Mechanical Support Research Articles

Green hydrogen prospects in Peninsular Malaysia: a techno-economic analysis via Monte Carlo simulations

According to Malaysia's National Energy Transition Roadmap, hydrogen is a critical component of the country's energy transition. However, there is a scarcity of hydrogen studies for Peninsular Malaysian states, which limits discussions on green hydrogen production. This study employs a Monte Carlo model to assess the economic and technical factors influencing the success of green hydrogen in Peninsular Malaysia. The study focuses on three target years: 2023, 2030, and 2050, representing various stages of technological development and market adoption. The levelized cost of hydrogen (LCOH) of a 1-MW Proton Exchange Membrane (PEM) electrolyzer system ranges from $5.39 to $10.97 per kg in 2023, highlighting early-stage challenges and uncertainties. A 6-MW PEM electrolyzer system could achieve an LCOH of $3.50 to $4.72 per kg by 2030, indicating better prospects. Because of technological advancements and cost reductions, a 20-MW PEM electrolyzer system could achieve an LCOH of $3.12 to $3.64 per kg in 2050. The findings indicate that the northern regions of Peninsular Malaysia have consistently low LCOH values due to favorable geographical conditions. Due to minor variations in solar capacity factors, uncertainty distributions in LCOH remain stable across different regions. Some states may face increased uncertainty, emphasizing the need for additional policy support mechanisms to mitigate risks associated with green hydrogen investments. The sensitivity analysis shows that key cost drivers are shifting, with early-stage electrolyzer investments dominating in 2023 and electricity prices becoming more important in 2030 and 2050. Future research could focus on optimizing green hydrogen systems for areas with underdeveloped green hydrogen industries. This study contributes to informed discussions about green hydrogen production by emphasizing the importance of tailored strategies that consider local conditions and highlighting the role of Peninsular Malaysia in the energy transition.

Perceptions of vision care following neurological impairment: a qualitative study

BackgroundVisual impairment is a common consequence of neurological impairments, and can impact a person’s ability to undertake everyday tasks, affecting their confidence and mental health. Previous qualitative research in the UK has shown inequalities to exist where patients are accessing vision care after stroke, but little is known around the experiences of accessing vision care following other neurological impairments, and a lack of national guidelines prevent standardised care planning. The aim of this qualitative study is to explore the perceptions of vision care after neurological impairment, and to identify possible inequalities and support mechanisms, where it has been possible to access vision care.MethodsUniversity ethical approval was obtained, and adults with a visual impairment as a result of a neurological impairment were offered an in-depth interview to explore their vision care experiences. Data were collected between April and November 2021 and analysed using iterative, thematic analysis (TA), informed by a social constructionist ideology.ResultsSeventeen participants were recruited. Three overarching themes were conceptualised in relation to the participants’ perception of vision care: Making sense of the visual impairment; The responsibility of vision care; and Influential factors in care quality perception.ConclusionInequalities were noted by participants, with most reporting a lack of suitable vision care offered as part of their neurological rehabilitation. Participants were thus burdened with the task of seeking their own support online, and encountered inaccurate and worrying information in the process. Participants noted changes in their identity, and the identity of their family carers, as they adjusted to their vision loss. The findings from this research highlight a need for clinicians to consider the long-term impact of vision loss after neurological impairment, and ensure patients are provided with adequate support and information, and appropriate referral pathways, alleviating this patient burden.

Delayed closure of ventricular septal defect with prolonged mechanical support

Introduction: Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum due to extensive myocardial necrosis. Despite advances in management, the mortality rate approaches 50%. We report a case of a 58-year-old male with VSD following MI who was successfully treated with a delayed surgical approach after haemodynamic support using Impella. Case description: A 58-year-old man with type 2 diabetes mellitus and hypertension presented with three days of chest pain. Testing revealed late presenting acute anterior ischaemic infarction and left-to-right shunt in the apical ventricular septum. Urgent cardiac catheterisation showed near-total occlusion of the left anterior descending artery. An Impella CP® was placed before angioplasty with a drug-eluting stent to optimise haemodynamics. After a multidisciplinary discussion, the Impella CP® was upgraded to Impella 5.5®, and surgery was delayed allowing for scar formation. The patient remained in the intensive care unit, where he underwent physical therapy, showing improvements in exercise tolerance by the time of surgery. He underwent a left ventriculotomy with a successful repair via an endocardial patch 28 days after initial presentation. Post-operative recovery was uneventful, with the patient discharged five days later, reporting no physical limitations one month post-discharge. Conclusion: The successful management of VSD post-MI relies on interdisciplinary collaboration, careful timing of surgical intervention and the strategic use of mechanical support devices such as the Impella. This case highlights the potential for favourable outcomes when tailored treatment approaches are employed.

