Positive Response Research Articles

Standardized Onboarding Increases Intention to Stay With the Organization

Advanced practice providers (APPs) are valuable members of health care teams integrated through orientation and onboarding. Comprehensive onboarding is crucial to retention and satisfaction in this group. A standardized onboarding program for new hire APPs was developed after a system-wide needs assessment showed poor satisfaction. Participants were surveyed upon completion of the program and compared with a preintervention cohort. An 80% increase in positive responses was noted in the intervention cohort when asked whether they intend to stay in their role for at least 1 year. Participants also identified recommendations for content in future programs.

Impact of Humic Substances on Alleviation of Soil Salinity and the Enhancement of Plant Productivity: a review

Humic substances (HS) are a major component of organic matter in soil, and they have long been recognized for their ability to promote plant growth in a sustainable manner. Recently, there has been a lot of effort put into using multiple approaches to study the connection between the chemical structure of HS compounds and their effect on plant biological processes. Positive physiological responses at the local and systemic levels have been linked to the presence of specific functional groups in HS. Hormone-like signaling pathways are responsible for eliciting these reactions. This review was written with one goal in mind: to help readers gain a firm grasp on the research surrounding the application of HSs. The spatial arrangement of hydrophilic and hydrophobic regions, as well as the dosage, source, molecular size, degree of hydrophobicity, and aromaticity, all contribute significantly to HS's biological efficacy. Therefore, our hypothesis explains the beneficial effect of HS in salt-affected rhizospheres, likely attributed to both direct and indirect influences on plant metabolism, soil microorganism metabolism, soil nutrient uptake dynamics, and soil physical conditions. Keywords: Humic substance, germination, salinity, plant growth

Kaposi sarcoma in HIV Patients: Case study and literature review

Introduction: Kaposi sarcoma (KS), a malignancy originating from endothelial cells and linked to human herpesvirus 8 (HHV-8), disproportionately affects individuals with human immunodeficiency virus (HIV). Despite decreased incidence in high-income countries due to antiretroviral therapy, KS remains a significant concern in sub-Saharan Africa. This article presents a case study of an HIV-positive patient treated exclusively with radiation therapy and provides a comprehensive literature review on KS management. Case Presentation: A 46-year-old HIV-positive patient, under well-controlled infection, exhibited nodular skin lesions, hyperpigmentation, and lymphedema primarily on the lower left limb. Histological analysis confirmed the diagnosis of KS. The patient underwent radiation therapy (36 Gy in 12 sessions) with subsequent topical imiquimod. Nine months post-treatment, no nodular lesions were observed, indicating a positive response. Conclusion: In the antiretroviral era, radiation therapy emerges as a crucial loco-regional treatment in the multimodal management of epidemic KS. With a focus on controlling disease within irradiated areas, excellent response rates and acceptable toxicity levels highlight the efficacy of this approach.

A Nasal Vaccine Candidate, Containing Three Antigenic Regions from SARS-CoV-2, to Induce a Broader Response

A chimeric protein, formed by two fragments of the conserved nucleocapsid (N) and S2 proteins from SARS-CoV-2, was obtained as a recombinant construct in Escherichia coli. The N fragment belongs to the C-terminal domain whereas the S2 fragment spans the fibre structure in the post-fusion conformation of the spike protein. The resultant protein, named S2NDH, was able to form spherical particles of 10 nm, which forms aggregates upon mixture with the CpG ODN-39M. Both preparations were recognized by positive COVID-19 human sera. The S2NDH + ODN-39M formulation administered by the intranasal route resulted highly immunogenic in Balb/c mice. It induced cross-reactive anti-N humoral immunity in both sera and bronchoalveolar fluids, under a Th1 pattern. The cell-mediated immunity (CMI) was also broad, with positive response even against the N protein of SARS-CoV-1. However, neither neutralizing antibodies (NAb) nor CMI against the S2 region were obtained. As alternative, the RBD protein was included in the formulation as inducer of NAb. Upon evaluation in mice by the intranasal route, a clear adjuvant effect was detected for the S2NDH + ODN-39M preparation over RBD. High levels of NAb were induced against SARS-CoV-2 and SARS-CoV-1. The bivalent formulation S2NDH + ODN-39M + RBD, administered by the intranasal route, constitutes an attractive proposal as booster vaccine of sarbecovirus scope.

