Carbon footprint and its cross-province transfer of plastic waste management system in China.

University courses with hundreds of students have become common, particularly during early years of university studies. The sheer scale of these courses limits traditional instruction, shifting it towards a one-to-many mode of delivery. This shift reduces student–instructor interaction and tailored instructor feedback which are crucial for student success. Automated feedback systems allow scaling feedback, but they often reduce instructor contributions to student learning. This paper investigates how emerging technologies can support, rather than replace, instructors in tailoring their teaching and feedback to identify and correct student knowledge gaps at scale. To address this challenge, the paper introduces a novel technological solution: the Knowledge Gaps to Mastery (KG2M) approach. KG2M combines discussion forum data with course-specific content and leverages large language models (LLMs) and Retrieval-Augmented Generation (RAG) for the dual purpose of identifying prevalent class-level knowledge gaps and transforming them into targeted learning activities and formative assessments. The approach was deployed across three computer science courses with a combined enrollment of 1,355 students and evaluated through semi-structured interviews with five instructors. Results indicate that instructors found the tool intuitive and pedagogically valuable, particularly for surfacing knowledge gaps and generating actionable teaching insights. The paper reports on the tool, the evaluation, and the current limitations of the approach that emerged during instructor evaluation. • Large classrooms are prevalent at universities, but they hinder instructors’ ability to provide feedback tailored to students’ needs. • The rise of GenAI shows promise in providing automated feedback at scale; however, it often lacks the nuanced guidance of instructor-led feedback. • Leveraging discussion forums with appropriate design and tech innovation could minimize instructor workload and address students’ learning needs. • We introduce an approach (KG2M) using LLMs and RAG to spot class-wide knowledge gaps and generate learning activities. • Evaluation via case studies in 3 CS courses (1355 students and 2878 unique posts) and with 5 instructors emphasizes pedagogical value.

Medical genetics and genomics (MGG) is one of many clinical specialties impacted by racial and ethnic disparities in healthcare access, experience, and outcomes. We explored US MGG residents' perceived gaps in knowledge regarding race and ethnicity related issues in clinical settings and their recommendations for supporting trainees in navigating such issues. From November 2022 to March 2023, US MGG residents were recruited for semi-structured interviews via email and social media. Using inductive coding reliability thematic analysis, key themes were identified and interpreted: (1) there is a lack of formal education on race and ethnicity related issues tailored to MGG residency curricula; (2) MGG residents struggle with implementing culturally informed genetic counseling and combating racial/ethnic prejudice in their clinical practice; (3) formal education on race and ethnicity related issues in MGG should be interactive, collaborative, and accessible to providers at all levels of training. Our findings highlight potential areas for improvement that may aid MGG providers and other medical specialties in delivering more just and equitable clinical care.

Knowledge, attitudes, and practices related to cystic echinococcosis in an endemic region of Türkiye: A One Health assessment.

Exploring the knowledge and practice of calcium channel blocker overdose management among South African Emergency Medicine doctors.

Slaughterhouse workers (SHWs) face occupational risk of zoonotic Campylobacter infection (ZCI) but exposure data are limited in low- and middle-income countries (LMICs), particularly Nigeria. This study assessed behavioral, educational, and infrastructural factors affecting Campylobacter exposure among 188 SHWs in Enugu, Nigeria. Data on socio-demographics, hygiene practices, knowledge of zoonotic transmission, and self-reported gastroenteritis symptoms were collected via a validated questionnaire. Descriptive statistics and multivariable logistic regression identified determinants of risky practices, knowledge gaps, and symptoms. Overall, 56.4% of SHWs were classified as high-risk for Campylobacter exposure. Unsafe practices included non-use of personal protective equipment (PPE) (77.1%), washing multiple carcasses in the same bowl (54.8%), eating or drinking during processing (45.7%), and consuming raw or undercooked meat (36.7%). Non-potable water was used by 90.4% of respondents, with only 14.1% purifying it. Behavioral practices aiding ZCI were significantly associated with lack of hygiene training (OR=3.7, 95% CI: 1.7-8.0, p=0.001), low educational attainment (OR=2.8, 95% CI: 0.15-0.85, p=0.020), age≥45years (OR=2.1, 95% CI: 0.25-0.92, p=0.028), and urban slaughterhouse location (OR=2.4, 95% CI: 1.26-4.57, p=0.007). Knowledge gaps were common, with 28-57% unaware of transmission risks via meat, water, PPE, or eating during processing. Self-reported gastroenteritis symptoms were documented in 64.4% of SHWs, with 76% continuing work while symptomatic. Having <10years' work experience (AOR=2.84, 95% CI: 1.36-5.95, p=0.006), lack of training (AOR=2.74, 95% CI: 1.12-6.67, p=0.027), low knowledge of Campylobacter transmission dynamics (AOR=4.46, 95% CI: 2.02-9.87, p<0.001), and high-risk practices (AOR=6.98, 95% CI: 3.0-16.2, p<0.001) were independently associated with symptoms. These findings highlight critical occupational exposure, entrenched unsafe practices, and knowledge deficits. Targeted One Health interventions, including provision of potable water, mandatory use of PPE, and context-specific hygiene training are urgently needed to reduce zoonotic Campylobacter transmission risks and enhance food safety in the study area.

