The One Health resistome: Integrating environmental, microbial, and human antimicrobial resistance surveillance and risk analysis in the digital age.

This literature review examines the importance of Evidence-Based Practice (EBP) in nursing, with a focus on its application in Intensive Care Units (ICUs). EBP, through the synthesis of qualitative and quantitative data, promotes evidence-based decision-making, improving care quality, reducing mortality, and limiting complications. The methodology involved a search of the MEDLINE, ELSEVIER, and SCOPUS databases for studies published from 2000 onwards. The findings highlighted key interventions, such as infection prevention, septic shock management, pressure ulcer prevention, and end-of-life care. Additionally, the use of telemedicine and artificial intelligence fosters the integration of EBP into nursing practice. Despite advancements, the review highlights challenges such as lack of time, insufficient training, and limited administrative support. Strategies are proposed, including continuous education, technological support, and strengthening clinical practice through information systems. The findings indicate that the full integration of EBP can lead to significant improvements in care quality and clinical outcomes in ICUs, establishing it as a vital tool for delivering high-level nursing care.

Method design and automation of a forensic toxicology LC-QTOF-MS technique to meet high-throughput routine applications.

Deep reinforcement learning-based energy management strategy integrating physics information and expert system: efficient regenerative braking energy recovery in urban rail transit traction power system

Alcohol and pregnancy: Benefits and harms of pregnancy-specific alcohol policies among maternal-infant dyads covered by Medicaid.

In the United States, approximately 2.3 million people live with limb loss, of whom about 91% have undergone lower extremity amputation. Despite these numbers, relatively few studies have evaluated outcomes after elective transtibial amputation. In particular, we do not know whether the outcomes after amputation for intractable neurogenic pain such as complex regional pain syndrome (CRPS) are comparable to outcomes after late amputations (6 weeks or more after limb salvage) performed for other reasons such as recurrent infection, soft tissue problems, recalcitrant nonunion, poor function, and chronic nonneurogenic pain. (1) Did patients who underwent late amputation for CRPS or neuropathic pain have inferior Patient-Reported Outcomes Measurement Information System (PROMIS) scores at follow-up compared with patients who had nonneurogenic elective amputation? (2) Did patients who underwent late amputation for CRPS or neuropathic pain have more pain, use more pain medication, or wear prosthetics less often than patients who have undergone nonneurogenic elective amputation? (3) Were patients who underwent late amputation for CRPS or neuropathic pain more likely to be revised to a higher level of amputation or express decision regret than patients undergoing nonneurogenic elective amputation? This retrospective comparative study examined 70% (50 of 71) of patients who underwent elective (that is, scheduled, nonurgent) transtibial amputation between July 2006 and September 2019 at least 6 weeks after lower extremity trauma (median [range] 2 years [6 weeks to 15 years]). Most patients were men (94% [47 of 50]) and active duty service members who sustained combat-related trauma (74% [37 of 50]). Patients with CRPS (defined using the Budapest criteria diagnostic guidelines, which requires ongoing disproportionate pain plus signs in four categories: sensory, vasomotor, sudomotor/edema, and motor/trophic changes, n = 10) and other forms of neuropathic pain (n = 10) were compared with a control group of patients who had nonneurogenic elective amputation (n = 30). Demographic characteristics among cohorts were not different given the numbers available. The median (range) follow-up was 9 years (3 to 16) after amputation. The primary outcome was the PROMIS pain interference score. Secondary outcomes included other PROMIS metrics, VAS pain, and patient-reported medication and prosthetic use as well as revision to a higher level of amputation and decision regret. With the numbers available, we found no difference in PROMIS pain interference scores for patients with transtibial amputations performed for neurogenic pain compared with other causes of late amputation (median [range] 57 [45 to 64] versus 56 [39 to 72]; p = 0.81). There were likewise no differences with the numbers available in PROMIS physical function, mobility, life satisfaction, and severity of substance use. Amputations performed for neurogenic pain resulted in more pain reduction than late amputations for other causes (median ΔVAS -5 [-9 to -1] versus median Δ VAS -3 [-8 to 7]; p = 0.02). Both groups reported a reduction in opioid use (100% reduction in median frequency of opioid administrations for both groups; p < 0.001). Prosthetic use was not different with the numbers available among all cohorts. No patients in the CRPS plus neuropathic pain cohort were revised to a higher level of amputation compared with 2 patients in the nonneurogenic elective amputation cohort. No patients expressed definitive decision regret. Patients undergoing elective transtibial amputations for intractable neurogenic pain experienced clinically meaningful improvement in pain. Our findings support the use of transtibial amputation for treatment-resistant neurogenic pain, and they provide reasonable, but generally favorable, expectations for patients considering this irreversible procedure that are generally comparable to outcomes from patients undergoing late amputations for other indications. Level III, therapeutic study.