Moving towards a mechanistic understanding of biostimulant impacts on soil properties and processes: a semi-systematic review

Biostimulants are gaining prominence in scientific research, with the potential to enhance plant productivity through benefits to crop yield/quality and tolerance to environmental stresses. Through possible improvements to nutrient use efficiency, they may also lessen the adverse environmental impacts of conventional inorganic fertilizer use in agriculture. The application of biostimulants is currently uncommon as a farming practice, with uncertain effectiveness in delivering these potential benefits. Current research focuses on biostimulant effects on plant physiological changes. There is little scientific evidence on the impact of biostimulants on soil properties (biological, physical, or chemical) or soil functions. This knowledge gap should be addressed considering the vital role of soil processes in the bioavailability of nutrients, as reflected in crop productivity. This review evaluates laboratory and field experimental work on the effectiveness of common, non-microbial biostimulants, with a focus on their modes of action within the soil matrix. Of 2,097 initial articles returned through the search strings, 10 were within the scope of this review. A common soil biostimulant mechanism emerges from this literature. This relates to the supply of nutrients provided by the biostimulants, which stimulate native soil microbiology in mineralizing organic material in the soil, thus producing more bioavailable nutrients for plant uptake. Additionally, some articles link biostimulant effects to soil physical and chemical changes, which in turn impact soil biology (and vice versa). However, there is inconsistent evidence to provide full support for these explanatory mechanisms. This review highlights the need for further research into the effect of biostimulants on the native soil microbiology and associated soil properties, to provide greater clarity on biostimulants’ modes of action and greater mechanistic insights into how they can be used to improve crop production.

Investigating the Institutional Embedding of Social Innovation at Five Leading Technical Universities in Europe

Although the relevance of social innovation has been increasingly discussed in politics and science in recent years, the role of universities in social innovation ecosystems still needs to be determined. In particular, there is little research on the role of European technical universities in promoting social innovations. Thus, this article uses a document analysis to conduct a cross-country analysis based on five European technical universities. The results show differences in promoting social innovation at five European technical universities and can thus provide an overview of the situation at technical universities. In brief, the results indicate that, in line with previous research on social innovation at universities, the five technical universities have not established holistic approaches to promote social innovation and that implementing social innovation in research and teaching could depend on policy instruments and support mechanisms for social innovation at the national and university levels.

Strategic technological processes in hospitals: Conflicts and personal experiences of healthcare teams.

Global health systems operate amid dynamic factors, including demographic shifts, economic variations, political changes, technological progress, and societal trends that lead to VUCA reality (Volatility, Uncertainty, Complexity, and Ambiguity). To address these challenges, healthcare organizations are increasingly turning to Strategic Technological Processes and digital transformation. Against this background, the current study examined the personal experiences, conflicts, difficulties, and moral dilemmas attendant upon accommodating this digital transformation of healthcare professionals. The study involved 27 healthcare professionals working in Israeli hospitals, whose experiences and perspectives were central to understanding the impact of digital transformation in healthcare settings. The study methodology rested on in-depth interviews, which were analyzed through the prism of the Listening Guide analytical technique. The research obtained pre-approval from the Ethics Committee at the researcher's institution. The study revealed that the healthcare professionals are indeed facing ethical conflicts and personal challenges related to digitalization (such as providing the best quality of care, being the best caregiver, and acting for the betterment of the hospital). It also identified dilemmas resulting from conflicts between the needs and demands of the health system and the healthcare professionals' values and resources. The study findings highlight the impact of ethical and moral challenges accompanying strategic organizational and digital transformation changes implemented by healthcare organizations worldwide. These challenges arise as healthcare institutions adapt to the demands of the 21st century, potentially leading to burnout and moral distress among healthcare professionals, further exacerbating the already stressful reality they face. In conclusion, the study emphasizes the critical necessity for comprehensive support strategies to alleviate stress and burnout among healthcare professionals. As healthcare organizations and personnel navigate significant organizational changes to address contemporary challenges, prioritizing the well-being of healthcare workers through effective support mechanisms becomes imperative.

