Complex Situations Research Articles

DO CFOs HAVE HEARTS? A REVEALING PHENOMENOLOGICAL INTERVIEW

This article sought to understand how Chief Financial Officers (CFOs) deal with feelings and emotions. Criticized for their strictly positivist view while reconciling scarce resources and diverse needs, financial directors are recognized for their coldness in dealing with sensitive issues such as massive layoffs, benefits, and investments cuts, referring to the numbers through a results-oriented perspective. Through an interview with a financial director using the phenomenological approach, it was possible to reveal little-known aspects of these professionals, related to the management of their feelings and emotions. The answers, based on her real experience, confirm the perceptions of the author, also a financial manager, that statements of positive emotions are better accepted than negative ones, not only in the finance area, but in the corporate environment in general. The importance of a supportive net and gender issues also appeared, such as the connection between feelings and weakness, attributed to women. Finally, the ability to deal with complex situations and external factors through emotional intelligence and a calm and balanced approach constitutes valuable quality to be achieved, inspiring respect and credibility.

Mainstreaming anti-Semitism on Turkey’s public broadcaster TRT: Examining Payitaht: Abdülhamid

While conspiracy theories have traditionally received attention from the Turkish public and political elite, recently, however, they have proliferated when explaining complex situations. This paper examines conspiracy theories in Turkey and the role of entertainment media, specifically the popular period drama, Payitaht: Abdülhamid, in mainstreaming conspiracy theories. Payitaht: Abdülhamid, as an ideological state apparatus, repurposes anti-Semitism as salient conspiracy theories by creating scapegoats and existential others. This paper argues that the state uses entertainment media to disseminate conspiracy theories and, in effect, endorses anti-Semitism. As a result, anti-Semitism has transformed from a marginal movement to a mainstream movement.

Nutritional aspects in autoimmune diseases undergoing hematopoietic stem cell transplantation: overview and recommendations on behalf of the EBMT ADWP and Nurses Group

Autoimmune diseases (ADs) represent a heterogeneous group of conditions affecting 5–10% of the global population. In recent decades, hematopoietic stem cell transplant (HSCT), mainly autologous, has been successfully adopted to treat patients affected by severe/refractory ADs. In this context malnutrition has a detrimental impact on relapse, mortality, infection rate, engraftment, long-term survival, and prolongation of hospitalization. However, in this population, the management of nutrition should be improved since nutritional assessment is partially performed in routine clinical practice. A panel of nurses and physicians from the European Society for Blood and Marrow Transplantation (EBMT) reviewed all available evidence based on current literature and expert practices from centers with extensive experience in HSCT for ADs, on the nutritional management of ADs patients during HSCT procedure. In this context, adequate nutritional status predicts a better response to treatment and improves quality of life. Herein, a systematic and comprehensive monitoring of nutritional status before, during and after HSCT, with adequate nutritional support in the case of ADs patients, in addition to assessing the dietary requirements associated with HSCT has been covered. Moreover, given the singularity of each AD, the underlying disease should be considered for an appropriate approach. The management and evaluation of nutritional status must be carried out by a multidisciplinary team to assess the needs, monitor the effectiveness of each intervention, and prevent complications, especially in complex situations as patients affected by ADs.

Effect of high sodium ion level on the interaction of AmB with a cholesterol-rich phospholipid monolayer

