Sufficient Evidence Research Articles

Walking Dead Macrophage-Based Positive Enhancement MRI for Ultrahighly Efficient Diagnosis of Nephritis.

Nephritis is an inflammatory condition of the glomerulus, and the clinical gold standard for its diagnosis is a kidney biopsy. However, obtaining biopsy results can take several days, which does not meet the requirement of rapid diagnosis, especially for rapidly progressive types. To achieve an effective and noninvasive diagnosis, we propose a nephritis-specific, positive magnetic resonance imaging (MRI) contrast agent based on Gd3+ anchored walking dead macrophage Gd-RAW. Gd-RAW exhibits high selectivity for inflammatory renal parenchyma and provides comparable results to histopathology methods. The Gd-RAW-based MRI contrast agent reduces the diagnostic time of nephritis from 14 days of biopsy to 1 h. Furthermore, in a unilateral nephritis model constructed by increasing the glycerol concentration, the T1WI of renal parenchyma exhibits an increased signal-to-noise ratio, which is crucial for evaluating nephritic severity. This work promotes rapid diagnosis of nephritis and potentially provides sufficient evidence for clinicians to offer timely treatment to patients. The methodology of paramagnetic ion-anchored macrophage corpse also opens up new prospects for designing more specific and biosafe MRI contrast agents.

Postpartum and interpregnancy care of women with a history of hypertensive disorders of pregnancy.

Hypertensive disorders of pregnancy (HDP) are common complications associated with maternal and neonatal morbidity and mortality worldwide. Insights gained from long-term cohort studies have revealed that women with a history of HDP are predisposed to recurrent HDP in subsequent pregnancies and face heightened risks for cardiovascular and metabolic diseases later in life. Pregnancy is a unique condition that overloads maternal cardiac and metabolic functions, and is recognized as a "maternal stress test" for future cardiovascular and metabolic diseases. Pregnancy and postpartum period provide a valuable opportunity for identifying women with underlying and unrecognized cardiovascular and metabolic risk factors. Establishing an effective postpartum healthcare program for women who have experienced HDP is crucial in reducing the future risk of health complications. Postpartum care consists of supportive care for both mothers and children, including not only the assessment of physical and psychological well-being but also long-term postpartum preventive health management. Interpregnancy care is a continuum from postpartum care and includes supportive care to prepare for future pregnancies. Various initiatives across nations have been initiated to establish follow-up programs for women with a history of HDP; however, sufficient evidence of the impact of such programs is not available. Substantial challenges persist in establishing an efficient postpartum follow-up program, including educational strategies, selection of effective lifestyle interventions, and collaboration among various healthcare providers. This review outlines the postpartum and interpregnancy care of women who have experienced HDP as well as the current status and challenges of related healthcare initiatives in Japan.

Pearls and Pitfalls in the Measurement of Direct Oral Anticoagulants.

Due to their widespread use, testing for direct oral anticoagulants (DOACs) has become urgent in certain clinical situations. Screening based on widely available, rapid, and simple hemostasis assays such as prothrombin time, activated partial thromboplastin time, or even diluted Russel Viper venom time may provide sufficient evidence of "over-coagulation" and could be used "in small/peripheral/spoke laboratories" as an emergency strategy, but is not thought to be reliable for driving clinical decision making. Given their good correlation with plasma concentration, urine dipsticks may be considered a valuable alternative for emergency screening, although their performance is dependent on renal function, may vary depending on the time since the last urination, and there may be problems of interfacing with the laboratory/hospital information system. Separation methods based on liquid chromatography and mass spectrometry may be clinically questionable, since they measure the concentration rather than the actual inhibitory effect of DOACs, are relatively expensive, cumbersome and time consuming, and therefore seem unsuitable for most conditions requiring urgent clinical decision making. A proposed approach therefore involves establishing a network of routine clinical laboratories, designating a reference center where DOAC tests could be available 24/7, establishing a clear diagnostic care pathway for ordering the tests from the laboratory and standard operating procedures for performing them, the use of the diluted thrombin time for dabigatran and anti-FXa assays (drug-calibrated) for rivaroxaban, apixaban, and edoxaban, as well as providing expert advice throughout the testing process, from ordering to interpretation of results.

