Decrease In Rate Research Articles

Patient Engagement Functionalities' Influence on Quality Outcomes: The Road via EHR Presence.

Patients engaged in self-care through information technology can potentially improve the quality of healthcare they receive. This study aimed to examine how electronic health record (EHR) system functionalities help hospitals mediate the impact of patient engagement on quality outcomes-notably, readmission rates. A pooled cross-sectional study design employed data containing 3,547 observations from general acute care hospitals (2014-2018). The breadth of patient engagement functionalities adopted by a hospital was used as the independent variable and the degree of EHR presence was used as the mediating variable. Mean time to readmission for acute myocardial infarction (AMI), pneumonia, and heart failure were the dependent variables. The Baron and Kenny method was used to test mediation. Patient engagement was associated with reduced AMI readmission rates both directly and via EHR system presence. Mediation effects were present, in that a 1-unit increase in patient engagement through EHR system presence was associated with a 0.33% decrease in AMI readmission rates (p <.05). For other disease categories (heart failure and pneumonia), a significant effect was not found. For hospitals with a comprehensive EHR system, patient engagement through information technology can potentially reduce readmission rates for some diseases. More research is needed to determine which specific clinical conditions are amenable to quality improvement through patient engagement. Synergies between patient engagement functionalities and an EHR system positively affect quality outcomes. Therefore, practitioners and hospital managers should leverage hospital investments made in their EHR system infrastructure and use it to engage patients in self-care.

Composite of Carboxymethyl Cellulose/MXene and Span 60 as Additives to Enhance Tribological Properties of Bio-Lubricants

Bio-lubricants are the future of lubricants as a substitute for mineral lubricants; however, bio-lubricants have drawbacks, such as poor thermal-oxidative stability. In addition, during the friction process, the temperature of the lubricant increases, so the lubricant must have good thermal conductivity to conduct heat to the environment. To combat the drawbacks of bio-lubricants, some additives have been used to improve their performance as lubricants. Composites of carboxymethyl cellulose (CMC)/MXene and Span 60 as surfactants were used as additives in CPO with different compositions. The physicochemical properties of the addition of CMC/MXene and Span 60 in CPO have changed, including kinematic viscosity, TAN, thermal conductivity, and fatty acids, which have a positive impact on lubrication performance in terms of reducing oxidation processes and increasing thermal conductivity. From fatty acid composition tests and FTIR analysis, the additives work to suppress the oxidation process. A pin-on-disk test was performed to evaluate the tribological performances of bio-lubricants. The results show that CM 10 SP (0.5% wt of CMC and MXene and 1% wt Span 60) demonstrated a significant decrease in CoF and wear rate by 49% and 74%, respectively, at a load of 50 N and a speed of 1400 rpm compared to CPO without additives. An interface layer of CMC/MXene and Span 60, separating two surfaces, could induce wear on the surface of the disk and pin.

Bioorthogonal labeling and profiling of N6-isopentenyladenosine (i6A) modified RNA.

Chemical modifications in RNAs play crucial roles in diversifying their structures and regulating numerous biochemical processes. Since the 1990s, several hydrophobic prenyl-modifications have been discovered in various RNAs. Prenyl groups serve as precursors for terpenes and many other biological molecules. The processes of prenylation in different macromolecules have been extensively studied. We introduce here a novel chemical biology toolkit that not only labels i6A, a prenyl-modified RNA residue, by leveraging the unique reactivity of the prenyl group, but also provides a general strategy to incorporate fluorescence functionalities into RNAs for molecular tracking purposes. Our findings revealed that iodine-mediated cyclization reactions of the prenyl group occur rapidly, transforming i6A from a hydrogen-bond acceptor to a donor. Based on this reactivity, we developed an Iodine-Mediated Cyclization and Reverse Transcription (IMCRT) tRNA-seq method, which can profile all nine endogenous tRNAs containing i6A residues in Saccharomyces cerevisiae with single-base resolution. Furthermore, under stress conditions, we observed a decline in i6A levels in budding yeast, accompanied by significant decrease of mutation rate at A37 position. Thus, the IMCRT tRNA-seq method not only permits semi-quantification of i6A levels in tRNAs but also holds potential for transcriptome-wide detection and analysis of various RNA species containing i6A modifications.

