Greater Use Research Articles

Adherence to riluzole therapy in patients with amyotrophic lateral sclerosis in three Italian regions-The CAESAR study.

Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease. Riluzole may increase survival and delay the need for mechanical ventilation. The CAESAR project ('Comparative evaluation of the efficacy and safety of drugs used in rare neuromuscular and neurodegenerative diseases', FV AIFA project 2012-2013-2014) involves evaluating prescribing patterns, and analysing effectiveness and comparative safety of drugs, in patients with neurodegenerative diseases. The aim of this study is to evaluate adherence to riluzole in patients with ALS during the first year of use, identifying adherence clusters. A retrospective cohort study was conducted using administrative data from Latium, Tuscany, and Umbria. We identified subjects with a new diagnosis of ALS between 2014 and 2019, with the first dispensation of riluzole within 180 days of diagnosis. We considered a two-year look-back period for the characterization of patients, and we followed them from the date of first dispensing of riluzole for 1 year. We calculated 12 monthly adherence measures, through a modified version of the Medication Possession Ratio, estimating drug coverage with Defined Daily Dose. Adherence trajectories were identified using a three-step method: (1) calculation of statistical measures; (2) principal component analysis; (3) cluster analysis. Patient characteristics at baseline and during follow-up were described and compared between adherence groups identified. We included 264 ALS patients as new users of riluzole in Latium, 344 in Tuscany, and 63 in Umbria. We observed a higher frequency of males (56.2%) and a mean age of 67.4 (standard deviation, SD, 10.4) in the overall population. We identified two clusters in all regions: one more numerous, including adherent patients (60%, 74%, 88%, respectively), and another one including patients who discontinued therapy (40%, 26%, 12%, respectively). In Tuscany patients discontinuing riluzole more frequently died (28.6% vs. 15.4%, p-value <0.01). Additionally, low-adherers had a higher frequency of central nervous system disorders (69.0% vs. 52.5%, p-value 0.01), and a greater use of non-pharmacological treatments (p-values ≤0.01 for invasive ventilation and tracheostomy). We did not observe any differences in Lazio, whereas in Umbria we observed a higher use of drugs for dementia-related psychiatric problems among low-adherers (57.1% vs. 7.8%, respectively, p-value <0.01), although with small numbers. Most ALS patients who start riluzole adhere to therapy during the first year. Patients who discontinue therapy early show greater fragility and mortality.

Real-World Analysis of the Underdiagnosis, Clinical Outcomes and Associated Burden of Hematopoietic Stem Cell Transplantation-Associated Thrombotic Microangiopathy (HSCT-TMA) in the United States of America

