Early effects of scheduling gabapentin on medication adherence among epilepsy patients on gabapentin in Virginia.

Epidemiological characterization of fowl adenovirus in China from 2021 to June 2025.

This study examines the COVID-19 experiences of K-12 school campus directors, especially in terms of building and grounds, transportation, and food services from the Midwestern United States. The COVID-19 pandemic has changed to online education mode and implemented safety protocols to ensure equitable access to K-12 education. School directors play a crucial role in United States’s school administration. The researchers used a mixed method research design and purposive sampling. The sample included 9 school-grounds directors, 34 food service directors, and 31 transportation directors. A 5-point Likert-type questionnaire was prepared by the researchers to collect the relevant data for the study. The data were analyzed using descriptive statistics and thematic analysis. While revealing their experiences, various school directors mentioned that key challenges are reliable sources of information for them to work, inequities in resource allocation, finance allocation, and lack of professional training. The survey highlighted the need for several resources, including federal and state funding, teacher professional development programs, and community partnerships that support K-12 education. School directors addressed challenges regarding transportation, buildings, grounds, and food services during COVID-19. The study revealed the need for systemic policy changes and communication resources to create resilient and adaptive learning environments for K-12 education. Eventually, the study recommended that policymakers and educational leaders bring changes to K-12 infrastructure to withstand crises like COVID-19.

With the rapid advancement of Internet of Things (IoT) and the growing complexity of network infrastructures, the traditional network management model based on manual configuration is no longer able to meet the dynamic IoT secure communication requirements. Intent-based networking (IBN) significantly improves network manageability and agility by driving network automation through high-level business intent. However, policies in IBN are highly dynamic, and issues such as frequent changes in user intent, role or attribute adjustments, and ad-hoc access requirements in multi-tenant environments make it necessary for the system to quickly adapt to policy changes to ensure secure data sharing. Attribute-based encryption has become a key enabler for securing IoT communications, offering fine grained access control and adaptability to users’ dynamic access requirements in real time. In this paper, we propose an attribute-based access control supporting policy reconfiguration (ABACPR) for the highly dynamic nature of policies in IBN, aiming to improve the flexibility and efficiency of policy updating and ensure the security and consistency. Finally, We compared the theoretical and experimental analysis with related works and the results demonstrate that ABACPR is better suited for secure IoT communication in IBN.

European states have set ambitious targets to meet their climate goals and decarbonize their energy sector. These included development plans for the marine environment, knowing its potential in harnessing Offshore Renewable Energy (ORE) through wind, wave and tidal resources. The latter is becoming highly attractive due to its predictability, reliability and potential to answer communities' energy needs, but it is still associated with several challenges that are often overlooked. This paper aims to identify the barriers and drivers for tidal energy development in Ireland following the recent policy changes. This is done through semi-structured interviews with key local and regional stakeholders in the ORE field, which are analysed following Braun and Clarke's Thematic Analysis approach. The main challenges for tidal energy development revolve around the uncertainties and dynamic nature surrounding the existing regulatory framework in terms of marine spatial planning and planning processes, in addition to the technology's high cost, limited competitiveness and lack of resources in state agencies and departments. Moreover, community objections, socio-economic interests and supply chains issues play a key role in project delays. Nevertheless, the technology offers undervalued advantages in terms of its predictability and reliability, particularly in remote and island communities. Interviews revealed the need to provide better clarity and faster action at all levels of the ORE value chain. This cannot happen without providing incentives, enhancing awareness and community participation, and ensuring environmental sustainability. As the identified barriers represent typical challenges encountered in other country-cases, Ireland can learn from leading EU and international countries to enable projects’ commercialization, and can also lead by example for similar island nations. • This paper examines the barriers and drivers for tidal energy development using the Republic of Ireland as a case study following the Government decision to shift from a developer-led to a plan-led approach. • A thematic analysis approach through semi-structured interviews with key public and private stakeholders in the ORE field was followed. • Tidal Energy offers undervalued advantages such as predictability and reliability, particularly in remote and island communities. • Qualitative interviews highlighted the need for more clarity at all levels of ORE development in future years, and underscored the dynamic and interconnected nature of ORE policies in Ireland. • Ireland is well positioned to learn from EU and international experience to enhance tidal and ORE potential and lead as an example for other island nations.