Difficult but doable: Health professional perspectives of assessing clinical deterioration in children with dark-coloured skin.

Developing models of aged care that align with Māori aspirations has been identified as a national priority in a recent report by the New Zealand (NZ) Aged Care Commissioner. We aimed to identify key considerations useful for informing Māori aged care and to identify known gaps and proposed solutions, which could be prioritised in health and social service design, delivery and implementation, and for investigation in future research. We undertook a critical review of peer-reviewed academic and grey literature to identify relevant studies. Studies were grouped into three pre-defined areas: components and values of care models; physical spaces of care; and infrastructures of care. We included 45 articles that focussed on diverse areas including broad experiences of older age, quality of life and well-being, frailty, housing and aged residential care. Findings relating to care models highlighted the aspiration for holistic care models that supported maintaining independence and included meaningful activities. Connection to place and community was important within physical spaces of care and a cross-sectoral approach that allowed for connected and informed decision-making and appropriate resourcing was an important infrastructure consideration. By identifying relevant knowledge relating to models, physical spaces and infrastructures of care, this review provides an evidence base for future health and social service development and identifies gaps in knowledge, which require further research.

Growing evidence highlights maternal risk factors that can increase the likelihood of traumatic childbirth experience. Yet little is known about the availability of primary antenatal intervention for childbirth trauma to facilitate optimal maternal and infant outcomes. The aim of this study was to conduct a systematic review of the literature and empirical evidence to identify antenatal interventions and their effectiveness for treatment of childbirth trauma, post-traumatic stress disorder (PTSD), subthreshold PTSD, or post-traumatic stress (PTS) from childbirth. Four databases were accessed: PUBMED, CINAHL, ProQuest, and EBSCOHOST. PRISMA guidelines were followed for screening and reporting. Inclusion criteria were as follows: (1) peer reviewed articles; (2) samples of pregnant women; (3) published in English; (4) measure of PTSD, PTSD symptoms, PTS or fear of childbirth; (5) variable of childbirth trauma or childbirth experience; (6) antenatal intervention; and (7) human studies. We identified 2034 articles, with 12 articles in the final sample. The most common antenatal intervention in four studies was childbirth plans, which were associated with an increase in positive childbirth experience, childbirth control, mastery, and participation, as well as increased self-efficacy and reduced PTSD symptoms (p < 0.01). Other interventions included antenatal counseling and psychoeducation; eye movement desensitization and reprocessing; counseling; haptotherapy; trauma-informed care; cognitive behavioral therapy; and hypnosis for childbirth trauma. Methodological limitations as well as a lack of inclusion of women with perinatal mental health difficulties represent gaps in knowledge. Findings suggest promising evidence for the implementation of antenatal interventions in clinical and hospital contexts to treat childbirth trauma.