Epidemic preparedness and innovations in digital healthcare: enhancing post-pandemic speech-language pathology services for child and adolescent mental health in Qatar

BackgroundThis paper discusses the critical importance of epidemic preparedness and innovations in digital health care by examining the transformative impact on speech-language pathology (SLP) services in a specialist outpatient child and adolescent service (CAMHS).MethodThis retrospective review analyzes referral data from three periods: pre-pandemic (15 March 2019–14 March 2020), pandemic (15 March 2020–14 March 2021), and post-pandemic (15 March 2021–14 March 2022). Statistical analyses assess trends in referrals and diagnoses during these periods. Feedback was also obtained from Parents of children who received virtual consultations during the pandemic.ResultsThe results reveal an increase in the demand for SLP services during and after the pandemic, with a surge in referrals (increased from 9.7 to 12.9% when compared pre-pandemic to post-pandemic periods; Chi-Square value 3.33, P = 0.068) for children with social communication challenges and autism spectrum disorder. Phone and video consultations were effectively adopted. Feedback from families shows a positive response (69%–98% of participants responded as strongly agreed and agreed on various items listed in feedback form specifically designed in line with the service objectives) to telehealth interventions, with many parents finding virtual consultations effective and helpful.ConclusionsThe study emphasizes the importance of telehealth SLP services in meeting the increasing demand for mental health interventions among children and adolescents. It suggests integrating telehealth into clinical practice beyond the pandemic and highlights the need for long-term evaluation and addressing potential barriers to access.

Effects of sensory cues on consumers’ wine taste perceptions and behavior: evidence from a wine-tasting experiment

Purpose This study aims to investigate how sensory cue order, wine knowledge and visual–olfactory (V–O) congruence affect consumer’s taste perceptions of wine and their subsequent behavior. Design/methodology/approach An experiment was performed to identify the effects of sensory cue congruence and sensory cue order on wine consumers’ perceptions of wine, affective evaluations, cognitive evaluations and purchase intentions. Findings Wine experts exhibited positive emotional responses to congruent sensory cues in the V–O order. Experts’ enjoyment of wine’s aroma, their emotional responses, their cognitive evaluations and their purchase intentions were lower in the incongruent condition. Consumers’ negative emotions elicited by the V–O sequence were also less intense than those triggered by the olfactory–visual (O–V) sequence. Wine experts demonstrated more positive emotional responses in the V–O sensory congruent condition. Research limitations/implications This study highlights how visual and olfactory sensory cue order, wine knowledge and sensory cue congruence interact to clarify wine-related behavioral intention. Findings reveal the roles of these factors in shaping sensory perceptions, cognitive evaluations, affective evaluations and behavior related to wine consumption. Practical implications This study holds implications for various stakeholders, including winemakers, wine businesses, restaurants and the broader hospitality industry. Wine businesses can enhance advertising effectiveness by tailoring their marketing efforts to customers’ knowledge levels and emphasizing the inherent attributes that align with individuals’ preferences. Winemakers can improve consumers’ sensory experiences by enhancing the natural color of wines. Restaurants can strive to ignite diners’ positive emotions and experiences by providing congruent information. Furthermore, sensory-driven strategies can be used in the hospitality sector to elevate customers’ positive emotions. Originality/value This study fills gaps in wine research by delineating how wine knowledge and related sensory cues can influence consumers’ sensory perceptions, cognitive evaluations, affective evaluations and behavior. These aspects have been largely overlooked in previous work.

Evaluation of Sensory Characteristics of Rubber Tree (Hevea Brasiliensis) Sawdust and Leaves as Alternative Biofuels

