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Expanding Horizons: Transesophageal Ultrasound across Organ Systems in Prone Acute Respiratory Distress Syndrome Patients

Comment on “Spectrum and Outcome of Acute Kidney Injury in Nonsurgical Cardiac Intensive Care Unit Patients: A Prospective Observational Study”

Utility of Lung Ultrasonography for Early Diagnosis and Monitoring of Ventilator-associated Pneumonia in Mechanically Ventilated Patients: A Prospective Observational Study

Knowledge, attitudes, and practice about protective ventilation among physical therapists

Objectives To measure knowledge, attitudes and practice (KAP) towards protective ventilation and identify factors associated with KAP among physical therapists in a country-wide survey. Methods We conducted an online survey using a validated questionnaire with 55 items including individual and institutional information, KAP, and barriers to protective ventilation. The survey was distributed by email and social media. We calculated a total KAP score and scores for knowledge, attitudes, and practice, using a standardized scale from 0 to 100. Results We included 408 participants from all states of Brazil. Median knowledge score was 80 (IQR 72–88) out of 100, with 95% respondents agreeing that they were familiar with the ventilatory settings to achieve protective ventilation, but 34% reported that airway pressures are not always discussed during rounds. Total KAP score had a median of 71 (62–79) out of 100. In the multivariate analysis, years of ICU experience, attending conferences, and ICU beds per physical therapist were independently associated with KAP score. The most significant barriers to protective ventilation were lack of education to provide low tidal volume ventilation and maintaining protective ventilation in pressure support. Participants reported there was an increase in the practice of protective ventilation during COVID-19 pandemic. Conclusions In this countrywide study, physical therapists had good knowledge, attitudes, and practice regarding protective ventilation, and lack of education was an important factor associated with KAP. Discussing airway pressures during ICU rounds and developing specific training may improve awareness and practice of protective ventilation and impact patient outcomes.

Prevalence of dural puncture headache after caesarean section at a tertiary hospital in the Gambia

Background Following a caesarean section performed under spinal anaesthesia, a common complication is post-dural puncture headache (PDPH). Spinal anaesthesia has become the most common anaesthetic procedure during caesarean section in our practice. Therefore, knowing the prevalence and risk factors of PDPH will inform practice and add value in our obstetrics practice. Methodology A cross-sectional study was conducted at Edward Francis Small Teaching Hospital Banjul and data was effectively collected from August to October 2023. A structured data collection tool was used. The data was entered into a computer database and analyzed using the SPSS version 26. Pain was graded using a 10-cm visual analogue scale. Results were expressed in simple descriptive statistics and test of significance was set at p-value 0.05. Results A total of 89 participants with mean age of 28 years (SD ± 6.1) and majority 45(50.6%), between 21 to 30 years. Majority had low parity (0 to 3), 64(71.9%), emergency CS of 71(79.8%), while only 20.2% (n = 18) were elective CS. Overall prevalence of Post Dural Puncture Headache (PDPH) was 42.7% with majority of cases presenting with Occipital headache (71%), lasting for 3hrs (42%). A statistically significant association between PDPH and Gestational age with p-value (p = 0.02); number of attempts with p-value (p = 0.01); larger needle gauge and number of CSF drops (p = 0.01), respectively were observed. Conclusion Prevalence of PDPH was high and associated with the use of large needle gauges, multiple attempts and increased CSF drops. Patients that underwent emergency CS, have a higher risk of developing Post-Dural Puncture Headache.

Efficacy and neural mechanism of acupuncture for essential hypertension: Study protocol for a randomized clinical trial