Invasive fungal infections are a primary reason for high mortality in immunocompromised people, especially in critically ill patients, such as intensive care unit (ICU) patients, advanced cancer patients, or severe burn patients. Hypernatremia also can increase mortality in severely ill patients. Amphotericin B (AmB) is the gold standard for treating infections, but in severely ill patients, AmB can cause hematotoxicity when administered intravenously due to its interaction with cholesterol on red blood cell membranes. This results in limited doses of AmB and affects the treatment of infections. The proportion of cholesterol molecules in membrane lipids in red blood cells is as high as 50 mol%, and the sodium ions can influence the interaction between AmB and lipids on the membrane. Therefore, in the complex clinical situation of a severely ill patient with a fungal infection and hypernatremia, the interaction between amphotericin B and the red blood cell membranes is worth studying in depth. In this work, the interaction between AmB and the dipalmitoyl phosphatidylcholine (DPPC)/cholesterol mixed monolayer in the presence of high sodium ion levels was studied when the proportion of cholesterol was 50%. The results show that the effect of AmB on reducing the monolayer’s area at a high level of sodium ions is slightly stronger at 30 mN/m. The effect of AmB on reducing the elastic modulus of the DPPC/Chol monolayer is significantly weakened by a high sodium ion level, compared with the level of sodium ions at normal physiological concentration. The higher the sodium ion concentration, the weaker the intermolecular force of the DPPC/Chol/AmB mixed monolayers. The scanning electron microscope (SEM) and atomic force microscopy (AFM) observations suggest that at a high sodium ion level, the presence of AmB significantly reduces the surface roughness of the DPPC/Chol monolayer. AmB may bind to cholesterol molecules, and it isolates cholesterol from the monolayer, resulting in a reduced height of the cholesterol-rich monolayer and an increasingly dispersed monolayer region. The results are beneficial to understanding the mechanism of impact of a high sodium ion level on the relationship between AmB and red blood cell membranes rich in cholesterol and are valuable for understanding the hemolytic toxicity of AmB to red blood cells at a high sodium ion level.

ISOLATED ANKLE FUSION FOR FAILED TOTAL ANKLE ARTHROPLASTY USING A SPINE CAGE AND ANTERIOR PLATING CONSTRUCT

BackgroundTotal ankle replacements (TARs) are becoming increasingly more common in the treatment of end stage ankle arthritis. As a consequence, more patients are presenting with the complex situation of the failing TAR. The aim of this study was to present our case series of isolated ankle fusions post failed TAR using a spinal cage construct and anterior plating technique.MethodsA retrospective review of prospectively collected data was performed for 6 patients that had isolated ankle fusions performed for failed TAR. These were performed by a single surgeon (IW) between March 2012 and October 2014. The procedure was performed using a Spinal Cage construct and grafting in the joint defect and anterior plating. Our primary outcome measure was clinical and radiographic union at 1 year. Union was defined as clinical union and no evidence of radiographic hardware loosening or persistent joint lucent line at 1 year.ResultsThe mean follow-up was 37.3 months (SD 13.2). Union was achieved in 5 of the 6 patients (83%). One patient had a non-union that required revision fusion incorporating the talonavicular joint that successfully went on to unite across both joints. Another patient had radiographic features of non-union but was clinically united and asymptomatic and one required revision surgery for a bulky symptomatic lateral malleolus with fused ankle joint.ConclusionThe failing TAR presents a complex clinical situation. After removal of the implant there is often a large defect which if compressed leads to a leg length discrepancy and if filled with augment can increase the risk of non-union. Multiple methods have been described for revision, with many advocating fusion of both the ankle joint and subtalar joint. We present our case series using a spinal cage and anterior plating that allows preservation of the subtalar joint and a high rate of union.

Activities of religious creeds in culture and education in the Bielsko poviat district in the years 1918-1939

The Bielsko poviat is known to have had a complex denominational situation. Key denominations of the region included Catholics, Protestants and Jews. In the city Bielsko itself lived followers of all three religions. The relations across the various religions of the region were heavily influenced by the nationalities of the population. In the inter-war period there were twelve Catholic parishes, four Protestant churches and one Jewish community in the Bielsko poviat district. The article presents the cultural and educational activities in the Bielsko poviat district in the years 1918-1939 against the backdrop of the above-mentioned religious groups.

