Multiple Challenges Research Articles

Experiences of informal caregivers of people with dementia in low- and middle-income countries: a systematic review protocol.

This review aims to synthesize the experiences of informal caregivers of people with dementia in low- and middle-income countries (LMICs). Globally, the burden of dementia is increasing disproportionately in LMICs. Informal caregivers play a vital role and face multiple challenges in LMICs, even though they also often lack the awareness and skills to provide adequate care for people living with dementia. Many LMICs have limited resources and caregivers lack support services. Understanding their experiences and perceptions may improve interventions, helping caregivers to better support those living with dementia. Studies from all settings in LMICs will be considered. Qualitative data from qualitative or mixed methods studies that explore caregivers' experiences and perceptions will be included in this review. Participants are informal caregivers of people diagnosed with dementia at any stage, regardless of age, gender, or their relationship with people living with dementia. This review will follow the JBI methodology for a qualitative systematic reviews, with meta-aggregation as the synthesis method. The review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A 3-step search strategy will be used to locate published and unpublished studies in MEDLINE, CINAHL, Embase, PsycINFO, AgeLine, LILACS, African Index Medicus, ProQuest Dissertations and Theses, Open Dissertations, Web of Science Core Collection, and Google Scholar. There will be no date or language limitations. All studies will be screened against the inclusion criteria and data will be extracted and critically appraised for methodological quality by 2 independent reviewers using JBI tools. Confidence in the final synthesized findings will be assessed using the ConQual approach. PROSPERO CRD42023453814.

Accelerating Single-Cell Sequencing Data Analysis with SciDAP: A User-Friendly Approach.

Single-cell (sc) RNA, ATAC and Multiome sequencing became powerful tools for uncovering biological and disease mechanisms. Unfortunately, manual analysis of sc data presents multiple challenges due to large data volumes and complexity of configuration parameters. This complexity, as well as not being able to reproduce a computational environment, affects the reproducibility of analysis results. The Scientific Data Analysis Platform (https://SciDAP.com) allows biologists without computational expertise to analyze sequencing-based data using portable and reproducible pipelines written in Common Workflow Language (CWL). Our suite of computational pipelines addresses the most common needs in scRNA-Seq, scATAC-Seq and scMultiome data analysis. When executed on SciDAP, it offers a user-friendly alternative to manual data processing, eliminating the need for coding expertise. In this protocol, we describe the use of SciDAP to analyze scMultiome data. Similar approaches can be used for analysis of scRNA-Seq, scATAC-Seq and scVDJ-Seq datasets.

Synthesis of bioengineered heparin chemically and biologically similar to porcine-derived products and convertible to low MW heparin

Heparins have been invaluable therapeutic anticoagulant polysaccharides for over a century, whether used as unfractionated heparin or as low molecular weight heparin (LMWH) derivatives. However, heparin production by extraction from animal tissues presents multiple challenges, including the risk of adulteration, contamination, prion and viral impurities, limited supply, insecure supply chain, and significant batch-to-batch variability. The use of animal-derived heparin also raises ethical and religious concerns, as well as carries the risk of transmitting zoonotic diseases. Chemoenzymatic synthesis of animal-free heparin products would offer several advantages, including reliable and scalable production processes, improved purity and consistency, and the ability to produce heparin polysaccharides with molecular weight, structural, and functional properties equivalent to those of the United States Pharmacopeia (USP) heparin, currently only sourced from porcine intestinal mucosa. We report a scalable process for the production of bioengineered heparin that is biologically and compositionally similar to USP heparin. This process relies on enzymes from the heparin biosynthetic pathway, immobilized on an inert support and requires a tailored N-sulfoheparosan with N-sulfo levels similar to those of porcine heparins. We also report the conversion of our bioengineered heparin into a LMWH that is biologically and compositionally similar to USP enoxaparin. Ultimately, we demonstrate major advances to a process to provide a potential clinical and sustainable alternative to porcine-derived heparin products.