Unexpectedly, triple super phosphate fertilizer induces maize drought resilience

Phosphorus fertilizer is commonly applied to soils in crop production as diammonium phosphate (DAP). To decrease ammonium addition to the environment, triple super phosphate (TSP) is being considered as a DAP replacement. This study was undertaken to compare the response of maize plants to soil fertilization with TSP vs. DAP under well-watered conditions, under soil-drying conditions, and root hydraulic conductance. It was found for well-watered conditions in a controlled environment that there was no difference in plant growth between DAP to TSP treatments. In soil dry-down experiments, however, the initiation of the decrease in transpiration rate was unexpectedly quite different between DAP and TSP treatments. The soil water content threshold for initiation of decrease in transpiration rate with DAP treatment (average fraction transpirable soil water for two experiments = 0.285) was consistent with common observations, but the threshold associated with TSP treatment occurred at an unusually high soil water content (average fraction transpirable soil water for two experiments = 0.545). The higher threshold with TSP resulted in an extended period of soil water use, i.e. soil water conservation. Soil water conservation resulting from the TSP treatment was associated with a 27% greater shoot mass accumulation following a 4-wk re-watering period after the water-deficit treatment than measured with the DAP treatment. The high threshold for decrease in transpiration resulting from TSP was consistent with measured lower root hydraulic conductance as compared to DAP treatment. The unexpected discovery of TSP-induced initiation of transpiration rate decrease at high soil water content is consistent with greater crop drought resilience.

Estimate of Wave Overtopping Rate on Armoured Slope Structures Using FUNWAVE-TVD Model

In this study, the program was modified by adding the empirical formula of EurOtop (2018) to enable calculation of wave overtopping on armoured slope structures in the FUNWAVE-TVD model using the fully nonlinear Boussinesq equation. The validity of the modified numerical model was verified by comparing it with CLASH data and experiment data for the rubble mound structure. This model accurately reproduced the change in wave overtopping rate according to the difference in the roughness factor of the armoured block, and well reproduced the rate of decrease in wave overtopping rate due to the increase in relative freeboard. The overtopping rate of the armoured slope structures showed significant differences depending on the positioning condition of the armoured blocks. When Tetrapods were placed with regular positioning, the overtopping rate increased significantly compared to when they were placed with random positioning, and it was consistent with when they were placed with Rocks. Meanwhile, when rocks were placed in one row, the wave overtopping rate was greater than when rocks were placed in two rows, which is believed to be due to the influence of the roughness and permeability of the structure’s surface.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ УРОВНЯ ИНФОРМИРОВАННОСТИ СТАРШЕКЛАССНИКОВ И СТУДЕНТОВ МЕДИЦИНСКОГО ВУЗА В ВОПРОСАХ СОЦИАЛЬНО-ЗНАЧИМЫХ ЗАБОЛЕВАНИЙ И ПРОФИЛАКТИКИ ИППП

As is known, the sexually transmitted infection (STI) incidence continues to be a pertinent issue: high contagiousness and negative impact on public health puts STIs on the list of socially significant diseases. The consequences of these diseases directly affect the demographic situation in the country, due to the deterioration of the reproductive health of the population with a subsequent decrease in the birth rate. This issue becomes especially pronounced among teenagers. This paper demonstrates the results of a study on socially significant diseases and STI prevention issues conducted among high school and medical students in Moscow with the aim of studying and identifying youth awareness problems, differentiating the knowledge of STI prevention among high school and college students, as well as determining respondents’ interest in getting information on these diseases online. Purpose: To study and identify problems of youth awareness, determine the difference in the knowledge of STI prevention among the high school and college students, as well as determine the interest of respondents in obtaining information on these diseases online. Materials and methods of research: The study includes the results of anonymous questionnaires filled out by schoolchildren of 15-17 years (115 respondents) and 3rd year students of the Faculty of Medicine (134 respondents). Research methods: analytical, statistical, sociological. Results: Based on the research data, we identified a difference in the answers of schoolchildren and college students in several types of questions. Thus, medical school students clearly appear as more mature, independent and busy people with more extensive knowledge on the given topics. The vast majority of respondents showed interest and wanted to obtain information on socially significant diseases and STI prevention. The best way to do so is to communicate comprehensive, high-quality knowledge of socially significant diseases and STI prevention using online technologies.

