Amyotrophic lateral sclerosis (ALS) affects military veterans at a higher rate than the general civilian population. The aim of the present study is to assess symptom burden and satisfaction with care among persons with ALS care enrolled in the US Veterans Health Administration (VA). A custom online survey was created with questions about symptom prevalence and management as well as care satisfaction. A survey link was sent by email to all veterans with an ICD-10 diagnosis of ALS in the VA for whom an email address was available in the electronic health record. Responses were received from 413 individuals (16% response rate). Respondents reported high care satisfaction and higher prevalence of treatment of symptoms compared to prior surveys of persons with ALS in the United States. Self-reported outcomes, including treatment, education, and satisfaction, were better for Veterans receiving care exclusively within the VA compared to those receiving care at both VA and non-VA facilities or receiving care exclusively at non-VA facilities. Areas for further improvement identified in the survey include education on genetic testing and research and management of non-motor symptoms. This survey indicates that, overall, veterans with ALS receive comprehensive symptom-based care within the nationalized VA care system and report high levels of satisfaction. Furthermore, this study provides baseline data and findings that may be used for quality improvement efforts across a large healthcare system and may serve as a model for similar efforts in other health systems.

Administrative health data provide valuable insights into healthcare, but missing data remains a major barrier to ensuring the veracity of findings. This paper presents a structured approach to addressing missingness in administrative datasets, focusing on data assessment and statistical methods. Using causal diagrams and understanding the types of missing data to guide appropriate analytical strategies aligned with the Treatment And Reporting of Missing data in Observational Studies (TARMOS) framework. A real-world example demonstrates multiple imputations in large-scale health research. By promoting transparent and rigorous methods, this methods paper enhances the reliability and policy relevance of administrative data-based healthcare research.

Bilirubin is a breakdown product of erythrocytes and plays a crucial role in elimination of heme-containing proteins. After its synthesis in the reticuloendothelial system, unconjugated bilirubin is released into plasma and taken up into the liver. In hepatocytes, bilirubin is conjugated and excreted into the gastrointestinal tract via bile, where it is further converted to urobilinoids. There are various genetic factors causing abnormal bilirubin levels in plasma, such as Gilbert syndrome, Crigler-Najjar syndrome, Dubin-Johnson syndrome, and Rotor syndrome. To better understand bilirubin metabolism and its disorders, this study develops a physiologically based computational model incorporating published literature as well as real-world clinical data from the Explorys database. The model simulates bilirubin levels in both healthy individuals and patients with disorders of bilirubin metabolism. Population simulations show that Gilbert syndrome requires a substantial reduction in UDP-glucuronosyltransferase 1A1 activity, while Crigler-Najjar syndrome requires near-complete loss of its function. In contrast, Dubin-Johnson syndrome is characterized by a significant impairment of multidrug resistance-associated protein 2 activity. To also illustrate model behavior under targeted perturbations, we simulated administration of atazanavir in healthy individuals and patients with Gilbert syndrome to investigate its effect on bilirubin levels. Relative to baseline, unconjugated bilirubin maximum concentration (Cmax) increased by 34% in healthy individuals but by 67% in Gilbert syndrome. Overall, this study provides a conceptual and mechanistically informed framework for studying bilirubin homeostasis and the functional consequences of drug administration in health and disease.

Background: To identify patients at the highest risk for acute care utilization, health care systems have developed “hot spotter” programs. Homelessness is a robust social determinant of acute care utilization. Objectives: To describe the prevalence, patterns, and correlates of meeting criteria for a hot spotter program among housing-insecure adults in the US Veterans Health Administration (VHA). Research Design: Among veterans on the VHA Homeless Registry in Fiscal Years 2018–2022 (N=1,469,893), we identified those who met criteria for a Hot Spotter Report [ie, ≥1 hospital admissions and/or ≥2 emergency department (ED) visits in at least one quarter], described their patterns of acute care use, and examined differences in patient characteristics and outpatient service use between those who met report criteria in multiple quarters (vs. one). Results: Thirty percent (N=446,974) met report criteria in at least one quarter; most (56%) met report criteria in ≥2 quarters. Diagnoses of depression (58%) and/or a substance use disorder (51%) were common; however, the rate of hospitalization in an acute medical setting during the cohort period was twice that of being hospitalized in an acute mental health setting (50% vs. 25%). Being on the Hot Spotter Report in multiple quarters (vs. one) was associated with more chronic conditions (M=5.08 vs. 3.29), higher rates of suicidality (23.7% vs. 11.7%), and higher likelihood of all types of outpatient care ( P <0.0001). Conclusions: Given rates of chronic medical conditions and medical hospitalizations, it may behoove hot spotter programs to increase care coordination with medical respite programs to support patients in the postacute phase.

