Management Approach Research Articles

Is Routine Group and Save Sampling Necessary for Emergency Laparoscopic Appendicectomy?

Background Laparoscopic appendicectomy is a commonly used approach for the surgical management of acute appendicitis. If complications arise, a blood transfusion may be necessary for patients undergoing emergency appendicectomy. The need for routine group and save (G&S) sampling prior to emergency laparoscopic appendicectomy remains a subject of ongoing discussion. The aim of this study was to evaluate whether routine G&S sampling is needed prior to emergency laparoscopic appendicectomy. Methods The present study retrospectively reviewed G&S sampling for emergency laparoscopic appendicectomy cases over a six-month period at two hospital sites in the United Kingdom: Croydon University Hospital (June 1, 2024, to November 30, 2024) and Tunbridge Wells Hospital (October 1, 2023, to April 30, 2024). A total of 304 patients across both sites were included in the review. Results In 2023, 23 procedures (7.6%) were performed, while 279 procedures (92.4%) occurredin 2024. The patient population consisted of 46.4% males (n = 141) and 53.6% females (n = 163), with a mean age of 37.1 years (median 33, range 6-84). A total of 406 G&S samples were collected, of which 351 (86.5%) were processed and 55 (13.5%) were rejected by the blood bank. From the sample size, only one patient received a blood transfusion prior to surgery due to a low hemoglobin level of 72 g/L, likely resulting from the delayed presentation of a perforated appendix. Conclusion This study suggests that omitting routine G&S sampling is safe for patients undergoing emergency laparoscopic appendicectomy. Hence, an individualized risk assessment approach should be used to identify high-risk patients requiring preoperative G&S sampling.

Comparative study about early full versus conventional partial enteral feeding in preterm new-born infants of 28-34 weeks

Background: Enteral feeding is a critical component of neonatal care for preterm infants. Enteral feeding is indicated for a range of medical conditions, including prematurity, where infants cannot suck and swallow effectively; neurological disorders such as cerebral palsy or brain injuries; congenital anomalies like cleft palate; and critical illnesses that prevent adequate oral intake. This study aims to evaluate and compare the outcomes of early full enteral feeding with conventional partial enteral feeding in preterm newborn infants born between 28 and 34 weeks of gestation, focusing on parameters such as growth and development, long term morbidity and mortality. Methods: This is a comparative prospective observational study designed to compare full enteral feeding with partial feeding on preterm. Total 180 preterm infants were included in the study. Participants were allocated into two groups - 90 preterm: full feed, and 90 preterm: partially feed. Results: A study of 180 infants compared full and partial feeding groups, each with 90 babies. The full-feeding group showed fewer complications (16% total) with no necrotizing colitis, while the partial-feeding group had more issues (30.33% total), including 3% with necrotizing colitis. Full-fed babies had better outcomes with higher discharge rates (88% versus 80%) and lower death rates (9% versus 15%). While both groups showed similar length growth, full-fed babies maintained more stable weight gain over 15 days. Conclusions: This study concludes that full enteral feeding is more beneficial approach in the nutritional management of preterm infants leading to improved growth in terms of weight, length and head circumference gain.

An Algorithmic Overview of Advanced Pain Therapies: A Narrative Review.

Quickly referenceable, streamlined, algorithmic approaches for advanced pain management are lacking for patients, trainees, non-pain specialists, and interventional specialists. This manuscript aims to address this gap by proposing a comprehensive, evidence-based algorithm for managing neuropathic, nociceptive, and cancer-associated pain. Such an algorithm is crucial for pain medicine education, offering a structured approach for patient care refractory to conservative management. A comprehensive literary review with PubMed and regulatory documents from the United States Food and Drug Administration were searched for a variety of interventions. Pain syndromes were categorized into nociceptive and neuropathic pain, and an algorithm was constructed. Serving as an educational tool for patients, trainees, and non-pain specialists, and as an accessible reference for pain specialists, this algorithm bridges knowledge gaps, promotes interdisciplinary collaboration, and streamlines the learning curve for new practitioners. The strength of this algorithm lies in integrating extensive clinical data, emphasizing the latest clinical evidence, and providing a structured decision-making pathway.