In the face of rising fuel costs and environmental concerns, the need for alternate energy sources is growing. Charcoal, generated from animal and vegetable sources, has emerged as a viable alternative fuel. Briquetting, which compresses organic materials into compact briquettes, offers an environmentally responsible solution for waste management and energy production in the Philippines. Basilan, noted for its agricultural methods, generates a substantial amount of agricultural waste, including rubberwood sawdust (RBS) and Rubber Tree Leaves which is perfect for briquette production due to its lignocellulose content. Charcoal briquettes, made of charcoal fines and binder, are an economical, smokeless, and long-lasting fuel option which may poses sustainable solution as the conventional method of charcoal manufacture, which involves tree felling, poses ecological concerns. This exploratory experimental design study investigates the viability and possibility of utilizing biocharcoal from dried leaves of rubber trees and rubberwood sawdust (Hevea brasiliensis) as an environmentally benign and cost-effective option. This study intends to create a sustainable cooking fuel alternative to standard charcoal by reusing agricultural trash. The study aims to developed briquettes and assesses their physical characteristics such durability, efficiency, kindling time, burning time, and heating quality to three identified evaluators. Overall, the positive responses from those who were interviewed shed light on the promising potential of rubber sawdust charcoal briquettes (x̄=4.8 (liked very much)) and rubber tree leaves (x̄=4.23 (liked very much)) as a viable and environmentally friendly energy source for applications involving heating and cooking. Due to limited laboratory apparatuses, researchers recommended for a further evaluation of the developed briquettes such doing proximate analysis (e.g. measuring the moisture and ash content) established strong data to support the existing data.

Post-seismic Ionosphere Effects after Croatian MW 6.4 Earthquake on December 29, 2020

The main idea of the present investigation is to study the relationship between post- seismic effects as a result of Petrinja, Croatia earthquake which occurred on December 29, 2020 in some ionospheric parameters. Two types of ionospheric data were used: the critical frequency of the F2 region (foF2), obtained from the vertical sounding of the ionosphere and Total Electron Content (TEC) data. The ionospheric response is studied by the relative deviation of both quantities foF2 and TEC. The results of the ionospheric parameter behaviour show the following: a) a positive anomaly is observed in both ionospheric characteristics; b) the most significant positive response is observed at ionospheric stations closer to the epicentre; c) the delay of the observed post-seismic ionospheric effect increases with distance from the epicentre in both data used. The observed anomalies in the behaviour of considered ionospheric parameters could be associated with the considered lithospheric phenomenon because the selected period is with completely quiet geomagnetic conditions. The results of this research gives additional insight into the Lithosphere-Atmosphere-Ionosphere Coupling during Earthquake processes.

The use of biologics and JAK inhibitors in the management of moderate to severe Hidradenitis Suppurativa treatment: a scoping review.

This scoping review aims to characterize the use of biologics and Janus Kinase inhibitors (JAKi) in the treatment of Hidradenitis Suppurativa (HS), which is a chronic inflammatory condition. A comprehensive literature search was conducted in PubMed/NCBI, Embase, Web of Science databases, and the Clinicaltrials.gov register. The search included interventional trials assessing the use of biologics or JAKi in HS, with no geographic or time restrictions. Secukinumab and adalimumab were identified as the only two drugs approved by the FDA for treating moderate to severe HS in adults. Several other drug classes showed promising results based on clinical studies reviewed. IL-12/23 inhibitor ustekinumab demonstrated improvements in disease severity scores and HiSCR rates in small trials. IL-17 inhibitors such as brodalumab, bimekizumab, and CJM112 showed preliminary positive responses in early-phase clinical studies and case reports. While evidence was mixed, some TNF-α inhibitors such as infliximab provided benefits according to a randomized controlled trial, though etanercept trials yielded non-significant or inconsistent findings. Larger, well-designed studies are required to further establish their efficacy and safety, but biologics and JAKis show potential as alternative treatment options for moderate to severe HS. The findings of this review contribute to the growing interest among patients and to enhancing the understanding of physician's regarding potential alternative therapeutic options for HS and provide a basis for further research in this field.

Knowledge, Attitude and Practices (KAP) of Sterilization and Disinfection of Health Care Professionals in Bangladesh