Flowering time responses to climate differ between species in mesic and xeric habitats in Alberta

Ongoing climate change is likely to put increased selection pressures on the phenology of plants, yet for many species their abilities to respond to environmental cues are unknown. The present research focuses on using herbarium specimens to examine how 14 native plant species in Alberta have adjusted or adapted to changes in temperature and precipitation over the past century. We specifically investigate the impact of flowering-time responses and determine (1) whether herbaria collections contain sufficient evidence of these phenological responses to climate in plant species in Alberta, and (2) whether the responses are dependent on the typical moisture regime of their habitat. We compared plants from mesic and xeric habitats in terms of their phenological responses to air temperature and precipitation. In this study, the taxonomic relationships between the species were considered by selecting 14 species representing seven different angiosperm orders (one pair of species for each order). By collating data on the peak flowering date over the past century using preserved specimens, we found that on average, species from xeric habitats are more responsive to temperature, but not precipitation. This tendency might be explained by the thermal properties of mesic habitats, a finding that may lead to ways to predict the degree to which environmental cues will govern flowering.

Extracorporeal Photopheresis in Dermatological Diseases.

Extracorporeal photopheresis (ECP) is an apheresis procedure that is conventionally used as a first-line treatment for cutaneous and leukemic subtypes of T-cell lymphoma, such as Sezary's syndrome and mycosis fungoides. Over the past three decades, its immunotherapeutic properties have been tested on a variety of autoimmune conditions, including many dermatologic diseases. There is ample evidence of ECP's ability to modify leukocytes and alter cytokine production for certain dermatologic diseases that have been refractory to first-line treatments, such as atopic dermatitis. However, the evidence on the efficacy of ECP for the treatment of these dermatologic diseases is unclear and/or lacks sufficient evidence. The purpose of this paper is to review the literature on the utilization and clinical efficacy of ECP in the treatment of several [autoimmune] dermatologic diseases and discuss its applications, guidelines, recommendations, and future implementation for dermatologic diseases.

Emerging concern on air pollution and health: Trade-off between air pollution exposure and physical activity

Air pollution is a major contributor to the global disease burden, especially affecting respiratory and cardiovascular health. However, physical activity is associated with improved lung function, a slower decline in lung function, and lower mortality. The public is more likely to be exposed to air pollution during outdoor physical activity. However, studies on how long-term and short-term exposure to air pollution interacts with physical activity yield inconsistent results, and the thresholds for air pollution and physical activity remain unclear. Thus, more studies are needed to provide sufficient evidence to guide the public to safely engage in outdoor physical activity when exposed to air pollution.

Radioiodine ablation after thyroidectomy could be safely abandoned or postponed in selected stage I papillary thyroid carcinoma patients of low-risk group: an observational prospective study