Objective: Examine whether self-reported cognitive symptoms, an indicator of need, were associated with the likelihood that Veterans with moderate-severe traumatic brain injury (msTBI) received a cognitive rehabilitation referral. We also explored whether non-clinical factors modified the relationship between cognitive symptoms and receipt of a referral. Setting: Veterans Health Administration (VHA). Participants: Veterans with msTBI, determined using Comprehensive Traumatic Brain Injury Evaluation data from 2013–2023 ( n = 10 790). Design: Cross-sectional study of VHA medical record data. Modified Poisson regression modelled the likelihood of cognitive rehabilitation referral based on cognitive symptom severity and non-clinical predisposing (eg, race/ethnicity) and enabling (eg, drive time) factors. Models were specified to explain referral to occupational therapy (OT), speech-language pathology (SLP), and neuropsychology. Statistical interactions determined whether non-clinical factors modified the relationship between cognitive symptoms and referral. Main Measures: Cognitive rehabilitation referrals, identified using a validated algorithm detecting key phrases in unstructured consult data. Self-reported cognitive symptom severity measuring using the Neurobehavioral Symptom Inventory. Results: Only 35% received a cognitive rehabilitation referral, with SLP services being the most common discipline (25%). Veterans with more severe self-reported cognitive symptoms were more likely to receive a referral (relative risk [RR], 1.06; 99% confidence interval [CI], 1.05-1.08), and this relationship was stable in discipline-specific models. However, many Veterans without a referral reported disabling cognitive challenges, indicating unmet need. Non-clinical factors—including drive time (RR, 0.86; 95% CI, 0.77-0.97) and rurality (RR, 0.92; 95% CI, 0.85-0.99)—were associated with receipt of a referral, though these relationships varied across discipline-specific models. Interactions did not provide support for non-clinical factors modifying the relationship between cognitive symptoms and receipt of a referral. Conclusions: While cognitive rehabilitation services tend to be allocated to those in need, results revealed gaps in access. Findings can guide development of strategies expanding access to cognitive rehabilitation among Veterans with msTBI, enhancing clinical outcomes.

More than 30 million people in the US take prescribed benzodiazepines, which, when taken long-term, carry risks of falls, cognitive decline, and dependence. A previous trial showed that a patient-focused self-management intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) can reduce long-term benzodiazepine dependence use and the risks that accompany it. To replicate the finding of the EMPOWER trial after converting the intervention from printed materials to electronic format. This 2-arm, individually randomized clinical trial with a 6-month follow-up was conducted at US Veterans Health Administration primary care clinics in 2 Veterans Affairs health care systems. Participants included 161 primary care patients taking benzodiazepines for 3 or more months and having access to a smartphone, tablet, or desktop computer. Recruitment occurred from June 1, 2022, to January 31, 2024. Participants were randomized to either the electronically delivered EMPOWER (EMPOWER-ED) protocol or asked to continue to follow clinician recommendations regarding their benzodiazepine use (treatment as usual). Preregistered primary outcomes were complete benzodiazepine cessation and at least 25% dose reduction at 6-month follow-up, assessed using pharmacy data. Secondary outcomes were self-reported anxiety symptoms, sleep quality, and overall health and quality of life. Analysis was performed on an intent-to-treat basis. The 161 participants had a mean (SD) age of 61.9 (13.7) years and were mostly male (134 [83.2%]). Individuals assigned to the EMPOWER-ED group had a significantly greater likelihood of complete benzodiazepine cessation (odds ratio [OR], 5.31 [95% CI, 1.12-25.12]). There was no likelihood of at least a 25% dose reduction in the EMPOWER-ED group relative to the control group (OR, 2.51 [95% CI, 0.91-6.90]). No statistically significant difference was found between the 2 groups for the secondary outcomes. This randomized clinical trial found a large effect of a low-cost, self-administered electronic intervention for reducing benzodiazepine use among long-term users. Findings from this replicated clinical trial are encouraging given the prevalence of benzodiazepine dependence and the constraints on clinician time available to address it. Dissemination of this intervention-which is in the public domain-by health care and public health systems seems warranted. ClinicalTrials.gov Identifier: NCT04572750.