<i>Background:</i> Healthcare professionals face a constant risk of acquiring infections from patients. Exposure to blood, saliva, and sharp instruments increases their susceptibility to various infectious diseases. Proper sterilization and disinfection procedures are crucial for protecting both healthcare workers and patients. <i>Objective:</i> This study aimed to assess the knowledge, attitude, and practices regarding sterilization and disinfection among healthcare professionals in Bangladesh.<i> Methods</i>: A cross-sectional study was conducted at the National Institute of Cardiovascular Diseases & Hospital in Dhaka, Bangladesh, from January to June 2023. A total of 81 healthcare professionals were randomly selected and participated in the study after providing verbal consent. Data collection involved a pre-structured questionnaire focusing on knowledge, attitude, and practices related to sterilization and disinfection. Statistical analysis was performed using SPSS software, and results were presented as frequencies and percentages. Ethical clearance was obtained before the study commenced. <i>Results: </i>The study included healthcare professionals from various backgrounds, with the majority being young adults (21-25 years old). Knowledge assessment revealed a good understanding of sterilization methods, disinfection procedures, post-sterilization instrument management, and waste disposal practices. Additionally, most participants were aware of the hospital's sterilization protocols and infection prevention policies. Regarding attitudes, a positive response was observed towards regular training for staff, proper use of personal protective equipment (PPE), and adherence to sterilization and disinfection guidelines. However, a minority expressed concerns about reusing disposable items. Practices reflected the positive knowledge and attitudes, with a high percentage of participants following hand hygiene protocols, using PPE, and opting for disposable equipment. However, a small number reported experiencing needle-stick injuries, highlighting a potential gap between knowledge and practice. <i>Conclusions:</i> the study found that a majority of healthcare professionals in this setting demonstrated good knowledge, positive attitudes, and appropriate practices regarding sterilization and disinfection. However, a small knowledge, attitude, and practice gap was identified, particularly concerning needle-stick injuries. These findings suggest a need for ongoing education and reinforcement of safe practices to ensure optimal infection prevention and control in healthcare facilities.

The influence of subclavian ansae stimulation on cardiac hemodynamics and electrophysiology in atrial fibrillation- exploring a novel target for neuromodulation in atrial fibrillation (SAS-AF study)

Abstract Background Sympathetic nervous system activation plays a significant role in arrhythmia development and maintenance.Neuromodulation techniques such as stellate ganglion block and sympathectomy, are limited by off-target side effects and complex targeting.The Subclavian Ansae (SA,a nerve cord encircling the subclavian artery) may be an intravascular site allowing specific targeting of the cardiac afferent sympathetic system.Preclinical studies have revealed increased sympathetic tone upon selective SA stimulation. Objective We sought to define for the first time in Humans the functional anatomy and physiology of Subclavian Ansae via a percutaneous approach. Methods A prior cadaveric study defined the anatomical course of the subclavian ansae, encircling the subclavian arteries and connecting the middle cervical ganglia to inferior cervical ganglia/stellate.Patients undergoing catheter ablation for paroxysmal atrial fibrillation(pAF) under general anesthesia were prospectively recruited for the study. Subclavian Ansae stimulation (SAS) was performed on the left and/or the right (L/SAS ± R/SAS) within the subclavian artery using the TactiCath Ablation Catheter introduced via a femoral arterial sheath. Stimulation parameters included up to 70 V output, 10 Hz frequency, and pulse width of 2-4ms for 20-30s. Test pulses ensured no cardiac capture during stimulation. Participants discontinued antiarrhythmic agents at least 4-5 half-lives prior to the procedure. Invasive arterial blood pressure(BP), heart rate (HR), and electrophysiological parameters were recorded in response to selective stimulation. An increase of ten percent or more in either arterial blood pressure(BP) or heart rate(HR) from the initial baseline measurements was deemed a positive response. Results 15 patients (62±11 years, 9 males, pAF duration 51±24 months) underwent the simulation protocol prior to their clinical AF ablation procedure. A positive hemodynamic response was observed in nine patients, and among them, arrhythmia was inducible in 3 patients (atrial fibrillation in 2 patients and repeated runs of atrial ectopy in 1 patient) in response to SAS. Mean sinus cycle length(CL) decreased(chronotropic) after stimulation,particularly with a significant change observed in response to R/SAS. Additionally,L/SAS led to a notable increase in mean systolic (SBP) and diastolic(DBP) blood pressure (inotropic). While the mean right atrial effective refractory period (ERP) did not significantly decrease after stimulation, there was a demonstrable difference in interatrial conduction time(dromotropy). Six patients, including the initial 3 subjected to low-energy stimulation (up to 12V), did not exhibit an adrenergic response. Conclusion This study represents the first successful application of selective SAS in humans. A heterogeneity in electrophysiological modulation by SAS exists, including laterality.The SA is a potential important target for targeted autonomic neuromodulation therapy

