Research Site Research Articles

Epidemiological characteristics of gastric and pancreatic cancers in Latin America: GASPAR (LACOG 0222) study.

369 Background: Gastric (GC) and pancreatic cancer (PC) have poor prognosis representing major public health challenges, particularly in Latin America. Real-world data are limited. GASPAR (LACOG 0222) study addresses this gap by creating a multicenter database to analyze epidemiological, clinical, and pathological data, treatments, and outcomes for patients (pts) with GC and PC. Methods: This retrospective and prospective observational cohort study enrolled pts from 7 research sites in 3 LATAM countries with metastatic/locally advanced not amenable to curative intent GC (Cohort A) and PC (Cohort B) diagnosed from January 2019. Data were collected from medical records. ( NCT05924789 ). Results: 201 pts were included: 122 with GC (Cohort A) and 79 with PC (Cohort B). 150 (75%) from Brazil, 29 (14%) from Argentina, and 22 (11%) from Colombia. Median age at diagnosis was 69 years (IQR 57-78), 70 (35%) had history of tobacco use, and 153 (76%) were covered by private healthcare (Table). In Cohort A (GC), HER2 status was assessed in 105 (86%) pts, with 12 (11%) HER2-positive; PD-L1 was tested in 87 (71%): 55 (63%) had ≥1% expression and 28% had ≥10%; all 88 (72%) patients who had MMR tested had MMR proficient. First-line treatment was given to 107 (88%) pts: 78 (73%) chemotherapy (CT) alone (FOLFOX in 43 [40%]; FLOT in 16 [15%]); 23 (21%) CT + immunotherapy; and 7 (7%) CT + anti-HER2. Only 59 (48%) pts received second-line treatment and 31 (25%) third-line. With median follow-up (mFUP) of 29 months (CI95% 18.2-50.4), the median progression-free survival (mPFS) at first-line was 5.6 months (CI95% 4.2-6.3) and the median overall survival (mOS) was 11.2 months (CI95% 9.2-14.1). In Cohort B (PC), 67 (85%) pts received first-line treatment: 41 (61%) FOLFIRINOX and 14 (21%) gemcitabine-nab-paclitaxel. 27 (34%) pts received second-line treatment and 10 (13%) third-line. With mFUP of 21 months (CI95% 15.6-NR), the mPFS at first-line was 5.4 months (CI95%3.9-6.4) and the mOS was 10.2 months (CI95% 8.6-13.1). Conclusions: The GASPAR study provides valuable real-world data on GC and PC in Latin America. Notably, the mPFS in both cohorts was slightly lower than historical controls for first-line treatments, while the mOS was similar, suggesting earlier disease progression despite comparable overall survival. Improved therapeutic strategies and healthcare access are needed to enhance outcomes for these populations. Clinical trial information: NCT05924789 . Clinical characteristics. Characteristic GC (Cohort A)N=122 PC (Cohort B)N=79 Median age (IQR), yr 66 (51–78) 71.0 (61–79) Male – n. (%) 58 (56) 40 (51) Race – n. (%) White 67 (55) 71 (90) American Indian or Alaska Native 15 (12) 6 (8) Black 7 (6) 0 Other 7 (6) 0 Not reported 26 (21) 2 (2) Disease status at study entry Locally advanced disease 4 (3) 14 (18) Metastatic disease 118 (97) 65 (82) ECOG status in first-line advanced disease – n. (%) 0-1 75 (70) 45 (67) ≥ 2 13 (12) 3 (4.5) Not reported 19 (17.8) 19 (28.4)

Polycyclic Aromatic Compounds in Ambient PM2.5 in the Central Region of Ghana: Molecular Distribution, Origin and Cancer Risk Assessment

