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Implementing an identification tool to accurately capture non-ambulatory fragility fractures: a quality improvement project
Non-invasive estimation of inspiratory muscle pressure and work of breathing by airway pressure extrapolation from the P0.1 maneuver during assisted ventilation
Abstract Monitoring inspiratory effort during assisted mechanical ventilation is essential to balance lung protection and respiratory muscle loading. Esophageal pressure monitoring remains the reference standard for estimating inspiratory muscle pressure and work of breathing but is invasive and rarely used in routine clinical practice. Non-invasive alternatives based on routinely available ventilator signals are therefore needed. This monocentric physiological substudy of the ICEBERG observational trial included adult patients with acute hypoxemic respiratory failure undergoing assisted mechanical ventilation. Inspiratory muscle pressure (P mus ) was first estimated non-invasively by linear extrapolation of the airway pressure drop recorded during a standardized end-expiratory occlusion (P0.1 maneuver) into early inspiration (up to 500 ms after occlusion). Using the extrapolated P mus together with airway pressure, airway resistance was calculated during early inspiration, both with and without correction for respiratory system elastance determined by occlusion maneuvers. The resulting resistance and elastance were then used to parameterize the equation of motion of the respiratory system, allowing subsequent reconstruction of the inspiratory P mus waveform over the entire breath. From the reconstructed pressure signal, peak inspiratory P mus , work of breathing, and pressure–time product were calculated. Esophageal pressure–derived measurements served as the reference standard, and agreement was assessed using linear regression and Bland–Altman analysis. Eighteen patients (age 67 ± 12 years, PaO₂/FiO₂ 198 ± 44 mmHg) contributed 33 valid measurements. Based on a patient-average analysis, non-invasively estimated P mus during early inspiration showed statistically significant correlations with esophageal pressure–derived values across all analyzed time points (all p < 0.01), with the highest agreement and lowest bias observed at 100 ms extrapolation time after the end of the P0.1 maneuver. Elastance-corrected airway resistance demonstrated slightly improved agreement compared with uncorrected resistance estimates. Work of breathing derived from non-invasive inspiratory P mus showed good agreement with reference measurements (R 2 = 0.70; bias = − 0.05 J), whereas pressure–time product exhibited greater bias and wider limits of agreement. A P0.1-guided, non-invasive method based on airway pressure extrapolation allows feasible and physiologically meaningful estimation of inspiratory P mus during assisted ventilation. Derived work of breathing shows good agreement with esophageal pressure-based measurements, supporting the potential of this approach for non-invasive monitoring of inspiratory effort in patients with acute hypoxemic respiratory failure.
Obstetric outcomes in pregnancies with solitary huge uterine fibroids: size versus type and location
Abstract Huge uterine fibroids represent a rare but clinically significant complication of pregnancy. This study aimed to evaluate their impact on major obstetric outcomes and to determine whether fibroid type and anatomical location modify these risks. This retrospective observational study (2010–2023) compared 64 singleton pregnancies complicated by a single huge uterine fibroid (maximal diameter ≥ 10 cm) with 128 matched fibroid-free controls. Fibroids were classified sonographically by type and location. Outcomes included mode of delivery, gestational age (GA) at birth, preterm birth (PTB), neonatal birthweight, 5 min Apgar and maternal hemoglobin decline. Multivariable logistic regression was used to identify independent predictors of cesarean delivery (CS). Among 57,200 pregnancies, huge uterine fibroid was identified in approximately 1 in 670 pregnancies (0.15%). These pregnancies were associated with higher rates of CS compared with controls (39.1% vs. 8.6%, P < 0.01), earlier GA (median 38.0 vs. 39.6 weeks, P < 0.01), a markedly increased rate of PTB (29.7% vs. 4.7%, P < 0.01), and greater maternal hemoglobin decline. Within the fibroid cohort, fibroid size relative to the median diameter was not associated with adverse outcomes. In contrast, intramural fibroids were strongly associated with both earlier GA and an increased risk of CS compared with subserosal lesions (adjusted OR 23.79, 95% CI 3.67–534.32, P < 0.01). Fibroids located in the lower uterine segment or cervix were also associated with elevated CS rates. Obstetric risk of pregnancies complicated by a huge solitary fibroid is driven primarily by fibroid type and anatomical location rather than size alone, supporting individualized counseling and delivery planning.