The Mediating Role of Positive Emotion in the Nexus of Marketing Strategies and Sustainable Marine Tourism: Study on Coral Reef Conservation Area at Mengiat Beach, Bali

This study investigates the impact of relationship marketing and education-based marketing on sustainable marine tourism, utilizing positive emotion as a mediating factor. Through a quantitative approach and purposive random sampling with 100 respondents, the research underscores the significance of relationship marketing and education-based marketing in shaping positive emotion and its correlation with sustainable marine tourism. Data were collected through questionnaires and analyzed using the Partial Least Square (PLS) method in Smart PLS Version 3.0. Relationship and education-based marketing emerge as critical influencers of positive emotion and contribute positively to sustainable marine tourism. Positive emotion is a crucial mediator, linking emotional experiences to advancing sustainable marine tourism. The study's implications for marketing management emphasize the pivotal role of relationship marketing in cultivating positive customer emotions and its subsequent influence on sustainable marine tourism. Marketing practitioners can leverage these insights by prioritizing personalized engagement strategies and loyalty programs, strengthening emotional connections between tourists and destinations. Integrating educational initiatives, such as partnerships with environmental organizations and awareness campaigns, is essential for promoting marine conservation and sustainable practices. The study emphasizes the necessity of diverse marketing approaches to evoke positive emotional responses, offering practical guidance for marketers to benefit marine conservation efforts and enhance the tourism experience.

Two-photon imaging of excitatory and inhibitory neural response to infrared neural stimulation.

Pulsed infrared neural stimulation (INS, 1875nm) is an emerging neurostimulation technology that delivers focal pulsed heat to activate functionally specific mesoscale networks and holds promise for clinical application. However, little is known about its effect on excitatory and inhibitory cell types in cerebral cortex. Estimates of summed population neuronal response time courses provide a potential basis for neural and hemodynamic signals described in other studies. Using two-photon calcium imaging in mouse somatosensory cortex, we have examined the effect of INS pulse train application on hSyn neurons and mDlx neurons tagged with GCaMP6s. We find that, in anesthetized mice, each INS pulse train reliably induces robust response in hSyn neurons exhibiting positive going responses. Surprisingly, mDlx neurons exhibit negative going responses. Quantification using the index of correlation illustrates responses are reproducible, intensity-dependent, and focal. Also, a contralateral activation is observed when INS applied. In sum, the population of neurons stimulated by INS includes both hSyn and mDlx neurons; within a range of stimulation intensities, this leads to overall excitation in the stimulated population, leading to the previously observed activations at distant post-synaptic sites.

Procedural heart rate variability and its effect on short-term symptoms after cardioneuromodulation procedure

Abstract Background Syncope is a miscellaneous clinical condition that affects a large portion of the population every year all over the world and responsible for a considerable amount of hospital and particularly emergency department admissions (1) The use of a right-sided approach in catheter ablation of ganglion plexi (GP) has been applied to reduce syncope episodes caused by vasovagal syncope (VVS) and decrease the overall burden of syncope (2). Purpose Our aim is to show that right-sided GP ablation which is known as cardioneuromodulation (CNM) is a new and promising way to cease recurrent syncope episodes and assess its effects on heart rate (HR), P-P intervals, ventricular depolarisation/repolarization parameters (QRS,QTc,Tpe durations, QTc/Tpe ratio), recurrence of syncope episodes, and patients symptoms such as fatigue, dizziness, etc. We also aimed to identify changes between pre and post procedural heart rates and its effects on short-term symptoms during follow-up. Methods A group of 55 patients with positive tilt table response or recurrent vasovagal syncope with pauses >2 sec in holter monitoring was enrolled this study. During the EP study, GPs determined both anatomically and by EP stimulation then autonomic denervation was performed focused by radiofrequency ablation. All patients followed-up for 12 months. Results Right-sided ablation was performed during the procedure and HR increased significantly in all patients after the procedure compared to before. Syncope episodes of the patients decreased significantly after the procedure. The patients who did not complain of syncope at the first, second and third appointment, respectively, 76.4% (n:42), 90.9% (n:50) and 92.7% (n:51). Patients had complaints at most within the first 4 months after the procedure (Table-1). At the first appointment, 4 (7.3%) patients had syncope and 9 (16,4%) patients had sinus tachycardia. Patient group with heart rate variability varying more or less than 20% during the procedure were examined, 81% of those with HR variability <20% did not have any symptoms, while 64.7% of the group with HR variability above 20% did not have any symptoms at first appointment (p:0,461) (Table.2). Tachycardia was seen in 23.5% of those with HR variability >20%, while it was determined as 9.5% in those with a HR variability <20 % Although these comparisons do not show a statistically significant difference due to the number of few patients, it is clinically significant. The same relationship was not observed between HR variability and symptoms in the second and third appointments. Conclusion Cardioneuromodulation is a remarkable treatment modality and it should be taken into consideration that more symptoms may develop in the early post-procedural period in the group who has post-procedure heart rate variability over 20%, and a cut-off should be determined for the target heart rate during the procedure.Table-1Table-2