Prenatal exposure to ambient air pollution has been implicated in adverse neurodevelopment, but evidence from large-scale, long-term studies in Asian populations remains limited. We examined the association between in utero exposure to multiple air pollutants and the risk of neurodevelopmental disorders (NDD) in offspring using a nationwide cohort in South Korea. We conducted a nationwide retrospective cohort study using linked administrative health and environmental data. A total of 1,436,685 children born between January 1, 2010, and December 31, 2014, were identified from the National Health Insurance Service database and followed up through December 31, 2023. Maternal exposure to nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), and particulate matter ≤10 μm (PM10) was estimated by linking residential postal codes to fixed-site monitoring data. NDD diagnoses were identified from healthcare claims. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models adjusting for maternal sociodemographic, medical, obstetric, and neonatal covariates. During up to 13 years of follow-up, 140,971 children (9.8%) were diagnosed with an NDD. Prenatal exposure to NO2 showed the strongest association: each 0.01-ppm increase was associated with an 18% higher hazard of NDD (aHR 1.18, 95% CI 1.17-1.19; p < .001). SO2 exposure also demonstrated a small but statistically significant association (per 0.001-ppm increase: aHR 1.01, 95% CI 1.01-1.02; p = .008). These associations persisted across major NDD subtypes - including intellectual disabilities, developmental delays, and behavioral or emotional disorders - and remained robust in trimester-specific, stratified, and sensitivity analyses. Prenatal exposure to ambient air pollutants - particularly NO2 and SO2 - is associated with increased long-term risk of NDD in offspring. These findings highlight the neurodevelopmental vulnerability of the prenatal period and underscore the need for strengthened environmental policies to reduce maternal exposure to harmful pollutants.

To evaluate healthcare cost associated with a standardized mental healthcare bundle in two tertiary pediatric emergency departments (EDs) in Alberta, Canada. We linked data from the two EDs and administrative health databases. Patients < 18 years presenting with mental health concerns were enrolled during two periods: pre-implementation (standard care) and implementation (mental health bundle). Healthcare resource utilization (HCRU) and costs were compared over 12 months following the initial ED visit. The study included 686 pre-implementation (mean age 12.6 years) and 692 implementation (mean age 13.0 years) patients with similar sex distribution (p = 0.65). Implementation patients had lower admission rates at the index ED visit (4.6% versus 9.8%; p < 0.001). During 1 year of follow-up, implementation patients had fewer hospitalizations (mean = 0.4 versus 0.5; p < 0.001), non-ED ambulatory care visits (mean = 2.7 versus 10.0; p < 0.001), and practitioner claims (mean = 34.3 versus 46.8; p = 0.001). Implementation patients had lower healthcare costs ($12,408 [95% CI $10,336-$14,479] versus $19,326 [95% CI $16,596-$22,056]; p < 0.001) attributable to lower hospitalization ($6845 [95% CI $5257-$8435] versus $9994 [95% CI $8205-$11,782]; p = 0.01), ambulatory care ($1711 [95% CI $1383-$2038] versus $4027 [95% CI $3326-$4727]; p < 0.001), and practitioner ($3851 [95% CI $3410-$4292] versus $5306 [95% CI $4676-$5935]; p < 0.001) expenses during the follow-up. After risk adjustments, care bundle was associated with a 40% [95% CI 26-52%] reduction in mental health-related healthcare costs (p < 0.001) and 37% (95% CI 23-49%) reduction in all-cause healthcare costs (p < 0.001). Integrating a standardized mental healthcare bundle in pediatric EDs was associated with less healthcare use and cost savings. These findings support its broader use to enhance mental healthcare delivery in emergency settings.