Background: Thrombotic microangiopathy (TMA) associated with hematopoietic stem cell transplantation (HSCT-TMA) is a serious post-transplant complication. HSCT-TMA is difficult to diagnose due to overlapping symptoms with other conditions and a lack of universally adopted diagnostic criteria. Objectives: This study aimed to assess the incidence and diagnosis of HSCT-TMA in real-world practice across the US, including possible missed diagnoses, alongside clinical outcomes and associated burden of HSCT-TMA. Methodology: This retrospective, observational study investigated the incidence of HSCT-TMA from July 2009-August 2020 using data from the TriNetX US Electronic Medical Record (EMR) database. Patients who underwent autologous or allogenic HSCT procedures and had conditioning regimens recorded were stratified into three cohorts: confirmed TMA, suspected TMA, and non-TMA patients. Confirmed TMA was defined as any individual with at least one recorded hemolytic uremic syndrome (HUS)/TMA diagnosis code within 12 months of HSCT. Suspected TMA included individuals without a recorded HUS/TMA ICD code, but who met the modified published criteria (Cho BS, et al. Transplantation 2010;90:918-26; Jodele S, et al. Transfus Apher Sci 2016;54:181-90) within 12 months of HSCT; published criteria were adapted to fit data available in the TriNetX database. Non-TMA patients did not meet criteria to be included in either of the previous two cohorts. Adult and pediatric patients were analyzed separately. Demographic and clinical characteristics at baseline, clinical outcomes, and all-cause unadjusted healthcare resource utilization within 12 months of HSCT, were assessed. The baseline period was defined as the six months before the index date (inclusive), unless specified; index date was defined as the date a patient had a HSCT procedure code recorded. Statistical comparisons, where conducted, were made against the non-TMA cohort using the Fisher's exact test for categorical variables, the student's t test for means, and the Mann-Whitney U test for medians. Significance was set at the level of p&amp;lt;0.05. Results: In total, 16,809 adult and 901 pediatric patients had an HSCT procedure code and a recorded conditioning regimen. The confirmed TMA group comprised 125 (0.7%) adult and 30 (3.3%) pediatric patients, the suspected TMA group included 3,029 (18.0%) adult and 94 (10.4%) pediatric patients, and the non-TMA group included 13,655 (81.2%) adult and 777 (86.2%) pediatric patients. Baseline demographics were similar across all groups. Mortality within the first year of HSCT was significantly higher in adult patients with confirmed TMA (40.0%) and suspected TMA (30.7%) compared with patients without TMA (13.6%). Mortality was numerically highest in pediatric patients with confirmed TMA (26.7%) followed by suspected TMA (23.4%), and lowest in non-TMA patients (15.8%). Comorbidity impact (based on the Charlson Comorbidity Index) was significantly higher, and HSCT complications significantly more common, in confirmed and suspected TMA patients (Table 1). Clinical outcomes in the first year after HSCT were significantly worse in confirmed and suspected TMA patients than in non-TMA patients (Table 2). All patients with confirmed and suspected TMA had a significantly higher frequency of oxygen/intubation compared with non-TMA patients. Dialysis rates were significantly higher in all patients with confirmed TMA (adults, 26.4%; pediatrics, 20.0%) and adult patients with suspected TMA (6.9%), compared with patients with no TMA (adults, 2.2%; pediatrics, 4.0%); pediatric patients with suspected TMA (8.5%) had numerically higher dialysis rates compared with those without TMA (4.0%). Patients with confirmed and suspected TMA had significantly greater use of targeted therapies and a higher number of total ICU visits, compared with non-TMA patients (Table 2). Conclusions: This study showed that HSCT-TMA is associated with a high mortality and morbidity burden. Furthermore, these results suggest that HSCT-TMA is underdiagnosed in the real-world setting, as patients with suspected TMA had worse outcomes and a higher burden of disease than patients without TMA following HSCT. This study highlights the need for timely diagnosis of this severe complication, as well as novel approaches to treat and manage this vulnerable population.

Cisgenics and intragenics: boon or bane for crop improvement

Recent advances in molecular biology and genetic engineering have made it possible to increase agricultural yields when compared to conventional methods. However, lots of challenges are to be addressed due to changing climatic conditions. Although genetically modified organisms (GMOs) have proven their potential in a few crops, but needs to be explored in majority of the field/vegetable crops to overcome food and nutritional security in view of alarming population explosion. In spite of advantages from GMO crops due to the presence of foreign DNA, queries regarding their safety, environmental dangers and health effects needs to be addressed. One of the major environmental issues concerning transgenic crops is the mixing of genetic components across species that cannot hybridize naturally. Due to these limitations, new revolutionary technologies have been developed, such as intragenesis and cisgenesis for the transformation and development of superior plants. While cisgenesis entails genetic modification employing a complete copy of natural genes with their native regulatory components that only belong to sexually compatible species, intragenesis refers to the transfer of unique combinations of genes and regulatory sequence inside the same species. In cisgenesis, the donor genes are the same genes employed in conventional breeding. The two benefits of cisgenics are avoiding linkage drag and making greater use of existing gene alleles. This method significantly shortens the time it takes to breed plants by combining conventional methods with cutting-edge biotechnological tools. Because of this, plant genomes can be altered without causing drastic changes to the whole plant population and the environmental effects of cisgenic plants cannot be compared to those of transgenics. Transgenesis and cisgenesis share the same transformation methods; hence, cisgenic, intragenic and transgenic plants produced through random insertion do not pose any distinct risks with regard to host genome modifications. In contrast, using new genome techniques lessens the dangers related to potential unintentional changes to the host DNA. The use of cisgenesis and intragenesis as alternatives to transgenesis has been restricted to a small number of species due to incomplete understanding of the required regulatory sequences.