Background Hypertension is a major risk factor for cardiovascular diseases. Acupuncture has been used to control blood pressure in clinical, however, the high-quality clinical evidence is insufficient and the underlying mechanisms remain unclear. Objectives This study aims to evaluate the efficacy of electroacupuncture for patients with essential hypertension (EH) compared with sham electroacupuncture and explore the neural mechanism. Study design and methods his is an 8-week, parallel-grouped, randomized clinical trial. A total of 66 patients diagnosed with EH are randomly assigned (1:1) to receive either the electroacupuncture or sham electroacupuncture treatment 3 sessions per week for 4 weeks. The primary outcome is the mean systolic blood pressure change at week 4 from the baseline measurement. The independent sample t-test will be used to compare the differences between two groups. The secondary outcomes include the change in mean diastolic blood pressure, the proportion of patients with controlled blood pressure (< 140/90 mm Hg), and quality of life. The outcome variables are measured at baseline, week 2, week 4 and week 8. Functional magnetic resonance imaging scans, pulse rate variability acquisition, and image-based photoplethysmography recording are performed at baseline and the end of the intervention period to explore acupuncture-related neuroplasticity changes. Correlation analyses are performed to investigate the relationships between the neural changes and clinical symptoms. Adverse events during the trial are monitored. Trial registration Chinese Clinical Trials Registry, the number is: ChiCTR2400082315 (https://www.chictr.org.cn/showproj.html?proj=223840).

Relationship between diagnostic accuracy and self-confidence among medical students when using Google search: A mixed-method study

Background With the growing volume of medical information, proficiency in utilizing clinical decision support systems (CDSSs) is increasingly important for physicians. Further, research has primarily focused on CDSSs’ accuracy for specific symptoms, diseases, and treatments, but the extent to which CDSSs contribute to the clinical reasoning process and evaluation of their output remains unclear. While Google is not a traditional CDSS, previous studies have evaluated its role as a diagnostic support tool, demonstrating its ability to assist physicians in retrieving relevant medical information and influencing diagnostic decision-making. Objective This study aimed to assess whether using Google search can enhance diagnostic accuracy and confidence among medical students, and to evaluate how the interpretation of search results influences their diagnostic confidence. Methods Forty-eight fifth-year medical students in clinical clerkship at Chiba University Hospital were presented with ten clinical scenarios in text format. Initially, they provided the most likely diagnosis without assistance and recorded their confidence levels. Subsequently, they used Google search to revisit their diagnoses and confidence levels, using a 7-point Likert Scale. Focus group interviews were conducted to discuss changes in confidence, and the interviews were analyzed qualitatively using content analysis. A mixed-methods analysis compared the average number of correct diagnoses and confidence levels before and after using Google search. Results In total, 470 responses from 48 fifth-year medical students were evaluated after excluding 10 inappropriate responses. Correct diagnoses increased from an average of 63.6% without assistance to 76.2% using Google search (P < .001), and confidence levels rose from 4.9 to 5.9 (P < .001). Qualitative analysis of higher-confidence responses identified 108 codes within 17 subcategories related to diagnostic processes. Conclusions This study underscores the value of using Google search in medical education to enhance diagnostic skills and confidence. The improvement in accuracy and confidence among students demonstrates the supportive role of Google search in clinical reasoning and education. This highlights the need for educators to teach discernment in information analysis to ensure optimal use of CDSS in medical training. Proper integration of these tools is crucial for developing future physicians capable of effectively navigating vast amounts of medical data.

Exploring differences among serial, portfolio, and novice entrepreneurs: A study of demographic and psychological factors in micro and small enterprises

The aim of this study was to empirically validate selected demographic and psychological factors from Shane’s model in the context of serial and portfolio entrepreneurship. The analysis involved 326 entrepreneurs, including 110 serial entrepreneurs, 105 portfolio entrepreneurs, and 111 novice entrepreneurs (control group). The study employed a survey questionnaire combined with five validated psychological instruments, administered in a manner that enabled control for common method bias. The analysis revealed that two demographic factors—education and having entrepreneurial parents—were statistically significant for distinguishing serial and portfolio entrepreneurs. In terms of personality traits, differences were observed in the levels of psychological capital, suchas: hopefulness, resilience, and also risk-taking propensity, conformity-nonconformity behaviour, with the portfolio entrepreneurs scoring the highest in these areas. This study successfully validates Shane’s model in relation to micro and small-scale entrepreneurship, contributing to a deeper understanding of entrepreneurial behaviour.