City diplomacy as a mechanism of multi-level solidarity and support for Ukraine: A study of the changes following the 2022 Russian invasion

The full-scale Russian invasion of Ukraine in 2022 changed the situation in Europe, impacting various aspects, such as politics, security, and international relations. It also underscored the significance of local authorities, particularly cities, in responding to and addressing the consequences of the crisis. The paper answers the questions on the impact of the Russian invasion on the international partnerships of Ukrainian cities, the role of city diplomacy in promoting solidarity and support for Ukraine, and the dynamics of multi-level cooperation in supporting Ukraine during the war. This research was based on a survey sent to 56 Ukrainian cities, of which 70% of them responded. The findings indicate that almost 90% of Ukrainian cities receive diverse forms of support from foreign partners, and two-thirds of them engage in forging new partnerships. Moreover, through many multi-level initiatives, they contribute significantly to the dynamic interplay between local, national, and international levels of governments. These results highlight the noteworthy role of cities in international relations as actors in times of war.

Development and Characterization of Heparin-Containing Hydrogel/3D-Printed Scaffold Composites for Craniofacial Reconstruction.

Regeneration of cartilage and bone tissues remains challenging in tissue engineering due to their complex structures, and the need for both mechanical support and delivery of biological repair stimuli. Therefore, the goal of this study was to develop a composite scaffold platform for anatomic chondral and osteochondral repair using heparin-based hydrogels to deliver small molecules within 3D-printed porous scaffolds that provide structure, stiffness, and controlled biologic delivery. We designed a mold-injection system to combine hydrolytically degradable hydrogels and 3D-printed scaffolds that could be employed rapidly (<30min) in operating room settings (~23°C). Micro-CT analysis demonstrated the effectiveness of our injection system through homogeneously distributed hydrogel within the pores of the scaffolds. Hydrogels and composite scaffolds exhibited efficient loading (~94%) of a small positively charged heparin-binding molecule (crystal violet) with sustained release over 14days and showed high viability of encapsulated porcine chondrocytes over 7days. Compression testing demonstrated nonlinear viscoelastic behavior where tangent stiffness decreased with scaffold porosity (porous scaffold tangent stiffness: 70%: 4.9MPa, 80%: 1.5MPa, and 90%: 0.20MPa) but relaxation was not affected. Lower-porosity scaffolds (70%) showed stiffness similar to lower ranges of trabecular bone (4-8MPa) while higher-porosity scaffolds (80% and 90%) showed stiffness similar to auricular cartilage (0.16-2MPa). Ultimately, this rapid composite scaffold fabrication method may be employed in the operating room and utilized to control biologic delivery within load-bearing scaffolds.

Islamic finance principles and performance of micro, small and medium enterprises (MSMEs) in Makindye Division Kampala District Central Uganda

Purpose Micro, small and medium-sized enterprises (MSMEs) are vital for economic growth in developing countries. Yet, little research has explored the link between Islamic principles and MSME performance, especially in Uganda. This study aims to investigate the relationship between Islamic financial principles and MSMEs’ performance in Makindye Division Kampala – Uganda. Design/methodology/approach This study used a correlational research design involving 86 respondents from 30 MSMEs between January and May 2023. Data collected through questionnaires was analyzed with Statistical Package for Social Sciences, examining three independent variables: ethicality, Halal investment and prohibition of riba, in relation to MSME performance. Findings The results revealed significant relationships between these variables and MSME performance. Prohibition of riba (r = 0.296, n = 86, p = 0.006), Halal investments (r = 0.308, n = 86, p = 0.004) and ethical principles (r = 0.283, n = 86, p = 0.008) all exhibited a statistically significant relationship. Regression analysis with R = 0.405, R2 = 0.164 and adjusted R2 = 0.134 indicated that all hypothesized variables were significant predictors of MSME performance. Based on findings, this study rejected the null hypothesis, confirming a moderately positive and significant relationship between Islamic financial principles and MSME performance. Originality/value This study underscores the importance of active involvement from key stakeholders such as the Uganda Halal Bureau, Uganda Muslim Supreme Council, Islamic financial institutions and government agencies in integrating robust support mechanisms for MSMEs into their strategic frameworks. Such efforts could enhance Uganda’s economic landscape, aligning with the experiences of Malaysia and Indonesia in leveraging Islamic principles for economic growth.