Although a large percentage of pregnancy-related morbidity and mortality is the result of cardiovascular diseases, little is known about the underlying mechanisms that contribute to the development of adverse cardiac changes during pregnancy. It is clear that during pregnancy, the heart adapts to increased ventricular preload through the development of a reversible, pregnancy-induced cardiac hypertrophy. Cardiomyocyte growth must be supported by changes in the cardiac extracellular matrix (ECM), an extremely diverse and dynamic set of components, whose composition and regulation affect cardiac biomechanics. The ECM undergoes extensive remodeling during periods of cardiac stress, such as those experienced during pregnancy and the postpartum period. The full extent of ECM changes and their contributions to biomechanical changes and maternal heart plasticity, however, remain vastly understudied. Recent studies suggest that alterations in the expression of several fibrillar collagens, such as collagens I and III, and regulatory proteins, such as matrix metalloproteinases and tissue inhibitor of matrix metalloproteinases, occur during a healthy pregnancy. On the contrary, in the setting of pregnancy-associated cardiovascular diseases, such as preeclampsia and peripartum cardiomyopathy, adverse changes in ECM remodeling have been reported. This review aims to summarize the current state of the field, highlighting changes in the cardiac ECM and its components during healthy pregnancies, how perturbations in ECM remodeling can lead to the development of pregnancy-related cardiovascular pathologies, and discuss the notable gaps in knowledge that need to be addressed if we are to fully understand ventricular remodeling in the context of pregnancy and reduce maternal cardiovascular disease burden.

We provide an account of enteric neuron types and their roles throughout the digestive tract. It is notable that CNS control is essential in the esophagus and has greater importance in the stomach and distal colon than in the small intestine. CNS control is not essential for the small intestine. Enteric neuron phenotypes and ENS circuits have been determined in detail in the small intestine and colon, but for only two functions, muscle movement and fluid secretion. We discuss neurons controlling other ENS functions, in particular control of neuro-immune interactions and control of nutrient transport. In the small intestine, key neurons include intrinsic primary afferent neurons (IPANs), muscle motor neurons and secretomotor neurons. Neurons for control of acid, enzyme and hormone secretion occur in the stomach, but, except for the muscle motor neurons, gastric neuron types are poorly understood, and information on equivalences of structural and functional types with types defined by expression analysis is lacking. There are substantial gaps in knowledge of esophageal circuitries. IPANS occur in the colon, but whether they occur in the stomach and esophagus is uncertain. We also discuss species differences in organisation of the enteric plexuses and chemical coding of functionally identified neurons. We conclude that there are at least 26 definable enteric neuron types, and several subtypes. There is a need for more in-depth correlated functional and gene expression studies in order to reach a fuller understanding of the physiological roles of the ENS, its constituent neurons and its central connections.

Aquaponics is a recognised food system for its circular nutrient management potentiality, as it redirects aquaculture waste into plant production. However, current practices still fall short of closing nutrient loops, with substantial losses occurring through dissolved effluents and solid waste. This review examines strategies to reduce losses, recover nutrients, internally recycle dissolved streams, and valorise solid side streams in aquaponics, with particular attention to nitrogen and phosphorus due to their dual role as essential, and often limiting, inputs in aquaculture and plant production as well as key pollutants with major eutrophication potential. First, we identify the fate of dissolved and solid nutrients from both aquaculture and hydroponic subsystems. Second, we evaluate strategies to recover these nutrients, exploring opportunities to recycle dissolved nutrients and water, reuse solid waste, and reduce system-wide impacts. Third, we discuss the importance of integrating these processes at a system level and reflect on how current innovations can be better aligned with circular bioeconomy principles. Our synthesis concluded that while the integration of these strategies into optimally efficient, circular aquaponic systems is an ongoing challenge, several key nutrient recovery technologies are themselves well-established and have been successfully implemented. Addressing the gap in knowledge and industry practice will require systems thinking, deeper cross-disciplinary collaboration, and applied research that goes beyond isolated interventions.