Opioid overdose (OD) remains a pressing public health crisis in the United States, with substantial gaps in postoverdose care, particularly among veterans. Understanding the demographic and clinical factors associated with appropriate postoverdose care is essential to addressing these gaps. A retrospective cohort study of 1032 veterans who experienced a nonfatal opioid overdose and received care through the veterans Health Administration system was conducted. Data were extracted from electronic health records, including demographic, pharmacy, and clinical variables. The primary outcome was receipt of appropriate clinical response within 90 days postoverdose, defined as initiation of medication for opioid use disorder (MOUD), counseling for opioid use disorder (OUD), or a ≥25% reduction in morphine equivalent daily dose. A binary logistic regression model was used to examine factors associated with receiving appropriate overdose care. Of the total sample, 57.46% received an appropriate clinical response postoverdose, the majority of which reflected opioid dose reductions rather than initiation of MOUD or counseling for OUD. There were statistically significant differences between those who received appropriate clinical response versus not by rurality, marital status, substance use disorder and treatment, care access, bipolar disorder, and schizophrenia. In adjusted models, those with a documented substance use disorder had significantly higher adjusted odds of receiving appropriate clinical response (aOR=1.91; 95% CI: 1.38-2.63; P<0.0001). Black veterans had significantly lower odds of receiving appropriate clinical response compared with White veterans (aOR=0.71; 95% CI: 0.51-0.98; P=0.04). Other variables were not statistically significantly associated with appropriate clinical response in the adjusted model. The primary response to OD was dose reduction and MOUD was profoundly underutilized. Future research should incorporate social determinants of health to better understand contextual influences on overdose risk and care access.

The insights available from linking routine health data have transformative potential for understanding and improving population health and well-being. However, cross-sectoral data linkage in the UK remains challenging, with persistent barriers around governance, interoperability and data quality.This Perspective paper draws on the experiences of the Developing research resources And minimum data set for Care Homes Adoption and use (DACHA) study which linked administrative health and social care records with records from care home software providers for over 700 older adult care home residents, an underserved population in research, in England to build a proof-of-concept minimum dataset.From our learning, we make eight recommendations for researchers, research funders, data owners, data controllers and policymakers to strengthen future data linkage across health and social care. We recommend: (1) sharing metadata to support transparency and efficient reuse; (2) clarifying purposes for data sharing; (3) streamlining information governance processes; (4) recognising the health and social care system as a research partner; (5) resourcing data quality at the point of collection; (6) acknowledging the work needed to adapt routine data for research; (7) standardising core variables for interoperability; and (8) designing linkage for wider public benefit and safe data reuse.Implementing these recommendations would help create a more coherent, efficient and equitable data landscape, realising the potential of existing data to improve care quality, research capacity and population health.