Background. The European Thyroid Association consensus for the management of differentiated thyroid cancer (2006) suggested to avoid radioactive iodine (RAI) after thyroidectomy in patients with unifocal microcarcinoma (≤ 1 cm) with no extension beyond the thyroid capsule and without lymph node metastases. As the new data was collected and the risk stratification was revised, in 2022 the same recommendation was expanded to the patients with microcarcinoma and central neck lymph node involvement. The American Thyroid Association guidelines (2015) advocated no RAI ablation after hemi- or total thyroidectomy for thyroid cancer less than 1 cm with 5 and less micrometastases up to 2 mm in central neck lymph nodes as this strategy has no negative impact on the disease prognosis. In low-risk patients, no sufficient evidence of the obligatory postsurgical radioiodine ablation has been yet demonstrated. The aim of our study was to reveal whether RAI after thyroidectomy can be abandoned or postponed until the disease progression is confirmed in low-risk patients. Materials and methods. Two groups of patients (30 per group, 60 in total) with papillary microcarcinoma Т1N1a (5 and less level VI micrometastases up to 2 mm) were observed during a 5-year follow-up. In the first group, patients received 100 mCi (3.75 GBq) I131 shortly after total thyroidectomy while in the second group, postponed RAI was applied when progression signs were observed (elevated serum thyroglobulin level and US/CT suspected findings) after thyroid surgery. Results. After 5 years, no significant difference between groups was observed regarding post-RAI local recurrences (one in the first group and two in the second group) and/or distant metastases (t-test, p = 0.58). All cases of neck recurrences were treated with subsequent surgical excision, with no new data of progression within the specified follow-up. Conclusions. RAI adjuvant therapy for papillary thyroid carcinoma Т1N1a may not be necessary for patients with small number of level VI micrometastases. Local and distant metastases revealed during the careful follow-up by thyroglobulin level elevation and when using visualization techniques can be effectively treated with postponed RAI therapy and/or surgery.

Identification of Lactic Acid Bacteria Strains Isolated from Sourdoughs Prepared with Different Flour Types

Species identification is the first step in the examination of newly isolated microorganism strains, including the cases when they are intended for application in the development of probiotic preparations or starters for different food products. The thorough identification process of newly isolated strains combines the application of different physiological, biochemical, and molecular genetic methods. The aim of the present study was to identify the species-level lactic acid bacteria (LAB) strains isolated from spontaneously fermented sourdoughs prepared from different flour types: Khorosan wheat, wheat, barley, buckwheat, spelled, spelt, and corn. Both classical phenotypic (cellular morphology characterization, and API 50 CHL) and molecular genetic methods (RAPD, ARDRA-analysis, 16S rDNA sequencing, and species-specific PCR) were applied. It was found that cultures with a short-rod morphology predominated among the 30 sourdough isolates. According to the RAPD profiles obtained, the isolates were divided into nine genotypes corresponding to nine genetically distinct strains. It was determined that individual sourdoughs made with different flour types shared cultures with a common genotype. The analysis of the physiological and biochemical profiles of the LAB isolates performed with the API 50 CHL system divided them into two groups according to their identification: Lactiplantibacillus plantarum (Lp. plantarum) 1 and Levilactobacillus brevis (Lv. brevis) 3. According to the 16S rDNA restriction profile, the LAB isolates showed two profiles corresponding to the Lp. plantarum and Lv. brevis groups. 16S rDNA sequencing and a comparison of the partially read 16S rDNA sequences of the studied isolates confirmed that some of them belonged to the Lv. Brevis species, but did not provide sufficient evidence that the rest of the cultures belonged to the Lp. Plantarum species. The species-specific PCR clearly separated the isolates from the Lp. plantarum group into two groups: isolates of the Lp. plantarum species and isolates of the Lp. paraplantarum species. The summary of the results of the conducted polyphasic taxonomic study determined the investigated LAB strains isolated from spontaneously fermented sourdoughs as representatives of the Lv. brevis, Lp. plantarum ssp. paraplantarum, and Lp. paraplantarum species.

Psychometric evidence of the Wong-Law Emotional Intelligence Scale (WLEIS) in university students from Lambayeque-Peru

Introduction: Emotional intelligence (EI) is a key skill for the personal and academic development of university students. Therefore, it is appropriate to have relevant instruments to measure this construct. Objective: This study aims to analyze the evidence of validity and reliability of the Wong-Law Emotional Intelligence Scale (WLEIS) in university students in the region of Lambayeque, Peru. Method: Our study has an instrumental design. We applied a virtual questionnaire distributed in social networks to 317 university students (124 males and 193 females) from different professional careers, aged between 18 and 30 years (M=20.3; SD=2.7). Confirmatory factor analysis was performed (WLSMV estimator), and internal consistency was assessed. Result: We found four correlated factors, higher order, and bifactor, the first being the one with the best-fit indices: X2(98) = 262.63, p < .001, CFI = .97, TLI = .96, RMSEA = .07 [CI 90%; .06 - .08], SRMR = .04 and WRMR = .91. Internal consistency results using the omega coefficient are ωSEA = .81, ωOEA= .79, ωUOE= .84 and ωROE = .85. Conclusion: The WLEIS in university students in the Lambayeque region of Peru has sufficient evidence of validity and reliability to guarantee the relevance of its application.