The State of Palliative Care in Nigeria: A Scoping Review.

Investigating the utility of each MELD edition in predicting liver transplant outcomes.

Changes in national allocation policy and regulatory practices have led to increases in cold ischemia time (CIT) and out-of-sequence allocation (AOOS) or expedited placement (EP) of deceased donor kidney transplants in the United States. The aims of this study were to gauge the clinical relevance of the increased CIT that accompanied kidney allocation system (KAS) 250 NM (KAS250), and to measure CIT for AOOS or EP kidneys. The United Network for Organ Sharing (UNOS) data from 2007 to 2023 were analyzed across pre-KAS, KAS, and KAS250 eras. The impact of CIT on kidney graft survival and the CIT of kidneys undergoing AOOS or EP during these eras was assessed. Median CIT increased from 16 hours to 19.6 hours, and the incidence of AOOS or EP increased from 0.5% to 13%. Transplants with CIT of 32 to 36 hours had a 10% increase in overall graft loss compared with CIT of 16 to 20 hours (P = 0.0002). For kidney donor profile index (KDPI) 20% to 34% and 35% to 85% groups, every additional hour of CIT increased the risk of graft failure by 0.5% (P = 0.0019) and 0.4% (P < 0.0001), respectively. In the KAS250 era, CIT was 4 hours longer for AOOS or EP kidneys (P < 0.0001). In addition, AOOS or EP kidneys with KDPI > 85% declined from 9% to 7%, whereas AOOS or EP kidneys with KDPI < 20% increased from 13% to 15% (P = 0.0306). Current allocation practices do not prioritize CIT. Extended CIT is associated with inferior long-term graft survival. AOOS or EP is designed to prevent discards but does not currently target high KDPI kidneys. Our data provide a framework to assess the relative importance of CIT in allocation policy.

From anti-reflexive politicization to anti-reflexive policies: The emergence of renewable exclusion zones in United States environmental policy

To provide an in-depth description of an innovative Doctor of Nursing programme which prepares nurses for senior roles in healthcare and related organisations. This programme provides nurse leaders with the knowledge and skills to advance systems through healthcare innovation design, implementation, and evaluation. A comparison of doctoral nursing programmes, highlighting the unique aspects of the University of Calgary Doctor of Nursing programme. The University of Calgary Doctor of Nursing programme addresses key gaps that currently exist within nursing education. Few existing programmes directly support the development of nurses as healthcare leaders and innovators. This programme enables nurse leaders to leverage their front-line experience into senior system-level leadership roles. Each core course includes a building block assignment that develops key doctoral skills: framing research questions, appraising literature, selecting methods and data, planning ethically sound projects, and translating evidence into persuasive arguments for policy or system change. Nurses play a vital role in healthcare around the world. The University of Calgary Doctor of Nursing programme recognises the value of investing in nursing leaders and emboldening them to leverage their frontline leadership experience to advance data-driven change, innovation, and policy development in the complex healthcare systems in which they work and lead. Currently, there is a dearth of programmes available to prepare nurses for senior leadership roles in healthcare or related organisations, despite significant demand from prospective students and employers alike. The University of Calgary Doctor of Nursing programme meets the workforce demand for a programme focused on nursing leadership, to advance health systems through skill development in systems innovation, appraisal of evidence and implementation science, as well as quality assurance/quality improvement and programme evaluation. This programme focus also better equips students to examine and evaluate systemic inequities and challenges currently facing healthcare systems, practitioners and users.