A review of India's water policy and implementation toward a sustainable future

ABSTRACT India is one of the most significant economies globally, and the sustainable use of this priceless resource depends considerably on its water supplies. Moreover, a rural and monsoon-dependent nation faces water scarcity challenges, fueling potential conflicts among sectors and regions while intensifying challenges to food security and livelihoods. This paper conducts a chronological review of India's evolving water supply policies, assessing their impact, identifying gaps in policy implementation, and striving to provide insights for the country's future development of equal and sustainable access to water. In this context, integrating artificial intelligence (AI), particularly in smart water management systems, presents promising implications for improving water supply efficiency and optimizing service delivery processes, proving indispensable in addressing water-related challenges, particularly in regions like India. It could detect and mitigate water losses within distribution systems, providing practical water purification, distribution, and conservation solutions. This review paper also discovered that the Practical Integrated Water Resource Management approach emphasizes decentralized management of water resources and advocates for more efficient, context-specific, and locally tailored solutions for assessing the water resource system for implementing water policy. This approach further leads to minimizing the water scarcity problem in a particular area or region.

P-32 MANAGEMENT OF A RARE COMPLICATION IN TYPE 1 DIABETES WITH EXTREME LIVER ENLARGEMENT AND GROWTH FAILURE

Abstract Clinical Case A 21 year old single male presented with growth failure, delayed puberty, and significant liver enlargement attributed to glycogen deposition, a rare complication observed in some children and young adults with Type 1 Diabetes Mellitus (T1DM), irrespective of glycemic control. In his initial visit (Sep 5, 2020):Height: 144 cm, Weight: 40 kg. The patient’s uncontrolled diabetes and growth failure were notable. In the follow-up visits (Oct 4, 2020 - May 20, 2024), the patient exhibited fluctuating glycemic control (HbA1c ranging from 9.7% to 12.0%), variably elevated liver enzymes (ALT and AST), and concerning lipid profiles, with triglycerides peaking at 905 mg/dL. Growth parameters remained below the expected range for age and sex, indicating persistent growth failure. Laboratory tests highlighted uncontrolled diabetes, hypertriglyceridemia, and liver enzyme elevation. Endocrinological assessments revealed low testosterone levels with slightly altered FSH and LH, pointing to a hypogonadotropic pattern. The persistent high HbA1c levels (>10%) indicated poor glycemic control, complicating the patient’s liver condition and growth failure. The treatment regimen focused on intensive insulin therapy to manage diabetes, using combinations of NovoRapid, Tresiba, Ryzodec (aspart+degludec), and Apidra (Glulisine insulin). Lipid profile management included Lipanthyl (Fenofibrate) and Crestor (Rosuvastatin). Nutritional support was indicated with Nutrigen syrup aiming to address growth failure and possible micronutrient deficiencies. Despite the comprehensive management approach, challenges in achieving optimal glycemic control were apparent with the latest HbA1c at 9.7%. However, some improvement in liver enzymes and lipid profile was noted. Growth failure and delayed puberty remain significant concerns requiring ongoing multidisciplinary care. Conclusion This case underscores the complexity of managing rare complications of T1DM like extensive liver enlargement due to glycogen deposition, in conjunction with growth failure and delayed puberty. It highlights the necessity of an integrated therapeutic strategy focusing not only on glycemic control but also on the management of associated metabolic derangements and hormonal imbalances. Further research into targeted treatments for such rare complications is warranted. Managing patients with T1DM who develop rare complications such as extensive liver enlargement, growth failure, and delayed puberty is challenging. A holistic and tailored approach is essential for improving patient outcomes, underlining the crucial role of continuous monitoring, adjustment of therapeutic strategies, and multidisciplinary care.

Antioxidants in Age-Related Macular Degeneration: Lights and Shadows

Age-related macular degeneration (AMD) is a leading cause of vision impairment worldwide, primarily driven by oxidative stress and inflammation. This review examines the role of antioxidants in mitigating oxidative damage, emphasizing both their therapeutic potential and limitations in AMD management. Key findings underscore the efficacy of specific antioxidants, including vitamins C and E, lutein, zeaxanthin, and Coenzyme Q10, in slowing AMD progression. Landmark studies such as AREDS and AREDS2 have shaped current antioxidant formulations, although challenges persist, including patient variability and long-term safety concerns. Emerging therapies, such as mitochondrial-targeted antioxidants and novel compounds like saffron and resveratrol, offer promising avenues for AMD treatment. Complementary lifestyle interventions, including antioxidant-rich diets and physical activity, further support holistic management approaches. This review highlights the critical role of antioxidants in AMD therapy, advocating for personalized strategies to optimize patient outcomes.