BackgroundIn 2021, the US Food and Drug Administration approved the first complete long-acting (LA) injectable antiretroviral therapy (ART) regimen, cabotegravir plus rilpivirine (CAB+RPV LA), for use in people with HIV (PWH) to maintain viral suppression. The Veterans Health Administration (VHA) is the largest provider of HIV care in the US and creates an opportunity to examine CAB+RPV LA uptake in a national cohort with uniform ART access. We aimed to describe demographic, temporal and geographic trends of CAB+RPV LA use in VHA nationwide.MethodsUsing the VHA’s Corporate Data Warehouse, we identified PWH who initiated CAB+RPV LA between January 2021 and December 2024. Those with documented receipt of at least 3 CAB+RPV LA injections were categorized as ‘exposed’. We defined ‘unexposed’ as those who did not receive CAB+RPV LA in the pre-defined study period, were virally suppressed at entry into the study and had at least one oral ART fill. We described the nationwide uptake in CAB+RPV LA, summarizing patient characteristics, and geographic trends over time. We compared the exposed and unexposed groups using Chi-squared and Wilcoxon rank sum tests and summarized the prescribing trend across states and VHA facilities.ResultsWe identified 1004 exposed patients who initiated CAB+RPV LA from January 2021 to December 2024, while 23,688 patients were unexposed. Exposed patients were younger (mean age 49 years vs. 60 years; p< 0.001) and more likely to live in an urban area (88% vs. 84%, p=0.0024) than unexposed. The exposed group included higher proportions of Black (53% vs. 48%), Hispanic (10% vs. 8.7%) and female patients (4.9% vs. 3.6%) than the unexposed cohort. Uptake increased from 6 initiations nationally in 2021 to 441 in 2024. The number of VHA facilities that had prescribed CAB+RPV LA increased from 5 in 2021 to 81 in 2024, representing 58% of all VHA facilities treating eligible PWH. Patients at high complexity facilities, which are generally located in large metropolitan areas, were overrepresented in the exposed cohort (66% vs. 58%).ConclusionUptake of CAB+RPV LA has increased in the VHA since FDA approval in 2021 with greater uptake in large, high complexity, urban facilities. Further studies should evaluate barriers to implementation at smaller, rural serving clinics and older patients.DisclosuresPuja Van Epps, MD, ViiV Healthcare: Grant/Research Support

BackgroundPersons who inject drugs (PWID) are at increased risk for acquiring HIV, hepatitis C virus (HCV), and severe injection related infections (SIRI). There is sparse data about Veterans with a history of injection drug use (IDU) who access care through the Veterans Health Administration (VHA). This study aimed to identify a cohort of Veterans with evidence of IDU in order to assess clinical outcomes and harm reduction receipt.Table 1.Demographic characteristics of the cohort, stratified by OUD or StUD, with either HCV exposure or a SIRI.Table 2.IDU history, harm reduction uptake, and STI history among Veterans with either OUD or StUD and either HCV exposure or a SIRI.MethodsA retrospective study was conducted of data obtained through the VHA Corporate Data Warehouse. Veterans who visited the VHA between 2016-2022 with an international classification of diseases, tenth edition (ICD-10) diagnosis of opioid use disorder (OUD) or stimulant use disorder (StUD), and a diagnosis of acute or chronic HCV or a SIRI were included. Cohort fidelity was assessed through a random sample of 560 Veterans. Active or remote IDU history was confirmed via text within the electronic health record. Demographics, rurality, census region, living and employment status, insurance, incarceration history, mental health and substance use histories were obtained. Harm reduction receipt was assessed.Table 3.HCV exposure or SIRI diagnoses in Veterans with either OUD or StUD who visited a VA facility between 2016 and 2022.ResultsThere were 41,961 Veterans with OUD and HCV or a SIRI, and 46,936 Veterans with StUD and HCV or a SIRI. The OUD and StUD cohorts had a mean age of 62.2 and 61.4 years and was predominately male, White, and non-Hispanic. The highest census region was in the southern United States and in urban settings. HCV exposure was found in 28,505 (67.9%) Veterans with OUD and 33,707 (71.8%) Veterans with StUD. In the randomly selected cohort, 301 (53.8%) Veterans had a IDU history and 194 (34.6%) had active IDU. HCV exposure was found in 259 (86%) Veterans with a IDU history and 158 (81.4%) with active IDU. In Veterans with active IDU, 87 (55.1%) were treated for HCV or self-cleared, 114 (64%) were prescribed a medication for opioid use disorder (MOUD), and 147 (75.8%) were prescribed naloxone. Ten (5.2%) had a prior STI.ConclusionA significant proportion of Veterans with OUD or StUD have a history of IDU. Veterans with active IDU may benefit from expanded efforts to increase MOUD and naloxone uptake, STI testing, treatment and PrEP for HIV in conjunction with syringe services programs. HCV exposure has a strong concordance with a history of IDU.DisclosuresAll Authors: No reported disclosures