Effect of Iron (Fe) heavy metal content at different pH on the germination of seven soybean varieties in Indonesia

Greater use of acid soil has expanded the area under cultivation for soybeans; however, acid soil is associated with heavy mineral toxicity, including Iron (Fe). This investigation looked at how well soybean seeds germinated in media containing heavy metal Fe and how the pH of the media affected the viability of soybean seeds. This research was conducted at the Seed and Plant Breeding Laboratory at the University of Lampung, Indonesia. The experimental design was a randomized block design. The first factor was seven soybean local varieties – Grobogan, Anjasmoro, Derap 1, Detap 1, Dena 1, Deja 1, and Dega 1 – and the second factor was heavy metal Fe solution pH of 6–7 and 4.5 and without heavy metal Fe (control). Seed viability in heavy metal Fe medium was assessed using radicle emergence, germination capacity or percentage, germination speed, number of normal seedlings, normal seedling hypocotyl length, main root length of regular seedlings, and normal shoot dry weight. This research found that heavy metal Fe affected soybeans’ seeds’ viability in pH 6–7 and 4.5. The observed data showed that all seeds’ viability variables in media with heavy metal Fe, both in pH 6–7 and in pH 4.5, differ from the control media. The seed viability in media heavy metal Fe pH 6–7 was not significantly different from the control media, but in pH 4.5, the difference is significant. Soybean varieties’ characteristics also influence how heavy metal Fe in different pH affects seed viability. Overall, Anjasmoro, Deja, Grobogan, and Dega were the types that consistently demonstrated resistance or adaptation to heavy metal Fe existence, while Dena, Derap, and Detap are susceptible to heavy metal Fe existence. Seed viability in Iron medium is not always related to seed physical performance; therefore, before planting soybean in acid soil, it is recommended to conduct a seed viability test.

Pre-Post Cannabis Legalization for Adult Use: A Trend Study of Two Cohorts of Young Adult Cannabis Users in Los Angeles

ABSTRACT Cannabis was legalized for adult use in California in 2016 for individuals 21 and older. Among 18–20-years-olds, who can possess cannabis legally as medical cannabis patients (MCP) but not as non-patient cannabis users (NPU), the impact of adult use legalization (AUL) on cannabis and other substance use is unknown. Two cohorts of 18–20-year-old cannabis users (MCP and NPU) were surveyed, one in 2014–15 (n = 172 “pre-AUL”) and another in 2019–20 (n = 139 “post-AUL”), using similar data collection methods in Los Angeles, California. Logistic and negative binomial regressions estimated cohort and MCP differences for cannabis and other drug use outcomes based on past 90-day use. In both pre- and post-AUL cohorts, MCP were more likely to self-report medical cannabis use (p < .001) while the post-AUL cohort reported greater use of edibles (p < .01), but fewer mean days of alcohol (p < .05) and cigarette (p < .01) use in multivariate models. Notably, frequency of cannabis use (days or hits per day) did not significantly differ between the pre- and post-AUL cohorts, except for greater use of edibles, despite potentially greater access to cannabis.

Cascading effects of Chinese American parents' COVID-19 racial discrimination and racial socialization on adolescents' adjustment.

Using a three-wave longitudinal sample of 108 Chinese American parent-adolescent dyads (Mparent-ageW1 = 45.44 years, 17% fathers; Madolescent-ageW1 = 13.34 years, 50% boys), this study examined the effects of parents' COVID-19-related racial discrimination experiences on adolescents' ethnic identity exploration and anxiety as mediated by parents' awareness of discrimination (AOD) socialization and moderated by parents' anxiety and racial socialization competency (RSC). Parents' racial discrimination experiences in 2020 predicted adolescents' greater ethnic identity exploration or greater anxiety in 2022 via parents' greater use of AOD in 2021, depending on the levels of parents' anxiety and RSC. These findings highlighted individual and contextual factors impacting racial socialization processes in Chinese American families.

Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study

BackgroundThe high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities.Objectiveto investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon.Methodsan ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5.ResultsA total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of – 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care.ConclusionsThe increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state’s health regions and macroregions.

Child and Maternal Factors Associated with Feeding Practices in Children with Poor Growth.

The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother-child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of -2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = -0.40, -0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = -0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = -0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.