Nusa Penida Diving: Visit Bali Waters to See Manta Rays

In nations with large archipelagos, marine ecotourism is becoming more popular. Ecotourism itself is a concept of tourism activities that contain elements of conservation. An integrated coastal management approach must be carried out comprehensively. This study aims to find out the challenges of marine ecotourism of special interest in Nusa Penida Bali Indonesia. The research was conducted in July 2024 using a survey method. The results showed that the challenges to marine tourism activities are getting bigger because there are so many foreign tourists who want to do diving and snorkling at Manta Point. There were 13 species of manta rays (Manta alfredi) found. Temperature is 29oC and salinity 33 ppt is ideal for Manta rays live. Management in ecotourism with manta rays must be integrated so that this achieve sustainable tourism

Rainfed agriculture in Ethiopia: a systematic review of green water management pathways to improve water and food security

It is widely acknowledged that the world is currently experiencing an unprecedented water shortage, with agriculture being a crucial contributor. This paper presents a synthesis of available evidence, identify knowledge gaps, and make a state-of-the-art synthesis on green water management in Ethiopia. A systematic review methodology was implemented, encompassing the compilation and analysis of peer-reviewed and gray literature. The paper demonstrates that rainfed agriculture, which relies on “green water” (soil moisture from rainfall), accounts for 80% of cultivated land and 60-70% of global crop production. However, green water management has not received adequate attention in water policy and land rehabilitation programs in Ethiopia, where irrigation is limited. The analysis reveals a large yield gap and water productivity gap for major crops like maize, sorghum, and wheat in Ethiopia’s rainfed agriculture. Increasing crop yields through better soil, water, and crop management practices can significantly improve water productivity, offering “windows of opportunity” to enhance food and water security. Thus, a paradigm shift from the traditional narrow focus on soil erosion control towards an integrated green-blue water management approach in water and agricultural policies and programs is urgently required. Increased investments and expertise in green water management at the government level are crucial. Optimizing the use of green water resources in rainfed farming can also unlock Ethiopia’s export potential while improving domestic water and food security through strategic virtual water trade. In conclusion, the review highlights unlocking the potential of green water resources through targeted investments and policy support for rainfed agriculture can significantly contribute to Ethiopia’s water and food security objectives in a cost-effective and environmentally sustainable manner.

Entrepreneurship-Based School Management Model to Increase Entrepreneurial Interest of Vocational Education Students at SMK Negeri 5 Padang

The purpose of this research project is to ascertain how the entrepreneurial-based managerial model that will be applied at SMK Negeri 5 Padang is seen by learners, educators, and administrators, as well as their expectations for how it will boost students' interest in business management. case study methodology combined with qualitative research. Data sources included learners, professionals, and administrator questionnaires at SMK Negeri 5 Padang as well as observation. It is thought that the entrepreneurship-based management approach can foster an environment in the classroom that encourages the growth of an entrepreneurial mindset. However, in order to increase student interest in entrepreneurship, dedication and support from all stakeholders—including better facilities—are required. Students' interest might be piqued in entrepreneurship by implementing a complete management model centered on entrepreneurship and bolstering infrastructure support.

Prevalence of Comorbidities and Racial Disparities in Anterior Uveitis Risk Among Ankylosing Spondylitis Patients