Background Mobile health (mHealth) technologies have emerged as critical tools for strengthening community health outreach in low- and middle-income countries (LMICs), particularly in settings affected by health workforce shortages, infrastructural constraints, and geographic barriers. While mHealth initiatives are expanding globally, evidence comparing their implementation, effectiveness, and contextual determinants across diverse LMIC settings remains limited. This study examines the influence of mHealth innovations on community health outreach in Sierra Leone and India. Methodology A comparative mixed-methods design was employed, combining a cross-sectional survey of 300 respondents (150 per country) with 24 Key Informant Interviews. Participants included Community Health Workers, health system administrators, and community beneficiaries. Quantitative data were analysed using descriptive statistics, inferential tests, and logistic regression, while qualitative data were analysed thematically using NVivo to explore implementation experiences, barriers, and contextual factors. Results mHealth awareness and utilisation were highest among Community Health Workers and administrators in both countries, with significantly higher integration and regular use observed in India. Perceived benefits included improved patient communication, health data tracking, referral efficiency, and patient compliance. Infrastructure-related barriers—such as poor network coverage, unreliable electricity, and limited digital literacy—were more pronounced in Sierra Leone. Logistic regression identified country context, education level, mobile phone ownership, and mHealth training as significant predictors of regular mHealth use. Qualitative findings highlighted the importance of policy integration, continuous training, and community trust in shaping adoption and sustainability. Conclusion mHealth innovations enhance community health outreach when embedded within supportive health systems, adequate infrastructure, and culturally responsive implementation strategies. The comparative findings underscore that technology alone is insufficient; sustainable impact depends on governance, workforce capacity, and system-level integration. These insights provide valuable guidance for policymakers and practitioners seeking to leverage mHealth to advance equitable primary healthcare in LMICs.

Air pollution poses significant threats to human health and environmental sustainability, requiring strong predictive models to monitor and forecast air quality. This research sought to develop and assess a resilient air pollution forecast model using data-driven modelling methodologies. The study used a thorough technique that included the compilation of worldwide air pollution datasets, succeeded by data pre-treatment and modification to guarantee the precision and pertinence of the input data. This data-centric methodology enabled the examination and interpretation of the dataset using several machine learning methods. The research examined the efficacy of several machine learning algorithms, including AdaBoost, Decision Tree, Extra Tree, Random Forest, Naïve Bayes, K-Nearest Neighbour (KNN), and Neural Network, in predicting diverse levels of air quality. Each algorithm was assessed according to precision, recall, F1-score, and overall accuracy, with specific emphasis on difficult air quality classifications. The findings indicated that some models, including Decision Tree, Extra Tree, Random Forest, and Neural Network, attained excellent accuracy and F1-scores, whilst others, such as AdaBoost and Naïve Bayes, exhibited deficiencies in managing certain air quality categories. An ensemble model was created to address these constraints and improve overall forecast accuracy by integrating the capabilities of the most effective algorithms. The ensemble model exhibited outstanding performance, attaining flawless precision, recall, F1-scores, and accuracy across all air quality categories, signifying its potential as a highly dependable instrument for real-time air quality monitoring and prediction. This research finds that the ensemble model signifies a substantial improvement in air pollution forecasting. Therefore, providing an effective option for environmental monitoring systems. The research underscores the significance of amalgamating several machine learning algorithms to enhance model resilience and precision, offering critical insights for public health administration and policy formulation.

Decentralization has emerged as a central governance reform in health systems worldwide, motivated by the expectation that transferring authority and resources to subnational entities would enhance efficiency, responsiveness, and equity. Yet, three decades of empirical research reveal inconsistent evidence. This systematic review synthesizes global studies examining how political, administrative, and fiscal decentralization influence health system performance across five domains: access, efficiency, quality, equity, and population health outcomes. Following PRISMA 2020 guidelines, eight studies met the inclusion criteria from an initial pool of twenty-four records identified through major databases and organizational sources. The findings indicate that decentralization often improves access to maternal and child health services and immunization coverage when local autonomy is coupled with predictable fiscal transfers and adequate institutional capacity. However, evidence on efficiency and quality remains mixed, reflecting trade-offs between flexibility and coordination. Most critically, decentralization has not consistently reduced health inequities; in some cases, it has widened regional or socioeconomic disparities, particularly where redistributive mechanisms are weak. Contextual factors—such as fiscal capacity, governance quality, and political stability—emerge as decisive determinants shaping outcomes. Overall, decentralization should not be seen as a uniform solution but as a conditional governance reform whose success depends on institutional design, intergovernmental accountability, and equitable resource allocation.