The Wearable Activity Tracker Checklist for Healthcare (WATCH): a 12-point guide for the implementation of wearable activity trackers in healthcare

Increasing physical activity in patients offers dual benefits, fostering improved patient health and recovery, while also bolstering healthcare system efficiency by minimizing costs related to extended hospital stays, complications, and readmissions. Wearable activity trackers offer valuable opportunities to enhance physical activity across various healthcare settings and among different patient groups. However, their integration into healthcare faces multiple implementation challenges related to the devices themselves, patients, clinicians, and systemic factors. This article presents the Wearable Activity Tracker Checklist for Healthcare (WATCH), which was recently developed through an international Delphi study. The WATCH provides a comprehensive framework for implementation and evaluation of wearable activity trackers in healthcare. It covers the purpose and setting for usage; patient, provider, and support personnel roles; selection of relevant metrics; device specifications; procedural steps for issuance and maintenance; data management; timelines; necessary adaptations for specific scenarios; and essential resources (such as education and training) for effective implementation. The WATCH is designed to support the implementation of wearable activity trackers across a wide range of healthcare populations and settings, and in those with varied levels of experience. The overarching goal is to support broader, sustained, and systematic use of wearable activity trackers in healthcare, therefore fostering enhanced physical activity promotion and improved patient outcomes.

Long-Term Psychological and Physiological Effects of Male Sexual Trauma.

Male sexual trauma presents multiple clinical challenges. Although the topic has received increased attention in the last couple decades, male sexual trauma continues to be underreported and underrecognized. This study aimed to investigate the long-term effects of sexual trauma for men who were victimized within an institutional environment by a person in a position of power. This study included data from 47 adult men who were victims of sexual abuse or misconduct by an assigned physician at a higher education academic institution between 1966 and 2003. A primary finding was elevated rates of intimacy and sexual problems and erectile dysfunction, which started shortly after the abuse and persisted over time. We found that there was an association between intimacy and sexual problems and difficulty maintaining employment, drug addiction, erectile dysfunction, and loss of meaningful and romantic relationships. Levels of potential psychopathology were prominently linked to loss of sexual interest or pleasure, intimacy concerns, and loss of intimate and other personal relationships. Men who experienced sexual abuse as adults within an institutional environment developed long-standing patterns of interpersonal and professional problems. This study emphasizes the need for nuanced screening, evaluation, and treatment for male sexual trauma.

Expanding useful degrees of freedom for more powerful quantum cryptography

Exploiting all of light’s degrees of freedom would enable faster, more secure communication, but getting there requires addressing multiple challenges.

Stem cell therapy for degenerative disc disease: Bridging the gap between preclinical promise and clinical potential.

Stem cell therapy has gained attention in the field of regenerative medicine due to its potential to restore damaged tissue. This article focuses on the application of stem cell therapy for treating spinal pathologies, particularly intervertebral disc degeneration. Disc degeneration is a major cause of low back pain and is characterized by changes in the matrix and inflammation. Animal studies have demonstrated that the implantation of mesenchymal stem cells (MSCs) yields promising results, including increased disc height, improved hydration, and reduced inflammation. However, the number of clinical trials remains limited, necessitating further research to optimize MSCs therapy. Although preclinical studies offer valuable insights, caution is needed when extrapolating these findings to clinical practice. Stem cell therapy still faces multiple challenges, such as the durability and survival of MSCs upon implantation, uncertain pathways to discogenic differentiation, and the adverse impact of a harsh microenvironment on cell survival. The avascular nature of the intervertebral disc and dynamic loading conditions also affect the adaptation of transplanted cells. Despite these obstacles, stem cell therapy holds promise as a potential treatment for disc degeneration, and ongoing research aims to fill the current gap in conclusive data.

"I'd Rather Be Broke Than Harmed": A Qualitative Analysis of the Experiences of People Engaged in Commercial Sex Work During the COVID-19 Pandemic.

People involved in commercial sex work during the COVID-19 pandemic, particularly those compelled to sell sex, faced multiple challenges to their safety and well-being. We explored, in real time, the impact of the COVID-19 pandemic on people involved in commercial sex work and the broader commercial sex industry. Using a participatory action research approach, we interviewed 159 English- and Spanish-speaking adults who had engaged in commercial sex work under the direction of a third party in Sacramento County, California, within the past 5 years (approximately 2017-2022). As part of a larger study, our interview protocol included 1 question about the COVID-19 pandemic: "Has COVID-19 changed anything about your experience with sex work?" We transcribed and analyzed interviews using QSR-NVivo, a qualitative coding software. Participants described the effects of increased isolation, decreased demand, difficulty accessing social services, fear of contracting COVID-19, difficulty in following public health guidance on social distancing and wearing face masks, and how the pandemic resulted in some people entering or exiting commercial sex work. Most participants were familiar with recommended public health safety measures, but lack of agency and financial need limited their ability to comply with all recommendations. A lack of access to social services added stress to those most in need of emergency housing or substance use treatment and left them vulnerable to continued abuse. Stress and financial insecurity generally increased among people involved in commercial sex work during the pandemic, and no efforts were made to understand and mitigate the hardships that this population faced. Future research should address how to maintain social service availability during times of public health emergencies and other crises.