The role of β-adrenergic receptors in the regulation of cardiac tolerance to ischemia/reperfusion. Why do β-adrenergic receptor agonists and antagonists protect the heart?

Catecholamines and β-adrenergic receptors (β-ARs) play an important role in the regulation of cardiac tolerance to the impact of ischemia and reperfusion. This systematic review analyzed the molecular mechanisms of the cardioprotective activity of β-AR ligands. We performed an electronic search of topical articles using PubMed databases from 1966 to 2023. We cited original in vitro and in vivo studies and review articles that documented the cardioprotective properties of β-AR agonists and antagonists. The infarct-reducing effect of β-AR antagonists did not depend on a decrease in the heart rate. The target for β-blockers is not only cardiomyocytes but also neutrophils. β1-blockers (metoprolol, propranolol, timolol) and the selective β2-AR agonist arformoterol have an infarct-reducing effect in coronary artery occlusion (CAO) in animals. Antagonists of β1- and β2-АR (metoprolol, propranolol, nadolol, carvedilol, bisoprolol, esmolol) are able to prevent reperfusion cardiac injury. All β-AR ligands that reduced infarct size are the selective or nonselective β1-blockers. It was hypothesized that β1-AR blocking promotes an increase in cardiac tolerance to I/R. The activation of β1-AR, β2-AR, and β3-AR can increase cardiac tolerance to I/R. The cardioprotective effect of β-AR agonists is mediated via the activation of kinases and reactive oxygen species production. It is unclear why β-blockers with the similar receptor selectivity have the infarct-sparing effect while other β-blockers with the same selectivity do not affect infarct size. What is the molecular mechanism of the infarct-reducing effect of β-blockers in reperfusion? Why did in early studies β-blockers decrease the mortality rate in patients with acute myocardial infarction (AMI) and without reperfusion and in more recent studies β-blockers had no effect on the mortality rate in patients with AMI and reperfusion? The creation of more effective β-AR ligands depends on the answers to these questions.

Optimizing Nitrogen Application for Enhanced Barley Resilience: A Comprehensive Study on Drought Stress and Nitrogen Supply for Sustainable Agriculture

Soil water scarcity hinders crop productivity globally, emphasizing the imperative for sustainable agriculture. This study investigated the role of nitrogen in alleviating drought stress in barley. Parameters such as relative water content, photosynthetic rate, stomatal conductance, mesophyll concentration of CO2, total leaf nitrogen, grain yield, total organic nitrogen content, starch content, and macronutrient concentrations (N, P, K, Ca, Mg) were examined. The optimal grain yield (3.73 t·ha−1) was achieved with 1 g of nitrogen per container (near 200 kg N hectare−1) under ideal moisture conditions. However, under drought stress, nitrogen supply variants (1 g and 2 g per container) exhibited a significant decrease in photosynthetic rate (Pn), NRA activities, and a notable increase in Ci values. Stomatal conductance exhibited a substantial decrease by 84% in the early growth phase, especially with a 2 g dose of nitrogen supply. Nitrogen enhanced crude protein levels, yet both drought stress and nitrogen application reduced grain weight and starch content. Nitrogen effectively improved metabolic processes under drought, particularly in earlier growth stages (e.g., tillering). This research highlights the importance of sustainable agricultural practices related to the growth stage of barley, emphasizing nitrogen optimization to enhance crop resilience in water-scarce environments. The results underscore the intricate interplay between nitrogen fertilization, drought stress, and crop yield, indicating benefits during initial stress exposure but detrimental effects in subsequent growth stages.

Mitigating bisphenol A-induced apoptosis in KGN cells: the therapeutic role of 1,25-dihydroxyvitamin D3 through upregulation of PGC-1α expression and inhibition of the mitochondrial cytochrome c pathway.