Genome-wide identification and transcription factor regulation of monolignol biosynthetic genes in Ginkgo biloba L.

BackgroundGinkgo biloba L. is a widely cultivated Mesozoic relict gymnosperm, and the wood is resource-rich. As a main component of plant cell walls, lignin serves for plant water transport and mechanical support, as well as directly defining the properties of wood-based products. The lignin biosynthesis pathway in gymnosperms is simpler than that in angiosperms, but has been poorly studied due to the lack of model plants. ResultsIn the present study, we systematically identified a total of 157 monolignol biosynthetic genes from 10 families in G. biloba, including 12 Gb4CLs, 34 GbC3Hs, 7 GbC4Hs, 34 GbCADs, 8 GbCCoAOMTs, 19 GbCCRs, 13 GbCOMTs, 14 GbCSEs, 11 GbHCTs and 5 GbPALs. The chromosome localization, gene structure, gene promoter and other analyses were also conducted. We established a regulatory network between the identified monolignol biosynthetic genes and TFs generated by TGMI algorithm using 133 public RNA-seq datasets of various G. biloba tissues. We then examined 2 gene pairs from the network of their regulatory relationship via yeast one-hybrid and dual-luciferase reporter assay, and the results were positive confirming interactions existing between the GbMYB-025 protein and GbCAD31 promoter, GbERF-174 protein and GbCSE13 promoter in vivo. ConclusionsOur results provided a new effective approach to find transcriptional regulatory relationships and established an important foundation for molecular mechanisms and genetic regulation of monolignol biosynthesis in G. biloba.

V-A ECMO window of opportunity: identification of potential responders after an acute myocardial infarction complicated by cardiogenic shock

Abstract Funding Acknowledgements None. Background V-A ECMO is designed to supply oxygen demands in patients with circulatory failure. Neutral results obtained in recent cardiogenic shock (CS) trials are probably related to the inclusion of a high proportion of patients with SCAI C stage, in many of whom, the device might not provide hemodynamic benefit despite the addition of inherent complications. Mechanical circulatory support could potentially have a role only for patients in SCAI D-E stages. Purpose Our aim was to explore the excess in mortality explained by a SCAI D-E stage at 12h, compared to a SCAI A-C stages at 12h, in patients admitted due to an acute myocardial infarction (AMI) complicated by CS (stages C-E at admission). Additionally, we aimed to identify those factors at admission—clinical, electrocardiographic, gasometrical, echocardiographic, and angiographic—which predict whether a patient will progress to SCAI D-E stages within the subsequent 12h from CS onset. Main Outcome: SCAI D and E stage at 12h. Methods We retrospectively analysed those patients admitted due to an AMI in SCAI C-E stages at admission, that had been prospectively screened for EUROSHOCK trial. We classified the patients in two groups: "SCAI A-C" and "SCAI D-E" at 12 hours and conducted a survival analysis. Additionally, we conducted a univariate and multivariate analysis including arrival potential predictors for SCAI D-E at 12 hours. Results A total of 72 patients were included. At admission 25 patien were in SCAI D-E. At 12 hours, 42 patients were in SCAI D-E, and this group showed a higher 30-day mortality rate particularly explained by an excess of mortality within the first 7 days (Figure 1). There were no significant differences between groups in most baseline characteristics (Table 1) such as age or gender. We observed a fewer proportion of previous chronic treatment with negative inotropes (betablockers and calcium channel antagonists) in the SCAI D-E group. Overall, anterior ST elevation on EKG was more prevalent among SCAI D-E group, median pH lower and median glycaemia and lactate higher. In the multivariate analysis after adjustment by confounders, the independently predictors at arrival for the development of a SCAI D-E stage at 12h were culprit LAD, cardiac arrest in the cath Lab, low initial median pH and final TIMI &amp;lt;3 result. Conclusions In a cohort of AMI patients complicated by CS, those patients who remained in a SCAI D-E stage at 12 hours from CS onset, compared to those in A-C, showed a 26% excess mortality at 30-day follow-up, especially during the first week. Patients who presented with LAD as the culprit artery, low initial pH, cardiac arrest in the cath lab, and got a TIMI &amp;lt;3 result after PCI were independently associated with the development of SCAI D-E within 12 hours from admission. Patients meeting these criteria could benefit from early selective mechanical support and be taken into consideration in the design of future randomized controlled trials.