Adaptation pathways for effective responses to climate change risks

AbstractClimate related changes are already affecting every area of our world and will increasingly do so as global warming increases, resulting in compounding and cascading risks across multiple locations and sectors. Deliberative processes and anticipatory actions are required to adapt to the associated complex and uncertain systemic risks, with dynamic and long‐term planning needed even where there is limited knowledge of the effectiveness of adaptation. In this focus article, we examine the adaptation pathways developed for the Europe Chapter of the IPCC AR6. We argue that illustrative pathways built on quantitative and qualitative assessment of adaptation effectiveness can inform adaptation planning to manage the increasing severity of risks. We find that as the global warming level increases adaptation pathways can diverge, leading to radically different futures, for example, adaptation responses to sea level rise. We illustrate how adaptation measures for different risks interact resulting in trade‐offs, for example, increasing water scarcity. Although pathways offer a useful framework to address multiple adaptation challenges, other supporting conditions are needed for the successful implementation of adaptation, such as establishing legitimacy and buy‐in through collaboration of various actors and effective governance. Ultimately, adaptation will be increasingly more complex and constrained in a warmer world, increasing risks of losses and damages to people and nature.This article is categorized under: Vulnerability and Adaptation to Climate Change > Institutions for Adaptation The Social Status of Climate Change Knowledge > Climate Science and Decision Making Assessing Impacts of Climate Change > Evaluating Future Impacts of Climate Change Vulnerability and Adaptation to Climate Change > Learning from Cases and Analogies

Surgical Navigation in the Anterior Skull Base Using 3-Dimensional Endoscopy and Surface Reconstruction

Image guidance is an important adjunct for endoscopic sinus and skull base surgery. However, current systems require bulky external tracking equipment, and their use can interrupt efficient surgical workflow. To evaluate a trackerless surgical navigation system using 3-dimensional (3D) endoscopy and simultaneous localization and mapping (SLAM) algorithms in the anterior skull base. This interventional deceased donor cohort study and retrospective clinical case study was conducted at a tertiary academic medical center with human deceased donor specimens and a patient with anterior skull base pathology. Participants underwent endoscopic endonasal transsphenoidal dissection and surface model reconstruction from stereoscopic video with registration to volumetric models segmented from computed tomography (CT) and magnetic resonance imaging. To assess the fidelity of surface model reconstruction and accuracy of surgical navigation and surface-CT model coregistration, 3 metrics were calculated: reconstruction error, registration error, and localization error. In deceased donor models (n = 9), high-fidelity surface models of the posterior wall of the sphenoid sinus were reconstructed from stereoscopic video and coregistered to corresponding volumetric CT models. The mean (SD; range) reconstruction, registration, and localization errors were 0.60 (0.24; 0.36-0.93), 1.11 (0.49; 0.71-1.56) and 1.01 (0.17; 0.78-1.25) mm, respectively. In a clinical case study of a patient who underwent a 3D endoscopic endonasal transsphenoidal resection of a tubercular meningioma, a high-fidelity surface model of the posterior wall of the sphenoid was reconstructed from intraoperative stereoscopic video and coregistered to a volumetric preoperative fused CT magnetic resonance imaging model with a root-mean-square error of 1.38 mm. The results of this study suggest that SLAM algorithm-based endoscopic endonasal surgery navigation is a novel, accurate, and trackerless approach to surgical navigation that uses 3D endoscopy and SLAM-based algorithms in lieu of conventional optical or electromagnetic tracking. While multiple challenges remain before clinical readiness, a SLAM algorithm-based endoscopic endonasal surgery navigation system has the potential to improve surgical efficiency, economy of motion, and safety.