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the axial spine, commonly associated with extra-articular manifestations such as anterior uveitis (AU). Racial disparities have been observed in the prevalence of AU among AS patients, with African American individuals often experiencing higher frequencies compared to their white counterparts. Moreover, AS is linked with various comorbidities, contributing to increased morbidity and mortality. This study aims to investigate the prevalence of AU and associated comorbidities among AS patients, with a focus on racial differences. Methods: This retrospective study utilised data from the 2020 National Inpatient Sample (NIS) database, identifying adult patients with AS admitted to hospitals in the United States. Descriptive statistics were employed to analyse demographic characteristics and comorbidity prevalence. Multivariate analysis assessed the association between AU, race, comorbidities, and inpatient outcomes. Results: Our analysis revealed significant racial disparities in the prevalence of AU among AS patients. Patients with AU tended to be younger, with a mean age of 48 years versus a mean age of 60 in patients with AS without AU. Among patients with AS without AU, 82% were Caucasians and African Americans represented 6%. Among patients with AS with AU, Caucasians represented 71% and African Americans represented 18%. In terms of outcomes, patients with a history of AU exhibited similar inpatient mortality rates (less than 1%) compared to those without (3%). Acute kidney injury (AKI) was more prevalent among patients with AU (24%) versus those without (16%) but was not statistically significant. The comorbidities commonly associated with AS include hypertension, both complicated (23%) and uncomplicated (40%), along with diabetes presenting with and without chronic complications at rates of 17% and 11%, respectively. Conclusion: Our study underscores the need for further research to elucidate the relationships between AS, AU, and comorbidities, particularly in the context of racial disparities. Improved risk assessment and early detection strategies tailored to the African American population are crucial for facilitating timely diagnosis and targeted treatment interventions for AS. Addressing these disparities and advocating for proactive management approaches can help mitigate healthcare inequities and enhance overall health outcomes for African American AS patients.

More than just a broken limb: Unmasking CRPS in Pakistan

Madam, Complex Regional Pain Syndrome (CRPS) is a debilitating pain disorder, usually affecting one limb, and occurring after a trauma. It is marked by intense pain out of proportion to the severity of the initial injury. Because CRPS is a rare condition, its pathophysiology, diagnosis, and treatment are not completely understood. The pathophysiology might involve an interplay between inflammation, genetics, nervous system changes, and psychological influences1. Despite the challenges in diagnosis, the currently accepted diagnostic criteria is the Budapest Criteria, established after revising the previous IASP Criteria which led to overdiagnosis.2 Once CRPS is identified, therapy can be just as complicated. The UK Royal College of Physicians outlines a multidisciplinary approach based on each patient’s individual needs.3 This involves patient education, utilizing intervention and medications for the pain, physical rehabilitation, and psychological intervention. Each of these elements is equally important for recovery. Older studies indicate a significant delay in CRPS diagnosis, with patients waiting an average of 4 years.4 The lack of knowledge among physicians, unnecessary surgeries, and the belief that patients might be exaggerating about their pain, all contribute to a delayed diagnosis. This leads to a further decline in limb function, muscle wasting, difficulty in performing everyday activities, and eventually, social isolation. To improve the understanding of CRPS in low-resource settings with limited patient data, Lewis et al. presented a global series from 9 different countries, including Pakistan.5 Despite being the world’s 5th most populous country, Pakistan lacks sufficient CRPS prevalence and presentation data. Out of the identified patients, only 16% were diagnosed according to the globally recognized Budapest criteria, and for 65% of patients, only pharmacological intervention was used. The essential multidisciplinary approach was rarely used. This highlights several issues that need to be resolved. This letter calls for localized research to help refine management protocols tailored to the Pakistani population. By raising awareness about the clinical features of CRPS and the consequences of neglect towards patients, we can promote timely diagnoses and avoid long-term complications. Physicians need to build trust with their patients and make them feel heard. CRPS is a complicated condition, so a culture of strict adherence to standardized diagnostic and management approaches must be created. Integration of said protocols into the healthcare curriculum is also essential. This comprehensive approach requires immediate implementation to improve quality of life and reduce unnecessary suffering.

Police Management and Community Policing: A Case Study from Scotland

This paper reports on a case study of police management in Scotland and its focus on orientating the service toward community policing and away from a target-driven approach. Contemporary police report and planning documents are analyzed to chart this shift in orientation towards what is referred to as New Public Governance (NPG) This involves a focus on the public good and represents moving beyond the previous target-driven approach of New Public Management (NPM). New Public Governance stresses community involvement and the co-creation of objectives between professionals and the public they serve. The study examines the extent to which the police service in Scotland is, through formal reporting structures, seeking to align with NPG and if there are vestiges of the NMP approach. A discourse analytic methodology is adopted which examines the rhetorical nature of the documents. The focus of the analysis is the extent to which these public-facing documents represent an attempt to convey police acceptance and enthusiasm for NPG, or if they can be considered as attempts to bolster public confidence and police legitimacy. The ambivalent nature of the discourse in the documents is examined in terms of the adoption of both NPG and NPM through references to key aspects of these managerial approaches, including a focus on the setting of policing objectives through community co-creation in the case of the latter, and stress upon outcomes and measurable outcomes about the former.

