Pain in Parkinson's disease (PD) manifests clinically in a variety of ways and several pain types have been identified, however, their characteristics have not been extensively studied. To describe the characteristics of common pain types in people with PD. A survey of people with PD that experience pain symptoms was conducted. Participants were recruited using a combination of sampling methods. The survey questions focused on collecting information about the topographical, sensory, and temporal characteristics of pain. Descriptive statistics were used to report results. Two hundred and sixteen participants were included in the data analyses. A median of 5 (interquartile range [IQR] 4-7) pain types were experienced by participants. Pain was commonly localized in the lower limbs but often affected several different body segments. Acute attacks of pain were characteristic for many participants in most pain types and were typically frequent (two to six times per week or more) and prolonged (minutes to hours). Periods of pain accentuation were most likely to occur in the morning, evening, and night and appear to be associated with PD medication pharmacology and a variety of exacerbating and ameliorating factors. Fluctuations in pain were found to range from mild to severe in all pain types. This study makes a valuable contribution to the existing literature by providing the most detailed assessment of the topographical, sensory, and temporal characteristics of common PD pain types to date that may be used to guide clinical diagnosis and treatment.

Community pharmacists' perceptions of their work-related quality-of-life: Implications for pharmacists' well-being, compassionate patient care, and relationships.

Psychological dimensions of feedback literacy in EFL writing: A mixed-methods study of teacher-student alignment in Thailand.

Nomenclature and abbreviation heterogeneity in immune-mediated necrotizing myopathy: A call for standardization.

Getting It Done and Done Well: A Mixed-Methods Analysis of the Pitfalls and Success Factors for Professional Development Experiences During Surgical Residency.

Vice Chairs of Education in Departments of Surgery: Responsibilities, Value, and Future Directions.

Ultrasonography is the recommended first-line investigation for the diagnosis of pediatric nephrolithiasis. Despite higher sensitivity and specificity for this condition, computed tomography is reserved for more complex cases due to its radiation exposure. Despite increasing stone prevalence in the pediatric population, there is a lack of low-dose computed tomography pediatric urolithiasis protocols and descriptions of low-dose protocols are sparse. Herein we report the development and implementation of a low-dose protocol to reduce radiation exposure to this vulnerable population. A novel low-dose computed tomography protocol was designed through multidisciplinary collaboration, literature review, and phantom trials. Patients undergoing computed tomography for urolithiasis assessment were evaluated using the novel low-dose protocol and were compared to a retrospective cohort. Radiation reduction was characterized using descriptive statistics and comparative analysis. Mean (± standard deviation) age for the low-dose group was 12.6 ± 4.2 years (n = 26) compared to 12.4 ± 3.7 years for the standard-dose group (n = 15). The low-dose protocol reduced radiation dose when compared to the standard-dose group by 55.5 % (≥45 kg) (p = 0.02) and 27.8 % (<45 kg) (p = 0.03). The low-dose protocol visualized stones seen on ultrasound with 100 % accuracy (n = 6), and in 61.5 % (n = 16/26) of patients. There was no difference in stone sizes between groups. Reduced-dose computed tomography protocols are effective for assessing urolithiasis while reducing radiation exposure. Implementation of reduced-dose computed tomography protocols in cases of suspected urolithiasis is advised to limit radiation exposure while maintaining diagnostic imaging detail.

Older adults experience multiple co-occurring symptoms that contribute to increased healthcare utilization, decreased physical performance, and poorer quality of life. This study aimed to characterize symptom burden in a population-based cohort of community-dwelling adults aged 70 years and older enrolled in the MOBILIZE Boston study (n=765). Descriptive statistics and chi-square tests were used to categorize symptom prevalence and associations with demographic factors for nine symptoms: pain, balance impairment, weakness, limited endurance, sleep difficulty, depression, anxiety, and hearing and vision impairments. Latent class analysis was used to identify distinct classes of symptom burden. Pain was the most prevalent symptom (81.3 %), with 43.1 % of individuals indicating severe pain. Symptoms related to vision, hearing, sleep, and endurance were also reported by over 40 % of individuals. Except for vision, reported symptoms were found to be positively correlated. Four symptom burden groups were identified via latent class analysis: mild (30.1 %), moderate (51.3 %), moderate-severe (10.2 %) and severe (8.4 %). Those in the severe symptom burden group experienced worse levels of all symptoms compared to other groups. Pain and vision symptoms were similar across all symptom burden classes. Balance, endurance, weakness, anxiety and sleep symptoms were comparatively more common and severe for the 18.6 % of individuals in the moderate-severe and severe groups. Understanding overall symptom burden, both in terms of numbers and severity of symptoms, is the first step in determining the impact of symptom burden as a possible new clinical indicator for fall risk and other detrimental health outcomes.

