPH) and cocoa bean shell (CBS) extracts to inhibit viral replication and oxidative stress in an in vitro model of CHIKV infection. Materials and methods The viability of Huh-7 cells in the presence of extracts (15.6 to 250 µg/mL), and CHIKV-infected cells treated with the extracts was evaluated using the resazurin reduction assay. Antiviral activity was determined by RT-qPCR and plaque assays, while reduction of oxidative stress in infected cells was measured using the dichloro-dihydro-fluorescein diacetate (DCFH-DA) assay at 12 and 24 hours post-infection (hpi). Results CPH and CBS extracts exhibited minimal cytotoxicity in Huh-7 cells. Remarkably, both extracts exhibited antiviral and antioxidant properties at concentrations above 62.5 µg/mL mainly at 12 hpi. This was evidenced by a significant reduction in viral RNA copies and infectious virus particles, as well as decreased levels of reactive oxygen species (ROS) in CHIKV-infected cells. Discussion and conclusion Cocoa extracts reduce the oxidative stress induced by CHIKV in Huh-7 cells while exhibiting antiviral properties, highlighting their potential to modulate both oxidative stress and viral replication. Further studies are recommended to elucidate the mechanisms by which these extracts work.

Impact of a 6000-m rowing ergometer test on gastrointestinal integrity in elite rowers

Expression of Concern: Spatiotemporal variation in fish species distribution and abundance in the Vaishav stream, Kashmir Himalaya–India

Risk analysis of power surging in novel power systems: a hybrid framework driven by accident chain and WPMixer

Molecular signature of COVID-19 prior to its exacerbation by multi-omics survey

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic due to its high transmissibility and ability to evade innate immune responses. Comprehensive characterization of the disease is essential for elucidating its pathophysiology and clinical progression. In this study, we performed multi-omics analyses of plasma samples collected from SARS-CoV-2-positive patients prior to clinical deterioration of coronavirus disease 2019 (COVID-19). These samples revealed the potential of previously reported clinical parameters, including CRP and neutrophil level, to predict COVID-19 exacerbation in the early stage. Our analysis identified a novel panel of molecules that precede the clinical manifestations associated with COVID-19 progression. These candidate biomarkers exhibited strong correlations with previously reported clinical and immunological parameters. Notably, several inflammation-related markers showed inverse associations with specific interferon subtypes, including IFN-α6 and IFN-α8, potentially reflecting mechanisms of SARS-CoV-2-mediated immune evasion. Our findings contribute to the understanding of virus-induced acute exacerbation and offer a valuable foundation for future pandemic research.

Analysis of survival and prognostic factors in lacrimal gland adenoid cystic Carcinoma

The relationship between fat talk and body image in Chinese female nursing students: The mediating role of self-acceptance

Objective This study examined whether self-acceptance mediates the relationship between fat talk and body image among Chinese female nursing students, a group under high appearance pressure. Methods A cross-sectional survey was conducted among 1,280 female nursing students from five medical universities in Henan Province, China, Participants were recruited from randomly selected classes, and questionnaires were distributed in person via QR codes.. Participants completed validated scales measuring fat talk (Fat Talk Scale), self-acceptance (Self-Acceptance Questionnaire), and body image (Body Image States Scale). Data were analyzed using correlation and mediation analysis (PROCESS macro, Model 4) with bootstrapping. Results Fat talk was positively correlated with both self-acceptance (r = 0.543, p < 0.001) and body image (r = 0.344, p < 0.001). Self-acceptance was also positively correlated with body image (r = 0.457, p < 0.001). After controlling for “relationship status, grade, only child status, and BMI,Mediation analysis revealed a significant indirect effect of fat talk on body image through self-acceptance (effect = 0.174, 95% CI [0.132, 0.222]), accounting for 57.80% of the total effect (total effect = 0.301). The direct effect remained significant (effect = 0.127, 95% CI [0.032, 0.222]).The standardized indirect effect (β = 0.080) indicates a small-to-moderate effect size. Conclusion Among Chinese female nursing students, engaging in fat talk conversations is associated with a more positive body image. Self-acceptance accounting for 57.80% of the total effect, though the standardized indirect effect (β = 0.080) suggests a small-to-moderate effect size. This finding highlights the importance of cultural and contextual factors in shaping body discourse and suggests that fostering supportive communication environments and self-acceptance could be beneficial in this population.

Multivariate assessment of nutritional, morphological and biochemical diversity among black mulberry (Morus nigra L.) genotypes across five regions of Iran

Work restrictions and Unfitness to work: Prevalence and risk factors a cross-sectional study on 70 000 occupational visits