Cost-effective data classification storage through text seasonal features

Data classification storage has emerged as an effective strategy, harnessing the diverse performance attributes of storage devices and orchestrating a harmonious equilibrium between energy consumption, cost considerations, and user accessibility. As research on emerging storage media (e.g. Non-Volatile Memory (NVM)) delves deeper, in scenarios characterized by dynamically evolving storage demands, conventional paradigms of rigid classification strategy and Solid-State Drive (SSD) and Hard Disk Drive (HDD) storage architectures fall short of addressing such complex situations. In this paper, we propose an effective data classification storage method using text seasonal features based on the traditional access frequency analysis strategy. First, to procure richer semantic information, we employ external knowledge actualizing the short-text feature expansion. Then, we leverage the ensemble learning stacking method optimized models to improve the accuracy of data classification based on seasonal features. Additionally, following the seasonal feature, we further classify the data into hot, warm, and cold and place them separately on the NVM, SSD, and HDD, which conserves storage energy consumption and operational costs while ensuring the quality of user access. The experimental results demonstrate that data classification accuracy can reach more than 95.10%, and the energy consumption and operating cost can be reduced by more than 30.22% and 8.73%, respectively.

Digital Interventions to Understand and Mitigate Stress Response: Protocol for Process and Content Evaluation of a Cohort Study.

Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions for moral distress and moral injury are limited. This study has the following aims: (1) to characterize and reduce stress and moral distress related to decision-making in morally complex situations using a virtual reality (VR) scenario and a didactic intervention; (2) to identify features contributing to mental health outcomes using wearable, physiological, and self-reported questionnaire data; and (3) to create a personal digital phenotype profile that characterizes stress and moral distress at the individual level. This will be a single cohort, pre- and posttest study of 100 nursing professionals in Ontario, Canada. Participants will undergo a VR simulation that requires them to make morally complex decisions related to patient care, which will be administered before and after an educational video on techniques to mitigate distress. During the VR session, participants will complete questionnaires measuring their distress and moral distress, and physiological data (electrocardiogram, electrodermal activity, plethysmography, and respiration) will be collected to assess their stress response. In a subsequent 12-week follow-up period, participants will complete regular assessments measuring clinical outcomes, including distress, moral distress, anxiety, depression, and loneliness. A wearable device will also be used to collect continuous data for 2 weeks before, throughout, and for 12 weeks after the VR session. A pre-post comparison will be conducted to analyze the effects of the VR intervention, and machine learning will be used to create a personal digital phenotype profile for each participant using the physiological, wearable, and self-reported data. Finally, thematic analysis of post-VR debriefing sessions and exit interviews will examine reoccurring codes and overarching themes expressed across participants' experiences. The study was funded in 2022 and received research ethics board approval in April 2023. The study is ongoing. It is expected that the VR scenario will elicit stress and moral distress. Additionally, the didactic intervention is anticipated to improve understanding of and decrease feelings of stress and moral distress. Models of digital phenotypes developed and integrated with wearables could allow for the prediction of risk and the assessment of treatment responses in individuals experiencing moral distress in real-time and naturalistic contexts. This paradigm could also be used in other populations prone to moral distress and injury, such as military and public safety personnel. ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398. DERR1-10.2196/54180.

The Impact of Educational Attainment on Women's Empowerment: A Multidisciplinary Analysis

This study investigated the multiple relationships between the educational attainment and women's empowerment. It also examined how education helps women to gett knowledge, critical thinking, and the ability to struggle any complex situations. To empowers them in various aspects of life, including economic independence, social and political participation, and overall well-being. Secondary research methods was employed in this study which engage a multidisciplinary approach, analyzing the link through the eye of Human Capital and Feminist Theory examining how education challenges traditional gender roles and empowers women to advocate for themselves and their communities. The study has limited to current research and proposes a future direction which emphasized the need to consider cultural contexts, quality education and safety measures to maximize education's empowering potential for women across diverse situation.