Ocean-Mixer: A Deep Learning Approach for Multi-Step Prediction of Ocean Remote Sensing Data

The development of intelligent oceans requires exploration and an understanding of the various characteristics of the oceans. The emerging Internet of Underwater Things (IoUT) is an extension of the Internet of Things (IoT) to underwater environments, and the ability of IoUT to be combined with deep learning technologies is a powerful technology for realizing intelligent oceans. The underwater acoustic (UWA) communication network is essential to IoUT. The thermocline with drastic temperature and density variations can significantly limit the connectivity and communication performance between IoUT nodes. To more accurately capture the complexity and variability of ocean remote sensing data, we first sample and analyze ocean remote sensing datasets and provide sufficient evidence to validate the temporal redundancy properties of the data. We propose an innovative deep learning approach called Ocean-Mixer. This approach consists of three modules: an embedding module, a mixer module, and a prediction module. The embedding module first processes the location and attribute information of the ocean water and then passes it to the subsequent modules. In the mixing module, we apply a temporal decomposition strategy to eliminate redundant information and capture temporal and channel features through a self-attention mechanism and a multilayer perceptron (MLP). The prediction module ultimately discerns and integrates the temporal and channel relationships and interactions among various ocean features, ensuring precise forecasting. Numerous experiments on ocean temperature and salinity datasets show that Mixer-Ocean performs well in improving the accuracy of time series prediction. Mixer-Ocean is designed to support multi-step prediction and capture the changes in the ocean environment over a long period, thus facilitating efficient management and timely decision-making for innovative ocean-oriented applications, which has far-reaching significance for developing and conserving marine resources.

Inefficient Forecasts at the Sportsbook: An Analysis of Real-Time Betting Line Movement

This paper tests the efficiency of a set of sports betting markets using detailed betting line movement from opening until closing for four different sportsbooks for each of 3,681 Major League Baseball games. The reliability of the markets’ forecasts are assessed at several lead times. The forecasts are mostly reliable, but there are simple betting strategies that would have yielded significant profit. In addition, forecasts do not always improve monotonically as the games get closer, despite more information being available; forecasts at weekend day games’ start times are significantly worse than forecasts 90 minutes earlier. Furthermore, analysis of the sequences of forecasts within individual games reveals that these betting markets do not incorporate information optimally. There is sufficient evidence to reject weak form market efficiency; specifically, betting lines tend to overreact, exhibiting significant negatively autocorrelated changes that could be exploited by sophisticated bettors. This paper was accepted by Manel Baucells, behavioral economics and decision analysis. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2022.00456 .

Extrusion modification of prolamins from distiller's grains to facilitate the construction of biopolymer films.

Distiller's grains (DGs), which are rich in natural ingredients such as prolamins, are often used as low-value feed or discarded directly, resulting in great environmental pollution and resource waste. Prolamins from DGs (PDGs) were found to be a potential material for the construction of biopolymer films due to their good film-forming properties. In this study, extrusion processing was conducted to modify the physicochemical and structural properties of PDGs to facilitate the construction of biopolymer films with superior characteristics. Results indicated that extrusion led to improved solubility (17.91% to 39.95%) and increased disulfide bonds (1.46 to 6.13 μmol g-1 ) in PDGs. The total and sulfur amino acid contents of extruded PDGs were increased by 13.26% and 38.83%, respectively. New aggregation patterns were formed after extrusion according to the results of scanning electron microscopy, Fourier transform infrared spectroscopy and X-ray diffraction. Extrusion resulted in reduced surface hydrophobicity of PDGs (10 972 to 3632), sufficient evidence for which could be also found from structure analyses of PDGs. Finally, PDGs extruded at 110 °C were found to facilitate the forming of biopolymer films with superior mechanical properties, water resistance and thermal stability. Physicochemical and structural properties of PDGs were effectively modified by extrusion processing, and extrusion modification of PDGs could be a great way to facilitate the construction of biopolymer films with superior characteristics. It could provide more possibilities to extend the applications of DGs to alleviate the problems of environmental pollution and resource waste. © 2024 Society of Chemical Industry.