The distribution, sources and the cancer risk of human exposure to PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) were investigated in this work. Airborne particulate samples were obtained at the Winneba highway junction (WHJ) and Apam fish-smoking community (AFC) in the Central Region of Ghana from July 2022 to June 2023. PM2.5 particulates were collected using a Gent sampler equipped with a Gast pump and a stacked filter unit. 24-hour sampling was done two times a month using Teflon filters. Dichloromethane and gas chromatography with a mass spectrometer (GC-MS) were used to extract and analyse the samples, respectively, to identify 14 PAH compounds. The study discovered average PAH concentrations of 67.38 ng/m3 at WHJ and 41.59 ng/m3 at AFC. PAH profile was predominated with Phenanthrene, accounting for 25-27 % of total PAHs. The distribution pattern of PAHs was LMW>HMW>MMW at the two research sites. A strong correlation was found among BaA, BkF, BbF and BeP. The diagnostic ratio model revealed that PAHs stemmed from pyrogenic sources. The carcinogenic PAHs (BaP, BaA, Chr, BbF, BkF, BghiP) contributed approximately 90 % to the carcinogenic activity of total PAHs, denoting a high cancer potential of PAHs. The mean levels of BaP were about 8-10 times higher than the permissible limit of 1 ng/m3. The overall cancer risk values for exposure to PAHs via inhalation were more than 10-4, signifying high cancer risks: 11.61×10-4-21.14×10-4 for children and 19.91×10-4-36.24×10-4 for adults. Reducing PM2.5 and its health effects requires the use of clean fuel and the adoption of eco-friendly transportation.

High definition transcranial direct current stimulation as an intervention for cognitive deficits in Alzheimer's dementia: A randomized controlled trial.

Recent disease-modifying treatments for Alzheimer's disease show promise to slow cognitive decline, but show no efficacy towards reducing symptoms already manifested. To investigate the efficacy of a novel noninvasive brain stimulation technique in modulating cognitive functioning in Alzheimer's dementia (AD). Pilot, randomized, double-blind, parallel, sham-controlled study SETTING: Clinical research site at UT Southwestern Medical Center PARTICIPANTS: Twenty-five participants with clinical diagnoses of AD were enrolled from cognition specialty clinics. Treatment consisted of high definition transcranial direct current stimulation (HD-tDCS) delivered for 20 min over the medial prefrontal cortex. Ten sessions of sham, 1 mA, or 2 mA stimulation were received. Cognitive outcomes were measured at baseline, after the last HD-tDCS session, and 8-weeks post-treatment. The primary outcome was change in total learning and delayed recall on the Rey Auditory Verbal Learning Test (RAVLT) immediately post-treatment and at 8-weeks. Secondary outcomes included measures of language, processing speed, and executive functioning. A multi-stage approach was used to examine cognitive outcomes, which included evaluation of effect sizes, statistical effects, and rate of clinically meaningful responses. In this pilot trial, no statistically significant differences on cognitive outcomes were found between sham and active HD-tDCS immediately post-treatment (p's > 0.05). However, moderate-to-large effect sizes were identified for enhanced RAVLT total learning (Cohen's d = 0.69-0.93) and phonemic fluency (d = 1.08-1.49) for both active HD-tDCS conditions compared to sham, with rates of clinically relevant improvement between 25 and 33%. Meaningful enhancement persisted to 8 weeks only for the 1 mA condition. Multiple sessions of HD-tDCS over the medial prefrontal cortex appears to have potential to produce meaningful cognitive enhancements in a proportion of patients having AD with improvements maintained for at least 8 weeks in some. ClinicalTrials.gov (NCT05270408). Registered December 30, 2021.

Research Best Practices for Eye Stroke Vision Rehabilitation: A Qualitative Study

Purpose Central retinal artery occlusion, also known as an eye stroke, results in visual impairment and functional challenges. Our study objectives were to identify meaningful measures and factors that indicate or enable successful recovery after eye stroke and to determine optimal processes to support research, including exploring barriers and facilitators to successful research participation. Methods We used qualitative methods including the 5Ts Framework (target population identification, team composition, time considerations, tips to accommodate older adults, tools for inclusive enrollment of older adults) to provide a guide to the development of the semi-structured interviews and to help facilitate the research process such as the set-up of interviews. We enrolled three groups: individuals living with the sequelae of eye stroke, care partners, and health care providers. We conducted a descriptive content analysis with an inductive approach. Results Twenty-five people participated. This group included 10 eye stroke survivors (median age, 62.5; range, 56–84 years; 20% were women), 4 care partners (median age, 57 years; range, 56–59 years; 100% were women), and 11 health care providers (median age, 33 years; 25–60 years; 54.5% were women). Four themes emerged from the data: (1) returning to full independence, (2) family support, (3) strategies for participation, and (4) lack of accessibility. Conclusions The themes identified by participant groups indicated that strategies such as providing sufficient lighting and incorporating family support are key for research participation by individuals with vision impairment related to eye stroke. Furthermore, it is essential that researchers determine ways to address inequities, including lack of accessibility to research sites. This work has implications for how research teams develop research processes and implement research findings into clinical settings for eye stroke survivors.