This study investigated the potential of 1,25-dihydroxyvitamin D3 (1,25(OH)2VD3) to mitigate bisphenol A (BPA)-induced apoptosis in human ovarian granulosa KGN cells with the aim of establishing a theoretical foundation for understanding of how vitamin D improved ovarian function in patients with polycystic ovary syndrome (PCOS). The impact of varying concentrations of BPA and 1,25(OH)2VD3 on KGN cell viability was elucidated. It was established that BPA-induced apoptosis in KGN cells. Subsequently, KGN cells underwent pretreatment with 1,25(OH)2VD3, followed by exposure to BPA. The apoptosis rate, reactive oxygen species (ROS) levels, and mitochondrial function of the cells were meticulously assessed, along with the expression levels of genes associated with apoptosis as well as antioxidant and mitochondrial biogenesis. BPA induced a notable increase in apoptosis (P < 0.001) and oxidative stress (P < 0.001) in KGN cells, accompanied by a significant reduction in mitochondrial membrane potential (P < 0.001) and severe impairment of mitochondrial function. Following pretreatment of KGN cells with 1,25(OH)2VD3, there was a significant decrease in the apoptosis rate (P = 0.004), coupled with a reduction in ROS production (P = 0.002). Concomitantly, the upregulation of PGC-1α (P = 0.009) and SOD (P = 0.018) was observed, while mRNA expression of BAX (P = 0.011), Cyt c (P = 0.001), Apaf-1 (P = 0.012), caspase-9 (P < 0.001), and caspase-3 (P = 0.011) was downregulated. Notably, the mitigation of mitochondrial damage was evident through restored mitochondrial membrane potential (P < 0.001), as corroborated by electron microscope results. 1,25(OH)2VD3 mitigated BPA-induced damage and apoptosis in KGN cells by upregulating the expression of PGC-1α and impeding the mitochondrial cytochrome c (Cyt c) apoptotic pathway. This study established a novel theoretical foundation for utilizing vitamin D in the treatment of PCOS patients.

Large-scale in-silico analysis of CSF dynamics within the subarachnoid space of the optic nerve

BackgroundImpaired cerebrospinal fluid (CSF) dynamics is involved in the pathophysiology of neurodegenerative diseases of the central nervous system and the optic nerve (ON), including Alzheimer’s and Parkinson’s disease, as well as frontotemporal dementia. The smallness and intricate architecture of the optic nerve subarachnoid space (ONSAS) hamper accurate measurements of CSF dynamics in this space, and effects of geometrical changes due to pathophysiological processes remain unclear. The aim of this study is to investigate CSF dynamics and its response to structural alterations of the ONSAS, from first principles, with supercomputers.MethodsLarge-scale in-silico investigations were performed by means of computational fluid dynamics (CFD) analysis. High-order direct numerical simulations (DNS) have been carried out on ONSAS geometry at a resolution of 1.625 μm/pixel. Morphological changes on the ONSAS microstructure have been examined in relation to CSF pressure gradient (CSFPG) and wall strain rate, a quantitative proxy for mass transfer of solutes.ResultsA physiological flow speed of 0.5 mm/s is achieved by imposing a hydrostatic pressure gradient of 0.37–0.67 Pa/mm across the ONSAS structure. At constant volumetric rate, the relationship between pressure gradient and CSF-accessible volume is well captured by an exponential curve. The ONSAS microstructure exhibits superior mass transfer compared to other geometrical shapes considered. An ONSAS featuring no microstructure displays a threefold smaller surface area, and a 17-fold decrease in mass transfer rate. Moreover, ONSAS trabeculae seem key players in mass transfer.ConclusionsThe present analysis suggests that a pressure drop of 0.1–0.2 mmHg over 4 cm is sufficient to steadily drive CSF through the entire subarachnoid space. Despite low hydraulic resistance, great heterogeneity in flow speeds puts certain areas of the ONSAS at risk of stagnation. Alterations of the ONSAS architecture aimed at mimicking pathological conditions highlight direct relationships between CSF volume and drainage capability. Compared to the morphological manipulations considered herein, the original ONSAS architecture seems optimized towards providing maximum mass transfer across a wide range of pressure gradients and volumetric rates, with emphasis on trabecular structures. This might shed light on pathophysiological processes leading to damage associated with insufficient CSF flow in patients with optic nerve compartment syndrome.

Photosynthetic gas exchange, plant water relations and osmotic adjustment of three tropical perennials during drought stress and re-watering.