Visual experience is a primary channel through which the values of tangible cultural heritage are perceived and governed, making visual evaluation and management central to conservation and to Sustainable Development Goal (SDG) 11.4. However, practice remains fragmented across scales, and many statutory toolkits lag behind advances in geographic information systems (GIS)-based visibility analysis, 3D visualization, remote sensing, and perception-based evidence. We compile, code, and cross-analyze a multi-level corpus spanning 26 international instruments, 293 national items from 112 countries, and 867 World Heritage properties. Using a four-dimensional framework (values, typology, visual-evaluation methods, and visual-management strategies), we apply k-medoids clustering with multidimensional scaling (MDS) at the national level, mask-aware association mapping at the property level, and cross-level diagnostics. Across levels, practice converges on a technical-spatial regime. At the property level, GIS-based viewshed and visual sensitivity analysis, verified visuals and 3D visualization techniques, and GIS-based spatial-historical analysis form a near-universal methodological core and are most frequently translated into zoning and spatial regulation and height or massing controls. Participatory and perception- or experience-based methods remain sporadic. Value framings are dominated by Historic, Social and Political, and Aesthetic emphases, while Ecological and Scientific are comparatively marginal. Cross-level coherence is strongest where governance frameworks are mature, and portfolios are coherent; it weakens where portfolios are heterogeneous or in federated or lower-capacity settings. National portfolios cluster into four method-strategy regimes that explain characteristic object-method-strategy sequences. In response, we outline operational bridges including tiered standards for visibility and 3D evidence, deployable perception protocols, participation modules linked to Heritage Impact Assessment (HIA) or Visual Impact Assessment (VIA) triggers, and auditable communication packages. These are organized within a Global Peer Network aligned to portfolio archetypes and method-strategy regimes. The study contributes a reusable global dataset and map of visual-heritage practice and an integration framework that supports more transparent, comparable, and context-sensitive decisions across levels. • Mapped heritage visual practice across international, national, and site levels. • Used a harmonized 4D framework (type/scale, values, evaluation, management) to compare practice across levels. • Proposed an integration framework linking analytical and visualization techniques to routine governance, planning and design. • Proposed an integration framework linking evidence to zoning/design controls to strengthen visual heritage governance.

Enhancing hospital drug and medical supply request processes through a clinically prioritized and demand-variability-aware adaptive decision support framework.

Comparative Effectiveness of Intravenous Immunoglobulin vs Steroids in the Treatment of Pediatric Acute (Non-COVID) Myocarditis: A Pediatric Health Information Systems Database Study.

Early, controlled weight-bearing using an antigravity treadmill may improve outcomes following definitive fixation of lower extremity periarticular fractures. We hypothesized that patients randomized to 10 weeks of antigravity treadmill therapy would report better 6-month joint-specific patient-reported function compared with standard of care. This prospective, multicenter, randomized trial included patients 18 to 55 years of age with fractures of the knee and distal tibia randomly assigned to either 10 weeks of antigravity treadmill therapy (intervention) or standard of care (control). The primary outcome was 6-month patient-reported function (Knee injury Osteoarthritis Outcome Score) for patients with knee fractures and Ankle Osteoarthritis Scale for patients with distal tibia fractures. Secondary outcomes included 6-month Patient-Reported Outcomes Measurement Information Systems Physical Function scores, 12-month fracture healing and complications, and 6-week, 3- and 6-month satisfaction with therapy. Of 80 randomized patients, 78 were included in the final analysis (intervention n = 38; control n = 40). Their mean age was 37 years; 55 (71%) had knee fracture and 23 (29%) had distal tibia fracture. The average Knee injury Osteoarthritis Outcome Score were 54 and 61 in the intervention and control groups, respectively (adjusted difference: -6.1; 95% confidence interval, -18.4, 6.2; P = 0.32). The average Ankle Osteoarthritis Scale scores were 28 and 50 for the intervention and control groups, respectively (adjusted difference: -19.5; 95% confidence interval, -39.3, 0.30; P = 0.05). No difference was found between treatment groups in Patient-Reported Outcomes Measurement Information Systems Physical Function, fracture healing, or complications. Patients in the intervention group reported higher satisfaction with their therapy at 6 weeks (9.5 vs. 8.5; P = 0.01) and 3 months (9.5 vs. 8.6; P = 0.04). This study suggests that antigravity treadmill therapy may be beneficial for patients with distal tibia fractures. Moreover, the study demonstrates that a 10-week antigravity treadmill therapy program is safe and feasible with high patient satisfaction, providing foundation for future effectiveness trials for patients with periarticular injuries.