Investigation on Thermal Environment of Urban Slow Lane Based on Mobile Measurement Method—A Case Study of Swan Lake Area in Hefei, China

Abstract: Numerous issues with the urban thermal environment have been brought on by the rapid development of urbanization. The thermal climate of the slow lane, a major urban activity area, is directly tied to the well-being and comfort of city dwellers. The Swan Lake area in Hefei was chosen as the research site for this paper. The mobile measurement method was used to determine the heat island intensity distribution of the slow lane in each season of the year. The effects of building density, the percentage of permeable underlying surface, and shading on the slow lane’s thermal environment were then thoroughly examined. According to the study, the distribution of heat island intensities along the mobile measurement route varies significantly depending on season, as well as time of year. Summer and winter have the most notable variations in the distribution of heat island intensities along the mobile measurement route; the summer values range from 0.1 to 4, while the winter values range from −0.3 to 3. The results showed a maximum difference of 30.2 °C in surface temperature (Ts) readings and 11.9 °C in air temperature (Ta) readings between the identical sites with and without shading, according to tests conducted at four typical mobile measurement locations along the mobile measuring route. The shading factor has a greater effect on the slow lane’s thermal environment than permeable underlying surface and building density, as seen by the standardized coefficient of shading being significantly higher than both of these factors. With a standardized coefficient of shading of −0.493 in the winter and a standardized coefficient of shading of −0.517 in the summer, the effect of the shading factor on the thermal environment is more noticeable in the summer.

Advancing Data Quality Assurance with Machine Learning: A Case Study on Wind Vane Stalling Detection

High-quality observational datasets are essential for climate research and models, but validating and filtering decades of meteorological measurements is an enormous task. Advances in machine learning provide opportunities to expedite and improve quality control while offering insight into non-linear interactions between the meteorological variables. The Cabauw Experimental Site for Atmospheric Research in the Netherlands, known for its 213 m observation mast, has provided in situ observations for over 50 years. Despite high-quality instrumentation, measurement errors or non-representative data are inevitable. We explore machine-learning-assisted quality control, focusing on wind vane stalling at 10 m height. Wind vane stalling is treated as a binary classification problem as we evaluate five supervised methods (Logistic Regression, K-Nearest Neighbour, Random Forest, Gaussian Naive Bayes, Support Vector Machine) and one semi-supervised method (One-Class Support Vector Machine). Our analysis determines that wind vane stalling occurred 4.54% of the time annually over 20 years, often during stably stratified nocturnal conditions. The K-Nearest Neighbour and Random Forest methods performed the best, identifying stalling with approximately 75% accuracy, while others were more affected by data imbalance (more non-stalling than stalling data points). The semi-supervised method, avoiding the effects of the inherent data imbalance, also yielded promising results towards advancing data quality assurance.

Bridging incremental to transformative hazard management strategies on the Tule River Indian Reservation

Abstract Compounding hazards are becoming more common due to global environmental change. To build societal resilience, there is a need to focus on how people are made vulnerable by our social, political, and economic systems that turn hazards into disasters. Incremental adaptation, often piecemeal and hazard-specific actions, will be insufficient for keeping pace with the rapid global environmental changes already underway. Instead, transformative adaptation is necessary for meeting this need, although the pathways for how to create transformative as opposed to incremental change through individual action and social systems are challenging. These challenges for climate adaptation are on display in rural American Indian Tribal Nations, including the Tule River Indian Reservation, the site of this co-produced research. The Reservation is rural and isolated, and many of the 2000 members manage chronic health conditions like diabetes alongside increasing wildfire and wildfire smoke, extreme heat, drought, and flooding hazards. We ask: how do emergency managers and health practitioners on the Reservation characterize hazards and the vulnerabilities of the people they serve, and how do these understandings determine viable pathways for adaptation to support community health? We interviewed 16 practitioners with expertise in emergency management and health care services on the Tule River Indian Reservation. Using a grounded theory approach to analyze practitioner interviews, our article makes two major contributions. First, we identify a conceptual framework by which practitioners connect people to each other and to place, from place to compounding hazards, and from vulnerabilities to hazard management strategies. Second, our conceptual framework illustrates the incremental-transformative adaptation tension. Most adaptation strategies under consideration or implemented are incremental in nature and hazard-specific. Yet, we demonstrate how action at earlier points in the framework could promise transformative adaptation, addressing the disconnection between people, place, and infrastructure in ways that incremental adaptation actions cannot.