Planting vegetation on slopes is an effective way of improving slope stability while enhancing the aesthetic appearance of the landscape. However, plants growing on slopes are susceptible to natural drought stress (DS) conditions which commonly lead to water deficit in plant tissues that affect plant health and growth. This study investigated the photosynthetic gas exchange, plant water status and proline accumulation of three tropical perennials namely Clerodendrum paniculatum, Ipomoea pes-caprae and Melastoma malabathricum after being subjected to DS and re-watering (RW). During DS, there was a significant decrease in light-saturated photosynthetic CO2 assimilation rate (Asat), stomatal conductance (gs sat), and transpiration rate (Tr) for all three plant species. Leaf relative water content, shoot water potential, and leaf, stem and root water content also declined during DS. Proline concentration increased for all three species during DS, reaching especially high levels for C. paniculatum, suggesting that it heavily relies on the accumulation of proline to cope with DS. Most of the parameters recovered almost completely to levels similar to well-watered plants after RW, apart from M. malabathricum. Strong linear correlations were found between Asat and gs sat and between gs sat and Tr. Ultimately, C. paniculatum and I. pes-caprae had better drought tolerance than M. malabathricum.

Factors Influencing Duration of Breastfeeding: Insights from a Prospective Study of Maternal Health Literacy and Obstetric Practices.

Numerous factors concerning early breastfeeding abandonment have been described, including health literacy (HL). This study's objective was to analyze factors related to early breastfeeding abandonment (<6 months). This prospective multicentric study examined the duration of breastfeeding at 6 months postpartum and was conducted in four different regions of Spain from January 2021 to January 2023. A total of 275 women participated in this study, which focused on maternal HL and obstetric practices. A decrease in the breastfeeding rate was observed from hospital discharge (n = 224, 81.5%) to the sixth month postpartum (n = 117, 42.5%). A Cox regression analysis revealed that inadequate HL levels, lack of mobilization during labour, and induced labour were significantly associated with early breastfeeding cessation (p = 0.022, p = 0.019, and p = 0.010, respectively). The results highlight that women with adequate HL had a 32% lower risk of early breastfeeding abandonment. In comparison, mobilization during labour and induction of labour were linked to a 32.4% reduction and a 53.8% increase in this risk, respectively. These findings emphasize the importance of considering obstetric and HL factors when addressing the breastfeeding duration, indicating opportunities for educational and perinatal care interventions.

Enhancing stability of microchannel plates (MCPs) through freeze-drying method

The crystallization and gain decrease of microchannel plates (MCPs) have a significant impact on the dark noise and working life of optoelectronic devices. By employing a freeze-drying method instead of high-temperature drying during MCP manufacturing, stability can be improved. Freeze-drying at low temperatures (−100 °C) mitigates chemical reactions between potassium (K) and oxygen (O2) or water (H2O) in the secondary emission layer, reducing crystallization during production and storage. Furthermore, freeze-drying eliminates the need for organic solvents, which can lead to carbon (C) element pollution on the MCP surface. Minimizing C element pollution is beneficial in reducing unstable “gas gain” and attenuating MCP gain during electron scrubing. Long-term storage tests demonstrate that freeze-dried MCPs exhibit over 20% reduction in crystallization and more than 10% decrease in gain loss rates. These findings highlight freeze-drying as an effective approach to enhance MCP stability, resulting in photomultiplier tubes (PMTs) with lower dark counting rates and higher gains.

Changes in Phytohormones and Transcriptomic Reprogramming in Strawberry Leaves under Different Light Qualities.

Strawberry plants require light for growth, but the frequent occurrence of low-light weather in winter can lead to a decrease in the photosynthetic rate (Pn) of strawberry plants. Light-emitting diode (LED) systems could be used to increase Pn. However, the changes in the phytohormones and transcriptomic reprogramming in strawberry leaves under different light qualities are still unclear. In this study, we treated strawberry plants with sunlight, sunlight covered with a 50% sunshade net, no light, blue light (460 nm), red light (660 nm), and a 50% red/50% blue LED light combination for 3 days and 7 days. Our results revealed that the light quality has an effect on the contents of Chl a and Chl b, the minimal fluorescence (F0), and the Pn of strawberry plants. The light quality also affected the contents of abscisic acid (ABA), auxin (IAA), trans-zeatin-riboside (tZ), jasmonic acid (JA), and salicylic acid (SA). RNA sequencing (RNA-seq) revealed that differentially expressed genes (DEGs) are significantly enriched in photosynthesis antenna proteins, photosynthesis, carbon fixation in photosynthetic organisms, porphyrin and chlorophyll metabolisms, carotenoid biosynthesis, tryptophan metabolism, phenylalanine metabolism, zeatin biosynthesis, and linolenic acid metabolism. We then selected the key DEGs based on the results of a weighted gene co-expression network analysis (WGCNA) and drew nine metabolic heatmaps and protein-protein interaction networks to map light regulation.