P.036 Vagal nerve stimulation in three cases of continuous spike and wave in slow-wave sleep

Background: Continuous spike and waves during slow-wave sleep (CSWS) is a childhood-onset epileptic encephalopathy that is characterized by clinical seizures, electrical status epilepticus during sleep (ESES), and neurocognitive regression. Early intervention can preserve neurocognitive development, and vagus nerve stimulator (VNS) therapy had positive outcomes in the few previously reported case reports. We present three patients with intractable CSWS unresponsive to medications, who had a positive response to VNS therapy. Methods: Review of clinical records of three pediatric patients diagnosed with CSWS were compared for selected clinical outcomes and electrographic data both prior to and in the years following the initiation of VNS therapy. Results: Three patients now aged 13, 16 and 20 years, were treated with VNS following intolerance and a lack of response to multiple medications (5-9) for CSWS. The ketogenic diet was not an option. The CSWS resolved in all three patients, resulting in improved cognitive function. Patient 3 had resurgence of CSWS on EEG when the VNS settings inadvertently reset to the factory settings and improved with adjustment in the cycling. Conclusions: In patients who are unresponsive to medication, VNS provides an alternative option for resolving CSWS to preserve and, in some cases, potentially restore neurocognitive function.

PENYUSUNAN MEDIA PROMOSI BERBASIS INFORMASI DAN TEKNOLOGI UNTUK BALAIYANPUS DPAD DIY

DPAD DIY Library Service Center (Balaiyanpus), which provides resources for disseminating knowledge and information, always needs to introduce to the public its three units: Grhatama Pustaka Library, Jogja Library Center, and Modern Learning House. Unfortunately, its promotional materials were limited. To optimize its promotion, the English Literature Study Program of UNY conducted a Community Service (PkM) aiming to develop information technology-based promotional media through creating contents for social media and translating its leaflets from Bahasa Indonesia into English. During preparation, the PkM team conducted a needs analysis and field survey. In development stage, the promotional media were designed by the team, given feedback by Balaiyanpus DPAD DIY, and revised. Afterwards, the translated promotional leaflets were posted on its website and 30 digital contents were broadcast via its Instagram and Tiktok accounts. Evaluation was received from respondents and Balaiyanpus DPAD DIY. The promotional contents were considered informative, interesting, understandable, fairly easy to remember, and appropriate for the social media. An assessment from Balaiyanpus DPAD DIY shows that those contents received a positive response from the public.

A time-dependent analysis of sacubitril/valsartan and gliflozins benefits in patients receiving cardiac resynchronization therapy