SIRT1 mediates breast cancer development and tumorigenesis controlled by estrogen-related receptor β.

Silent mating type information regulation 2 homolog 1 (SIRT1) is a class III histone deacetylase (HDAC) that is NAD + dependent and essential for metabolism, senescence, and cell survival. SIRT1 is overexpressed in several cancers, including breast cancer. SIRT1 is a well-known target gene of the estrogen receptor alpha (ER alpha) and is closely related to ER alpha deacetylation. Transcription factor Estrogen-related receptors (ERRs) share sequence homology with ERs in the DNA-binding domain, therefore, the possibility of sharing target genes between them is high. Our current research aims togain insight into the function of ERRβ in regulating the activity of SIRT1 during the progression of breast cancer. ER-positive (ER + ve) breast cancer cells and tissues had considerably enhanced SIRT1 expression. Six potential ERRE sites were identified by analysis of the 5' upstream region of SIRT1, and both in vitro and in vivo experiments supported their presence. We found SIRT1 to be up-regulated in ERRβ overexpressed ER + ve breast cancer cells. Furthermore, our findings suggested that ectopic production of ERR and PCAF would increase SIRT1 activity. Our findings also indicated that ectopic production of ERRβ and PCAF increased SIRT1 activity. With sufficient evidence demonstrating the substantial involvement of SIRT1 in cell proliferation, migration, and colony formation capability, we were also able to illustrate the tumorigenic role of SIRT1. Overall, our findings highlight SIRT1's tumorigenic influence on breast cancer and suggest that SIRT1 inhibitors might serve as potential therapeutic drugs for the treatment of breast cancer.

A scoping review on natural cholesterol lowering supplements sold in South African pharmacies.

Dyslipidaemia is defined as elevated total or low-density lipoprotein (LDL) levels or low levels of high-density lipoprotein (HDL). Patients may often make use of natural cholesterol lowering supplements (NCLSs) available at the pharmacy; however, limited information on these supplements is readily available. Pharmacists should be knowledgeable about NCLSs to ensure that the use of these supplements is supported by evidence and to provide appropriate advice to patients for desirable therapeutic outcomes. This study aimed to identify the NCLSs being sold in South African pharmacies and review the scientific evidence for each of the ingredients in these NCLSs. Seventeen NCLS products were identified, and the Joanna Briggs Institute (JBI) scoping review methodology was used to conduct a literature review of NCLSs. From the ingredients reviewed it is evident that co-enzyme Q10, probiotics and sterols have sufficient evidence supporting their use. However, there is still limited scientific evidence available to validate the remaining ingredients. Further research on NCLSs will provide practising pharmacists and practitioners with a guide of the evidence available on the various ingredients in NCLSs. This study provides a review of the available literature on the NCLSs being sold in the pharmacies across South Africa to provide pharmacists with a collated document of the evidence behind these popular supplements to assist them in making evidence based informed decision regarding natural products for cholesterol.