The Effect of Saponite Clay on Ruminal Fermentation Parameters during In Vitro Studies.

Reducing the emission of global warming gases currently remains one of the strategic tasks. Therefore, the objective of our work was to determine the effect of saponite clay on fermentation in the rumen of cows. The pH, total gas production, CH4, and volatile fatty acid (VFA) production in ruminal fluid was determined in vitro. Saponite clay from the Tashkiv deposit (Ukraine) has a high content of silicon, iron, aluminum, and magnesium. The addition of 0.15 and 0.25 g of saponite clay to the incubated mixture did not change the pH but reduced the total production (19% and 31%, respectively) and CH4 (24% and 46%, respectively) in the ruminal fluid compared to the control group and had no significant effect on the total VFA levels, but propionic acid increased by 15% and 21% and butyric acid decreased by 39% and 32%, respectively. We observed a decrease in the fermentation rates, with a simultaneous increase in the P:B ratio and an increase in the fermentation efficiency (FE) in the groups fermented with saponite clay, probably a consequence of the high efficiency in the breakdown of starch in the rumen. Therefore, further in vivo studies to determine the effective dose and effect of saponite clay on cow productivity and the reduction of gas emissions are promising and important.

Enhancing cotton sustainability: Multi-factorial intercropping, irrigation, and weed effects on productivity, quality and physiology

Drought stress and weed infestation are significant factors that significantly decrease cotton yield. Increasing the variety of plants within a cotton field ecosystem can strengthen its stability and protect it from susceptibility to both biotic and abiotic pressures. In this two-year experiment (2021 and 2022), the effects of intercropping systems (four growth conditions including mono- and inter-cropped cotton varieties Golestan and Hekmat with Nepeta crispa and dragon's head (Lallemantia iberica)), irrigation (three intervals of 3, 6, and 9 days), and weed competition (weed-free and weedy plots) on the agronomic performance, physiological characteristics, and seed quality of cotton in a semi-arid region of Iran were studied. In 2021, the volume of irrigation water applied was 9873, 6100, and 4650 m3 ha−1 for irrigation intervals of 3, 6, and 9 days, respectively. In 2022, the volumes were 9071, 5605, and 4272 m3 ha−1 for the corresponding irrigation intervals. Over two years, Xanthium strumarium, Amaranthus retroflexus, and Portulaca oleracea were the dominant weed species. Weeds had the most significant impact on total dry weight; weed control increased plant vigor and growth, ranging from 1.4 to 2.3 times, while weed impact on cottonseed yield ranged from 18% to 96% reduction. Increasing irrigation intervals resulted in reductions in various parameters, with decreases of 39%–80% in total dry weight, 34%–57% in cottonseed yield, and 48%–72% in lint yield. The harvest indices for seed cotton, cottonseed, and lint ranged from 35.3% to 56.5%, 18.3%–35.0%, and 15.4%–20.5%, respectively. Weeds were responsible for a 17% decrease in the 1000-seed weight. As the irrigation intervals increased from 3 days to 6 days and 9 days, the number of bolls per plant decreased by 19%–85%. Extending the irrigation interval from 3 days to 6 days and 9 days resulted in a substantial decrease in the photosynthetic rate, ranging from 42% to 92%. Mono-cropped Golestan performed well under unstressed conditions such as 3-day interval irrigation and weed-free conditions. On the other hand, intercropped Hekmat demonstrated better resilience to both moisture and weed stresses. The LER (Land equivalent ratio) indices of both intercropping systems were generally favorable, indicating higher productivity compared to sole cropping. The intercropping systems consistently showed the highest LER indices under weedy conditions, highlighting the significance of intercropping as a valuable method in integrated weed management.

Strategies for Improving Vaccine Communication and Uptake.

Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.

Retrospective analysis of pediatric sepsis and the burden of antimicrobial resistance in Duhok, Kurdistan Region of Iraq.