Prader-Willi syndrome (PWS) is a rare genetic disorder marked by metabolic, endocrine, and behavioral challenges, with hyperphagia as a central feature contributing to significant health risks. Diazoxide choline extended-release (DCCR; VYKAT™ XR) is a once-daily adenosine triphosphate (ATP)-sensitive potassium channel activator recently approved for the treatment of hyperphagia in individuals with genetically confirmed PWS aged 4 years and older. As this novel therapy enters clinical practice, clinicians require practical guidance on appropriate use. This manuscript provides actionable recommendations for patient selection, baseline assessments, and strategies for optimizing comorbid conditions prior to initiation. Structured, weight-based dosing and titration protocols are outlined, along with recommendations for monitoring glycemia and edema and managing common adverse events (AEs), including hyperglycemia, peripheral edema, and rash. Special considerations are discussed for patients with diabetes, cardiopulmonary risk factors, and those on concomitant medications with potential drug-drug interactions. The guidance is informed by data from the phase 3 DESTINY-PWS program, long-term extension studies, and real-world clinical experience. Emphasis is placed on early identification and management of AEs and the importance of a multidisciplinary approach to care. These recommendations aim to support clinicians in safely and effectively incorporating DCCR into the management of PWS, improving outcomes for affected individuals. Ongoing research and real-world evidence will continue to refine best practices and address remaining gaps in knowledge.

Combined Impact of Cannabinoids and Cocaine on Outcomes of Trauma Patients.

Daily mood reactivity, or the extent to which positive and negative moods change in response to experiences, is both a marker of overall psychological health and a predictor of future health and well-being. A preponderance of studies has focused on negative mood reactivity to stressful events, leaving gaps in knowledge about positive mood reactivity and the impact of positive daily experiences. We aimed to identify within-person patterns of adolescent positive and negative mood reactivity to daily interpersonal interactions, test correlates of mood reactivity patterns, and determine whether adolescent reactivity patterns precipitated mental and behavioral health outcomes in young adulthood. We used latent profile analysis to identify the patterns of positive and negative mood reactivity among 316 racially diverse adolescents (Mage = 16.4 at Time 1) in the United States. Most adolescents were characterized by typical reactivity (86%), showing mood responses in expected directions and average in magnitude. Some adolescents were characterized by heightened reactivity across most daily interactions (generalized heightened reactivity, 7%) or heightened reactivity to certain types of daily interactions (selective heightened reactivity, 7%). Adolescents in the latter two profiles were characterized by greater life stress. Adolescent profile membership was associated with differential cigarette and marijuana use at age 20, with most results indicating higher risk among those with heightened daily mood reactivity. Findings can be used to inform personalized prevention efforts, especially for adolescents with high life stress who may be more likely to exhibit heightened daily mood reactivity and eventually elevated substance use.

This is a summary of the original article "Overview of acute seizure management in US nursing homes." Nursing home residents are more likely than community-dwelling individuals to be diagnosed with epilepsy or seizures. These conditions often complicate care and are associated with an increased likelihood of illness and death. The objective of this survey was to investigate acute seizure management practices in nursing homes in the USA, identify gaps in knowledge, and guide future educational efforts, including acute seizure action plans. The survey was completed by 91 nursing home directors. Overall, 52% of nursing homes had a seizure protocol in place. These protocols were most often put into action by nurses. Most residents with seizures were given rescue medications, primarily older formulations of benzodiazepines, regardless of seizure history. Levetiracetam was the most prescribed antiseizure medication. Staff training/in-service education was infrequent, and 55% of respondents agreed that no-cost seizure education would be highly beneficial. This study highlights the need to improve the treatment of acute seizures in nursing homes, including the adoption of acute seizure action plans.

Obesity-related asthma in children: mechanisms, clinical challenges, and management strategies

Bibliometric mapping of the use of taping in the control of post-surgical edema.

Machine learning (ML)–based solutions have gained traction in various structural engineering applications, from structural design to assessment and monitoring. Nevertheless, the black-box nature of advanced ML models and the resultant limited interpretation and transparency are among the primary barriers to their broader adoption and implementation in the field. eXplainable ML (XML) is an interdisciplinary field that improves understanding of ML model performance. Despite the potential of XML to increase ML accessibility, the scattered available literature and the lack of a domain-specific holistic review have created a significant gap in knowledge about its application in structural engineering. Therefore, this paper presents a targeted review of XML—its definition, nomenclature and taxonomy, frequently used algorithms, and domain-specific literature. Additionally, three case studies are presented to illustrate different classes of XML algorithms and their implementation in diverse structural engineering problems at the component, structure, and inventory levels, providing insights into how these techniques can provide engineering-oriented interpretations that enhance understanding of studied problems.

Development of the INDIGO partnership knowledge exchange strategy