Evaluation of the performance of the Influenza-like Illness (ILI) surveillance system in the Okai Koi North District, Greater Accra Region, 2022

Background Influenza-like Illness (ILI) caused by the influenza virus, causes morbidity in Ghana. Records of ILI outbreaks in recent times and the COVID-19 pandemic disrupted surveillance activities, raises the quest to evaluate the ILI surveillance system. We evaluated the ILI surveillance system of Okai Koi North District to assess the system performance. Materials and methods We adapted the CDC Updated guidelines for evaluating public health surveillance systems for this evaluation at Okai Koi North District. We extracted and reviewed ILI 2018-2021 morbidity data from the district’s sentinel site and the National Influenza Center (NIC). We observed surveillance activities and interviewed key informants using an observational checklist and semi-structured questionnaire. Data were analyzed for frequencies and proportions, and results presented in charts and tables, Results Of the 525 suspected samples reported from the district’s sentinel site, 58 (11%) of 525 were Influenza positive with PVP, 11%. The system detected outbreaks over the evaluation period and has a year-round case detection. The system requires PCR for the detection of influenza virus. Nine (70%) of 13 staff indicated ILI surveillance system served as the backbone for case identification during the COVID-19 pandemic period. There is (89%) data completeness among sampled forms and data from the district and National Influenza Center. The system relies mostly on international donors. Nine (64%) of 13 staff confirmed no budget allocation for system operation. About 58% (306/525) of the ILI samples were transported to NIC for confirmatory test within the set 48 hours timeline. Conclusion The system is useful as its meeting most of its objectives and it is sensitive. The system though complex, is flexible, representative, timely in most activities and has good data quality. We urge national stakeholders to establish thresholds for system.

The impact of strategic alliances on corporate real investment and its mechanisms from the perspective of organizational learning theory: An empirical analysis based on Chinese listed companies

This study examines how firms enhance resource allocation efficiency and stimulate real investment through strategic alliances. The findings, based on data from Chinese A-share listed companies on the Shanghai and Shenzhen Stock Exchanges from 2009 to 2022, indicate a significant positive correlation between strategic alliances and corporate real investment. This suggests that strategic alliances effectively improve resource allocation efficiency and promote investment in the real economy. By differentiating between equity-based and bilateral contractual strategic alliances, the results highlight a significantly positive impact of equity-based strategic alliances on corporate real investment. Path analyses further reveal that strategic alliances promote real investment growth by stimulating innovation momentum, enhancing risk-taking capacity, and strengthening innovation capability. Additional analyses indicate that companies with robust capital acquisition abilities—characterized by high commercial credit, patient capital, and government subsidies—can significantly enhance the positive effect of strategic alliances on real investment. This study enriches theoretical discourse on the economic consequences of strategic alliances, and offers policy recommendations for firms to optimize resource allocation and for governments to effectively guide capital toward the real economy.

Hand hygiene after the COVID-19 pandemic: Is it still at a high level?

Background Hand hygiene (HH) is crucial for preventing healthcare-associated infections (HAIs), with compliance notably increasing during the COVID-19 pandemic. Whether this adherence can be sustained remains uncertain. We sought to assess changes in HH compliance following the pandemic and explore its correlation with HAIs. Methods A longitudinal study was launched to assess HH compliance and HAIs across two phases. Phase 1 spanned from October 2021 to January 2023, a period of normalized prevention and control of COVID-19, while phase 2 extended from February 2023 to July 2024, following the downgrade in the management of COVID-19. Observers recorded HH practices. HAIs were identified through using semi-automated, continuous surveillance software. Pearson correlation coefficient (rs) was used to evaluate the relationship between HAIs and HH. Results A total of 2,233 HH opportunities were observed with 966 during Phase 1 and 1,267 in Phase 2. Compliance with HH significantly declined from 90.27% (95% CI: 85.34% to 95.4%) in Phase 1 to 82.56% (95% CI: 80.35% to 84.61%) in Phase 2 (P < 0.001). Concurrently, the incidence of HAI rose notably from 16.79‰ (95% CI: 16.20‰ to 17.39‰) to 18.71‰ (95% CI: 18.20‰ to 19.24‰) (P < 0.001). However, despite these concurrent trends, monthly analysis found no statistically significant correlation between HH compliance and HAI incidence (rs = −0.296; P = 0.0897). Conclusions As the pandemic threat waned, maintaining high HH compliance became challenging, indicating it’s time to implement additional strategies. Moreover, the correlation between HH and HAI requires further study to uncover.