Background Few studies have assessed work restrictions and unfitness to work simultaneously, particularly on large populations, and evidence on their main influencing factors remains limited. Objective To assess prevalence and risk factors of work restrictions and unfitness to work. Method We included all visits conducted in occupational health departments of the Cher, over two consecutive years. Visits had to have a conclusion: fitness to work, temporary work restrictions, permanent work restrictions, and unfitness to work. Mixed multinomial models with individual random effects were used. Results Among the 71,848 occupational health visits, 62,436 had a conclusion. Most (90.6%, 95 CI 90.4 to 90.8%) were fit to work, 3.2% (3.1 to 3.3%) had temporary restrictions, 4.9% (4.7 to 5.1%) had permanent restrictions, and 1.3% (1.2 to 1.4%) were unfit to work. The risk of temporary restrictions was multiplied by 1.69 (1.16 to 2.48) in workers over 55 vs < 25 years old; by 1.74 (1.42 to 2.14) in workers with disabilities; by 1.30 (1.07 to 1.58) for workers with 10–20 vs < 5 years of seniority; and by 1.57 (1.22 to 2.01) in companies with 50–199 vs < 10 workers. The risk of permanent restrictions was multiplied by 2.24 (1.68 to 2.97) in workers over 55 yo; by 1.86 (1.57 to 2.21) in workers with disabilities; by 1.47 (1.05 to 2.06) for qualified workers; by 1.24 (1.05 to 1.46) for workers with 10–20 years of seniority; and by 1.30 (1.07 to 1.58) for workers in companies with 50–199 employees. The risk of unfitness to work decreased with increasing seniority in the company, while a significant interaction between sex and sector of activity was observed for temporary restrictions. Conclusion Nearly one worker out of ten were unfit to work or had restrictions. The main risk factors for both unfit to work and restrictions were older age, women, and return-to-work visits; whereas lower seniority and smaller companies were risk factors for unfit to work, and longer seniority and bigger companies were risk factors for restrictions.

Dental arch classification using deep learning and federated learning on DenPAR radiographs

Supply of interventional cardiologists and the provision of lower-value Percutaneous Coronary Interventions (PCI)

Background Percutaneous coronary interventions (PCI) can be lifesaving for patients with acute coronary syndromes but of lower value for patients with stable coronary artery disease (CAD). Previous studies suggest that larger provider supply drives higher healthcare utilization. Whether this is true for lower-value PCI is unknown. Objective To examine the association between the regional supply of PCI-performing physicians and PCI use and lower-value use. Design Cross-sectional. Setting 100% Medicare fee-for-service (FFS) claims and Medicare Advantage encounter data, linked to publicly available sources of population and hospital data. Participants All Medicare FFS and MA beneficiaries undergoing PCI at US hospitals, 2019–2021. Measurements Our exposure was the supply of PCI-performing physicians per million population in the hospital-referral-region (HRR). Our primary outcome was lower-value PCI provision defined as the share of all PCIs performed for stable CAD at the hospital-level, unadjusted and with multilevel linear regression adjustment for hospital and regional-population factors. We also examined both PCI use and lower-value use at the regional (HRR) level. Results Our final dataset included 1,580 hospitals across 306 HRRs with 5,505 PCI-performing physicians. In our primary, hospital-level analysis, the lower-value PCI provision rate averaged 17.3% among hospitals located in HRRs in the lowest quintile of PCI provider density and 22.6% among hospitals in HRRs in the highest quintile. In our fully adjusted model, hospitals in the highest provider density quintile had a 5.77 percentage point higher lower-value provision rate than those in the lowest quintile (95% CI 3.70, 7.84; p < 0.01). In our HRR-level analysis, both the total number of PCIs/beneficiary and lower-value PCIs/beneficiary rose with increasing regional PCI-provider density. Conclusions Among Medicare beneficiaries, the regional supply of PCI providers correlates with PCI overall and lower-value use. These findings support a role for health planning efforts to align workforce supply with community health needs to constrain both costs and the provision of low-value care.

Assessing the susceptibility of microalgae to space conditions using stratospheric balloons

Development and evaluation of a technology-enhanced simulation to measure physician decision making in trauma triage

Purpose Variable implementation of clinical practice guidelines causes preventable morbidity and mortality. The paucity of valid and reliable measures of physician performance impedes efforts to improve implementation. The objective of this study was to evaluate a low-cost, scalable simulation method to evaluate physician non-adherence to guidelines, using trauma triage in Emergency Departments (EDs) as an archetypal clinical problem. Methods We created an online simulation that mimicked the task environment of a non-trauma center ED. We recruited a sample of ED physicians, asked them to use the simulation, and obtained the electronic health records of injured patients treated by these physicians in the prior 3 years. We used signal detection theory, a behavioral science method, to analyze triage performance. The method quantified the influence of 2 determinants of non-adherence: perceptual sensitivity (diagnostic accuracy) and decisional threshold (revealed preferences for false positive/negative decisions). We collected evidence of the simulation’s response process, internal structure, content validity, and relations with other variables. Results Among 180 invited physicians, 60/180 (33%) enrolled and 45/60 (75%) participated; 38/45 (84%) had accessible electronic records. Physicians completed an average of 20/26 simulation trauma cases, spending 2.6 minutes/case (SD 1.8), and making 2.6 decisions/case (SD 1.7). Responses to similar types of simulation cases were consistent (Cronbach’s alpha 0.80–0.86). Users reported strong content validity. Perceptual sensitivity on the simulation and in real-life correlated moderately well among physicians who evaluated ≥10 severely injured patients/year (rho 0.46, 95% CI 0.07–0.76, p = 0.025), but not lower volumes (rho −0.26, 95% CI −0.87–0.50, p = 0.39); decisional thresholds were uncorrelated (rho 0.22, 95% CI −0.12–0.51, p = 0.18). Conclusions The technology- and behavioral science-enhanced simulation demonstrated evidence of validity across multiple domains, with mixed findings for relations with other variables. With further refinement, it offers a promising avenue for studying physician decision making in trauma triage, with possible application to other clinical domains.