A Novel Approach for the Counting of Wood Logs Using cGANs and Image Processing Techniques

This study tackles the challenge of precise wood log counting, where applications of the proposed methodology can span from automated approaches for materials management, surveillance, and safety science to wood traffic monitoring, wood volume estimation, and others. We introduce an approach leveraging Conditional Generative Adversarial Networks (cGANs) for eucalyptus log segmentation in images, incorporating specialized image processing techniques to handle noise and intersections, coupled with the Connected Components Algorithm for efficient counting. To support this research, we created and made publicly available a comprehensive database of 466 images containing approximately 13,048 eucalyptus logs, which served for both training and validation purposes. Our method demonstrated robust performance, achieving an average Accuracypixel of 96.4% and Accuracylogs of 92.3%, with additional measures such as F1 scores ranging from 0.879 to 0.933 and IoU values between 0.784 and 0.875, further validating its effectiveness. The implementation proves to be efficient with an average processing time of 0.713 s per image on an NVIDIA T4 GPU, making it suitable for real-time applications. The practical implications of this method are significant for operational forestry, enabling more accurate inventory management, reducing human errors in manual counting, and optimizing resource allocation. Furthermore, the segmentation capabilities of the model provide a foundation for advanced applications such as eucalyptus stack volume estimation, contributing to a more comprehensive and refined analysis of forestry operations. The methodology’s success in handling complex scenarios, including intersecting logs and varying environmental conditions, positions it as a valuable tool for practical applications across related industrial sectors.

Beyond Soil Health: The Microbial Implications of Conservation Agriculture

Conservation agriculture (CA) is a sustainable land management approach to improve soil quality while mitigating degradation. Although extensive information regarding the effect of CA on soil properties and microbiome is available, complete studies on the cumulative effect on specific interactions between soil parameters, crop productivity, and microbial communities over time are still lacking, mainly in arid regions. Thus, this study aimed to investigate the effects of no-tillage and residue retention over long- and short-term (24 and 3 years, respectively) periods. Six treatments were established in a maize–oat–triticale system from 1995 in a semiarid region: P + H—plow + harrow; H—harrow; MP—multi-plow (short-term); NT—no-tillage; NT33—NT + 33% residue surface cover (long-term); NT66—NT + 66% residue surface cover. Results indicated that CA improved soil quality by increasing soil organic matter (SOM), total carbon, and glomalin; it also enhanced microbial abundance, particularly fungi, and β-galactosidase activity. Nevertheless, conventional tillage practices led to SOM degradation and reduced crop yields. Principal component analysis revealed distinct groupings of treatments based on soil properties and microbial communities. Furthermore, changes could be detected from the short term. These findings highlight the importance of adopting sustainable agricultural practices to maintain soil health and ensure agricultural productivity in semi-arid regions.

Diagnosis and Management of Hypertensive Heart Disease: Incorporating 2023 European Society of Hypertension and 2024 European Society of Cardiology Guideline Updates