Pharmacy users' perceptions, awareness and future expectations of community pharmacy in England: a focus group study.

To explore pharmacy users' perceptions of current and future provision of community pharmacy services in England. Qualitative, reconvened focus groups were conducted with community pharmacy users. An initial focus group explored preliminary views. Participants were then given an evidence brief describing community pharmacy before a reconvened focus group two weeks later. Transcripts were analysed using inductive thematic analysis. Eleven individuals participated across two reconvened focus groups. Participants valued community pharmacies and staff, but lacked awareness of their services and roles: '… I don't think the general public is aware of all of this … it gives you a very different perspective'. Urgent care and long-term conditions management were identified as suitable for future development, facilitated by training, closer collaboration with general practices, shared access to health records, and premises with more space and confidentiality: 'I still think of it as a retail space more than as a health service'. Concerns were expressed about working conditions in community pharmacy and unplanned closures: 'doesn't sound like a great place to work'. Participants anticipated greater use of technology but did not want this to replace face-to-face contact with pharmacy staff: 'I am not saying it's inaccurate, it is so remote and impersonal'. Pharmacy users would value a greater role for community pharmacy in addressing the challenges currently faced by the health service in England, provided that their concerns on a range of issues are addressed.

Comparison of relative change with effect size metrics in Alzheimer’s disease clinical trials

BackgroundPer cent slowing of decline is frequently used as a metric of outcome in Alzheimer’s disease (AD) clinical trials, but it may be misleading. Our objective was to determine whether...

HPB P33 Evaluating the Disease Burden of Gram-negative Bacteraemia Secondary to Cholelithiasis in a Multi-site District General Hospital

Abstract Background The incidence of symptomatic cholelithiasis continues to rise. We are now observing an increasing number of cases within an elderly, frail, co-morbid patient population. Gram-negative bacteraemia (GNB) secondary to cholelithiasis in this high-risk patient cohort carries a significant morbidity and mortality rate. Reducing GNB rates has been identified as a national target by Public Health England. Our aim is to evaluate the burden of GNB due to cholelithiasis and the management received in a district general hospital in order to inform approaches to reducing the burden of GNB. Methods A cross-site audit was conducted across two ‘hot’ district general hospitals serving approximately 1 million people within the same NHS foundation trust. Patients with positive blood cultures for GNB secondary to cholelithiasis were identified. Data was collected regarding patient demographics, survival outcomes, whether definitive treatment for cholelithiasis was performed on the index admission and re-admission rates. Results A total of 176 GNB patients from a microbiology database were analysed of which 69 (39%) were identified to have gallstone disease on index admission. Median age of the cohort was 81 years old. Only 10 patients (14%) received a cholecystectomy. Previous gallstone-related admission was found in 23 patients, therefore 23/176 (13%) of GNBs were potentially preventable. Assessment of fitness found 11/176 (6%) were preventable as they were fit for surgery at index non-GNB biliary admission, 4 patients were on a waiting list. Overall, 25 patients were unfit for surgery of which 12 received a drain and 6 were readmitted. Conclusions This audit demonstrated a significant proportion of GNB is caused by gallstone disease however a minority of patients are receiving surgery during admission, relinquishing the opportunity to prevent readmission in surgically fit patients. With long waiting times for elective procedures, combatting the burden of GNB requires a shift towards the use of acute cholecystectomy lists. With an increasingly frail population optimal non-operative management is essential to reducing GNB burden, almost half of these patients received a drain which evidence suggests does not reduce recurrence. Greater use of cystic duct stents advised by NICE in this cohort may reduce GNB admissions.

Hematopoietic Cell Transplantation Trends and Outcomes in Canada: A Registry-Based Cohort Study.