Cardiac CT: Competition, complimentary or confounder

Coronary CT angiography (CCTA) has been gradually adopted into clinical practice over the last two decades. CCTA has high diagnostic accuracy, prognostic value, and unique features such as assessment of plaque composition. CCTA-derived functional assessment techniques such as fractional flow reserve and CT perfusion are also available and can increase the diagnostic specificity of the modality. These properties propound CCTA as a competitor of functional testing in diagnosis of obstructive CAD, however, utilizing CCTA in a concomitant fashion to potentiate the performance of the latter can lead to better patient care and may provide more accurate prognostic information. Although multiple diagnostic challenges such as evaluation of calcified segments, stents, and small distal vessels still exist, the technologic developments in hardware as well as growing incorporation of artificial intelligence to daily practice are all set to augment the diagnostic and prognostic role of CCTA in cardiovascular disorders.

Exploring the processes and mechanisms by which nonprofit organizations orchestrate global innovation networks: A case study of the COVAX program

In cocreating value with other organizations, nonprofit organizations may face multiple management challenges, posed by multistakeholder global innovation networks. Since these have not yet been systematically studied by academics, this study explores how nonprofit organizations can promote the cocreation of value in multistakeholder global innovation networks. Adopting a longitudinal single-case study approach from the perspective of network orchestration theory, this work deeply analyzes how nonprofit organizations can promote the evolution of the global innovation network of the COVID-19 vaccine under the COVAX program. The results show that nonprofits need to successively address the dilemmas of legitimacy, direction, and heterogeneity in constructing global innovation networks and that to solve these stage dilemmas, orchestrators must successively function as network architects, liaisons, and leaders to direct the implementation of network actions using trusted, leveraged, and adapted orchestration logics. This paper further proposes a model of the orchestration process and mechanisms by which nonprofit organizations facilitate multistakeholder global innovation networks. Theoretically, this study therefore extends network orchestration theory by summarizing the mechanisms and orchestration logics by which NPOs construct and develop networks when they act as orchestrators. From a practical perspective, this study also provides guidance for future unexpected global public health crises, improving the global community's ability to combat them.

Oral Delivery of the Vancomycin Derivative FU002 by a Surface-Modified Liposomal Nanocarrier.

Oral delivery of peptide therapeutics faces multiple challenges due to their instability in the gastrointestinal tract and low permeation capability. In this study, the aim is to develop a liposomal nanocarrier formulation to enable the oral delivery of the vancomycin-peptide derivative FU002. FU002 is a promising, resistance-breaking, antibiotic which exhibits poor oral bioavailability, limiting its potential therapeutic use. To increase its oral bioavailability, FU002 is incorporated into tetraether lipid-stabilized liposomes modified with cyclic cell-penetrating peptides on the liposomal surface. This liposomal formulation shows strong binding to Caco-2 cells without exerting cytotoxic effects in vitro. Pharmacokinetics studies in vivo in rats reveal increased oral bioavailability of liposomal FU002 when compared to the free drug. In vitro and in vivo antimicrobial activity of FU002 are preserved in the liposomal formulation. As a highlight, oral administration of liposomal FU002 results in significant therapeutic efficacy in a murine systemic infection model. Thus, the presented nanotechnological approach provides a promising strategy for enabling oral delivery of this highly active vancomycin derivative.

Want doctors to use VR simulation? Make it mandatory, accessible, educationally valuable, and enjoyable!

Background Virtual reality (VR) simulation training is mandatory for postgraduate year 1-2 doctors at the author’s hospital trust. Despite this, a preceding quantitative study demonstrated uptake below required levels. While the educational value of VR simulation has been highlighted, little attention has been paid to participant utilisation in postgraduate curricula. With the increasing development and incorporation of VR-based clinical education, it is essential to understand the factors influencing how frequently postgraduate doctors utilise it so that its potential can be maximised. Methods A qualitative study design was employed. All 108 postgraduate year 1-2 doctors from the 2020-21 training year were invited for a semi-structured interview. Interviews continued until data saturation was reached in the form of informational redundancy. Reflexive thematic analysis was conducted. Results A total of 17 interviews were conducted. Four main themes that influenced participation in VR simulation were identified: (1) the mandatory nature encouraged participation but led to negative perceptions as a tick-box exercise; (2) there were multiple challenges to accessing the resource; (3) the scenarios were felt to have limited educational value; and (4) there was untapped potential in drawing benefits from VR as an enjoyable leisure activity. Conclusions Recommendations from these findings include: (1) VR simulation should be mandatory but with a degree of learner autonomy; (2) sessions should be integrated into doctors’ rotas as protected time; (3) more challenging scenarios ought to be created aligned with postgraduate courses, examinations, and specialty training, and (4) presented as a difficulty level system akin to gaming experiences.