Advancing LGBTQI+ Inclusive Research Practices

This Viewpoint discusses the recommendations of the Secretary’s Advisory Committee on Human Research Protection on creating a more equitable and representative body of research with improved inclusion of LGBTQI+ participants, overcoming disconnection between institutional review boards and research sites, and addressing potential bias among institutional review board members.

A Study On Clinical Pharmacy Intervention In Drug Therapy At A Tertiary Care Hospital

As a branch of medicine, clinical pharmacy focusses on helping people lead healthier lives by reducing the risk of illness and maximising the effectiveness of their pharmaceutical regimen. Every healthcare system should prioritise improving patient safety. An essential part of any healthcare system is clinical pharmacy.At a tertiary care hospital, researchers followed patients for six months as part of a prospective observational study. After carefully reviewing the study requirements, patients were recruited in the trial at random.Over the course of six months, 150 medication records were examined as part of the research. There were a total of 99 drug-related problems, including 23 documented adverse drug reactions, 89 medication errors, 2 drug-lab interactions, 2 drug allergies, and 5 contraindications. There were 8 drug-drug interactions, 2 of which were mild, 4 of which were moderate, and 2 of which were serious. Throughout the course of the research, 22 patients were counselled on their conditions and the drugs they were taking. Five questions about drugs and five questions about poisons were fielded from the research site's doctors, nurses, and patients.Substance abuse issues occurred often. When chemists collaborate with doctors as part of a patient's care team, the chemist is in a prime position to step in and help patients follow their prescribed treatment plans.

Semaglutide in obesity-related heart failure with preserved ejection fraction and type 2 diabetes across baseline HbA1c levels (STEP-HFpEF DM): a prespecified analysis of heart failure and metabolic outcomes from a randomised, placebo-controlled trial.

About half of patients with heart failure with mildly reduced or preserved ejection fraction (HFpEF) have type 2 diabetes. In the STEP-HFpEF DM trial of adults with obesity-related HFpEF and type 2 diabetes, subcutaneous once weekly semaglutide 2·4 mg conferred improvements in heart failure-related symptoms and physical limitations, bodyweight, and other heart failure outcomes. We aimed to determine whether these effects of semaglutide differ according to baseline HbA1c. STEP-HFpEF DM, a double-blind, randomised, placebo-controlled trial conducted at 108 clinical research sites across 16 countries in Asia, Europe, and North and South America, included individuals aged 18 years or older with documented HFpEF (left ventricular ejection fraction ≥45%), type 2 diabetes, and obesity (BMI ≥30 kg/m2). Participants were randomly assigned (1:1), with a block size of four within each stratum using an interactive web response system, stratified by baseline BMI (<35 kg/m2vs ≥35 kg/m2), to receive either semaglutide 2·4 mg or placebo subcutaneously. The effects of semaglutide versus placebo on the efficacy endpoints were evaluated by HbA1c categories at baseline: low (<6·5%; <48 mmol/mol), medium (6·5% to <7·5%; 48 mmol/mol to <58 mmol/mol), and high (≥7·5%; ≥58 mmol/mol). The dual primary endpoints were change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) and bodyweight percentage from baseline to 52 weeks and were assessed in all randomly assigned participants by intention to treat. Hypoglycaemia events were also analysed to assess safety in all randomly assigned participants who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT04916470. Between June 27, 2021 and Sept 2, 2022, 616 participants were enrolled and randomly assigned (mean age 68·4 years [SD 8·9]; 273 [44%] were female, 343 [56%] were male, and 519 [84%] were White). The low baseline HbA1c group included 227 participants (112 assigned to semaglutide and 115 to placebo), the medium baseline HbA1c group included 226 participants (124 assigned to semaglutide and 102 to placebo), and the high baseline HbA1c group included 163 participants (74 assigned to semaglutide and 89 to placebo). The median duration of follow-up in the overall trial was 401 days (IQR 400-405). The change in KCCQ-CSS from baseline to 52 weeks was 12·4 points (95% CI 8·8 to 16·0) with semaglutide versus 5·7 points (2·1 to 9·2) with placebo (mean difference 6·7 points [1·6 to 11·8]) in the low baseline HbA1c group, 14·5 points (11·0 to 17·9) versus 8·5 points (4·8 to 12·2; 6·0 points [0·9 to 11·1]) in the medium baseline HbA1c group, and 14·5 points (10·0 to 19·0) versus 4·8 points (0·7 to 8·9; 9·6 points [3·5 to 15·7]) in the high baseline HbA1c group (pinteraction=0·64; ptrend=0·46). The change in bodyweight percentage from baseline to 52 weeks was -10·8 (95% CI -12·1 to -9·5) with semaglutide versus -3·3% (-4·6 to -2·0) with placebo (mean difference -7·5% [-9·4 to -5·6]) in the low baseline HbA1c group, -9·6% (-10·8 to -8·3) versus -3·3% (-4·7 to -1·9; -6·3 [-8·2 to -4·4]) in the medium baseline HbA1c group, and -8·6% (-10·2 to -7·0) versus -3·6% (-5·2 to -2·1; -5·0 [-7·2 to -2·7]) in the high baseline HbA1c group (pinteraction=0·22; ptrend=0·083). Hypoglycaemia events occurred in 30 (10%) of 310 participants (70 events; 22·9 events per 100 person-years) in the semaglutide group compared with 21 (7%) of 306 participants in the placebo group (90 events; 29·5 events per 100 person-years). Semaglutide 2·4 mg improved heart failure-related symptoms and physical limitations, and reduced bodyweight in patients with obesity-related HFpEF and type 2 diabetes, all independently of baseline HbA1c, and resulted in lower rates of hypoglycaemia than placebo, despite a well controlled baseline HbA1c and broad use of concomitant glucose-lowering medications. Novo Nordisk.