Hypertensive heart disease (HHD) continues to be a leading cause of cardiovascular morbidity and mortality worldwide, necessitating the evolution of evidence-based management strategies. This literature review examines the most recent updates from the 2023 and 2024 hypertension guidelines issued by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). These guidelines are compared with previous key recommendations, such as the 2017 American College of Cardiology/American Heart Association guidelines and the 2018 ESC/ESH guidelines. The updated recommendations reflect a paradigm shift in the approach to hypertension diagnosis and management, including a stricter systolic blood pressure (BP) target of 120–129 mmHg, which underscores the importance of early and precise BP control. The difference between the classification of “elevated BP” and hypertension in the ESC versus ESH guidelines, particularly, regarding their implications for early detection and prevention of HHD, are critically examined, highlighting areas of clinical and academic debate. The introduction of a new “elevated BP” category (120–139/70–89 mmHg) highlights a proactive strategy aimed at identifying at-risk individuals earlier in the disease course to prevent progression to HHD. Additionally, the divergent roles of hypertension-mediated organ damage (HMOD), including HHD, in risk stratification as recommended by the ESC and ESH are discussed, emphasising their significance in tailoring management approaches. For patients with resistant hypertension, the 2023 and 2024 updates also endorse innovative therapies, such as renal denervation, an interventional procedure that has demonstrated significant promise in managing treatment-resistant cases. This review synthesises these updates, focusing on their implications for clinical practice in diagnosing and managing HHD. By emphasising aggressive intervention and the integration of novel treatment modalities, the review aims to bridge existing gaps in earlier approaches to hypertension management. The critical evaluation of guideline discrepancies and evolving evidence seeks to provide clinicians with a nuanced understanding to optimise outcomes for patients with HHD, particularly considering emerging therapeutic possibilities and more stringent BP control targets.

SARS-CoV-2 Infection and the Risk of New Chronic Conditions: Insights from a Longitudinal Population-Based Study

Background: The post-acute impact of SARS-CoV-2 infections on chronic conditions remains poorly understood, particularly in general populations. Objectives: Our primary aim was to assess the association between SARS-CoV-2 infections and new diagnoses of chronic conditions. Our two secondary aims were to explore geographic variations in this association and to assess the association between SARS-CoV-2 infections and the exacerbation of pre-existing conditions. Methods: This longitudinal study used data from 8086 participants of the Specchio-COVID-19 cohort in the canton of Geneva, Switzerland (2021–2023). Mixed-effects logistic regressions and geographically weighted regressions adjusted for sociodemographic, socioeconomic, and healthcare access covariates were used to analyze self-reported SARS-CoV-2 infections, new diagnoses of chronic conditions, and the exacerbation of pre-existing ones. Results: Participants reporting a SARS-CoV-2 infection were more likely to be diagnosed with a new chronic condition compared to those who did not report an infection (adjusted odds ratio [aOR] = 2.15, 95% CI 1.43–3.23, adjusted p-value = 0.002). Notable geographic variations were identified in the association between SARS-CoV-2 infections and new diagnoses. While a positive association was initially observed between SARS-CoV-2 infections and exacerbation of pre-existing chronic conditions, this association did not remain significant after adjusting p-values for multiple comparisons. Conclusions: These findings contribute to understanding COVID-19’s post-acute impact on chronic conditions, highlighting the need for targeted health management approaches and calling for tailored public health strategies to address the pandemic’s long-term effects.

Effectiveness of Tralokinumab in Different Phenotypes of Atopic Dermatitis: A Real-World Study.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus and a relapsing course, affecting approximately 25% of children and 4-7% of adults. This study evaluated the efficacy, safety, and quality-of-life impact of tralokinumab, a humanized monoclonal antibody targeting interleukin-13 (IL-13), in treating moderate-to-severe AD in a real-world setting, with a focus on different AD phenotypes. An observational cohort of 30 adults treated with tralokinumab for ≥ 16weeks was analyzed. Clinical and demographic data were collected, and outcomes were assessed using the Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), and numeric rating scales (NRS) for pruritus and sleep disturbances. By week16, 60% achieved a 75% improvement inEASI (EASI75)and 31% reached a 90% improvement inEASI (EASI90), reflecting substantial clinical improvements. A ≥ 4-point reduction in pruritus NRS was observed in 63% of patients by week16, increasing to 70% by week32. Similarly, 75% achieved significant improvements in sleep disturbance NRS by week16, with sustained effects through week32. Subgroup analysis revealed superior clinical responses in patients with early-onset AD and atopic comorbidities. Lower total immunoglobulinE (IgE) levels at week16 correlated with better outcomes, suggesting total IgE as a potential biomarker. By week32, 70% of patients had a DLQI ≤ 5, indicating minimal quality-of-life impact. Additionally, 88% reached at least one therapeutic target, and 81% met composite endpoints combining clinician-assessed and patient-reported outcomes. The safety profile was consistent with clinical trials, with mild conjunctivitis and injection site reactions as the most common adverse events. These findings support tralokinumab as an effective and well-tolerated treatment, emphasizing the importance of phenotype-specific approaches in AD management.