Civil Society Organisations (CSOs) and Non-Governmental Organisations (NGOs) have long supported public health programs by delivering services, raising awareness, and advocating for policy change. Despite their key role in addressing complex health issues like HIV and COVID-19, their involvement in antimicrobial resistance (AMR) strategies remains underexplored. This study reviews how CSOs and NGOs are framed within AMR National Action Plans (NAPs) to better understand their role in mitigating AMR. Policy review. A content analysis of publicly available AMR NAPs was conducted using key terms related to CSOs and NGOs. Relevant excerpts were coded across seven focus areas of engagement, with multiple reviewers to ensure consistency. Data were analysed thematically to identify patterns in CSO and NGO involvement across countries. Of the 194 WHO member states, 129 (63%) AMR National Action Plans (NAPs) were available and reviewed, with 27% inclusive of 2025. References to CSOs appeared in 40% of NAPs, and NGOs in 51%, though the extent and specificity of their roles varied widely. CSO involvement was most commonly associated with advocacy, particularly in low-and-middle-income countries (LMICs), while education, prevention, surveillance, and resource mobilisation were less frequently addressed. Participation in government committees and policy-making was limited. The study revealed that referenced CSO and NGO involvement is often broad and lacks specificity. These findings underscore the need for more precise and context-specific inclusion of CSOs in AMR strategies to enhance their contribution to policy implementation and community-level action.

In October 2020, the United States Patent and Trademark Office (USPTO) introduced an automated process for routing new patent applications, in part to increase examiner specialization. In this research note, we first assess whether the USPTO achieved this objective using a difference-in-differences (DiD) research design on a sample of applications assigned to examiners between 2018 and 2021. The new routing system increased technical overlap between examiner work histories and newly assigned cases by 57 percent, indicating a substantial increase in examiner specialization across the agency. In addition, we show that automated routing — largely unknown in the academic literature — effectively eliminated quasi-random assignment of applications to examiners. Given the importance of quasi-random assignment for empirical research, we discuss our findings within this context and potential impact on future research. • In 2020, the USPTO introduced an automated routing system for applications to examiners. • The 2020 policy change increased examiner specialization by over 50%. • Specialization gains occurred broadly across Technology Centers and Art Units. • Automated routing effectively ended quasi-random assignment of patent applications to examiners.

In February 2022, Thailand transitioned from a 14-year "peritoneal dialysis (PD)-first" policy to a "patient-choice" model, allowing unrestricted modality selection. This study evaluated the patient- and system-level impacts of this policy change on access, providers, expenditure, and outcomes. We linked nationwide administrative datasets (2018-2024). System-level trends in dialysis prevalence, incidence, and mortality were evaluated using interrupted time-series analysis. We further examined the program expenditure and shifts in care provision between the public and private sectors. For incident patients, we compared demographics, unplanned initiations, and hemodialysis (HD) vascular access use. All-cause mortality was modelled using multivariable Cox proportional hazards models, adjusting for key covariates. Following the policy shift, dialysis utilization expanded rapidly; HD replaced PD as the dominant modality, driving increased incidence. Provision shifted to private providers, accompanied by more unplanned starts and prolonged use of temporary catheters. Expenditure increased by 74% from 2018, reaching USD 452 million in 2024. This accounted for 9.3% of the national health budget in a country with a GDP per capita of USD 7350. All-cause mortality increased, particularly within the first 90 days of treatment. Postpolicy initiation was associated with higher mortality, as were unplanned initiation, older age, and comorbidities. The reform resulted in rapid service expansion, requiring a substantially higher proportion of public funding and correlating with increased mortality. These findings underscore the importance of refining policy implementation strategies, including appropriate patient selection and implementing robust safeguards to ensure the integrity and sustainability of the national health system.