Introduction: Sepsis is a life-threatening complication in pediatric patients. This study primarily aimed to investigate sepsis-causing bacteria and their antimicrobial resistance profile and check the change in the antimicrobial resistance trend for some selected bacteria. In addition, we evaluated the incidence of sepsis, the related mortality rate, and the effectiveness and outcome of the treatment regimes in sepsis pediatric patients. Methods: A retrospective analysis was conducted on 4-year data (2018-2021) collected from three intensive care units at the Hevi Pediatric Teaching Hospital. Sepsis screening involved clinical detection and confirmation by blood culture. Results: A total of 520 out of 1,098 (47.35%) blood samples showed positive microbial growth. A decrease in sepsis rate was observed during the COVID-19 pandemic. Coagulase-negative Staphylococci (CoNS) and Klebsiella pneumonia were the most commonly isolated bacteria. A notable variation in the antimicrobial resistance trend was observed among sepsis-causing bacteria. The empirical sepsis treatment recommended by the WHO was ineffective, as certain bacteria exhibited 100% resistance to every antibiotic tested. The mortality rate significantly increased from 1.3% in 2018 to 16.5% in 2021. Discussion: The antimicrobial resistance profile of sepsis causing bacteria is of concerns, indicating a potentially serious situation. Thus, to avoid treatment failure, the monitoring of antimicrobial resistance in pediatric patients is essential.

The impact of abortion bans on short-term housing needs

ObjectivesState-level abortion bans in the United States have created a complex legal landscape that forces many prospective patients to travel long distances to access abortion care. The financial strain and logistical difficulties associated with travelling out of state for abortion care may present an insurmountable barrier to some individuals, especially to those with limited resources. Tracking the impact of these abortion bans on travel and housing is crucial for understanding abortion access and economic changes following the Dobbs U.S. Supreme Court decision. Study designThis study used occupancy data from an average of 2,349,635 (standard deviation = 111,578) U.S. Airbnb listings each month from October 1st, 2020, through April 30th, 2023, to measure the impact of abortion bans on travel for abortion care and the resulting economic effects on regional economies. MethodsThe study used a synthetic difference-in-differences design to compare monthly-level occupancy rate data from 1-bedroom entire-place Airbnb rentals within a 30-min driving distance of abortion clinics in states with and without abortion bans. ResultsThe study found a 1.4 percentage point decrease in occupancy rates of Airbnbs around abortion clinics in states where abortion bans were in effect, demonstrating reductions in Airbnb use in states with bans. In the 6-month period post Dobbs, this decrease translates to 16,548 fewer renters and a $1.87 million loss in revenue for 1-bedroom entire-place Airbnbs within a 30-min catchment area of abortion facilities in states with abortion restrictions. ConclusionThis novel use of Airbnb data provides a unique perspective on measuring demand for abortion and healthcare services and demonstrates the value of this data stream as a tool for understanding economic impacts of health policies.

Enhanced conductive body heat loss during sleep increases slow-wave sleep and calms the heart

Substantial evidence suggests that the circadian decline of core body temperature (CBT) triggers the initiation of human sleep, with CBT continuing to decrease during sleep. Although the connection between habitual sleep and CBT patterns is established, the impact of external body cooling on sleep remains poorly understood. The main aim of the present study is to show whether a decline in body temperatures during sleep can be related to an increase in slow wave sleep (N3). This three-center study on 72 individuals of varying age, sex, and BMI used an identical type of a high-heat capacity mattress as a reproducible, non-disturbing way of body cooling, accompanied by measurements of CBT and proximal back skin temperatures, heart rate and sleep (polysomnography). The main findings were an increase in nocturnal sleep stage N3 (7.5 ± 21.6 min/7.5 h, mean ± SD; p = 0.0038) and a decrease in heart rate (− 2.36 ± 1.08 bpm, mean ± SD; p < 0.0001); sleep stage REM did not change (p = 0.3564). Subjects with a greater degree of body cooling exhibited a significant increase in nocturnal N3 and a decrease in REM sleep, mainly in the second part of the night. In addition, these subjects showed a phase advance in the NREM-REM sleep cycle distribution of N3 and REM. Both effects were significantly associated with increased conductive inner heat transfer, indicated by an increased CBT- proximal back skin temperature -gradient, rather than with changes in CBT itself. Our findings reveal a previously far disregarded mechanism in sleep research that has potential therapeutic implications: Conductive body cooling during sleep is a reliable method for promoting N3 and reducing heart rate.