Enhancing outcomes for geriatric patients with evaluation of the social determinants of health.

Introduction: Presacral tumours are an extremely rare entity. Schwannomas account for only 3% of tumours in this region. Schwannomas are benign, unifocal and often asymptomatic. Presacral lesions are usually asymptomatic, although a few of these patients may present with compressive symptoms or neurogenic pain. Diagnosis and characterisation of nerve sheath tumours, of which schwannoma is a part, is usually done with Magnetic Resonance Imaging (MRI). Surgical excision is the mainstay of management, although it is associated with high morbidity. Although a few case reports are available, large datasets are sparse. Aim: To study the clinical presentation, imaging features and management of patients who underwent excision of presacral schwannomas. Materials and Methods: The present retrospective descriptive study was conducted in General Surgery Unit-IV in Christian Medical College and Hospital, Vellore, Tamil Nadu, India, from July 2013 to July 2024. All patients above 18 years of age, histopathologically confirmed presacral schwannomas, were identified and included. The demographic profile, presenting symptoms, imaging findings, preoperative assessment, surgical details, postoperative complications, and follow-up were recorded. Descriptive statistics were calculated, with mean and median serving as the measure of central tendency and the standard deviation representing the measure of dispersion. Results: A total of 20 patients were identified with a mean age of 41.3 years (±14.05), with 13 patients being male and the remaining female. Eleven patients presented with pressure symptoms due to direct compression of the pelvic organs. Imaging of choice was MRI in 19 patients. Seventeen patients had preoperative biopsy done, of which 16 were schwannoma and one was neurofibroma. Median largest diameter of these tumours at the time of presentation was 10.55 cm with a range of 6.8 to 25 cm. 19 patients underwent a laparotomy (transperitoneal approach) with intracapsular excision of the tumour. The mean operating time was 2.85 hours (±1.12), with a mean blood loss of approximately 500 mL (±240). 10% of patients developed postoperative neurological deficits. Three patients had neuropathic pain, which settled with medication in the postoperative period. Five patients developed a surgical site occurrence. The mean duration of hospitalisation for these patients was 7.7 days. The mean follow-up period was 27.8 months. 90% (18) of the patients had classical schwannoma on histopathology. Conclusion: Management of large presacral tumours is a daunting task even for the most experienced surgeons. Intracapsular excision of these tumours needs to be considered while planning these operations, based on the possible morbidity profile for these patients.

For intractable epistaxis unresponsive to conservative measures, surgical intervention, such as anterior ethmoid artery ligation (AEAL), can control bleeding in the superior nasal cavity. Yet, the literature is limited around AEAL for epistaxis control. This systematic review aims to identify the outcomes and complications of the various AEAL approaches. MEDLINE and PubMed were searched for English-language articles published in peer-reviewed journals using "Epistaxis" AND "anterior ethmoid artery" along with associated terms. Inclusion criteria captured full-text studies that examined AEAL in human subjects as the main treatment, or as part of a combination of treatments. Of the 160 articles reviewed, 21 (13%) met selection criteria. Data were extracted and descriptive statistics were calculated following PRISMA guidelines. A total of 122 patients underwent various AEAL approaches: external approach via a Lynch incision (76.2%), transnasal endoscopic approach (9.8%), and transcaruncular approach (13.9%). 7/108 patients had postoperative bleeding despite AEAL. 28/99 (28.3%) of patients were reported to have postoperative complications of varying severity. The following complications occurred after an external approach via Lynch incision: eyelid/orbital edema, ptosis, intracerebral abscess, diplopia, dilated pupil, ophthalmoplegia, trigeminal nerve irritation, keratoconjunctivitis, and orbital apex syndrome. AEAL effectively reduces epistaxis in suitable patients, with most complications from the Lynch incision being temporary. Further research is required to optimize AEAL's approach and utility for intractable epistaxis.