RF93. Kidney After Heart versus Simultaneous Heart-Kidney Transplantation: Perioperative Outcomes since the 2023 Safety Net Policy Change

Subject. This article discusses the impact of changing conditions in the external and internal environment on the financial and economic performance of PAO Inter RAO in 2020–2024. Objectives. The study aims to analyze the features of the operation of Russia's largest energy company, PAO Inter RAO, in the context of economic transformation. Methods. For the study, we used the methods of horizontal and vertical analyses, comparative analysis, and ratio analysis of the company's indicators. Results. The article reveals that despite the introduction of extensive economic restrictions since 2022, PAO Inter RAO demonstrates a high degree of resilience. Conclusions. The combination of changes in revenue structure, investment and dividend policy, as well as liquidity management, forms a sustainable adaptive trajectory under conditions of external shocks and increasing geoeconomic pressure.

Background Occupational diseases affect many workers in the United States, with Latinos disproportionately affected. Small businesses face barriers to implementing workplace health protections that community health workers (CHWs) may help overcome. The objective of this study was to determine whether a CHW-led industrial hygiene intervention could reduce volatile organic compound (VOC) exposure in small auto repair and beauty shops that primarily employ marginalized workers. Methods In this two-arm, parallel, cluster randomized trial, small business (≤25 employees) auto repair and beauty shops in Tucson, AZ were randomized to immediate or delayed intervention, stratified by sector. CHWs assessed shops and provided knowledge of controls and $300 for new ones. Total VOCs (TVOCs) were measured using photoionization detectors placed on or near participants. The primary outcome was the change in TVOCs at the shop level after the intervention, assessed across three timepoints with four workshift measurements per assessment. Mixed-effects models accounted for clustering by shop. Results We enrolled 38 auto repair shops and 46 beauty shops (73% Latino workers) and analyzed 846 workshift measurements at 236 shop assessments. Adjusted models showed a non-statistically significant intervention effect: auto shops experienced on average an estimated 28% TVOC increase (95% CI: −46% to 203%); beauty shops experienced on average an estimated 27% reduction (95% CI: −55% to 19%). Beauty shops had TVOC concentrations about 10 times higher than auto shops, and 87% of their assessments had ventilation rates below the recommended minimum. Conclusions Although not statistically significant, the CHW-led intervention may meaningfully reduce VOC exposure in beauty shops. High TVOC concentrations and inadequate ventilation in beauty shops highlight the need for targeted interventions and policy changes to improve the air quality in these underserved small businesses. Trial registration This trial was registered with clinicaltrials.gov ( NCT03455530 ) on March 6, 2018.

Abstract Background Digital technologies, such as equipment localization systems, can help clinics use mobile devices more efficiently. Their successful implementation, however, depends not only on technical feasibility but also on how staff and patients perceive and understand these systems. Objective This research used 2 complementary studies to (1) obtain an initial picture of clinic staff attitudes toward the localization of vacuum-assisted closure (VAC) pumps and related concerns and (2) examine whether a simple layout change in a privacy policy (using guiding questions vs standard text) is associated with greater subjective understanding and acceptance among potential patients. Methods In study 1, 38 employees of a German clinic completed a short survey assessing their comfort with and perceived usefulness of VAC pump localization and answered an open-ended question about reservations or concerns. Quantitative responses were analyzed descriptively, and free-text answers were coded using qualitative content analysis. In study 2, 498 participants from an online sample took part in a preregistered experiment. They were randomly assigned to read either a standard privacy policy information sheet or an otherwise identical version supplemented with guiding questions. Subjective understanding of the information and acceptance of the policy were then assessed and analyzed using rank-based regression models controlling for sociodemographic covariates. Results Clinic staff in study 1 generally reported high levels of comfort (mean 7.34, SD 2.75) and perceived usefulness (mean 7.29, SD 2.69) regarding localization on 0‐10 scales. Concerns centered mainly on implementation feasibility, technical reliability, costs, and possible additional workload, rather than on privacy. In study 2, subjective understanding was slightly higher in the guiding-question layout condition than in the standard layout condition (mean 3.37, SD 0.63 [n=248] vs mean 3.24, SD 0.68 [n=250]); this difference was also significant in the rank-based regression model (b=0.13, SE=0.05, t =2.57; P =.01), and better understanding was associated with higher acceptance of the policy, explaining about 13.8% of the variance in acceptance scores. Conclusions The exploratory findings suggest that, in the context of VAC pump localization, clinic staff generally view equipment tracking positively while still raising practical concerns that should be addressed during implementation. For potential patients, relatively small changes in the layout of privacy information—such as adding guiding questions—may support subjective understanding and willingness to accept data collection.