Negotiating the insider–outsider dilemma in urban research: Experiences of a graduate student returning home for fieldwork

AbstractAfrican doctoral students studying abroad and returning to their home countries for fieldwork face multiple and complex challenges. This paper reflexively addresses the question of positionality from the experiences of conducting research on urban governance and the spatial politics of street traders in Harare, Zimbabwe. The paper discusses dilemmas associated with navigating insider and outsider identities, showcasing how these categories continually shift while conducting research on street traders within a distinct socio‐cultural and political context. Moreover, the author's background as a former street trader, now pursuing a PhD at the University of Western Ontario in Canada, adds a layer of complexity to the situation, offering valuable insights into how these ‘multiple’ positionalities can either facilitate or hinder data collection. The paper underscores the nuanced experiences of the researcher in the field, shedding light on the potential challenges, pitfalls and opportunities inherent in grappling with one's positionality. By foregrounding these complexities, the paper contributes to our understanding of the positionalities of researchers in the social sciences and adds to the growing body of literature on methodologies for conducting urban studies, particularly with vulnerable populations.

GEORGIAN MANAGEMENT STYLE AND THE RESEARCH OF FACTORS AFFECTING THE BEHAVIOUR OF SUBORDINATES IN THE MINISTRIES OF ECONOMIC PROFILE

The behaviour of a leader has a significant impact on the actions and feelings of employees. Many European university researchers have recently focused on the impact of effective leadership behaviour on the behaviour of subordinates. Positive behaviour of the leader toward his subordinate creates a sense of belonging to the organization, which reduces the outflow of employees from the organization and improves support for the leader. Leader's behaviour was studied within our research. The object of the research was the Ministries of Economic Profile of Georgia. The purpose of this article is to analyze the influence of the leader's behaviour in terms of gender on such issues as the respondent's perception of himself as a valuable member at work, support for the respondent's career development, motivation of employees to perform the work, effort invested by the respondent at work, and desire to change the leader. Furthermore, the study aimed to investigate the impact of financial benefits on employee satisfaction and motivation. In total, 821 respondents participated in the study. The SPSS software package was used to analyze the obtained data. In such countries as Georgia, there is a stereotypical attitude towards women. Sometimes, the mentioned factor is also reflected in the leader's behaviour. As a result, women have to overcome a variety of challenges, frequently face the glass ceiling phenomenon, and have to break stereotypes. In some cases, as a result of research, it is clear that not only women but also men show a negative attitude toward the leader's behaviour, which indicates the shortcomings of the current management style. Five hypotheses were formulated during the research process, and based on their analysis, we developed recommendations that we believe to be an effective way to solve multiple challenges.

Mutation of wbtJ, a N-formyltransferase involved in O-antigen synthesis, results in biofilm formation, phase variation and attenuation in Francisella tularensis.

Two clinically important subspecies, Francisella tularensis subsp. tularensis (type A) and F. tularensis subsp. holarctica (type B) are responsible for most tularaemia cases, but these isolates typically form a weak biofilm under in vitro conditions. Phase variation of the F. tularensis lipopolysaccharide (LPS) has been reported in these subspecies, but the role of variation is unclear as LPS is crucial for virulence. We previously demonstrated that a subpopulation of LPS variants can constitutively form a robust biofilm in vitro, but it is unclear whether virulence was affected. In this study, we show that biofilm-forming variants of both fully virulent F. tularensis subspecies were highly attenuated in the murine tularaemia model by multiple challenge routes. Genomic sequencing was performed on these strains, which revealed that all biofilm-forming variants contained a lesion within the wbtJ gene, a formyltransferase involved in O-antigen synthesis. A ΔwbtJ deletion mutant recapitulated the biofilm, O-antigen and virulence phenotypes observed in natural variants and could be rescued through complementation with a functional wbtJ gene. Since the spontaneously derived biofilm-forming isolates in this study were a subpopulation of natural variants, reversion events to the wbtJ gene were detected that eliminated the phenotypes associated with biofilm variants and restored virulence. These results demonstrate a role for WbtJ in biofilm formation, LPS variation and virulence of F. tularensis.