Cinemeducation to teach patient safety: an experience in medical students

From early in medical school, students need to learn about patient safety, and how to prevent and reduce risks, errors and harm that occur to patients during health care provision. Cinemeducation is a teaching methodology that uses fragments of feature films or TV series in medical education. We hypothesized that cinemeducation could help simplify the comprehension of complex situations for students, aiding in the learning of patient safety and the understanding of human behaviors that impact it. This concept stands as an integral component within a comprehensive medical humanities approach. The study population was the 70 medical students of the second course of a six-year undergraduate program. In a 2-h class, after learning objectives were established, students watched a fragment from TV series The Resident centered on adverse events, and discussed them afterward. To measure learning achievements, we administered a 10-question multiple-choice pre and post-test and a 2-question open-essay post-test. Given the complexity of the concepts related to patient safety, we used a mixed quali-quantitative approach. An exploratory descriptive and content analysis was performed. Sixty-eight students participated and completed the questionnaires. Despite high pre-intervention scores, post-intervention scores improved (mean difference 0.779, 95% CI: 0.475–1.083, p < 0.001). The open-essay questions provided more information about the learning points, mostly related to the understanding of system error and preventive measures against adverse events. Classical teaching methods may be insufficient for learning how to deal with complex situations in hospital contexts. Our results show that cinemeducation may significantly improve learning on patient safety. Cinemeducation methodology can be effective in teaching some complex concepts in medical education. The integration of cinemeducation within medical education, through the lens of medical humanities, offers a dynamic approach to teaching patient safety. By using cinematic narratives to explore intricate medical scenarios, students engage with real-world complexities and the influence of human factor, enhancing their understanding.

HIV preventive practice and its associated factors among street dwellers in Ethiopia: Application of health belief model.

Street dwelling is the use of public space as a place of residence and nourishment for children, adolescents, and young people, revealing a complex and multifactorial situation. Moreover, homelessness facilitates HIV transmission and its progression due to the risky lifestyle of individuals. To the best of our knowledge, there is no study conducted in the study area on HIV preventive practices among street dwellers. The aim of this study was to assess HIV prevention practices and associated factors among street dwellers. A community-based cross-sectional study was conducted in Bahir Dar City from March 12, 2023 to April 30, 2023. By using the simple random sampling technique, 424 street dwellers were recruited. Bivariable and multivariable logistic regression were used for analysis. The magnitude of HIV preventive practice among street dwellers was 35.9%. Being male (AOR = 0.23, 95% CI: 0.10, 0.55), educational status (AOR = 7.53, 95% CI: 2.20, 25.6), practice of sex to earn money (AOR = 0.18, 95% CI: 0.08, 0.44), good knowledge about HIV preventive practice (AOR = 2.83, 95% CI: 1.46, 5.49), perceived susceptibility for HIV (AOR = 0.90, 95% CI: 0.81, 0.99), and perceived benefit of using HIV preventive practice (AOR = 1.09, 95% CI: 1.02, 1.17), were factors associated with HIV preventive practice. The magnitude of HIV preventive practice was low. Being male, the ability to read and write, the practice of sex to earn money, good knowledge about HIV preventive practice, perceived susceptibility to HIV, and the perceived benefit of using HIV preventive practice were significantly associated with HIV preventive practice. Therefore, responsible organizations, both governmental and non-governmental, should design inclusive strategies to improve HIV preventive practice among street dwellers by focusing on regular demand creation activities, awareness creation about HIV preventive practice, and sustainable condom distribution in the city.

In vitro and in vivo activity of ceftazidime/avibactam and aztreonam alone or in combination against mcr-9, serine- and metallo-β-lactamases-co-producing carbapenem-resistant Enterobacter cloacae complex.

Enterobacteriaceae carrying mcr-9, in particularly those also co-containing metallo-β-lactamase (MBL) and TEM type β-lactamase, present potential transmission risks and lack adequate clinical response methods, thereby posing a major threat to global public health. The aim of this study was to assess the antimicrobial efficacy of a combined ceftazidime/avibactam (CZA) and aztreonam (ATM) regimen against carbapenem-resistant Enterobacter cloacae complex (CRECC) co-producing mcr-9, MBL and TEM. The in vitro antibacterial activity of CZA plus ATM was evaluated using a time-kill curve assay. Furthermore, the in vivo interaction between CZA plus ATM was confirmed using a Galleria mellonella (G. mellonella) infection model. All eight clinical strains of CRECC, co-carrying mcr-9, MBL and TEM, exhibited high resistance to CZA and ATM. In vitro time-kill curve analysis demonstrated that the combination therapy of CZA + ATM exerted significant bactericidal activity against mcr-9, MBL and TEM-co-producing Enterobacter cloacae complex (ECC) isolates with a 100% synergy rate observed in our study. Furthermore, in vivo survival assay using Galleria mellonella larvae infected with CRECC strains co-harboring mcr-9, MBL and TEM revealed that the CZA + ATM combination significantly improved the survival rate compared to the drug-treatment alone and untreated control groups. To our knowledge, this study represents the first report on the in vitro and in vivo antibacterial activity of CZA plus ATM against CRECC isolates co-harboring mcr-9, MBL and TEM. Our findings suggest that the combination regimen of CZA + ATM provides a valuable reference for clinicians to address the increasingly complex antibiotic resistance situation observed in clinical microorganisms.