A mastery-oriented motivational climate focused on personal improvement, teamwork, and effort is linked to positive outcomes among young athletes, whereas a performance-oriented climate centered on social comparison and displaying superiority is associated with adverse outcomes. However, little is known about how these climates change during key developmental transitions in sport. This study examined changes in athletes’ perceptions of coach- and peer-created motivational climates during the children-to-youth sport transition (CYT) in Norway, a period characterized by policy changes, increased competitiveness, and greater specialization. We followed athletes through this transition by collecting data on three separate occasions, each approximately six months apart. In total, 425 soccer and handball players aged 11-14 (Mage at time one = 12.16; 47.1% girls) participated in the study, and latent growth curve modeling was used to study changes over time. The results showed a small decline in coach-created mastery climate, along with large increases in coach-created performance climate and moderate increases in peer-created performance climate during the CYT. Notably, decreases in coach-created mastery climate corresponded with rises in coach-created performance climate. Gender differences emerged, with girls showing sharper increases in coach-created performance climate. These findings highlight the value of monitoring climate changes and suggest that targeted initiatives, such as coach training and the promotion of positive peer norms, may support the maintenance of mastery cues as athletes transition to youth sports.

Background/Aim: The COVID-19 pandemic disrupted healthcare systems, affecting pregnant women's access to routine antenatal care. Changes in health policies and heightened anxiety may have influenced care utilization and outcomes. This study aimed to assess the pandemic's impact on antenatal attendance and compare pregnancy and neonatal outcomes with the pre-pandemic period in a tertiary center. Methods: We retrospectively included all women who delivered at Ankara Training and Research Hospital between September 2020 and January 2021 (pandemic period) and those who delivered between September 2019 and January 2020 (pre-pandemic control). Pregnancies with any documented SARS-CoV-2 infection were excluded. Demographics, number of antenatal visits, antenatal screening tests, obstetric complications, and perinatal outcomes were compared. Results: A total of 532 women delivered during the pandemic and 650 before the pandemic. The cesarean section rate was higher during the pandemic (40.4% vs 33.8%; P=0.020), with a higher primary cesarean rate (18.4% vs 11.2%; P&lt;0.001). Antenatal visit categories were &lt;4, 4–10, and &gt;10 visits for pandemic vs pre-pandemic groups as follows: 39.4% vs 38.5%, 36.8% vs 42.1%, and 23.8% vs 19.4%, respectively (overall comparison P=0.087). While not statistically significant, there was a trend toward fewer women having 4–10 visits and more having &gt;10 visits during the pandemic. Antenatal screening tests (Down syndrome screening, gestational diabetes screening, and second-trimester anomaly screening) were performed more frequently during the pandemic (all P&lt;0.05). The mean gestational age at delivery was higher during the pandemic (39.25 (1.42) vs 38.65 (2.84) weeks; P&lt;0.001), with fewer preterm (&lt;37 weeks) births and more post-term (&gt;41 weeks) births (P=0.012). Other neonatal outcomes were comparable, except for a small but statistically significant difference in 1-minute Apgar scores (9.02 (0.71) vs 9.10 (1.19); P=0.001). Conclusion: During the pandemic, overall antenatal attendance did not differ significantly from the pre-pandemic period, although screening tests were utilized more frequently and cesarean delivery was more common. Despite these changes, pregnancy and neonatal outcomes were largely similar between periods.

Rates of teen use of cannabis increased following legalization, and continued to increase after retail sales became legal (including for teens), but then decreased after the COVID‐19 pandemic, researchers have found. This suggests that societal disruptions as well as changes in cannabis policy affect adolescent cannabis use. The researchers concluded that universal screening should exist for teen cannabis use.