Including Students With Visual Impairments in Local Schools of Ethiopia: Availability of Resources and Support Services

Introduction: This study assessed the availability of resources and school supports for students with visual impairments who were mainstreamed in local primary and secondary schools of Addis Ababa, Ethiopia. Methods: A qualitative research approach was used where a semi-structured interview was the tool for gathering primary data from students with visual impairments and special needs education specialists at inclusive education resource centers at the sampled schools. A total of 13 students (5 male, 8 female) with visual impairments were drawn from 2 primary and 4 secondary schools. To ensure the credibility of the study findings, a triangulation of sources and member checks were used. Results: Establishment of inclusive education resource centers and deployment of special needs education specialists were considered promising practices in improving the quality of inclusive education at local schools. Some efforts, like pairing students with visual impairments with sighted peers and administering examinations by subject teachers, need to be strengthened at schools. Multiple challenges were also identified including shortage of resources like textbooks and reference books in braille, braille writing materials, and audio materials. Students with visual impairments encountered challenges during examinations and assignments. The level of support provided by inclusive education resource centers was also found to be below expectations. Discussion: The findings of the current study support previous research in the area, in which students with visual impairments were found to face challenges in accessing resources and appropriate supports. In contrast to earlier findings, however, the current study documented relatively better support for students with visual impairment from sighted peers. Implications for Practice: Policymakers need to closely follow up and check the implementation of various policies and working documents prepared to promote quality inclusive education. Educators and families of students with visual impairments can also use these findings to advocate for improved services.

Hospital Discharge Process: Context-Sensitive Care.

The transition from hospital to home after surgery is a vulnerable time for all cardiac surgical patients, particularly older adults. This postoperative phase presents multiple physical, physiological, emotional, and socioeconomic challenges, not only for patients but also for their families and informal caregivers, who often describe this period as stressful and overwhelming. Health-care professionals, particularly nurses, play an integral role in a patient's discharge process; the challenges can be ameliorated through timely discharge planning and effective discharge education. The context-sensitive solutions shared in this paper propose enhancing nurses' discharge practices to provide individualized care and to facilitate the hospital-to-home transition.

Substrate Comparison for Tomato Propagation under Different Fertigation Protocols

Greenhouse tomato production faces multiple challenges, including the excessive use of nonrenewable substrates that are difficult to dispose of after use. Currently, most growers propagate tomatoes in rockwool, but there is an increasing demand for sustainable media. The objective of this research was to evaluate sustainable and organic alternatives for greenhouse propagation of tomato seedlings intended for high-wire production. Different organic and inorganic substrates were evaluated in three experiments, using a nutrient solution composed of a complete water-soluble fertilizer. Germination and growth parameters, including height, stem diameter, number of leaves, leaf area, foliar chlorophyll levels (SPAD), and shoot fresh and dry weight, were measured. In the first experiment, which employed overhead irrigation, rockwool, coir, wood fiber–coir mix, medium-grade pine bark, pine bark < 0.64 cm, and pine bark < 0.32 cm were evaluated. Tomato germination was faster and achieved higher percentages with pine bark < 0.64 cm compared to other substrates. However, growth performance was similar or better in coir than in rockwool four weeks after transplantation. For the second experiment with sub-irrigation only, rockwool, coir, wood fiber–coir mix, pine bark < 0.32 cm bark, and peat were evaluated at different container heights. Peat resulted in greater growth across all parameters, followed by wood fiber–coir mix in all container heights, while pine bark had the least growth across all measured parameters. In the third experiment with overhead irrigation, rockwool, wood fiber–coir mix, pine bark < 0.32 cm, and a commercial peat-based mixture were evaluated under different fertilizer rates (electrical conductivity of 1.1 and 2.2 mS·cm−1). Wood fiber–coir mix, peat-based mix, and rockwool were the substrates with the highest values for all evaluated parameters. While all the organic substrates showed potential for use in tomato propagation, pine bark < 0.32 cm bark and wood fiber–coir mix provided the best media for germination. Peat and wood fiber–coir mix showed the best media for subsequent seedling growth and demonstrated potential to be used as substitutes for rockwool.