Despite many hospitalized children missing recommended vaccines, vaccines are rarely administered during hospitalization. Our objective was to explore the key determinants for inpatient vaccine delivery in a sample of 11 US children's hospitals. We used the Pediatric Health Information System database to identify children's hospitals in the Pediatric Research in Inpatient Setting network who were in the top tertile (n = 6) and the bottom tertile of inpatient vaccine administration (n = 5). We recruited pediatric nurses, pharmacists, and hospitalists to participate in semistructured interviews. Interview questions were based on the Consolidated Framework for Implementation Research and focused on current practices and barriers to inpatient vaccine delivery. Interviews were conducted via telephone or teleconferencing and were recorded and transcribed. Two reviewers independently coded transcripts using thematic analysis; a third reviewer resolved discrepancies, as needed. We conducted 36 interviews: 10 hospitalists, 14 nurses, and 12 pharmacists. Several themes emerged as key determinants for inpatient vaccine delivery, including the following: 1) timing: vaccine administration happened predominately at discharge, which at times jeopardized vaccine delivery; 2) access: vaccinating during hospitalization was particularly important when children had difficulty accessing primary care or when traditional health care services were disrupted, eg,during the COVID-19 pandemic; and 3) workflow: vaccine-related workflow is often not standardized and lacks ownership. Despite variability in vaccine administration across children's hospitals, there are many common barriers and determinants. Solutions that address these barriers and meet the needs of multidisciplinary clinicians are essential to improve inpatient vaccine delivery.

Many patients with obstructive sleep apnea (OSA) are unable to tolerate long-term positive airway pressure (PAP) therapy, highlighting the need for alternative treatments. AD109 (investigational fixed-dose oral combination of aroxybutynin 2.5 mg/atomoxetine 75 mg) is designed to target neuromuscular dysfunction in OSA. To evaluate the efficacy/safety of AD109 over 6 months in a diverse OSA population unable to use PAP. SynAIRgy enrolled adults with mild-to-severe OSA who were intolerant to or refused PAP therapy into a randomized, double-blind, placebo-controlled, 26-week parallel-arm trial of AD109 vs placebo across 69 centers. The primary efficacy endpoint was change from baseline to week 26 in apnea-hypopnea index (AHI). Key secondary endpoints were oxygen desaturation index (ODI), Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue T-score, hypoxic burden (HB), PROMIS-Sleep Impairment T-score, and proportion of participants with ≥50% AHI reduction. A total of 646 eligible participants (median age 58 years, 49.3% female, median body mass index 32.4 kg/m2) were randomized. Median baseline AHI was 19.6 events/hour with 35% mild, 42% moderate, and 23% severe OSA. At week 26, mean AHI treatment difference was -4.0 events/hour (95% CI, -6.4 to -1.6; P = .001), representing a model-estimated 44.1% vs 17.6% decrease from baseline (P <.0001). AD109 demonstrated improvements in ODI and HB at week 26 vs placebo; however, no statistically significant difference was observed for PROMIS-Fatigue. Overall, 21.2% of participants on AD109 and 3.1% on placebo discontinued therapy due to adverse events. The most common adverse events with AD109 were dry mouth, nausea, insomnia, and urinary hesitation, with no serious treatment-related adverse events. AD109 significantly improved airway obstruction and oxygenation at 26 weeks across a broad range of patients unable to use PAP, suggesting that AD109 could become a potential treatment option for patients with OSA. www.clinicaltrials.gov (NCT05813275 [SynAIRgy]).