Effects of banditry security risk on livelihood of cattle herders in Katsina State, Nigeria

Livestock enterprise is an important source of livelihood to many people in Nigeria. Vulnerability of livestock business to insecurity risk is a major threat to the livelihood of stakeholders in the livestock value chain (cattle herders and marketers). Insecurity risk among livestock herders has a ripple effect in the economy of Nigeria. Empirical information is scanty for the clarification and development in security risk control model especially with the emergence of banditry in Nigeria. This study broadly examines the effect of insecurity risk on the livelihood of livestock herders in Katsina State, Nigeria. Primary data obtained with the use of structured questionnaire from randomly selected 200 respondents were analyzed by descriptive and inferential statistical tools (mean, frequency distribution table, probability and multiple regression). The result shows that the probability of banditry attack was 20%. The major benefit derivable from livestock business by herders is income generation. The major cause of banditry insecurity was unresolved conflict between farmers and herdsmen (100%), unemployment/deliberate negative tendency of bandits to climb wealth ladder (93.5%) and corruption among government officials (93%). Test of hypothesis indicates that all the insecurity indicators (cattle rustling, theft, kidnapping and tax imposition) negatively and significantly (P < 0.05) affected livelihood capital (asset) (income savings and herd size). There are sufficient evidence to conclude that livelihood capital of cattle herders is worst hit by banditry insecurity risk in Katsina State, Nigeria. It was recommended that government should adopt amnesty policy of disarmament, reintegration and rehabilitation of repentant bandits. This study has expanded the frontier of literature of the ripple effects of banditry insecurity on cattle value chain and implications for policy options.

Expression and prognosis analysis of TBX2 subfamily in human lung carcinoma.

Lung cancer has a high morbidity and mortality rate of all cancers worldwide. Therefore, there is an urgent need for reliable cancer markers for diagnosis and prognosis of patients with lung cancer. In this study, we used the bioinformatics database to compare the expression of the TBX2 subfamily at the transcriptional and protein levels in non-small cell lung cancer. Then, to confirm our bioinformatics analysis above, we used western bloting to determine the expression of TBX2, TBX3, TBX4 and TBX5 in human lung squamous carcinoma cell lines. Besides, low expression of TBX2 subfamily predicted a poor prognosis of patients with lung cancer. Finally, The methylation database was used to explore the relationship between the low expression of TBX2 subfamily and methylation of gene promoter region. Our data showed a significant decrease of TBX2 subfamily expression in lung cancer tissues of several histological subtypes. Finally, the methylation of TBX2 subfamily members in the promoter region of NSCLC was significantly higher than that in normal tissues. Our research provided sufficient evidence that TBX2 subfamily might play an inhibitory role in malignancy progression of lung cancer, which is promising to shed light on discovering a novel reliable cancer marker for prognosis of lung cancer patients.

Rapid genomic sequencing for genetic disease diagnosis and therapy in intensive care units: a review.

Single locus (Mendelian) diseases are a leading cause of childhood hospitalization, intensive care unit (ICU) admission, mortality, and healthcare cost. Rapid genome sequencing (RGS), ultra-rapid genome sequencing (URGS), and rapid exome sequencing (RES) are diagnostic tests for genetic diseases for ICU patients. In 44 studies of children in ICUs with diseases of unknown etiology, 37% received a genetic diagnosis, 26% had consequent changes in management, and net healthcare costs were reduced by $14,265 per child tested by URGS, RGS, or RES. URGS outperformed RGS and RES with faster time to diagnosis, and higher rate of diagnosis and clinical utility. Diagnostic and clinical outcomes will improve as methods evolve, costs decrease, and testing is implemented within precision medicine delivery systems attuned to ICU needs. URGS, RGS, and RES are currently performed in <5% of the ~200,000 children likely to benefit annually due to lack of payor coverage, inadequate reimbursement, hospital policies, hospitalist unfamiliarity, under-recognition of possible genetic diseases, and current formatting as tests rather than as a rapid precision medicine delivery system. The gap between actual and optimal outcomes in children in ICUs is currently increasing since expanded use of URGS, RGS, and RES lags growth in those likely to benefit through new therapies. There is sufficient evidence to conclude that URGS, RGS, or RES should be considered in all children with diseases of uncertain etiology at ICU admission. Minimally, diagnostic URGS, RGS, or RES should be ordered early during admissions of critically ill infants and children with suspected genetic diseases.