Background: Hematopoietic cell transplantation (HCT) is an established therapy for hematologic malignancies and serious non-malignant blood disorders. Despite its curative potential, HCT is associated with substantial toxicity and health resource utilization. Effective delivery of HCT requires complex hospital-based care, which limits the number of HCT centres in Canada. In Canada, the quantity, indications, temporal trends, and outcomes of patients receiving HCT are not known. Methods: A retrospective cohort study of first transplants reported to the Cell Therapy Transplant Canada (CTTC) registry between 2000 and 2019. We determined overall survival (OS) and non-relapse mortality (NRM), categorizing the cohort into early (2000-2009) and later (2010-2019) eras to investigate temporal changes. Results: Of 18,046 transplants, 7571 were allogeneic and 10,475 were autologous. Comparing the two eras, allogeneic transplants increased in number by 22.3%, with greater use of matched unrelated donors in the later era. Autologous transplants increased by 10.9%. Temporal improvements in NRM were observed in children and adults. OS improved in pediatric patients and in adults receiving autologous HCT. In adults receiving allogeneic HCT, OS was stable despite the substantially older age of patients in the later era. Interpretation: HCT is an increasingly frequent procedure in Canada which has expanded to serve older adults. Noted improvements in NRM and OS reflect progress in patient and donor selection, preparation for transplant, and post-transplant supportive care. In allogeneic HCT, unrelated donors have become the most frequent donor source, highlighting the importance of the continued growth of volunteer donor registries. These results serve as a baseline measure for quality improvement and health services planning in Canada.

Treatment of Thoracic Tuberculosis Through Posterior Costal Transverse Joint Window: A Clinical Study

BackgroundThe surgical treatment of thoracic spinal tuberculosis has garnered enormous interest from researchers towards the development of posterior surgical techniques that have contributed to greater use of the one-stage posterior approach. This study aims to demonstrate the initial clinical experience of a modified total posterior approach, in which the one-stage posterior approach preserves the posterior spinal column structure by combining with the endoprosthetic implant fusion for thoracic spinal tuberculosis. MethodsIn this clinical study, we intended to report the initial idea of a modified total posterior approach. In detail, a one-stage posterior approach was applied to preserve the posterior spinal column structure that could be applied to clinical practice. ResultsThe employed practical procedure presented a reduced duration of surgical intervention and intraoperative trauma. Nevertheless, further studies with large samples and multiple centers are required to explore the idea comprehensively. ConclusionsThis approach offered some advantages in terms of intraoperative exposure, blood loss volume, and length of surgery. Further, multi-center studies with large samples are needed to understand the precise effects and implications of the approach.

Health warning labels on heated tobacco products and their impact on use intentions and risk perceptions: a cross-sectional study of adult tobacco users in the US and Israel.

Health warning labels (HWLs) represent an evidence-based tobacco control strategy; however, their application to heated tobacco products (HTPs) and related impacts are understudied. This study examined the impact of HTP HWLs on HTP use intentions and risk perceptions among current tobacco users. We analyzed cross-sectional survey data from adults in the US and Israel reporting past-month tobacco use and awareness of HTPs (N = 424). Multivariate analyses examined: (1) sociodemographics in relation to self-reported impact of HTP HWLs (i.e., more concerned about HTP use, reassured, no effect [referent]) among those who noticed HTP HWLs (multinomial regressions); and (2) HWL impacts in relation to HTP use intentions and perceived addictiveness and harm (linear regressions). Among participants who noticed HTP HWLs (n = 372, 87.7%), 27.7% reported HWLs increased their concerns about HTP use, 22.6% were reassured about use, and 49.7% reported no effect. Factors associated with increased concern (vs. no effect) included other tobacco product use (aOR = 2.10, 95% CI 1.21-3.64) and being female (aOR = 1.77, 95% CI 1.03-3.05). Factors associated with being reassured about HTPs use (vs. no effect) included current HTP use (aOR = 2.11, 95% CI 1.11-4.00) and being from Israel (vs. US: aOR = 3.85, 95% CI 1.85-7.69), female (aOR = 1.91, 95% CI 1.07-3.42), and less educated (< college education: aOR = 2.57, 95% CI 1.42-4.63). Reporting that HWLs on HTPs increased concern (β = 0.46, 95% CI 0.03-0.89) and reassured of use (β = 0.94, 95% CI 0.47-1.41) were positively associated with HTP use intentions; no associations with risk perceptions were found. Findings indicate that most tobacco users noticed HWLs on HTPs, but the majority reported no effect or being reassured of using HTPs, effects that were magnified for specific subgroups. Both increased concern and reassurance correlated with greater use intentions. Additional research should evaluate HTP HWL impacts and ensure effectiveness in communicating risks and discouraging use.