Developing a cost-effective and efficient safety case management solution for data coordinating center projects.

A centralized safety function can support multiple clinical trials and provide efficient, standardized processes for the management of serious adverse events. From 2017 to 2022, the centralized safety desk used pharmacovigilance software compliant with FDA regulations, including 21 CFR Part 11. This software assisted with processing safety cases for regulated clinical trials, including allowing capture of event data, and provided process flow management, documentation storage, and transmission of safety reports to FDA. During the software's tenure, we experienced incompatibilities with other clinical research software resulting in unanticipated inefficiencies. Furthermore, the small number of periodic and suspected unexpected serious adverse reaction (SUSAR) cases rendered the annual license fee not cost-effective. An internal analysis of our workflow, systems, and processes revealed that developing a cost-effective and efficient customized solution for our existing data coordinating center (DCC) projects was feasible. The customized solution mimics the key functionality and workflow of the prior software. It utilizes existing electronic data capture systems and document management solutions, ensuring 21 CFR Part 11 compliance without incurring additional expenses. The proposed process received internal approval and launched in December 2022. The process outlined in this paper is particularly advantageous for DCCs or academic clinical research sites that must meet regulatory reporting requirements without depending on specialized pharmacovigilance software. Additionally, it is a cost-effective option for organizations with a low volume of SUSAR events. In this paper, we present the process of developing and implementing a customized safety case management solution and the lessons learned pre and post implementation.

Innovative Approaches to Teaching Arabic Vocabulary at PQA Elementary School in Malang City: Implementing the BCM Strategy

This study aims to explore the innovation of Arabic vocabulary teaching variations using the BCM strategy with first and second-grade elementary school students at PQA elementary school in Malang City. The study employed a qualitative method with a case study approach. Data were collected through observations, interviews, and documentation involving teachers and students at the research site. The results show that the implementation of the BCM strategy significantly improved students' vocabulary comprehension, with "hiwayaty" reaching 100% and "al-bait" reaching 94.44%. The strategy also sparked students' interest in learning, with 100% participation in singing, 88% in playing, and 75% in storytelling. Gamification emerged as the most widely used method (45%), followed by singing (30%) and storytelling (25%). The implications of this study suggest that the BCM strategy can be implemented as an innovative method to enhance Arabic vocabulary mastery in elementary schools. Interactive activities such as playing, storytelling, and singing were shown to significantly increase student participation. This approach also supports student-centered learning, catering to diverse learning styles. Furthermore, teacher training in the application of BCM can strengthen the effectiveness of teaching. This study opens opportunities for further research on the application of the BCM strategy in other linguistic aspects across different educational levels.