Radiologic technologists play a crucial role in healthcare by utilizing diagnostic imaging technologies to aid in patient care. Given the inherent risks associated with ionizing radiation exposure, adherence to radiation safety protocols is paramount to ensure the well-being of both patients and healthcare professionals. Compliance with regulations set forth by agencies such as the Occupational Safety and Health Administration (OSHA) and the National Council on Radiation Protection and Measurements (NCRP) is fundamental. Radiologic technologists must remain vigilant in implementing best practices, including limiting radiation exposure through proper shielding and distance management, regular equipment maintenance, and consistent training in radiation safety measures. Their proactive approach to safety not only minimizes risks but also reinforces the credibility of the radiologic profession. In addition to regulatory compliance, fostering a culture of safety within the healthcare environment is essential for radiologic technologists. This entails engaging in continuous education and training, staying updated with the latest safety guidelines, and participating in peer reviews to promote shared accountability. Protective practices, such as the use of lead aprons, protective shields, and personal dosimetry badges, are critical in mitigating unnecessary radiation exposure. Regular audits and assessments of workplace practices can further enhance safety measures and enable technologists to identify and address potential hazards promptly. By prioritizing safety compliance and protective practices, radiologic technologists can effectively safeguard their health and that of their patients while delivering high-quality diagnostic care.

Social determinants of health associated with receipt of psychotherapy for veterans with posttraumatic stress disorder.

Zhang Yong is the first person to obtain a doctoral degree in modern China's sports world, choosing sports as his lifelong career and leaving more sports theories and practical experiences for China's sports academics, but there are quite a few results of the current research on Zhang Yong's sports thought. Method: literature method. A total of 19 articles published by Zhang Yong was collected. 1. advocated the establishment of sports administration departments and sports inspectors. Zhang Yong defended his doctoral dissertation, “State Organization and Administration of Health and Physical Education,” at Columbia University in the United States in March 1932, and after returning to China in that year, he combined his doctoral dissertation with his proposal to set up a department of physical education and a sports inspectorate, which was finally adopted. To this day, the achievements made in the field of sports cannot be separated from the scientific management of the sports administration. 2. Advocating the popularization of sports, so that every child can enjoy the happiness brought by sports. Zhang Yong found that many students were interested in sports and that the purpose of sports was not to cultivate proud and untamed athletes, but to let students have fun through sports and cultivate the spirit of national unity and cooperation. 3. Advocating the study of foreign languages and translating foreign works. Zhang Yong has translated more than a hundred foreign writings and news articles, among which “Sports in America” has provided valuable reference materials for the study of modern foreign sports. Conclusion: 1. Provide theoretical support for the targeted integration of physical education and competitive sports. More scholars are needed to go to the grassroots level the difficulties and highlights in the process, realize the in-depth integration of physical education and competitive sports. 2. Provide practical direction for the full implementation of physical education classes, so that students can enjoy the fun of sports. Implement the “four-in-one” guideline. 3. Enhance the foreign language learning of physical education teachers, so that they can learn about Chinese and foreign countries, past and present. There is an urgent need to cultivate interpreters who know, understand, and love sports as Zhang Yong does.