Immersive Technologies for Digital Libraries

The purpose of the study is to analyse modern immersive technologies and the possibility of their application in the development of digital libraries in the context of the introduction of virtual, augmented and mixed reality technologies, as well as the use of artificial intelligence technologies. Research methods. To achieve the research goal, the methods of analysis and synthesis, generalisation of theoretical data, and a systematic approach were used. This made it possible to analyse the peculiarities of the use of immersive technologies in digital libraries and to determine the benefits of introducing such technologies in the creation of a modern information space of libraries. The scientific novelty lies in the analysis of immersive technologies in the context of their implementation in modern digital libraries. An analysis of the role of artificial intelligence, and augmented and virtual reality technologies in creating a modern information space in libraries has shown both the advantages and disadvantages of digitalisation in libraries. The ethical issues related to inclusiveness in the use of information resources and the protection and preservation of users’ data are analysed. Recommendations and approaches for the successful implementation of these technologies in digital libraries are proposed. Conclusions. Immersive technologies are becoming more widespread and their use in libraries is expanding. Ethical and legal issues in the use of virtual reality and augmented reality will inevitably arise in the future. Today, the Western world is making greater use of both technologies, although they are free and, in some cases less expensive than before. The article examines the transformative intersection of new technologies and digital libraries, highlighting the path to an enriched and accessible knowledge landscape. Focusing on artificial intelligence (AI), machine learning (ML), natural language processing (NLP), augmented reality (AR) and virtual reality (VR), it explores how these technologies are redefining the work of digital libraries. Artificial intelligence and machine learning algorithms enable intuitive content management and recommendations, changing the way users interact with digital resources. NLP bridges the gap between human language and digital systems by enhancing search functions. AR overlays digital information on the physical world, expanding the possibilities of interactive learning, while VR immerses users in virtual realms, revolutionising educational paradigms. This article discusses the integration of these technologies into digital libraries not only to preserve huge amounts of knowledge but also to present information in attractive and accessible formats. Through the creation of artificial intelligence-based metadata and tagging of content, digital libraries are systematically organized and enriched, improving search accuracy. These innovations not only preserve the past, but also illuminate a future where knowledge is publicly available, fostering curiosity, learning, and research. This article explores the potential of these technologies and describes the expectations of library users to ensure a user-centred approach in shaping the digital libraries of the future. The use of immersive technologies is making a significant contribution to the evolution of digital libraries, paving the way for inclusive and engaging knowledge experiences for diverse users around the world.

Does the Validity of the Environmental Kuznets Curve Postulation Empirically Depend on the Level of Human Development in Africa?

Purpose: The interconnectedness between human development and environmental degradation is a complex issue that warrants investigation in Africa. Although there are a few studies on the economic growth and environmental degradation nexus for African countries, there is a huge scarcity of empirical research that explores the Environmental Kuznets Curve (EKC) postulation in the context of human development and environmental degradation in Africa. The study therefore empirically explored the relationship between Human Development and Environmental Degradation within the framework of the EKC using 50 African countries subdivided into High Human Development Index Countries (HHDICs), Medium Human Development Index Countries (MHDICs) and Low Human Development Index Countries (LHDICs) from 2000 to 2019. Data for the study were obtained from the World Bank’s development indicators and the Human Development Reports of the United Nations Development Programme (UNDP-HDR).&#x0D; Methodology: The study made use of the Panel Corrected Standard Error (PCSE) model and the Feasible Generalised Least Squares Regression model (FGLS) which are econometrically suitable to handle N &gt; T and T &gt; N panels respectively, and are both robust to cross sectional dependence, contemporaneous correlation, group wise heteroscedasticity and slope heterogeneity. Other econometric techniques such as Descriptive Statistics, Correlation Analysis, Variance Inflation Factor test (Multicollinearity), second generation unit root tests (CADF and CIPS), Durbin Watson, Breusch Godfrey tests (Serial Correlation) and the White Test (Heteroscedasticity) were also employed in the study.&#x0D; Findings: The empirical results produced evidence that the data is integrated of order one I(1) and exhibits cross sectional dependence, slope heterogeneity and cointegration. The data was also found to be serially correlated and heteroscedastic. However, multicollinearity was absent. The panel estimates of the PCSE and the FGLS estimators showed that Human Development is a key driver of Environmental Degradation in Africa, with the greatest proportion of the impact on HHDICs, followed by MHDICs and then finally LHDICs. The results also revealed the validity of the EKC postulation only in the HHDICs, evidenced by the presence of an inverted U-shaped relationship between Environmental Degradation and Human Development. In The LHDICs and MHDICs on the other hand, U-shaped relationships between Environmental Degradation and Human Development were found, signalling the invalidity of the EKC. There was significant evidence for the support of the feedback hypothesis between Human Development and Environmental Degradation in HHDICs, MHDICs, LHDICs and all the 50 African countries at large. Based on the findings, Policymakers were given recommendations that took into consideration the uniqueness of the economic situations in HHDICs, MHDICs, LHDICs and Africa as a whole.&#x0D; Recommendations: The study shows that the degree of environmental degradation is proportional to the level of human development in Africa and indicates that the validity of the EKC postulation in the context of human development) is exclusive to only the HHDICs in Africa. This provides an incentive for policy makers in the MHDICs and LHDICs of Africa to make human development a priority through industrialisation and other profitable economic activities. This is likely to help them afford innovations and technological developments that protect the environment through the greater use of cleaner energy than the naturally abundant fossil fuel as well as the institutionalisation of policies that protect the environment as human development appreciates.