Management and outcome of high-risk pulmonary embolism in intensive care units: results from a retrospective single-center analysis

Abstract Funding Acknowledgements None. Background High-risk pulmonary embolism (PE) patients are exposed to hemodynamic/multiorgan compromise including hypotension, cardiogenic shock and/or cardiac arrest (CA). Few data exist on management and outcome in patients admitted to intensive care units (ICU) with high-risk PE. Purpose We sought to analyse the epidemiology, management and outcome of patients admitted to ICU due to high-risk PE. Methods Retrospective monocentric analysis of adult patients with high-risk PE admitted from 2017 to 2023; COVID-19 patients were excluded. Demographic, clinical presentation, management and outcome data have been collected. Descriptive analysis comparing means adjusted for organ involvement severity and Cox regression were performed. Results 85 patients (55 male, 63±12 years old, BMI 29.06± 6) were included in the analysis. All patients received the diagnosis through the computed tomography angiography except 4 of them who underwent extra-corporeal cardiopulmonary resuscitation (eCPR) and the diagnosis was made with trans-oesophageal echocardiography. Overall mortality was 32%, eCPR rate was 9%. 92% were treated with adrenergic drugs (norepinephrine 78%, dobutamine 65%, epinephrine 35%); 7 patients required VA-ECMO due to CA. 42 patients received mechanical ventilation (MV) during the first 12 hours; those patients had higher rate of CS (p &amp;lt;0.001), higher lactates (mean difference 1.45±3.2; p &amp;lt;0.001), higher SOFA and SAPS II scores (respectively, mean difference 12.5±0.49 and 7.9±3.4; p 0.004). 75 patients underwent systemic thrombolysis. 10 patients with contraindication to systemic thrombolysis, underwent catheter directed thrombolysis (CDT); in 6 cases CDT was preceded by mechanical suction thrombectomy. Patients undertaking CDT had higher SOFA score at admission (mean difference 2.45±1.6; p 0.04), worsen creatinine (p &amp;lt;0.001), lower PaCO2 (mean difference -0.54±5.3; p 0.01), higher PaO2 (mean difference 28.7±6.5; p 0.009), higher bilirubin (mean difference 3.2±1.6; p &amp;lt;0.001) and lower systolic blood pressure (mean difference -6.8±3.36; p 0.01). At the Cox regression, higher lactates (HR 1.45 [0.40-0.99], p 0.004, panel A), lower glomerular filtration rate (HR 1.1 [1.02-1.09], p 0.001, panel B), higher bilirubin (HR 2.6 [1.20-6.03,] p 0.016), higher ALT (HR 1.07 [0.95-0.99], p 0.04), lower PaO2/FiO2 ratio (HR 1.1 [0.97-0.99], p 0.024, panel C), MV (HR 1.1 [0.78-7.58], p 0.04, panel D) and VA-ECMO (HR 2.5 [1.25-3.54], p 0.002) were associated with increased mortality; CDT was associated with lower mortality (HR 0.82 [0.68-1.89], p 0.04). Conclusions High-risk PE was burdened by high mortality. Signs of worsen organ failure and respiratory and mechanical support are associated with increased mortality. In this monocentric population the use of CDT was performed when systemic thrombolysis contraindicated and it was associated with favourable outcome, although the small sample (10%) should warn contextualization in results’ interpretation.

The utility of qSOFA in assessing outcomes of patients with acute heart failure in a level II hospital: a single-center retrospective analysis