Psychosocial risk factors and health status of nurses in a Geriatric Hospital in the city of Rosario in August 2021

The professional practice of nursing involves exposure to a series of factors and conditions that demand the physical, cognitive and emotional involvement of nurses. The imbalance between these demands and the possibility of the professional's response can give rise to a scenario of occupational stress that, if prolonged over time, harms the physical and mental health of individuals. The aim of this study was to describe the psychosocial risk factors and the health status of nurses in a Geriatric Hospital in the city of Rosario in August 2021. A descriptive and cross-sectional research study was carried out with a qualitative methodological approach design on the two variables under study. The research site was a comprehensive care institution for the elderly where 30 nurses were selected to perform nursing functions in the 9 inpatient wards. The sampling was non-probabilistic and random until the proposed number of nurses from all the wards was covered.The data collection technique was the survey and a self-administered questionnaire with 21 closed and one open-ended questionnaire was used as an instrument. The instrument was tested with 14 undergraduate students to assess the clarity of the questions posed. The surveyed data showed that the quantitative deficit in the provision of nursing equipment within the work schedule influences their mental health more than the work shift itself (50% and 43% respectively). The work tasks and problems specific to Nursing influence the mental health of the respondents with fairly even parity (43% in both cases). The physical symptoms expressed by the respondents show a predominance of physical fatigue (80% of the cases), physical fatigue (80% of the cases), and physical fatigue (80% of the cases).physical fatigue (80% of the cases), myalgias (63%) and frequent headaches (43%). Some 13% of the nurses showed the psychic symptoms of emotional exhaustion, emotional hardening and frustration -indicators of chronic work stress-; 17% have at least two of these symptoms and 20% only one. Half of the nurses did not express any symptoms of chronic job stress

Concept and Making of Aqidah Learning Curriculum at Pondok Modern Darussalam Gontor

This research aims to discover the concept and making of the aqidah learning curriculum at Pondok Modern Darussalam Gontor. This study uses a qualitative approach with a descriptive method. The primary data source of this research was obtained through direct observation at the research site and interviews with key informants from the leadership of Pondok Modern Gontor. This team compiled the aqidah learning curriculum and Gontor alums. Meanwhile, secondary data is obtained from indirect sources such as documents, books, magazines, journals, and other documentation. The study results show that the learning of aqidah in Gontor is developing in line with the challenges faced at the time. In the early days of Gondor's establishment, aqidah learning used aqidah books, which only existed in two classes, namely in grade 1 and grade 2. Around the 1990s, books for grades 5 and 6 were added. Then, the next one is added again for grade 4. As for grade 3, there are still no books. When this research was carried out, the Pondok Modern Gontor aqidah learning curriculum team planned to compile a book that would be used for aqidah learning in grade 3. So far, the material for grade 3 is Islamic taqiyah material, not aqidah material.

Agreement between methods to assess potassium intake in patients with chronic kidney disease.

In the general population, 24-hour urine potassium excretion is considered the reference standard for estimating potassium intake. However, its agreement with food records and spot urine collections in adults living with chronic kidney disease (CKD) is not well-established. Given the risk of hyperkalemia related to changes in renal potassium handling, understanding if this reference standard is appropriate for the CKD population is important. This study aimed to compare agreement between methods for estimating potassium intake, using food records, 24-hour urine measures, and spot urine samples. A cross-sectional study was conducted among adults recruited from a kidney care clinic. Participants were instructed to complete a detailed food record and a 24-hour urine collection, both performed on the same day. The following day, participants provided a spot urine sample from the second void, at the research site. Potassium excretion was estimated from the spot urine sample using Tanaka's and Kawasaki's equations. Agreement between methods was assessed using the highest p-value for paired t-test and the lowest Bland-Altman bias combined with the narrowest upper and lower limits of agreements (LoA). 60 adults with Stage 3 and 4 CKD completed the study (48% male, 62.9±14.6years; eGFR=34.9±12.7ml/min). The food records showed the highest agreement with 24-hour urine potassium (1823.9±746.7 vs 1918.2±809.3, p=0.584). This was followed by Kawasaki's equation for spot urine (1994.8±441.9, p=0.231) and Tanaka's equation (1630.0±325.9, p=0.174). Food records and Kawasaki's equation had slightly higher mean values compared to 24-hour urine with mean differences <100-200 mg/day (bias; 95%CI: bias=-94.4 mg/day; -438.3 to 249.6 mg/day and -170.9 mg/day; -454.1 to 112.2 mg/day, respectively). Tanaka's equation had a lower mean value compared to 24-hour urine with a mean difference of 193.9 mg/day; -88.5 to 476.3 mg/day). The limits of agreement were as follows: in the Kawasaki's equation from -2082.2 to 1740.3 mg/day, in the Tanaka's equation from -1712.2 to 2100.0 mg/day and in the food records from -2416.1 to 2227.4 mg/day. Mean potassium intake estimates were similar across methods. Food records demonstrated the highest agreement with 24-hour urine potassium, followed by Kawasaki's equation. The Tanaka's equation showed the highest bias compared to 24-hour urine and was significantly different from food records. Combining food records with potassium excretion estimated using the Kawasaki's equation from spot urine samples may be a clinically useful tool for assessing potassium intake in adults with CKD.