Symptom expectations influence symptom severity in patients with pain disorders through nocebo and placebo mechanisms. Similar associations have been suggested for patients with somatic symptom disorder (SSD). While evidence underlines the significance of expectations for symptom experience, yet little is known about the nature of these expectations in SSD or about the psychological and biological factors that shape them. Patients diagnosed with SSD participated in a structured on-site assessment at the psychosomatic outpatient clinic of the University Medical Center Hamburg-Eppendorf. The assessment included standardized questionnaires, a physical examination, and a clinical interview. Descriptive statistics and multiple regression analyses were conducted on symptom impairment expectation and symptom-specific expectation measures. A total of N=241 patients participated in this study. The majority of patients (66.8% female, mean age=44.5years) reported negative short-term symptom expectations (54%). Patients with more negative expectations also reported greater somatic symptom severity, higher depression and anxiety severity, increased symptom-related distress, and higher symptom-related disability. Symptom-related disability was found to have the largest association with symptom impairment expectations (short-term: β=0.46, p<0.001, long-term: β=0.26, p<0.001), whereas symptom severity was associated with symptom-specific expectations the most (β=0.66, p<0.001). Negative symptom expectations are associated with elevated psychological burden in patients with SSD, indicating a clinically relevant subgroup that may benefit from expectation-focused interventions.

Animal shelters often operate under significant resource constraints while caring for large populations of dogs and cats, many of whom are affected by parasitic infections that impact animal health and pose zoonotic risks. These limitations hinder the implementation of standardized, evidence-based parasite control protocols. This study surveyed veterinarians working in Portuguese shelters to describe current antiparasitic treatment practices and identify key limitations. A structured questionnaire was distributed to veterinarians in shelters or kennels affiliated with ICBAS, University of Porto, collecting data on animal populations, location, diagnostic testing, and antiparasitic drug use. A total of 41 responses were analysed. Additionally, a cost analysis was performed using 2024 wholesale antiparasitic treatment prices, based on average weights (20kg dogs, 5kg cats). Commercially available products were reviewed for active ingredients, target parasites, and cost per treatment. Descriptive statistics were used to summarize responses; no inferential analyses were performed given the limited sample size. Ectoparasiticides were the most frequently used treatments, followed by broad-spectrum nematocides and cestocides. Only 12% of shelters reported conducting diagnostic testing prior to treatment. Drug selection was primarily influenced by cost and perceived efficacy. Commonly used compounds included praziquantel, pyrantel, fipronil, fenbendazole, and milbemycin oxime, several of which have reported resistance in parasite populations. Treatment costs ranged from €0.82 to €219 per dose for 20kg dogs and €0.73 to €34.84 for 5kg cats. The limited use of diagnostics and reliance on broad-spectrum drugs reflect a reactive rather than preventative approach. Findings underscore the need for improved diagnostic protocols and strategic drug selection to enhance parasite control and animal welfare.

Children with epilepsy often face barriers to school participation and appropriate seizure management. This study explored caregiver-reported challenges related to seizure action plans (SAPs), rescue medication access, and school inclusion. A 34-item survey, including items from the validated Brief School Needs Inventory (BSNI), was administered to caregivers of school-aged children with epilepsy receiving care at a tertiary children's hospital. Descriptive statistics and logistic regression analyses examined seizure-related experiences and school-level barriers, stratified by BSNI-assessed educational risk. Among 162 caregiver respondents, 50.6% reported their child had experienced a seizure at school. While 79% of students had a SAP in place, 11.7% did not. One-quarter of students required rescue medication at least annually, and 25.9% of caregivers were unsure if it could be administered in a timely manner at school. Additionally, 27.2% of students were excluded from school activities and 34% faced bus transportation barriers. Logistic regression showed students with high BSNI risk were over six times more likely to face transportation-related barriers (OR = 6.12, p<0.001) and nearly five times more likely to be excluded from activities (OR = 4.91, p<0.01) than peers with low risk. Despite federal protections and emerging state-level legislation, many students with epilepsy experience preventable educational and safety-related barriers. Improved standardization of SAPs, staff training, and care coordination between providers and schools are needed to reduce disparities and support full participation for students with epilepsy.