Impact of National health insurance on medication adherence among hypertensive patients: A hospital-based cross-sectional study from Kailali, Nepal

Introduction Noncompliance of medication among patients with chronic disease is a major challenge for the health system. Expanding of national health insurance among patients might increase their access to health care services, reduce out of pocket expenditures, and improve health outcomes. This study aimed to determine the association between enrollment in health insurance and medication adherence among hypertensive patients in Nepal. Methods A cross-sectional study was conducted among 402 patients visiting the outpatient department of Tikapur Hospital located in Kailali, Nepal. Data was collected by face-to-face interviews using a structured questionnaire. Adherence to hypertensive medication was assessed using the Hill Bone Medication Adherence Scale (HB-MAS). A multivariable logistic regression model was constructed to ascertain the association between enrollment in health insurance and medication adherence. Results Overall, 52.7% (60.2% of uninsured and 45.3% of insured) of the patients was medication adherence. Enrollment in health insurance was not significantly associated with medication adherence. The participants among those who had reported more than secondary level education was higher odds of medication adherence (AOR = 3.30; 95% CI: 1.25–8.73); those who reported more than five minutes of interaction with doctors (AOR = 2.97; 95% CI: 1.56–5.65); those on medication for more than 10 years had higher odds of adherence (AOR:2.56; 95% CI:1.35-4.86); aged group 50-59 years was lower odds of medicatio n (AOR = 0.46; 95% CI: 0.23-0.91); compared to patients with no formal education;those who reported less than or equal to 5 minutes of interaction with doctors; those who had less than 5 years of medication; participants younger than 50 years respectively. Conclusion Our study showed that enrollment in health insurance was not associated with medication adherence among patients with hypertension. Health system interventions such as improving counseling, patient education, and follow-up, and ensuring availability of medicines might improve medication adherence among patients. Health professionals also should set up education, and interventions aimed at increased awareness of the consequences of non-adherence to antihypertensive medication.

Can a noisy venue be bad for comedy?

People hear jokes live and pre-recorded in a variety of settings, from comedy clubs, bars, outdoor venues, cafes, to their own home or car. While a lot of research has analyzed the significance of the content of jokes, we know less about the significance of the setting one hears them in. Some settings can have interfering background noise or poor acoustics, reducing an audience’s ease of processing heard jokes. Would this affect how funny the jokes seem? Two experiments with audio clips of stand-up comedy performances show that participants found jokes less funny when background noise interfered with their listening.

Perspectives of multidisciplinary healthcare providers in elderly daycare centres: Challenges, opportunities and impacts on geriatric care in Chiangrai Municipality, Thailand

The global surge in the ageing population has intensified pressure on healthcare delivery systems, leading to a heightened demand for elderly daycare services. This demographic shift necessitates innovative approaches to meet the complex needs of older adults, including expanding community-based care options. Elderly daycare centers play a crucial role in comprehensive geriatric care by offering services. Understanding how healthcare providers experience their work in Elderly Daycare Centres is essential for improving both service quality and staff preservation. This study seeks the experiences of these providers to understanding of meanings healthcare professionals assign to challenges they face, the successful practices they employ, and highlight opportunities for enhancement within geriatric care. Interpretative phenomenology influenced by Heidegger’s philosophy in qualitative research was conducted. Thirteen semi-structured interviews and narrative accounts with multidisciplinary healthcare providers from four Elderly Daycare Centres were collected and analysed, and interpretative phenomenological analysis (IPA). Multidisciplinary healthcare providers discovered four key aspects of their experience while delivering services in the first two programs (the Muscle Strengthening Program and the Nutrition Program for individuals with nutritional deficiencies): Opportunities in policy implementation, Challenging experience, Enhancing organisational effectiveness and engaging support, and Reflections on Program Outcomes and Impacts. All findings mirrored the value and impact of providing healthcare services in Elderly Daycare Centres on the experiences of healthcare providers from various disciplines. Elderly Daycare Centres not only provide healthcare services that offer emotional support but also positively influence seniors’ mental and physical well-being. Multidisciplinary healthcare providers caring for older adults encounter various experiences shaped by the complexities of aging populations. Support of this nature will heighten awareness of the difficulties elderly individuals encounter and advance potential solutions. Therefore, healthcare professionals stressed the need for a more holistic and coordinated care framework to improve both the delivery of services and health outcomes for elderly individuals.