Corporate ownership and firm performance. Evidence from an emerging market

PurposeThis paper aims to examine the relationship between corporate ownership and firm performance, and the mechanisms through which ownership creates the firm value. Vietnam has been chosen as the research site because it is characterized by high ownership concentration, a high level of state ownership, strong incentives for foreign ownership and a weak external governance system.Design/methodology/approachWe use data on the ownership structure of 527 listed firms in Vietnam during the 2010–2021 period. Corporate ownership includes concentrated, state and foreign ownership, while firm performance is measured by ROA and Tobin’s Q. In addition to Pooled OLS, system GMM and the propensity score matching are employed to mitigate the possibility of unreliable and biased results.FindingsWe find that firms with highly concentrated ownership tend to have better performance. Both state ownership and foreign ownership with their unique advantages contribute to enhancing firm performance. Further analyses delve into specific channels through how controlling shareholders, state and foreign owners facilitate firm value creation: the ease of access to capital, the lower cost of capital and the higher sales. Our results are robust to alternative proxies for ownership concentration and different methodological approaches.Originality/valueOur study contributes to the ongoing debate about the ownership–performance relationship by providing novel insights into how corporate ownership influences firm performance.

A mixed method approach to substantiate quantitative data with qualitative data: Improving clinical judgment in prelicensure nursing students using simulation.

Current literature demonstrates a gap in research involving mixed method study of clinical judgment development in prelicensure nursing students. Clinical judgment of two groups of nursing students were compared using the Lasater Clinical Judgment Rubric (LCJR). A mixed method convergent parallel quasi-experimental cross-sectional approach was used to determine if simulation increased clinical judgment skills between beginner and advanced pre-licensure nursing students. The research site included nursing labs housing 20 hospital beds and a five-room medical simulation lab. Student participants were recruited from the Pacific Northwest. A convenience sample included 128 part-time and full-time beginner fundamental and advanced senior nursing students. t-Test differences were compared between quantitative dependent dichotomous independent variables. Differences in mean scores, standard deviations, and number of data values of each group were analyzed. Qualitative analysis of field notes and post simulation reflection logs occurred alongside quantitative findings. Quantitative differences in LCJR scoring (Lasater's Clinical Judgment Rubric) were statistically significant (p<.001) using the unpaired t-test as Cohort B (advanced senior) scored higher than Cohort A (beginner fundamental). Qualitative analysis of the 11 LCJR subset data substantiated quantitative scoring through triangulation. Post-simulation reflection logs revealed comparatively similar qualitative responses for both cohort groups as the need for improvement while expressing emotion during simulation was captured. Recommendations for educators and administrators include the promotion, design, and execution of simulation across the nursing curriculum by well-trained nursing educators. Formative and summative clinical judgment evaluation will solidify this pedagogical feature in simulation and elsewhere. Simulation is considered a valid pedagogy requiring proper execution for the assimilation of knowledge, skills, and attitudes. Employment of regular clinical judgment assessment and evaluation should occur across the simulation curriculum. Simulation provides a dedicated time and space for nursing students to practice and reflect upon how they will be better prepared in clinical judgment upon graduation prior to entry to practice.