Role of perceived risks and perceived benefits on consumers behavioural intention to use Buy-Now, Pay-Later (BNPL) services

Purpose Perceived risk and benefits have been proposed as crucial elements in consumers’ technology adoption intention. Therefore, this study aims to use the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) framework, with perceived risks and benefits, to explore how they affect consumers’ Buy-Now-Pay-Later (BNPL) behavioural intention. Design/methodology/approach An online survey was conducted among 537 users of BNPL. Partial least square structural equation modelling analysis was performed to examine the hypothesized relationships. Findings The study found that perceived benefits, performance expectancy, effort expectancy, habit and social influence increase consumers’ behavioural intention towards BNPL. In contrast, perceived risk reduces the consumer’s intention to use. Additionally, the study revealed that consumers’ intention towards BNPL services positively affects their usage. Practical implications The lack of information makes consumers hesitant to use BNPL. Therefore, marketers should optimize facilitating conditions, such as user-friendly interfaces, accessible resources and efficient customer support, which should be the business strategy of BNPL service providers to ensure a seamless user experience. Originality/value The research empirically investigates the effect of perceived benefits on consumer behavioural intention. This contribution is crucial because while there was speculation about benefits as a driving force to consumers’ adoption intention, there was a lack of sufficient empirical evidence to support it.

Modeling relaxed policies for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions.

To evaluate the economic costs of reducing the University of Virginia Hospital's present "3-negative" policy, which continues methicillin-resistant Staphylococcus aureus (MRSA) contact precautions until patients receive 3 consecutive negative test results, to either 2 or 1 negative. Cost-effective analysis. The University of Virginia Hospital. The study included data from 41,216 patients from 2015 to 2019. We developed a model for MRSA transmission in the University of Virginia Hospital, accounting for both environmental contamination and interactions between patients and providers, which were derived from electronic health record (EHR) data. The model was fit to MRSA incidence over the study period under the current 3-negative clearance policy. A counterfactual simulation was used to estimate outcomes and costs for 2- and 1-negative policies compared with the current 3-negative policy. Our findings suggest that 2-negative and 1-negative policies would have led to 6 (95% CI, -30 to 44; P < .001) and 17 (95% CI, -23 to 59; -10.1% to 25.8%; P < .001) more MRSA cases, respectively, at the hospital over the study period. Overall, the 1-negative policy has statistically significantly lower costs ($628,452; 95% CI, $513,592-$752,148) annually (P < .001) in US dollars, inflation-adjusted for 2023) than the 2-negative policy ($687,946; 95% CI, $562,522-$812,662) and 3-negative ($702,823; 95% CI, $577,277-$846,605). A single negative MRSA nares PCR test may provide sufficient evidence to discontinue MRSA contact precautions, and it may be the most cost-effective option.

The Attributes and Areas for Improvement of Early Career Engineers in Sri Lanka

Over two thousand engineering graduates enter the job market in Sri Lanka annually from state and private sector universities. There is a growing concern in the industry whether those graduates have attained the required expectations of the employers. Academic literature also lacks sufficient evidence to demonstrate Sri Lankan early career engineers' strengths and areas for improvement. This study explores the strengths and areas for improvement of early career engineers from the perspectives of senior employer engineers in Sri Lanka. This study was conducted qualitatively by holding semi-structured face-to-face interviews with a purposively selected sample of twenty-two employer engineers. Voice-recorded interviews were transcribed verbatim and analysed employing the inductive thematic analysis method. Analysis has revealed that enhanced technical knowledge, analytical skills and computer literacy are the strengths of early career engineers, while money-mindedness, negative attitudes, sticking only to the job role and lack of hard-working skills, interpersonal skills and practical knowledge as the areas for improvement of present-day early career engineers in Sri Lanka. Further, few employer engineers have suggested modifying the university education system and educating academics &amp; training engineers to guide engineering undergraduates on the proper path to achieve the career success.