Factors Influencing the Human Talent Recruitment Process in Private Companies: A Systematic Review

Over time, organizations have made important changes with respect to the perspectives of human capital management, going from being a resource that is easy to replace to a resource with a sustainable vision in the company. Changing situations and technological advances have allowed organizations to give due importance to human participation, since it is a resource that, through its activities, makes the achievement of objectives possible. Therefore, organizations consider that the recruitment process must go through more demanding filters where the productive factors possessed by human talent are reliably captured. The present review has been submitted to databases such as: Dialnet, Redalyc, Scielo and Scopus, obtaining 25 articles, Redalyc had a greater contribution with 48% and the countries with greater implication for the study were Ecuador and Peru with 24%, the methodological design with greater use in the literatures was quantitative with 48% and the most used instrument was the questionnaire with 52%. Likewise, to detail the search procedure, the PRISMA 2020 diagram was used, and from a total of 3411 articles, a total of 2857 was excluded between non-retrieved and ineligible reports, arriving later under a final filter to a total of 25 articles. In conclusion, the results showed that the most influential factors in the recruitment process were education; where relevance is given to knowledge and professional and specialized training for effective decision making around their functions; on the other hand, work experience that links the technical and practical aspect of the collaborator who seeks efficiency in the processes; finally, the psychological traits that reflect the emotional balance and management of pressure situations and soft skills that affect productivity and performance. This research contributes to future researchers to identify the most used parameters in human recruitment processes for success and consistency in business decision making.

The Impact of Emotion Regulation Improvements on Intolerance of Uncertainty During Emotion Regulation Therapy

Both intolerance of uncertainty (IU) and impoverished emotion regulation repertoires characterize generalized anxiety disorder (GAD). Across two treatment studies, we explored relationships between two emotion regulation skills, decentering and reappraisal, and IU during emotion regulation therapy (ERT). Participants were treatment-seeking individuals diagnosed with GAD. Study 1 included data from two open trials of ERT (N = 52), and Study 2 examined data from a randomized controlled trial of ERT (n = 28) versus a minimal attention control (n = 25). IU and emotion regulation skills were measured at pre-, mid-, and post-treatment. Mediation models explored indirect effects of emotion regulation skills on the relationship between time (Study 1) or group (Study 2) and intolerance of uncertainty. Results demonstrated improvements in emotion regulation skills and reductions in IU during ERT. Greater use of reappraisal and decentering was associated with reduced IU over time. Tests of indirect effects suggested that observed between-group differences in IU can be explained by changes in emotion regulation skills. The findings from these studies highlight the utility of non-IU-specific interventions to help individuals tolerate uncertainty. Exploring the impact of emotion regulation skills on IU could lead to improvements in treating GAD.

The current state of anatomy education in United States doctor of physical therapy programs.