Medical academic excellence is based on leadership. This is because the appointments of department heads, deans, senior faculty administrators, and faculty members directly impact the quality of teaching and faculty motivation. A fundamental question is unanswered in Pakistan: what truly qualifies individuals to lead - higher academic qualification or experience? What about administrative abilities and research accomplishments? A Case for Qualifications and Competencies Beyond Years of Experience In some institutions, the majority of leadership positions are still awarded on the basis of chronological seniority and length of service. This is often done without taking into consideration academic qualifications or leadership capabilities. Years of service are equated with expertise in this long-standing, but flawed practice. The time spent at a job does not translate into a productive contribution. Many individuals have accumulated years with no measurable contribution to academic or scientific research, innovative teaching methods, or roles in institutional leadership. The higher the qualifications, whether it's a doctorate, a specialized fellowship, advanced training in health administration, medical research, education methodology, or research, then, the more likely you are to have the ability and capacity for transformative leadership. The expectation is that academic leaders will not just serve, but achieve have producing impactful work, obtaining grants, mentoring and supporting younger faculty, or representing their institution within scholarly communities. It is far more beneficial for an institution to have leadership that focuses on academic depth and excellence. Integrating Administrative and Research Competence Leadership is not possible without administrative expertise and research involvement. The ability to effectively manage academic teams and handle complex academic systems is essential for effective governance. Leadership with advanced degrees but without managerial skills may have difficulty implementing policies, and an administrator who lacks academic background or research knowledge risks turning academia into bureaucracy. The ideal leader of medical education should be an academically qualified, administratively skilled, ethically grounded professional with a strong research focus. PM&amp;DC Needs to Define Standards It is critical that Pakistani medical educators fill the gap of a lack of nationally recognized criteria to determine academic leadership. Pakistan Medical and Dental Council's (PM&amp;DC) role in setting leadership criteria must be based more on documented contribution and demonstrated expertise than just job longevity. Key policy recommendations include the following: Benchmarks for mandatory higher education (e.g., PhD or FCPS certification, or the equivalent advanced certification), required of Deans. Principals and Directors There are weighting systems that give more importance to research, postgraduate supervision, or scholarly output than simple seniority. Processes of selection transparently incorporating peer-review, academic audit, leadership interviews, etc. Continuous professional growth in academic leadership and healthcare administration with requirements for revalidation, impactful, research-based publications, not just the quantity of publications. The succession planning process identifies future leaders and prepares them based solely on performance and merit. Conclusion It is a common practice to confuse "years" of service with "experience". The result has been a decline in leadership standards across medical institutions. Academic leadership requires not only tenure but advanced knowledge, intellectual rigor, and a vision for transformation. For Pakistan to raise the quality and credibility of its medical system, it must switch from a time-based selection to a qualification-based and competence-based meritocracy. PM&amp;DC is both mandated and obligated to implement these standards in order to ensure that the leadership of medical academia goes to the most competent individuals who can advance education, professional ethics, and research. Leadership isn't measured by the number of years you have served. It's about impact, and this can only be achieved by a higher-level qualification.

ABSTRACT Objective: To present the TL Sharps Bin, a newly developed device designed to enhance safety and functionality in healthcare settings, and to evaluate its performance and usability among healthcare professionals. Material and Methods: A total of 82 participants, comprising 40 dental surgeons and 42 medical doctors, were selected using random sampling. Following a demonstration and hands-on session on the proper use of the TL Sharps Bin, participants completed a structured questionnaire consisting of 19 items. The questionnaire assessed the bin’s performance across two key domains: visibility and accommodation. To analyze the relationship between categorical variables, chi-square tests were applied, allowing for the assessment of associations between participant characteristics and their responses to the questionnaire. Results: The TL Sharps Bin was rated highly in all three dimensions, with safety receiving a mean score of 4.6, usability 4.5, and efficiency 4.7 on a 5-point Likert scale. Participants highlighted the bin’s superior puncture resistance, ease of use, and accessibility in busy clinical settings. Statistical analysis confirmed that the TL Sharps Bin significantly outperformed traditional containers in terms of both user satisfaction and adherence to safety protocols (p&lt;0.05). Conclusion: The TL Sharps Bin demonstrated exceptional performance in clinical settings, meeting and exceeding the safety guidelines set by the World Health Organization and the Occupational Safety and Health Administration. Its adoption is strongly recommended to improve sharps disposal practices and enhance occupational safety for healthcare workers. Further studies could explore its long-term impact on reducing the incidence of sharps-related injuries and infections.