Accessible tourism has emerged as a national priority within Saudi Arabia's Vision 2030 agenda, yet empirical evidence on the psychological mechanisms linking accessibility to tourist behavior remains limited. This study examines how accessibility barriers and service quality predict satisfaction and revisit intention among persons with disabilities, drawing on Expectancy-Disconfirmation Theory. Data were collected through an online questionnaire using purposive and snowball sampling, yielding responses from 173 participants across 11 regions. Descriptive statistics, Pearson correlations, multiple regression, and bootstrapped mediation analyses were conducted. Accessibility barriers were negatively associated with perceived service comprehensiveness and satisfaction, whereas inclusive service practices were positively linked to emotional evaluations and behavioral intentions. Satisfaction emerged as the strongest predictor of revisit intention and significantly mediated the effects of accessibility and service quality on loyalty outcomes. These findings highlight the central role of satisfaction in shaping tourism behavior and offer theoretical and practical insights that support ongoing national efforts to advance inclusive and accessible tourism within the framework of Vision 2030.

Dysphagia, cognitive function, amd dysphagia-related quality of life among oral cancer patients: A cross-sectional survey.

The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is ubiquitous in perioperative medicine and research as a tool for preoperative patient risk stratification. Despite widespread clinical adoption as a predictor of perioperative outcomes, the ASA-PS system is inherently subjective, leading to considerable inter-rater variability. A comprehensive mapping of the literature examining the relationship between ASA-PS scores and patient outcomes is lacking. To systematically map the extent, range, and nature of peer-reviewed literature examining the relationship between the ASA-PS classification and patient outcomes, and to identify key characteristics, themes, and knowledge gaps in this evidence base. This scoping review will be conducted according to the Joanna Briggs Institute (JBI) methodological framework and reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). The Population-Concept-Context (PCC) framework will guide eligibility assessment. A comprehensive search will be conducted across PubMed, EMBASE, Scopus, LILACS, and the Cochrane Central Register of Controlled Trials, with no language or date restrictions. Study selection will be performed independently and in duplicate by two reviewers in two stages (title/abstract screening, full-text review). If any discordance appears, a third reviewer verdict will be requested. Data will be extracted using a structured charting form and synthesized narratively. Any healthcare setting where an ASA-PS score is assigned prior to a procedure (inpatient hospital, ambulatory surgery center, outpatient clinic). Primary research designs, including randomized controlled trials, observational studies (cohort, case-control, cross-sectional, descriptive), and case reports will be eligible; review articles, editorials, letters to the editor, and commentaries will be excluded. The search will employ controlled vocabulary (MeSH terms) and free-text keywords including: "ASA score," "ASA Physical Status Classification System," "American Society of Anesthesiologists," in combination with outcome-related terms. Supplementary hand searching of reference lists and Google Scholar will be performed. Study characteristics (author, year, country, journal, design), population characteristics (sample size, age, comorbidity), context (clinical setting, specialty, procedure type, urgency), ASA score details, and outcome details (including statistical methods used to derive associations) will be extracted. A preliminary data charting form is provided in Appendix B. Narrative synthesis supported by descriptive statistics will map study characteristics, outcome categories, clinical contexts, study designs, and temporal and geographical distribution of research. No formal quality appraisal will be conducted. Ethics committee approval is not required for this protocol-based scoping review.

When distress meets technology: The mediating role of AI integration in the link between nurses' moral distress and moral integrity in critical care settings.

How You Say It Matters: Using Growth Mindset to Improve Faculty Feedback And Resident Motivation.

Objectives. To examine differences in the prevalence of gestational diabetes and gestational hypertension by maternal nativity and country of birth among Hispanic mothers in Florida. Methods. We conducted a retrospective analysis of 1 130 250 births from Florida birth certificate data between 2004 and 2022. We compared Hispanic maternal health outcomes by nativity (US-born vs foreign-born) and country of birth using descriptive statistics and nested log-binomial regression models, adjusting for sociodemographic covariates. Results. Foreign-born Hispanic mothers had a higher prevalence of gestational diabetes (5.3%) but lower rates of gestational hypertension (4.3%) than did US-born mothers (4.7% and 5.3%, respectively). Foreign-born mothers from Mexico, Guatemala, Honduras, and Nicaragua had significantly lower adjusted risks for gestational diabetes. Gestational hypertension risk was also lower for most foreign-born groups. However, foreign-born Puerto Rican and Cuban mothers had elevated risks for gestational diabetes compared with their US-born counterparts. Conclusions. Maternal health risks vary substantially in the Hispanic population by nativity and heritage, underscoring the need to disaggregate data to identify disparities. Public Health Implications. Policies and interventions should account for subgroup-specific risks to effectively address maternal health inequities in Hispanic communities. (Am J Public Health. 2026;116(4):512-521. https://doi.org/10.2105/AJPH.2025.308359).