Respiratory symptoms and lung function impairment among bakery employees exposed to flour dust in Abidjan, Cote d’Ivoire
Identification of cross-stage, cross-species malaria CD8+ T cell antigens
Impact of W-OH spraying on pore structure of two typical erodible soils in southern China
Assessment of indoor radon exposure risks in residential buildings using corentium home radon gas detector in Masha, South Wollo, Ethiopia
Publisher Correction: Novel T-ring-based probes for thermal ablation of tumors in different organs
Transcriptional regulation of the main olfactory epithelium by environmental olfactory exposures
Applications of a novel probabilistic hesitant fuzzy correlation coefficient in medical diagnosis and students’ performance assessment
Influence of personality traits and clinical role models on changes in medical students’ attitudes toward psychiatry: a prospective moderation analysis
Abstract Oman faces a critical shortage of psychiatrists, highlighting the need to better understand determinants of medical students’ career attitudes toward psychiatry. Utilizing Social Learning Theory and Situational Strength Theory, this study examined how attitudes toward psychiatry evolve during clinical training through the interaction between individual characteristics (personality traits) and contextual influences (clinical learning environment and role models). The study aimed to determine whether personality traits and exposure to clinical role models moderate changes in students’ attitudes during the psychiatry clerkship. A prospective single-group quasi-experimental pre-post study was conducted among 180 undergraduate medical students at Sultan Qaboos University during an eight-week psychiatry clerkship. Attitudes toward psychiatry and personality traits were assessed using the Attitudes Toward Psychiatry-30 (ATP-30) and Big Five Inventory-44 (BFI-44) scales. Moderation analyses were performed using Hayes’ PROCESS macro to evaluate interaction effects between baseline attitudes, personality traits, and perceived role-model influence. Attitudes toward psychiatry improved significantly following clerkship exposure (mean ATP-30 score increased from 105.66 to 110.38; p < .001). Personality traits did not significantly moderate attitude change. However, perceived resident role-model quality demonstrated a significant interaction with baseline attitudes (b = − 0.953, p = .004), with the greatest improvement observed among students with initially less favorable attitudes toward psychiatry. Prior personal contact with mental health services was independently associated with lower post-clerkship attitude scores (b = − 4.553, p = .047). Psychiatry clerkships were associated with improved student attitudes, with role-model mentorship appearing more consequential than stable personality characteristics. As improved attitudes do not consistently translate into specialty recruitment, workforce strategies should move beyond passive clinical exposure toward structured mentorship, targeted career engagement, and culturally responsive psychiatric training models.
Attenuation without protective immunogenicity: effects of codon-pair deoptimization on foot-and-mouth disease virus serotype O in swine
Abstract Foot-and-mouth-disease (FMD), caused by the FMD virus, is a contagious disease affecting cloven-hoofed animals. Since outbreaks often cause significant economic impact, control and prevention measures against FMDV, such as vaccines, are urgently needed especially in endemic regions. The use of inactivated whole-virus vaccines has led to the eradication of FMD in many industrialized nations. Nonetheless, recent outbreaks in Europe have highlighted the virus’s potential for rapid spread and its capacity to inflict substantial economic losses. Codon pair deoptimization is a novel strategy for viral attenuation. In this study, we report the first application of this approach to the P1 capsid coding region of FMDV serotype O. A recombinant virus carrying the deoptimized P1 region was attenuated in vitro, as evidenced by reduced replication capacity in porcine LFBK-αvβ6 cells. In vivo evaluations further demonstrated that a substantially higher dose was required to induce clinical disease in pigs than with wild-type viruses. However, immunization with lower and innocuous doses did not result in protective immunity. These findings underscore both the potential and the challenges of utilizing codon pair deoptimization for developing safe and effective FMDV vaccine candidates, emphasizing that further optimization is necessary to achieve a desirable balance between attenuation and immunogenicity.