Evaluation Study of Rooftop Solar Power System (RSPS) Utilisation Off Grid System at Ash Yard Office of Steam Power Plant (SPP) Mine Mouth (MT) Sumsel-82x660 MW

Indonesia is currently facing various challenges in meeting its national energy needs. About 60% of the country's electricity production depends on coal, making it crucial to reduce this dependence to achieve energy balance, enhance energy resilience, and develop environmentally friendly renewable energy sources. In this study, the feasibility of investing in off grid solar rooftop systems is evaluated, considering technical performance, environmental impact, and economic aspects, including installation costs and potential energy savings. This research proves that the design and installation of the off grid rooftop solar power system function well, with a performance ratio (PR) value of 83.22%, indicating that the system meets the expected standards (above 70%). In addition, the off grid rooftop solar power system is capable of producing electricity with an average annual value of 5,572 kWh. This off grid rooftop solar power system contributes to the reduction of carbon emissions at the research site by 50,531 tons of CO2e in one year, in line with the research objectives related to environmental aspects. The off grid rooftop solar power system at the Ash Yard Office is a feasible and profitable investment due to the power cable connection from the Sumsel-8 coal-fired power plant and the use of 20kV medium voltage electricity from PLN. It has a Payback Period of 19 (nineteen) years, which indicates that the investment in the rooftop solar power system at the Ash Yard Office is still worth pursuing because the Payback Period is shorter than the project's lifespan.

Exposure therapy consortium: Outcomes of the proof-of-principle study.

This paper reports on the outcomes of a proof-of-principle study for the Exposure Therapy Consortium, a global network of researchers and clinicians who work to improve the effectiveness and uptake of exposure therapy. The study aimed to test the feasibility of the consortium's big-team science approach and test the hypothesis that adding post-exposure processing focused on enhancing threat reappraisal would enhance the efficacy of a one-session large-group interoceptive exposure therapy protocol for reducing anxiety sensitivity. The study involved a multi-site cluster-randomized controlled trial comparing exposure with post-processing (ENHANCED), exposure without post-processing (STANDARD), and a stress management intervention (CONTROL) in students with elevated anxiety sensitivity. Feasibility was assessed using site performance metrics (e.g., timeline, sample size, missing data). Efficacy was assessed up to 1-month follow-up using the Anxiety Sensitivity Index-3. Despite challenges posed by unforeseen global crises, a standardized protocol for screening, assessment, and treatment at 12 research sites across four continents was successfully implemented, resulting in a total sample size of 400 with minimal missing data. Challenges in recruitment and adherence to the projected timelines were encountered. Significant reductions in anxiety sensitivity were observed in all conditions. Contrary to hypotheses, group differences were only observed at post-treatment, when ENHANCED and CONTROL outperformed STANDARD but were not significantly different from each other. This study demonstrates the feasibility of the Exposure Therapy Consortium. Findings raise questions regarding the efficacy of large group exposure interventions and underscore the importance of careful research site selection and an iterative approach to treatment development.

The Influence of Depression, Anxiety, and Stress on Ageism Among Undergraduates: Mediating Roles of Life Satisfaction, Gratitude, and Prosociality.

The rapid growth of the global aging population highlights the need to address ageism and promote social inclusiveness. While considerable research has explored the impact of perceived ageism on older adults' mental health, limited attention has been given to how negative mental health factors-such as depression, anxiety, and stress (DAS)-influence ageist attitudes among younger populations, along with the psychological mechanisms underlying this relationship. This study first investigates the prevalence of ageism among undergraduates and its variation across certain socio-demographic factors at the research site. It then examines the predictive effects of depression, anxiety, and stress (DAS) on ageism, accounting for these socio-demographic factors. Finally, the study explores how DAS influences ageism both directly and indirectly through life satisfaction, gratitude, and prosociality. A cross-sectional study conducted at 11higher education institutions in Jiangxi, China. A total of 1,213 undergraduates participated in the study between July and August 2024. Following data cleaning, 1174 responses were included for analysis. Data were collected using online questionnaires. T-tests and ANOVA assessed socio-demographic differences in ageism, and regression analysis examined DAS's predictive effects. Structural Equation Modeling (SEM) explored the pathways linking DAS to ageism via mediators. A moderate level of ageism was observed, with significant variations across socio-demographic factors like academic year, physical health, and contact with older adults. Depression and stress directly predicted ageism, while anxiety had indirect effects via depression and stress. DAS-as a composite construct-indirectly affected ageism via life satisfaction, gratitude, and prosociality. Educational interventions should not only target the reduction of ageist attitudes but also address the underlying mental health conditions that fuel these biases. Promoting life satisfaction, gratitude, and prosociality, along with fostering meaningful intergenerational interactions, will be crucial for developing more effective strategies to combat ageism.