Physical therapy education has significantly evolved over the past few decades. While gross anatomy is integral to physical therapy education curricula, the current state of anatomy education within these programs is not well understood. The primary purpose of this report was to provide an update on the current state of anatomy education across United States (US) Doctor of Physical Therapy (DPT) programs. A survey was disseminated to all 261 accredited US physical therapy programs. The survey was deployed in November 2020 with a deadline to respond by January 15, 2021. The response rate was 32.6% (85/261). When teaching anatomy, 90.5% of the responding programs used dissection, 71.4% used didactic lectures, 60.7% used computer-assisted technology, 58% used prosections, 23.8% used plastinated models, and 31% reported using other methods. DPT programs have experienced declines in PhD faculty (15.7%) and Master of Physical Therapy faculty (15.3%) and notable increases in DPT (16.5%) and physician faculty (8.2%) teaching anatomy within DPT programs. Despite greater use of computer-assisted technologies, these technologies have not replaced donor-based dissection in DPT programs.

MINOCA due to vasospasm compared to other mechanisms: patients characteristics, evolution and prognosis

Abstract Introduction coronary vasospasm is a common cause of MINOCA (myocardial infarction with non-obstructive coronary arteries). The aim of this study is to compare characteristics and prognosis of patients (pts) with MINOCA due to vasospasm (MINOCA-V) vs those with MINOCA due to other causes (MINOCA-O). Methods we included all MINOCA pts between January 2015-December 2022. The definitions of MINOCA and vasospasm were based on European Clinical Guidelines. The diagnosis of vasospasm was made in the cath lab or with non-invasive bedside tests (ergonovine). The follow-up analysis included major adverse cardiovascular events (MACE: death from any cause, cardiovascular readmission, reinfarction and stroke). The median follow-up was 59.5 months [36-75]. Results there were a total of 120 MINOCA pts, of which 19 (16%) were MINOCA-V and 101 (84%) MINOCA-O (embolism, dissection, type II infarction, unknown). Regarding the clinical profile of MINOCA-V, they were fewer women (21 vs 49% p=0.03), younger (mean age 56±11 vs 63±15 p=0.03) and more smokers (78.9 vs 50.5% p=0.02). There were no significant differences in cocaine use (7.7 vs 5.5% p=0.75) or other baseline characteristics (Table 1). Not only there was a higher percentage of pts with ST elevation at admission in the vasospasm group (53 vs 12% p&amp;lt;0.01), but also they presented with a higher elevation of biochemical markers of myocardial damage (MMD), both troponin (125.11±203.8 vs 609.48±1661.2 ng/L,p&amp;lt;0.01) and CK (201±272.4 vs 338.75±384.3 U/L p=0.01). There were no significant differences in renal function (Cr 1.4±1.8 vs 1.1±1.5mg/dL p=0.15) and cholesterol levels (163.05±48 vs 172.6±65.7mg/dL p=0.99). The use of magnetic resonance imaging to complete diagnosis did not differ between both groups (26vs37% p=0.34), although it was more effective when approaching the etiology in MINOCA-O (0 vs 18%, p=0.04). The duration of admission was similar between both groups (6±4 days in MINOCA-V vs 5±4 in MINOCA-O, p=0.78). The treatment at discharge was different, being greater the use of nitrates (53vs10% p&amp;lt;0.01) and calcium antagonists (CA), both not dyhidropyridines (53 vs 7% p&amp;lt;0.01) and dihydropyridines (53 vs23% p=0.01) in MINOCA-V and less that of beta-blockers (BB) (0 vs 62% p&amp;lt;0.01) and acetylsalicylic acid (ASA) (32vs73% p&amp;lt;0.01). During follow-up, the evolution was similar in terms of mortality (HR 1.81 IC95%[0.33-10] p=0.2) and MACE (HR 1.76 IC95%[0.69-4.51] p=0.17). No differences were found in cardiovascular readmissions (HR 1.04 IC95%[0.35-3.07] p=0.29), stroke (no cases in both groups) and reinfarction (HR 1.3 IC95%[0.25-6.81] p=0.57). Conclusion we conclude that pts with MINOCA-V are more likely to be male, younger and smokers than MINOCA-O. They usually present with ST elevation and increased elevation of MMD. Treatment at discharge is different: with greater use of nitrates and CA and lower ASA and BB. The prognosis is similar in both groups with no significant differences in mortality or MACE.