Abstract Funding Acknowledgements None. Introduction High all-cause mortality is associated with acute heart failure (AHF) hospitalization, both when the condition first develops and when it worsens. Although there are several risk models for patients with chronic heart failure (CHF), it is unknown whether these scoring systems may be applied to patients with ADHF to predict their chance of developing the condition. Purpose Acute Heart failure (AHF) patients benefit from accurate risk assessment. Those stratified with worse prognosis may benefit more from continuous and close monitoring, with subsequent prompt intervention in case of deterioration. Currently, there is a lack of a universally accepted risk score that can accurately predict outcomes in acute heart failure (AHF). Undeniably, sepsis and AHF share several clinical features. These similarities encourage the sepsis-to-AHF translation of SOFA and qSOFA scores. We compared different scoring systems used in sepsis and assessed their predictive accuracy. Methodology This retrospective study included all patients with acute heart failure admitted in a private teaching hospital between January 2014 and January 2023. This study included newly admitted adult patients with new-onset AHF or acute on chronic heart failure. Baseline qSOFA, SIRS, and SOFA values were determined. Receiver Operating Characteristics - Area under the Curve (ROC-AUC) analysis assessed these scores' ability to predict mortality, whereas chi-square and Fischer's exact test assessed secondary outcome risk. Results 545 patients were included in the study. The majority were males with a mean age of 65 years. Most patients in the study required oxygen support, were classified as NOHRIA A, and with NYHA Functional Class II. Renal and respiratory failures were prominent upon arrival. About 11% met ≥2 points in qSOFA. Therein, systolic BP of &amp;lt;100 mmHg was the most frequent criterion met. The primary endpoint, that is in-hospital mortality, occurred in 9.52% of patients. A positive qSOFA, defined as a score of 2 or more, was consistent in the majority of those meeting the primary endpoint (Chi2 = 264.698, p&amp;lt;0.001). The ROC analysis of qSOFA (AUC 0.949, 95% CI 0.924–0.974, accuracy of 73%), SOFA (AUC 0.935, 95% CI 0.887–0.983, accuracy of 72%), and SIRS criteria (AUC 0.939, 95% CI 0.917–0.961, accuracy of 72%) show no fundamental differences regarding the prediction of the primary endpoint. Patients with positive qSOFA criteria were more frequently affected by organ failure (OR 5.386, p &amp;lt;0.001), needed more vasopressors (OR 4.921, p &amp;lt; 0.001), notably with an ejection fraction &amp;lt;40% (OR 3.363, p &amp;lt;0.001), and required mechanical ventilator support more often (OR 3.794, p&amp;lt;0.001). Conclusion In conclusion, qSOFA used in Acute Heart Failure is a valuable tool in the early detection of in-hospital mortality and detection of worse outcomes, hence should be considered when making therapeutic strategies and decisions.AUC for Primary OutcomesSecondary Outcomes

Pediatric Takotsubo cardiomyopathy: a review and insights from a national multicentric registry

Abstract Funding Acknowledgements None. Background Takotsubo syndrome (TTS) in the pediatric population is an infrequent but relevant cause of morbidity and mortality, with limited studies addressing its clinical course and prognosis. Objectives We aimed to analyze the clinical features and prognosis of pediatric TTS in a nation-wide multicenter registry and considering the published literature. Methods we included a total of 54 patients from 4 different hospitals in Spain, as well as pediatric TTS patients from the published literature. Comparisons between groups were performed in order to assess for statistically and clinically relevant prognostic differences between pediatric and adult population features. Results Comparison between the RETAKO general population is detailed in Table 1. Pediatric patients with TTS had a median age of 11 years (IQR = 4-14). When compared to the RETAKO general population, they were more often male (51.9% vs 23.3%, p&amp;lt;0.001), and displayed a higher prevalence of secondary forms (90.7% vs 35.6% in adults, p&amp;lt;0.001). Regarding race, 11 cases (20.4%) were from Asia and 42 (77.8%) were Caucasian; whereas in RETAKO 1420 (94.9%) were Caucasians, with under 5 cases (&amp;lt;0.1%) being Asian. Pediatric patients presented less commonly with angina (11.1% vs 64.1%, p&amp;lt;0.001) or dyspnea (30% vs 41.7%, p&amp;lt;0.001), compared to the general RETAKO cohort. Nevertheless, pediatric patients with TTS exhibited a higher Killip status on admission (Killip IV 74.1% vs 10.5%, p&amp;lt;0.001), and higher needs of vasoactive and mechanical ventilatory support during hospitalization. Regarding complementary exams, pediatric patients presented with lower LVEF on admission (30.5+10.4 vs 36.9+16.9, p = 0.014) together with greater prevalence of atypical (basal or midventricular) TTS patterns on echocardiography (30.2% vs 15.8%, p = 0.006). Additionally, there were significantly less ST-segment alterations in the pediatric population (either ST-segment elevation or depression), without differences on T wave inversion in the admission ECG. During follow-up, all-cause deaths (11.1% vs 12,5%, p = 0.761) and TTS recurrences (3.8% vs 3,8%, p = 0.863) were similar between groups. Conclusions TTS in the pediatric population presents a distinctive clinical profile, with higher prevalence of atypical symptoms and physical triggers; as well as higher rates of cardiogenic shock on admission and similar mortality and recurrence rates than those of the adult population. This study provides valuable insights into understanding pediatric TTS and underscored the necessity for further research in this age group.Table 1