Integrated metabolomic and histopathological analysis of renal alterations in mice following chronic bisphenol A (BPA) exposure
Schema for regional evaluation supporting class VI well applications in the Arbuckle Group of Kansas
Abstract An integrated, basin-scale methodology was developed to screen areas for geologic carbon storage in Kansas, focusing on the Arbuckle Group – the principal candidate for large-scale carbon capture and storage (CCS) in the U.S. Midcontinent. This approach is fit-for-purpose at the pre-Class VI stage, providing a defensible, regional framework to support early decision-making before undertaking more detailed site-specific characterization. The methodology integrates a faulted framework geocellular property model with spatial chance-of-adequacy (COA) evaluation for four fundamental CCS play elements: reservoir presence, reservoir quality, reservoir seal, and CO 2 phase state. By combining elements at the basin scale, the workflow identifies areas with favorable geologic conditions and estimates effective storage resource ranges at the formation scale. Legacy data spanning a century were evaluated for confidence, enabling differentiation between areas with robust screening results and those where additional data could materially change CCS potential. Results support significant CO 2 storage potential across Kansas, with effective storage resource estimates ranging from ~ 24–75 Gt statewide with a best estimate of ~ 39 Gt. Areas with high aggregate COA values align with previous Kansas Geological Survey CCS assessments, reinforcing confidence in the statewide screening outcomes. Importantly, this regional evaluation establishes the regional geologic framework and trends that can support Class VI site selection, where detailed stratigraphic, structural, geochemical, and geomechanical analyses are mandatory. State-led, publicly accessible regional subsurface evaluations provide a neutral, basin-wide framework that frames subsurface uncertainty, improves technical communication, can be leveraged for Class VI applications, and may accelerate CCS project development and enable long-term carbon storage planning.
Unveiling hidden prehistoric structure via high-resolution GPR survey at Hierakonpolis, Aswan, Egypt
Abstract Hierakonpolis was a major population and political center in Upper Egypt during the Predynastic era (c. 3800–3100 BC). Its ancient remains are preserved mainly as negative archeological features (i.e., structural cuts that disrupt the natural soil), such as postholes and foundation trenches for buildings of wood. One of these constructions is a large palisade wall, of which over 50 m of its length has been uncovered by archaeologists. To trace the buried continuation of this structure without excavation, researchers conducted a ground-penetrating radar (GPR) survey using a high-frequency (900 MHz) antenna. Despite subtle physical contrasts between the remains and the soil, the arid conditions allowed the GPR to detect the foundation trench as a lateral discontinuity within the Nile silt layer that extends across the entire study area. GPR scans revealed that the wall continues westward along the same trajectory as its excavated segments for an additional 18 m before the signal terminated. Analysis of GPR facies suggests that repeated flooding from an ancient Nile channel compromised the site’s stability, likely resulting in the destruction of the wall in the northwestern sector. Archaeological findings indicate the wall demarcated a large ceremonial and administrative complex, while the survey results also suggest it had a broader functional role as a defensive barrier against Nile floodwaters and other natural threats.
Waste tyre pyrolysis oil–hemp biodiesel ternary blends with graphene oxide and thermal barrier coating: CI engine performance and machine learning prediction
Genomic characterization of phosphate-solubilizing Klebsiella variicola strain PSEG-1 from earthworm gut
YOLO11-guided swin transformer for molar occlusion classification
Assessment of potential nephrotoxicity biomarkers after [177Lu]Lu-DOTA-(Tyr3)-octreotate administration and effects of antioxidant α1-microglobulin
Abstract Patients with neuroendocrine tumours may receive higher total amount of [ 177 Lu]Lu-DOTA-(Tyr 3 )-octreotate and achieve better tumor control if the risk of kidney toxicity could be predicted individually for each patient. One strategy for such a prediction includes the evaluation of early responding biomarkers for kidney damage during treatment to decide the number of treatment cycles. The aims of this study were to (1) evaluate if urinary RBP4, NGAL, creatinine and cystatin C levels may serve as early responding biomarkers for kidney damage, (2) assess the expression of NGAL, KIM-1, CDKN1A, S100A6 and ADIPOQ in kidney tissue to validate their use as histological indicators of toxicity, and to (3) examine the long-term effects of the proposed radioprotector α 1 -microglobulin (A1M) in mice exposed to [ 177 Lu]Lu-DOTA-(Tyr3)-octreotate. Mice were injected with 90 or 150 MBq [ 177 Lu]Lu-DOTA-(Tyr3)-octreotate with or without A1M. Urine was collected at several time-points, and the animals were sacrificed after 9 months. Urinary RBP4 increased from day 35 after injection of 150 MBq [ 177 Lu]Lu-DOTA-(Tyr 3 )-octreotate, creatinine decreased from day 131 and cystatin C increased from day 223. KIM-1, CDKN1A and S100A6 showed a dose dependent kidney expression. Morphological signs of kidney injury were observed in mice injected with 150 MBq [ 177 Lu]Lu-DOTA-(Tyr 3 )-octreotate. No clear kidney protective effect was detected when A1M was co-administered with [ 177 Lu]Lu-DOTA-(Tyr 3 )-octreotate.