Correlates of Inaccuracy in Reporting of Energy Intake Among Persons with Multiple Sclerosis

Background/Objectives: Persons with multiple sclerosis (MS) are interested in diet as a second-line approach for disease management. This study examined potential variables that correlate with inaccuracy of self-reported energy intake (EI) in adults with MS. Methods: Twenty-eight participants completed two assessment appointments within a 14-day period that included a standard doubly labeled water (DLW) protocol for estimating total energy expenditure (TEE). The participants reported their EI using the Automated Self-Administered 24 h (ASA24) Dietary Assessment Tool. The primary variables of interest for explaining the discrepancy between TEE and ASA24 EI (i.e., inaccuracy) included cognition (processing speed, visuospatial memory, and verbal memory), hydration status (total body water), and device-measured physical activity. Pearson’s correlations assessed the association between absolute and percent inaccuracy in reporting of EI with outcomes of interest, followed by linear regression analyses for identifying independent correlates. Results: California Verbal Learning Test—Second Edition (CVLT-II) z-scores and light physical activity (LPA) were significantly associated with mean absolute difference in EI (r = –0.53 and r = 0.46, respectively). CVLT-II z-scores and LPA were the only variables significantly associated with mean percent difference in EI (r = –0.48 and r = 0.42, respectively). The regression analyses indicated that both CVLT-II and LPA significantly explained variance in mean absolute difference in EI, and only CVLT-II explained variance for percent difference in EI. Conclusions: The results from this study indicate that verbal learning and memory and LPA are associated with inaccuracy of self-reported EI in adults with MS. This may guide timely research identifying appropriate protocols for assessment of diet in MS.

From Dysbiosis to Disease: The Microbiome’s Influence on Uveitis Pathogenesis

Abstract: The microbiome, comprising the diverse microbial communities inhabiting the human body, has emerged as a critical factor in regulating immune function and inflammation. The relationship between the microbiome and uveitis represents a promising frontier in ophthalmological research, with the microbiome increasingly implicated in disease onset and progression. Research has predominantly focused on the gut microbiome, with animal studies providing evidence that dysbiosis is a key factor in autoimmunity. As the understanding of the microbiome increases, so does the potential for developing innovative treatments that leverage the microbiome’s impact on immune and inflammatory processes. Future research will be crucial for deciphering the complexities of the interaction between the microbiome and immune system and for creating effective microbiome-based therapies for those with uveitis. Incorporating microbiome research into clinical practice could transform how uveitis is managed, leading to better and more individualized approaches for management. This review discusses the current understanding of the microbiome–uveitis axis, the promise of microbiome-based diagnostics and therapeutics, and the critical need for large-scale, longitudinal studies. Unlocking the potential of microbiome-targeted approaches may revolutionize the management of uveitis and other inflammatory diseases.

The Mediating Role of Trust in Manager in the Effect of Workload on Job Stress in Emergency Health Services

Workload is the number of activities an employee or organizational structure must complete using its skills and potential. Job stress is a harmful physical and emotional reaction that can occur when an employee faces job demands and pressures unrelated to knowledge, skills, and abilities, making it difficult to cope. Trust in managers is based on the idea that employees believe that their managers will keep their word and have a consistent, fair, and egalitarian managerial approach without any discrimination among employees. This study aims to determine the mediating role of trust in managers in the effect of workload on job stress in emergency health services (EHS). There is no study in the literature examining the relationship between workload, job stress, and trust in managers in EHS. The use of trust in managers as a mediating variable in the study contributes to the originality of the study. A cross-sectional research design was used in the study. A questionnaire was applied to 372 people working in EHS in a province in Turkey. Descriptive statistical methods, Pearson correlation analysis, and PROCESS macro Model 4 were used in regression analysis. Workload has a negative effect on job stress. However, this negative effect does not increase when trust in managers is used as a mediating variable. In other words, there is no mediating effect of trust in managers on the effect of workload on job stress. The workload of EHS employees’ leads to job stress. However, trust in the manager does not affect job stress. EHS managers should consider that workload can lead to job stress. The negative relationship between employees' trust in management and workload and job stress should be considered. Determining the optimal workload for healthcare workers and ensuring fairness in the distribution of tasks can reduce job stress and insecurity.