Factors associated with posttraumatic stress and anxiety among the parents of babies admitted to neonatal care: a systematic review

BackgroundPosttraumatic stress (PTS) and anxiety are common mental health problems among parents of babies admitted to a neonatal unit (NNU). This review aimed to identify sociodemographic, pregnancy and birth, and psychological factors associated with PTS and anxiety in this population.MethodStudies published up to December 2022 were retrieved by searching Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health electronic databases. The modified Newcastle–Ottawa Scale for cohort and cross-sectional studies was used to assess the methodological quality of included studies. This review was pre-registered in PROSPERO (CRD42021270526).ResultsForty-nine studies involving 8,447 parents were included; 18 studies examined factors for PTS, 24 for anxiety and 7 for both. Only one study of anxiety factors was deemed to be of good quality. Studies generally included a small sample size and were methodologically heterogeneous. Pooling of data was not feasible. Previous history of mental health problems (four studies) and parental perception of more severe infant illness (five studies) were associated with increased risk of PTS, and had the strongest evidence. Shorter gestational age (≤ 33 weeks) was associated with an increased risk of anxiety (three studies) and very low birth weight (< 1000g) was associated with an increased risk of both PTS and anxiety (one study). Stress related to the NNU environment was associated with both PTS (one study) and anxiety (two studies), and limited data suggested that early engagement in infant’s care (one study), efficient parent-staff communication (one study), adequate social support (two studies) and positive coping mechanisms (one study) may be protective factors for both PTS and anxiety. Perinatal anxiety, depression and PTS were all highly comorbid conditions (as with the general population) and the existence of one mental health condition was a risk factor for others.ConclusionHeterogeneity limits the interpretation of findings. Until clearer evidence is available on which parents are most at risk, good communication with parents and universal screening of PTS and anxiety for all parents whose babies are admitted to NNU is needed to identify those parents who may benefit most from mental health interventions.

An in vitro and in vivo study of electrospun polyvinyl alcohol/chitosan/sildenafil citrate mat on 3D-printed polycaprolactone membrane as a double layer wound dressing

Double-layer dermal substitutes (DS) generally provide more effective therapeutic outcomes than single-layer substitutes. The architectural design of DS incorporates an outer layer to protect against bacterial invasions and maintain wound hydration, thereby reducing the risk of infection and the frequency of dressing changes. Moreover, the outer layer is a mechanical support for the wound, preventing undue tension in the affected area. A 3D-printed polycaprolactone (PCL) membrane was utilized as the outer layer to fabricate DS wound dressing. Simultaneously, a polyvinyl alcohol/chitosan/sildenafil citrate (PVA/CS/SC) scaffold was electrospun onto the PCL membrane to facilitate cellular adhesion and proliferation. Scanning electron microscopy (SEM) analysis of the PCL filaments revealed a consistent cross-sectional surface and structure, with an average diameter of 562.72 ± 29.15 μm. SEM results also demonstrated uniform morphology and beadless structure for the PVA/CS/SC scaffold, with an average fiber diameter of 366.77 ± 1.81 nm for PVA/CS. The addition of SC led to an increase in fiber diameter while resulting in a reduction in tensile strength. However, drug release analysis indicated that the SC release from the sample can last up to 72 h. Animal experimentation confirmed that DS wound dressing positively accelerated wound closure and collagen deposition in the Wistar rat skin wound model.