Abstract Background While sacubitril/valsartan (ARNi), gliflozins (or SGLT2i) and cardiac resynchronization therapy (CRT) are firmly recognized as cornerstones of therapy for heart failure with reduced ejection fraction (HFrEF), robust evidence validating the long-term efficacy of their combination remains elusive. The few data suggesting a synergistic advantage of these drugs alongside CRT have not rigorously considered their time-varying administration, leading to potential selection bias, since only patients with longer initial survival could commence these treatments. As a result, the literature to date lacks a comprehensive and persuasive demonstration of the additional survival benefits conferred by ARNi and gliflozins over CRT alone in HFrEF. Purpose To evaluate the impact of ARNi and gliflozins on reducing cardiovascular and overall mortality among HFrEF patients undergoing CRT. Methods Patients with heart failure and an ejection fraction ≤ 35%, who were referred for CRT-D implantation from 2015 to 2023, were retrospectively recruited for the study. These patients were grouped into two cohorts: those not receiving drugs (no drugs group) and those treated with ARNi and/or SGLT2i (ARNi/SGLT2i group). Importantly, ARNi and SGLT2i treatments were considered as time-dependent covariates in order to account for patients who initiated or discontinued therapy during follow-up. Results The cohort included 183 ischemic and non-ischemic HFrEF patients (148 male [80.9 %], 113 ischemic [61.7 %], median [IQR] age 73 [65-80] years). 117 (74 %) patients started ARNi (61, 52.1 %), gliflozins (7, 6 %) or both drugs (49, 41.9 %) and were assigned to ARNi/SGLT2i group. During a median follow-up of 5.67 (CI 95 %, 5 – 6.5) years, 63 (34.4 %) patients died, of whom 47 (74.6 %) died of cardiovascular HF-related death. Specifically, 44 (of whom 35 (79 %) due to HF-related death) died in the no drugs group vs 19 (12 (63 %) due to HF-related death) in ARNi/SGLT2i patients. At univariable analysis (Panel A in the Figure), ARNi and/or SGLT2i treatments reduced all-cause (HR 0.59 [0.34-1.02], p = 0.056) and cardiovascular (HR 0.47 [0.24-0.92], p = 0.029) mortality. However, after multivariable adjustment for key covariates (1-year CRT response, age, atrial fibrillation, baseline LVEF, chronic obstructive pulmonary disease, glomerular filtration rate), the survival benefits of ARNi and SGLT2i use diminished, and the only factor strongly associated with reduced mortality risk remained 1-year positive response to CRT (Panel B). Conclusions Despite their recognized therapeutic benefits, ARNi and SGLT2i have not demonstrated additional survival benefit compared to CRT alone in patients with HFrEF. A 1-year positive response to CRT remains the most significant prognostic factor. Further studies with larger sample sizes and extended follow-up periods are needed to confirm this hypothesis, also evaluating whether the timing of introduction of these medications may impact survival.

Study to Assess the Knowledge of Infection Control Practices among the ICU Nurses in Apollo Hospitals Bhubaneswar, Odisha

Background of the Study: The threat of healthcare-associated infections persists despite many new advances in the healthcare system. In this scenario, the lack of knowledge and practices related to preventing the spreading of various nosocomial infections can lead to more hospital-acquired infections and will hamper the quality of care provided by hospitals. Aim: This study aims to assess the knowledge of infection control practices among ICU Nurses. Methodology: This study is a descriptive study. The study used a self-administered structure questionnaire. A study population was selected by random sampling method. Results: The comprehensive awareness of infection control practices among the nursing professionals as per their year of work experience in the respective nursing field was interpreted as Excellent when the positive responses to all those questionnaires were > 90%. Defined Good with a response of 80- 90 %, at the same time average with 50-80% and below average mostly who have scored < 50 % of the questionnaire. Implication of the study: These findings suggest that more experienced nurses had good knowledge of various infection control practices whereas nurses with less experience had average and below-average knowledge. We can conclude that the infection control practices among ICU staff are average, which can lead to hospital-acquired infections. Conclusion: The study confirms that knowledge related to infection control practices among ICU nurses is good; there is a scope of improvement.

Top dressing of nitrogen and phosphorus fertilizer increases yield and leads to biofortification of a local cowpea genotype

The traditional local genotype, EPACE-10, has a higher grain protein content (GPC) but a lower yield than the commercial genotypes, Gurguéia or Novaera. This study aimed to evaluate whether the GPC and quality or productivity of these different genotypes could be affected by top dressing fertilization with nitrogen (N) or phosphorus (P). In the first experiment, EPACE 10 and Gurguéia were subjected to the following treatments: inoculated with Rhizobium and only inoculated with N fertilization 25 days after sowing (DAS) or at the first flowering stage. In the second experiment, EPACE-10 and Novaera were subjected to the following treatments: inoculated only; inoculated plus mono ammonium phosphate (MAP) or urea applied at the pollination stage. In both experiments, none of the treatments resulted in an increase in GPC for each genotype. However, treatment with N at 25 DAS in the first experiment and with MAP in the second experiment increased methionine and cysteine content in EPACE 10, while treatment with N in the second experiment increased methionine content in Novaera. Therefore, in both trials, the top dressing fertilizer treatments increased the yield of EPACE 10 to the same level as Gurguéia or Novaera. Furthermore, the local genotype EPACE 10 exhibited a positive response to P fertilization, resulting in increased methionine and cysteine content and yield specific to its genotype.