Establishment and application of a dual real-time PCR assay for differential detection of PiAdV-1 and PiAdV-2 among pigeons in China in 2022–2023

Pigeon virus diarrhea is very common in the clinic, which has caused great damage to the pigeon industry. Pigeon adenovirus constitutes a significant pathogen responsible for pigeon viral diarrhea. Among them, Pigeon adenovirus 1 (PiAdV-1) and Pigeon adenovirus 2 (PiAdV-2) are the most common adenoviruses discovered in pigeon diseases in recent years. Infection with these viruses is common in clinical settings, which makes differential diagnosis more difficult. At present, real-time PCR is one of the most widely used techniques for the identification and detection of pathogens. This study presents the development of a dual real-time PCR assay designed specifically for the detection of PiAdV-1 and PiAdV-2. The dual real-time PCR assay developed in this study demonstrated satisfactory specificity, sensitivity, repeatability, and reproducibility, while showing no cross-reactivity with unrelated pathogens. The limit of detection (LOD) for PiAdV-1 is 94.8 copies/µL, and the LOD for PiAdV-2 is 88.4 copies/µL. This method was then used to analyze 20 liver tissue samples collected from dead pigeons, and the results were verified by genome sequencing. To understand the current epidemic status of pigeon adenovirus in China, the dual real-time PCR method established in this study was used to detect 500 pigeon swab samples collected from 10 provinces in China from 2022 to 2023. The results showed that the positive rates of PiAdV detected by the real-time PCR was 27.00% (135/500). PiAdV-1 single infection was detected in 8 cases (1.6%), PiAdV-2 single infection in 123 cases (24.6%), and PiAdV-1 and PiAdV-2 co-infection in 4 cases (0.8%). This study established a valuable tool for differentiating between PiAdV-1 and PiAdV-2 in practical applications and provided significant insights into the prevalence of these viruses in China.

Effect of Omega 3 supplementation during pregnancy and lactation on cognitive functions in rat offspring

Aim This study investigates the effects of omega-3 supplementation starting in the preconception period, during the 1st, 2nd, and 3rd weeks of pregnancy, and lactation on the cognitive functions of rat offspring. Methods The study involved 30 mother rats divided into a test group receiving 400 mg/kg/day omega-3 supplementation via oral gavage and a control group with no supplementation. Omega-3 supplementation began at different stages for each group and continued through the lactation period (21 days). Two male pups from each mother, for a total of 60 pups, were tested for cognitive function at 45 days using the Morris Water Maze to assess spatial learning and reference memory. Results Significant differences were found between groups in initial weights, pre-mating weights, pre-birth weights, number of pups, and gestation duration (p < 0.05), but not in weight gain during pregnancy (p > 0.05). The time to find the platform on test days 1 and 2 was significantly different between groups (p < 0.05). Differences in platform-finding times across trials were also significant (p < 0.05). However, no significant difference was found in the probe test on day 5 (p > 0.05). Conclusion Initiating omega-3 supplementation during the early stages of pregnancy may be more effective for both short-term and long-term memory.

Enabling near real time use of wildlife necropsy data: Text-mining approaches to derive interactive dashboard displays

Manual review of necropsy records through close reading and collation is a time-consuming process, leading to delays in knowledge acquisition, communication of findings, and subsequent actions. Text-mining techniques offer a means to reduce these barriers by automating the extraction of information from large volumes of free-text clinical reports, minimizing the need for manual review. Additionally, interactive dashboards enable end users to interrogate data dynamically, tailoring analyses to their specific needs and objectives. Here, we describe the principles underlying an application designed to extract and visualize information from free-text necropsy records within the Wildbase Pathology register. Reflecting the structure of a traditional necropsy review—where each record is examined in detail to identify and collate key observations—the application is divided into three sections. The first allows a user to upload a dataset in comma separated value format as downloaded from the Wildbase Pathology Register. A user can then filter and interrogate selected signalment variables of the population within this dataset. The second section uses established text-mining calculations of word correlations and Latent Dirichlet Allocation to generate visualisations to give a user a subjective sense of common themes found within the uploaded data. The third and final section uses a custom rule-based algorithm to identify and quantify positive occurrences of clinicopathologic findings as input by an end user. The foundational methods employed in this application have the potential for broader application in veterinary and medical pathology, facilitating more efficient and timely access to critical insights.