‘Even (if) I choose the right answer, that goes wrong’

While studies on second language academic discourse socialization are increasing, how less academically prepared undergraduate multilingual students, such as RBSs, negotiate literacy challenges across the curriculum is still under-researched. As part of a larger qualitative study, which explored how three Bhutanese/Nepali youths negotiated the discursive, interactional, material and perceptual challenges they faced across their undergraduate curriculum in a US university, this article focuses on assessment-related textual challenges across the curriculum in a research university. Initiated as a teacher research-based study in an undergraduate ESL writing class, this longitudinal multiple-case study followed three RBSs for five years during their undergraduate study. While all three participants persistently struggled throughout their degree in various academic literacy events, they managed to graduate within five years because of various kinds of support they received. While there was no formal support tailored to RBSs at the university, this article illustrates how some literacy sponsors were able to create informal support mechanisms for these students. It also highlights how the most common literacy support at the university – that is, teaching of essayist literacies, was inadequate for preparing RBSs well in successfully negotiating academic literacy challenges.

A systematic review of workplace triggers of emotions in the healthcare environment, the emotions experienced, and the impact on patient safety

BackgroundHealthcare staff deliver patient care in emotionally charged settings and experience a wide range of emotions as part of their work. These emotions and emotional contexts can impact the quality and safety of care. Despite the growing acknowledgement of the important role of emotion, we know very little about what triggers emotion within healthcare environments or the impact this has on patient safety.ObjectiveTo systematically review studies to explore the workplace triggers of emotions within the healthcare environment, the emotions experienced in response to these triggers, and the impact of triggers and emotions on patient safety.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four electronic databases were searched (MEDLINE, PsychInfo, Scopus, and CINAHL) to identify relevant literature. Studies were then selected and data synthesized in two stages. A quality assessment of the included studies at stage 2 was undertaken.ResultsIn stage 1, 90 studies were included from which seven categories of triggers of emotions in the healthcare work environment were identified, namely: patient and family factors, patient safety events and their repercussions, workplace toxicity, traumatic events, work overload, team working and lack of supervisory support. Specific emotions experienced in response to these triggers (e.g., frustration, guilt, anxiety) were then categorised into four types: immediate, feeling states, reflective, and longer-term emotional sequelae. In stage 2, 13 studies that explored the impact of triggers or emotions on patient safety processes/outcomes were included.ConclusionThe various triggers of emotion and the types of emotion experienced that have been identified in this review can be used as a framework for further work examining the role of emotion in patient safety. The findings from this review suggest that certain types of emotions (including fear, anger, and guilt) were more frequently experienced in response to particular categories of triggers and that healthcare staff's experiences of negative emotions can have negative effects on patient care, and ultimately, patient safety. This provides a basis for developing and tailoring strategies, interventions, and support mechanisms for dealing with and regulating emotions in the healthcare work environment.

Preparedness of Occupational Therapy Academics to Support Students Experiencing Psychosis: A Qualitative Study

Students experiencing psychosis face increased difficulties within the higher education environment with support from academic staff being identified as one of the most significant factors in reducing attrition rates. Focus groups and interviews were used to consider the experiences of eight occupational therapy academics. Thematic analysis identified themes relating to the how of supporting a student experiencing psychosis; the challenges of supporting a student with psychosis; and mechanisms of support. Despite a small sample size, this study highlighted important considerations relating to the need for additional support and resources for academics to equip them to effectively provide student support.

Experience of Breastfeeding And Exclusive Breastfeeding For Women With Physical Disabilities: Scoping Review

The study aims to investigate the scientific evidence concerning breastfeeding and exclusive breastfeeding experiences among women with physical disabilities. Exclusive breastfeeding entails providing only breast milk to infants from birth to 6 months old, excluding any other food or drinks except medications and vitamins. However, breastfeeding is not halted after exclusive breastfeeding; it continues until the child is two years old. Utilising the scoping review method, the research employed the Population, Concept, and Context (PCC) framework. Six articles meeting the inclusion criteria were identified from a pool of 1,553 articles from PubMed, ScienceDirect, Wiley, and Research Rabbit databases. These articles shed light on the challenges, experiences, barriers, and support systems related to breastfeeding and childcare encountered by women with physical disabilities. The research on breastfeeding experiences among women with physical disabilities reveals both facilitators and barriers. Facilitators include adaptations, peer support, and necessary equipment, while barriers encompass insufficient support, health considerations, and milk production and latching challenges. These findings underscore the importance of tailored support and access to information for women with physical disabilities who aim to breastfeed effectively. Implementing such support mechanisms can contribute to improving breastfeeding rates among this demographic, thus promoting the health and well-being of both mothers and infants while addressing societal attitudes toward disability issues.