Should psychotherapists conduct visual assessments of nonsuicidal self-injury wounds?

Beneficence and nonmaleficence are key ethical principles toward which psychotherapists consistently strive. When patients engage in nonsuicidal self-injury (NSSI) during the course of psychotherapy, therapists may feel responsible for visually assessing the severity of the NSSI wound in order to benefit their patients and keep them from harm. However, there are no guidelines for conducting these visual assessments, and there is no research exploring their effects on patients. This article considers the ethical implications of visually examining NSSI wounds; discusses psychotherapist scope of practice and competence; draws attention to relevant ethical standards; underscores risk management, liability, and standard of care; and addresses the risk of suicide or accidental death resulting from NSSI. It also provides ethical guidance for conducting effective verbal assessments of NSSI wounds and offers suggestions for navigating complex clinical situations, such as when patients routinely and spontaneously show their therapists their wounds and how psychotherapists should handle assessments and interventions related to NSSI scars. It ends with implications for training and therapeutic practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A path to recovery for overlooked populations and their unique challenges: integrating rehabilitation in palliative care for patients with substance use disorders

Palliative care is a growing medical specialty focusing on providing compassionate and holistic management for those facing life-threatening diseases. These patients frequently present with physical, functional, emotional, and psychosocial problems that require comprehensive interdisciplinary management. However, there is a substantial opportunity to improve care for patients in palliative care who also have a substance use disorder (SUD). These opportunities include direct provision of SUD treatments by specialist palliative care providers and the integration of physical medicine and rehabilitation services. The purpose of this article is to examine the misunderstood and underutilized interaction between palliative care and SUDs, as well as describing the unique opportunities provided by physical medicine and rehabilitation providers to achieve a patient's palliative care goals and optimize overall quality of life. Substance Use Disorder is a chronic, often relapsing, illness that is relevant to palliative care practice due to the potential for significant morbidity and mortality through organ failure, chronic infections, and overdose syndromes. In traditional palliative care practice, it has been observed that past or current SUD diagnoses are often left untreated, resulting in increased distress, and exacerbating an already complex medical situation. Furthermore, many of these patients also experience physical, functional, or psychosocial changes that, when left untreated, will worsen distress and quality of life. To provide more comprehensive and successful palliative care for patients with SUD, the authors recommend an increased emphasis on specialist palliative care training in SUD management, proactive integration of rehabilitation services into the palliative care team, and consistent advocacy for these steps in various arenas. Combined, these actions can improve the care team's ability to provide a holistic, patient-centered approach that can have substantial positive outcomes for patients, health systems, and society.

Evaluation of moral distress and moral intelligence among medical residents

Background: Medical ethics is necessary in the medical field to protect patient rights, enhance professional conduct, manage complex situations, prevent malpractice, and advance healthcare policy. Aim: This study aimed to examine the levels of moral distress and moral intelligence among medical residents and explore the relationship between these two concepts. Methods: This descriptive-analytical cross-sectional study was performed on 221 medical residents in 2021. The participants were recruited by census sampling method. Data were collected by two standard questionnaires, including Corley’s moral distress scale (2001) and Lennick and Kiel’s moral intelligence scale (2005). Statistical analyses were conducted using both parametric and non-parametric methods. All analyses were performed by SPSS-22 software. Results: Of participants, 140 (63.4%) were non-surgical and 81 (36.6%) were surgical assistants. Moral distress was significantly higher in surgical than non-surgical disciplines, (P&lt;0.05). Further, according to the moral distress classification, 51.8% of surgical residents and 15.8% of non-surgical residents had severe moral distress. Moral intelligence was also higher in surgical than in non-surgical disciplines, but the difference was not statistically significant (P&gt;0.05), and moral intelligence was moderate to high. There was a significantly negative correlation between moral intelligence (and its four subscales) and moral distress (P &lt;0.001, r =-0.410). Conclusion: The results showed high moral distress and an inverse correlation between moral distress and moral intelligence among medical residents. The study highlights the importance of addressing issues related to moral distress and moral intelligence in medical education and training programs