While satisfaction is often used by clinicians to assess outcomes after knee arthroplasty, the Centers for Medicare & Medicaid Services (CMS) has defined a 20-point increase in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) at 1-year follow-up as their improvement metric representing a substantial clinical benefit (SCB). To better understand the differences between satisfaction and improvement, this study evaluated self-reported patient satisfaction, KOOS JR scores, and whether the CMS SCB was achieved at 1-year follow-up. We identified 715 unicondylar knee arthroplasties (UKAs) and 1,836 primary total knee arthroplasties (TKAs) performed from October 2020 through August 2024 among patients who completed KOOS JR and Patient-Reported Outcomes Measurement Information System Global Health surveys at preoperative and 1-year follow-up intervals. These patients also responded to a binary yes/no question asking if they were satisfied with their knee arthroplasty at 1-year follow-up. The mean age at surgery was 68 years (range, 32 to 94), and 61% (1,556 of 2,551) were performed among women. At 1-year follow-up, 92% (656 of 715) of UKA and 91% (1,673 of 1,836) TKA patients reported they were satisfied (P = 0.61). The mean KOOS JR change was 25 (range, -21 to 100) for UKAs compared to 27 (range, -48 to 100) for TKAs (P = 0.01), 62% (441 of 715) of UKAs and 66% (1,216 of 1,836) of TKAs achieved the CMS SCB (P = 0.03). Multivariable analyses indicated that lower preoperative KOOS JR scores, being women, and higher preoperative Global Health Physical scores were associated with increased KOOS JR changes and an increased likelihood of achieving the CMS SCB. Although UKA and TKA have similarly high rates of self-reported patient satisfaction, the frequency of patients achieving the CMS SCB can be considerably lower. Since 80% (718 of 894) of knee arthroplasty patients who did not achieve the CMS SCB were satisfied with their outcome, health care providers may want to discuss the difference between satisfaction and improvement when counseling their patients.

The diagnosis of T-cell lymphoma is challenging, and establishing clonality is an important aspect of the workup. Molecular testing to establish T-cell clonality though T-cell receptor (TCR) gene rearrangement polymerase chain reaction is the most common modality and can detect clonal rearrangements in ∼90% of T-cell lymphomas, but is limited by increased turnaround time and cost and the need for sufficient material for testing. In the maturation of T cells, the TCR locus rearrangement will result in the mutually exclusive expression of either the TCR beta-chain constant domain 1 or 2 (TRBC1, TRBC2). Antibodies to TRBC1 and TRBC2 have been used in the setting of flow cytometry, and more recently immunohistochemistry, to establish T cell clonality. This study evaluates the utility of a TRBC1/CD3 dual stain for the diagnosis of T-cell lymphoma. The laboratory information system was searched from 2019 through 2025 for cytology samples with a diagnosis of T-cell lymphoma. Twelve samples were identified along with controls. Dual color immunohistochemistry for TRBC1 and CD3 was performed using a brown chromogen for TRBC1 and a red chromogen for CD3. The proportion of cells staining for TRBC1 and CD3 was scored. A monoclonal T-cell population was detected in all samples of T-cell lymphoma. All B-cell lymphomas and benign samples showed a polyclonal staining pattern consisting of a mixture of brown and red cells. Using immunohistochemistry for TRBC1 paired with CD3 is a reliable surrogate for T-cell clonality testing in cytology specimens and can support a diagnosis of T-cell lymphoma on limited material.

Inguinal hernia repair is one of the most common surgical procedures worldwide and is frequently performed as day-case surgery. Postoperative pain may delay recovery and occasionally necessitate unplanned hospital admission. Regional anesthesia techniques, including transversus abdominis plane (TAP) and rectus sheath (RS) blocks, have shown promise in improving analgesia. However, their combined efficacy in open inguinal hernia repair has not been established in randomized trials. The PRO-RSTAP trial is a prospective, double-blind, four-arm randomized controlled trial conducted at three hospitals in Finland. The study evaluates the individual and combined effects of TAP and RS blocks in adults undergoing elective open inguinal hernia repair. Two hundred patients are randomized equally into four groups: (1) placebo TAP + placebo RS, (2) active TAP + placebo RS, (3) active RS + placebo TAP, and (4) active TAP + active RS. All patients receive standardized sedation and multimodal analgesia, including paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and rescue opioids. The primary outcome is cumulative perioperative opioid consumption from block administration until hospital discharge, expressed as intravenous morphine equivalents. Secondary outcomes include pain scores, conversion to general anesthesia, postoperative nausea and vomiting, time to discharge, and unplanned admissions or emergency visits within 7 days. The planned sample size provides 80% power to detect a clinically meaningful reduction in opioid use (two-sided α = 0.05). Analyses follow the intention-to-treat principle. The first participant was enrolled in September 2025, and the trial is ongoing. No interim efficacy analysis is planned. Safety is monitored continuously throughout the study. This randomized controlled trial is designed to determine whether combining TAP and RS blocks improves postoperative analgesia and recovery after open inguinal hernia repair. The results will contribute to evidence-based optimization of regional anesthesia strategies in ambulatory surgery. EU Clinical Trials Information System (CTIS): 2024-513406-59-00; ClinicalTrials.gov identifier: NCT07423910.