#2101 Beyond corticosteroids: rituximab in managing minimal change disease and glucocorticoid-related toxicity

Abstract Background and Aims Minimal Change Disease (MCD) is the primary cause of Nephrotic Syndrome in children, accounting for 10 to 20% of cases in adults. Glucocorticoids (GC) remain the cornerstone of treatment. Despite a positive response in the majority of patients, up to 25% experience frequent relapses, and up to 30% are GC-dependent, exposing them to significant GC-related toxicity. Rituximab has been increasingly used in these patients, although 2021 KDIGO guidelines still points to cyclophosphamide as the preferred second-line therapy. This study aims to describe a single-centre experience with RTX, examining its effectiveness and assessing its potential to reduce GC exposure. Method A retrospective cohort study was conducted on 19 patients with MCD who were considered for RTX at adult age at a tertiary hospital centre between 2015 and 2023. Patients who refused treatment, those with MCD associated with other glomerular diseases, and those with less than 6 months of follow-up post-RTX were excluded from the study. Results Twelve patients met the inclusion criteria, including 5 diagnosed before the age of 18. The mean age at RTX initiation was 38.8 ± 14.8 years, with 75% being male. The median MCD duration pre-RTX was 140.5 [18.8–353.5] months, and the median follow-up post-RTX was 18.0 [12.5–41] months. All patients had preserved renal function and exhibited GC-dependency and/or frequent relapses, with 8 patients having received prior cyclophosphamide and/or cyclosporine A (CsA) treatment. At RTX initiation, all patients were on GC therapy (median 11.1 [10–50] mg/day), with 4 also on CsA. 10 patients were in complete remission, while 2 were in a relapse phase, subsequently achieving complete remission. Various induction regimens were employed: 6 patients received 1000 mg of RTX twice within 2 weeks, 1 received a single dose of 1000 mg, and 5 received a single dose of 500 mg. Out of the 12 patients, 5 did not receive RTX maintenance administrations, while 6 received 500 mg of RTX every 6 to 9 months and 1 patient received 1000 mg every 6 months. Only one adverse event was reported, one uncomplicated upper respiratory tract infection. Regardless of the induction regimen, all patients maintained a sustained response with complete remission for the following 6 months. All the 7 patients who underwent RTX maintenance did not experience disease relapse, although 2 continued GC therapy (one due to an associated autoimmune disease). Among the 5 patients who did not undergo RTX maintenance, 3 maintained complete remission throughout the follow-up, with a mean time free from any immunosuppression of 14.8 ± 10.6 months. The other 2 patients relapsed at a mean time of 27.5 ± 0.7 months. After relapse, 1 patient resumed GC therapy, and both started RTX maintenance with 500 mg every 6 to 9 months, subsequently achieving and maintaining complete remission. Among the 12 patients, 9 discontinued GC (1 continued CsA) after an average of 5.9 ± 4.2 months post-RTX, with a mean GC-free period of 16.6 ± 13.2 months during the follow-up period. Conclusion RTX proved to be safe and effective for steroid-dependent and/or frequently relapsing MCD, even with a low induction single dose of 500 mg. This low induction regimen may be an effective and potentially preferable option to minimize toxicity. RTX can significantly reduce relapse rate and steroid dose, avoiding complications associated with extended and high-dose GC administration. Notably, this outcome was not achieved previously with cyclophosphamide or CsA. RTX maintenance therapy may not be universally required for all patients with MCD, since a long period without relapse can be observed after induction therapy. Considering the current absence of a marker for disease activity, it should be taken into account individual patient characteristics and disease severity, particularly previous relapses after RTX induction. Considering the RTX effectiveness, ability to extend remission, safety, and GC sparing ability, it should be seriously considered as the preferred second-line treatment.