Work Engagement: A Descriptive Qualitative Study on the perception of teachers

Work engagement is a state of mental motivation that allows workers to achieve success in the workplace. However, due to high work demands and exhaustion, teachers might find it difficult to engage in work. Teachers can develop work engagement if they intervene in the barriers that prevent them from doing their work by providing facilitators. The aim of this study was to describe teachers' perceptions of work engagement at different stages of education. A descriptive qualitative study was designed. Four focus groups were conducted with a total of 26 Spanish teachers. Three main themes and six sub-themes emerged from the analysis of the data: (1) Causes of the generation of work engagement: personal facilitators and facilitators of the environment; (2) Barriers to generating work engagement: individual and environmental; (3) Effects of work engagement: positive consequences and negative consequences. These findings indicate that there are several facilitators and barriers that promote and/or hinder the generation of work engagement in Spanish teachers. However, it should be noted that the study presents transferable results for other countries dealing with similar issues. In conclusion, training teachers in certain skills would improve their ability to solve complex situations and increase their levels of work engagement.

Infraorbital canal variants and its clinical and surgical implications. A systematic review.

Recent literature highlights anomalous cranial nerves in the sinonasal region, notably in the sphenoid and maxillary sinuses, linked to anatomical factors. However, data on the suspended infraorbital canal (IOC) variant is scarce in cross-sectional imaging. Anatomical variations in the sphenoid sinuses, including optic, maxillary, and vidian nerves, raise interest among specialists involved in advanced sinonasal procedures. The infraorbital nerve's (ION) course along the orbital floor and its abnormal positioning within the orbital and maxillary sinus region pose risks of iatrogenic complications. A comprehensive radiological assessment is crucial before sinonasal surgeries. Cone-beam computed tomography (CBCT) is preferred for its spatial resolution and reduced radiation exposure. The aim of this study was to describe the prevalence of anatomical variants of the infraorbital canal (IOC) and report its association with clinical condition or surgical implication. We searched Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to June 2023. Two authors independently performed the search, study selection, data extraction, and assessed the methodological quality with assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. Preliminary results show that three types are prevalent, type 1: the IOC does not bulge into the maxillary sinus (MS); therefore, the infraorbital foramen through the anterior wall of MS could be used for identification of the ION. Type 2: the IOC divided the orbital floor into medial and lateral aspects. Type 3: the IOC hangs in the MS and the entire orbital floor lying above the IOC. From which the clinical implications where mainly surgical, in type 1 the infraorbital foramen through the anterior wall of MS could be used for identification of the ION, while in type 2, since the lateral orbital floor could not be directly accessed an inferiorly transposition of ION is helpful to expose the lateral orbital wall directly with a 0 scope; or using angled endoscopes and instruments, however, the authors opinion is that direct exposure potentially facilitates the visualization and management in complex situations such as residual or recurrent mass, foreign body, and fracture located at the lateral aspect of the canal. Lastly, in type 3, the ION it's easily exposed with a 0° scope. This systematic review identified four IOC variants: Type 1, within or below the MS roof; Type 2, partially protruding into the sinus; Type 3, fully protruding into the sinus or suspended from the roof; and Type 4, in the orbital floor. Clinical recommendations aim to prevent nerve injuries and enhance preoperative assessments. However, the lack of consistent statistical methods limits robust associations between IOC variants and clinical outcomes. Data heterogeneity and the absence of standardized reporting impede meta-analysis. Future research should prioritize detailed reporting, objective measurements, and statistical approaches for a comprehensive understanding of IOC variants and their clinical implications. Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/UGYFZ .