Human papillomavirus (HPV) related cancer incidence is higher among American Indian/Alaska Native (AI/AN) women than among White women. Limited access to health care or preventive services in rural communities might increase cancer risk among AI/AN people. To understand disparities in Alaska, this study compares rural/urban HPV vaccination rates of AI/AN with non-AI/AN people. Immunization rate data were extracted for each year during 2018-2023. Immunization rates from the Alaska Immunization Information System (VacTrAK) were compared between AI/AN and non-AI/AN people. From 2018 to 2023, HPV vaccine series completion among Alaska adolescents aged 13-15 years ranged from 32% to 39%, with 32% up to date in 2023; 48% had initiated vaccination. AI/AN adolescents had significantly higher completion than non-AI/AN peers (48% vs. 29%, p < 0.01), with consistently higher coverage across years and in both rural and urban settings after stratification; rural coverage was higher overall. Regional disparities were substantial, with series completion ranging from 15% to 58%. HPV vaccination coverage among Alaska adolescents remained low from 2018 to 2023, with substantial decline between initiation and series completion. AI/AN adolescents had significantly higher coverage than non-AI/AN peers, challenging assumptions about access and highlighting the effectiveness of community-centered, Tribal-led vaccination efforts. Persistent regional and urban-rural disparities, along with recent declines in AI/AN coverage, underscore the need to strengthen equitable strategies and improve series completion.

Validation of the Standardized Outcomes in Nephrology - Life Participation (SONG-LP) Instrument in People Receiving Dialysis.

Consideration of social and environmental determinants of maternal and perinatal health in the geographic information systems era: a primer.

Specific patient-reported impairments in normal endeavors (SPINE): creating and preliminarily validating a novel lumbar radiculopathy survey.

Simultaneous bilateral total knee arthroplasty (BTKA) is avoided due to higher perioperative risk, favoring staged procedures. This study evaluated how the interval between staged TKAs affects patient-reported outcome measures (PROMs) and compared complications between the first and second procedures. We retrospectively reviewed patients undergoing primary, elective, staged, BTKAs at a high-volume academic center between 2011 and 2024. Intra- and perioperative data and complications were compared between the surgeries. Patients were stratified by interval: less than three months ("extremely short waiters"), three to six months, six to nine months, nine to 12 months, one to two years, two to five years, and greater than five years. The PROMs were compared across these groups. A total of 4,210 patients underwent 8,420 staged, BTKAs at a mean 21.4-month interval. The most common intervals were six to nine months (27.4%) and nine to 12 months (21.1%). Patients were more likely to return to the emergency department (22 versus 16, P = 0.030) and be readmitted (48 versus 26, P = 0.113) after the second surgery, primarily due to infection. Revision rates did not differ. "Extremely short waiters" had the greatest improvement in Patient-Reported Outcomes Measurements Information System Pain Intensity and interference scores nine months after the second TKA (change 13.4 and 15.1, P < 0.001). At three months following the second surgery, those who waited three to six months had the largest Knee Injury and Osteoarthritis Outcome Score for Joint Replacement score improvement (change 23.7, P = 0.004). At one year after the second surgery, "extremely short waiters" again showed the greatest reduction in Patient-Reported Outcomes Measurements Information System Pain Intensity (change 10.5, P = 0.007) and Interference (change 11.3, P < 0.001). The interval between surgeries significantly impacted PROMs, with shorter intervals associated with better pain relief and functional recovery. Surgical timing should be tailored to individual patient goals and recovery trajectories.