CD44 as a novel therapeutic target in pulmonary arterial hypertension: Insights from multi-omics integration and molecular docking

Pulmonary arterial hypertension (PAH) is a progressive and often fatal disorder characterized by increased pulmonary vascular resistance and subsequent right heart failure. Inflammation plays a pivotal role in the pathogenesis of PAH, and recent studies have highlighted the potential therapeutic significance of targeting inflammatory pathways. This study investigates the role of CD44, a cell surface receptor, in the inflammatory processes underlying PAH. By analyzing bulk RNA-seq data from idiopathic pulmonary hypertension (IPAH) patients and conducting single-cell RNA-seq analysis on pulmonary arterial cells, we identified CD44 as a key modulator of inflammation. Our findings suggest that elevated CD44 expression is not only in T cells but also prominently in pulmonary artery smooth muscle cells (SMCs), suggesting its involvement in vascular inflammation and remodeling. Molecular docking studies revealed a potential interaction between CD44 and progesterone, an anti-inflammatory drug and immunomodulator, and this indicates a novel avenue for therapeutic intervention. The results support the hypothesis that targeting CD44 may reduce inflammation and improve clinical outcomes in PAH patients.

Molecular basis for the activation of the bitter taste receptor TAS2R14 by Ritonavir

Ritonavir is a protease inhibitor used in combination with other antiretroviral drugs to treat HIV, especially in children. It enhances the effectiveness of these drugs by inhibiting the cytochrome P450-3A4 enzyme, thereby increasing their bioavailability. Ritonavir is also being investigated for cancer treatment due to its mechanism of action. However, its intense bitterness, particularly in liquid formulations, can be intolerable for some children. This bitterness is attributed to its activation of bitter taste receptors, including TAS2R14 (also named T2R14), as demonstrated in our previous study. In this study, we utilized molecular modeling, site-directed mutagenesis, and cell-based calcium mobilization assays to characterize the key residues involved in TAS2R14 activation by ritonavir. Eight critical residues for ritonavir interacting with the receptor were discovered. The results indicate two potential binding sites for ritonavir in TAS2R14 receptor, including orthosteric and allosteric sites. These findings can be useful for developing bitter blockers targeting TAS2R14 to eliminate or reduce the bitter taste of ritonavir.

Examination of unique volatile organic compound signatures in nasopharyngeal test swab viral transport media using an electronic nose

Rapid point of care tests for respiratory infections are associated with high rates of false negative results which can drive empiric, and potentially inappropriate, antibiotic use. Because infectious pathogens alter VOC composition, unique VOC signatures in biospecimens hold the potential to discriminate bacterial and viral infections from uninfected controls. One approach for rapid identification of respiratory pathogens is the electronic nose (e-nose), a sensor device that uses artificial intelligence to recognize disease-specific patterns in VOC profiles of gaseous mixtures. In this preclinical proof of concept study, we tested the validity of an e-nose to discriminate PCR-confirmed cases of infection with three viral pathogens (SARS-CoV-2, RSV, influenza A) from uninfected controls using nasopharyngeal test swab media. Using exploratory factor analysis, the e-nose discriminated both influenza A and SAR-CoV-2 from uninfected controls. To assess sensitivity and specificity, we applied factor analysis-based threshold values and obtained high levels of sensitivity (96.30%) and specificity (90.62%) for influenza A and more modest levels for SARS-CoV-2 (sensitivity=75%, specificity=68.57%). We did not apply threshold values to RSV samples because the e-nose sensors showed low discriminatory power for that pathogen. Our findings support proof of concept of the validity of the e-nose to discriminate common viral respiratory pathogens. Our use of binary thresholds for influenza A, which are easily adapted to point-of-care settings, yielded superior sensitivity results and comparable specificity results when compared to rapid tests. We recommend that future studies apply our analytic approach to samples of human breath to determine if these findings can be replicated or improved.