The Components of Multilevel Engagement Theory

This article presents the components (i.e., assumptions, concepts, and propositions) of the Multilevel Engagement Theory. Raza provided specific examples to describe the components of the theory and discussed these components in relation to the existing literature. The components of Multilevel Engagement Theory are also discussed in relation to three contemporary theories (i.e., family systems theory, feminist theory, and social exchange theory) to demonstrate similarities and differences between the Multilevel Engagement Theory and the other theories used in mainstream research. The author provided examples from his graduate level course assignments to further explain the componets of Multilevel Engagement Theory and demonstrate the use and application of this theory. The Multilevel Engagement Theory considers culture and diversity as the central aspects to the understanding of family relationships and functioning and provides researchers with a comprehensive conceptual framework to conduct research on contemporary families, understand multilevel phenomena, and explain complex real-life situations.

Efficacy of clear aligner wear protocols in orthodontic tooth movement-a systematic review.

Different expedited aligner wear protocols are currently in practice. This review was undertaken to systematically appraise the available evidence on the comparative efficacy of orthodontic tooth movement (OTM) across the different wear protocols. Two assessors conducted comprehensive searches of electronic databases, including MEDLINE (via PubMed), Scopus, Embase, Web of Science, Google Scholar, Directory of Open Access Journals, Cochrane Library, OpenGrey, and Clinical Trial Registry, till 18 February 2024. Titles and abstracts were independently screened. Prospective or retrospective studies comparing expedited wear protocols with the conventional 14-day protocol were included. A pre-piloted data extraction form was used. Risk of bias (RoB) assessment employed the Cochrane RoB 2.0 tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for non-RCTs. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation Pro tool. Six studies, including 3 RCTs and 3 non-RCTs, were selected from 9076 records. Four studies (two RCTs and two retrospective cohort) found no statistically significant difference (P > 0.05) in the OTM efficacy between expedited and conventional protocols. Two studies (one RCT and one prospective cohort) found greater efficacy (P < 0.05) with the 14-day protocol, with the RCT reporting greater efficacy for certain movements, such as maxillary posterior intrusion, maxillary posterior distal tipping and buccal torquing, and mandibular posterior intrusion and extrusion. One RCT reported statistically insignificant difference (P > 0.05) in pain perception between the 10-day and 14-day protocols. Two studies demonstrated low RoB, two moderate, and two high RoB. The evidence level was very-low for OTM efficacy and high for pain perception. Meta-analysis was precluded due to significant heterogeneity among the studies. Within the limitations of the study, the 7-day, 10-day, and 14-day protocols did not show any significant difference in OTM efficacy, except for certain movements that exhibited superior outcomes with the 14-day wear. Hence, a 'hybrid aligner-wear protocol', based on clinical judgement, might serve a better alternative in complex situations. PROSPERO CRD42021288179.

Changing Conditions: Global Warming-Related Hazards and Vulnerable Rural Populations in Mediterranean Europe

Human-induced climate change has profound effects on extreme events, particularly those linked to global warming, such as heatwaves, droughts, and wildfires. These events disrupt ecosystems, emphasizing the imperative to understand the interactions among them to gauge the risks faced by vulnerable communities. Vulnerability levels vary primarily based on a community’s resources. Rural areas, especially in the Mediterranean region of Europe, are experiencing acute depopulation, creating a complex situation affecting various aspects of society, from economic declines to cultural heritage loss. Population decline in rural regions weakens resources, leading to the abandonment of built environments, fostering desertification, and elevating the risk of wildfires. Communities undergoing this deterioration process become exceptionally vulnerable, especially when dealing with and recovering from extreme natural phenomena. This review offers insights into the dynamics of these hazards and the predominant challenges in rural areas. By focusing on a topic that has received limited attention, the aim is to inform future research initiatives, ultimately improving risk assessment and mitigation strategies for these vulnerable communities.