Critical Tool Research Articles

Evaluation of metronidazole oral monotherapy in anaerobic oral infections.

To evaluate the indications and dosing regimens for oral metronidazole monotherapy (OMM) for the management of oral anaerobic infections (OAIs) other than periodontitis. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in literature of PubMed/Medline, Scopus, and Cochrane databases. Data were retrieved from reports published in English in the period January 1, 1980 - August 30, 2023. Joanna Briggs Institute Critical Appraisal Tools were used to assess study risk of bias. A total of 228 articles were retrieved from the databases of which 16 met the inclusion criteria necessary for achieving the aims of the study. OAIs in which OMM was used or recommended included pericoronitis; necrotizing ulcerative gingivitis/periodontitis/stomatitis, osteomyelitis, acute periapical infection, and cellulitis. OMM was prescribed in dosages ranging from 200 to 500 mg t.i.d. for periods ranging from 2 to 7 days. Osteomyelitis of the jaw was the only infection for which the dosage regimen of metronidazole was not clearly described. Evidence from the databases searched support the view that OMM has clinical efficacy in the treatment of specific OAIs namely pericoronitis and necrotizing oral infections in immune-competent and immune-compromised patients. The evidence does not support the use of OMM in "deep tissue" infections such as osteomyelitis, and odontogenic infections such as acute apical infection and cellulitis. Clinical trials are warranted to determine the efficacy of OMM in comparison with other antibiotic regimens.

CMOS Pulse Oximeter

Abstract: This paper presents the design and implementation of a non-invasive pulse oximeter based on Complementary MetalOxide-Semiconductor (CMOS) technology, aimed at enhancing the accuracy and accessibility of blood oxygen saturation measurements. Pulse oximetry is a critical tool in clinical and personal health monitoring, providing vital information about respiratory function. The integration of CMOS technology allows for miniaturization and energy efficiency, facilitating the development of compact, wearable devices capable of continuous monitoring. The proposed system utilizes advanced signal processing techniques, including lock-in detection and dual-wavelength illumination, to improve the reliability of photoplethysmographic (PPG) signal acquisition under various conditions. Experimental validation demonstrates the device's capability to deliver accurate SpO2 readings even in the presence of motion artifacts and ambient light interference. Furthermore, the calibration methods employed ensure that measurements are consistent and precise across different users. By leveraging the advantages of CMOS technology, this study not only highlights the potential for improved patient comfort and compliance but also opens new avenues for the application of pulse oximetry in diverse environments. The findings underscore the effectiveness of CMOS-based pulse oximeters in advancing non-invasive health monitoring solutions, ultimately contributing to enhanced patient care and outcomes.

Leveraging big data analytics to combat emerging financial fraud schemes in the USA: A literature review and practical implications

The rise of emerging financial fraud schemes in the USA has presented significant challenges for financial institutions, regulators, and law enforcement agencies. As fraud tactics become increasingly sophisticated, traditional methods of detection and prevention are proving insufficient. This literature review explores the role of big data analytics as a critical tool in combating financial fraud, focusing on its practical applications and effectiveness. By leveraging machine learning, predictive analytics, and artificial intelligence, big data analytics enables real-time monitoring and detection of fraudulent activities, offering a more dynamic and adaptive approach to fraud prevention. The review synthesizes key studies, case reports, and industry practices, highlighting the implementation of big data in analyzing large volumes of transactional and behavioral data to identify suspicious patterns. It further discusses the challenges associated with integrating big data technologies into existing systems, including issues related to data privacy, regulatory compliance, and the high cost of implementation. Additionally, the paper assesses the impact of big data solutions on fraud prevention, comparing their effectiveness to traditional methods and identifying best practices for institutions looking to adopt these technologies. Finally, the review proposes future directions, emphasizing the potential of emerging technologies such as artificial intelligence and blockchain to enhance fraud detection capabilities. It offers recommendations for financial institutions, regulators, and policymakers to collaborate in developing more robust strategies to safeguard the financial system from evolving fraud threats. This paper provides a comprehensive analysis of the current state of big data analytics in combating financial fraud and its practical implications for the financial services industry in the USA.

Customer journey mapping framework for SMES: Enhancing customer satisfaction and business growth

Customer journey mapping (CJM) is an essential tool for small and medium-sized enterprises (SMEs) to understand and optimize their interactions with customers, thereby driving satisfaction and business growth. This review outlines a customer journey mapping framework designed specifically for SMEs, aiming to enhance customer experiences through a structured approach to identifying key touchpoints, pain points, and opportunities for improvement across the customer lifecycle. The proposed framework involves systematically mapping out every stage of the customer journey, from initial awareness to post-purchase interactions, highlighting moments that significantly impact customer satisfaction. By leveraging customer data, feedback, and analytics, SMEs can gain valuable insights into customer behavior, motivations, and preferences. This framework emphasizes the importance of personalization, using data to tailor the customer experience and foster deeper connections. Additionally, the framework integrates feedback loops, allowing SMEs to continuously gather and analyze real-time customer data. This iterative process helps businesses to proactively identify emerging trends, address customer concerns, and adapt to evolving market demands. By aligning customer needs with business objectives, SMEs can create more targeted marketing campaigns, improve product or service offerings, and enhance customer retention strategies. The implementation of this customer journey mapping framework can lead to several key benefits for SMEs, including improved customer satisfaction, increased brand loyalty, and greater operational efficiency. It also enables SMEs to compete more effectively in their markets by delivering personalized and seamless customer experiences. The framework supports scalability, allowing SMEs to refine their customer engagement strategies as their businesses grow. In conclusion, the customer journey mapping framework serves as a critical tool for SMEs looking to enhance customer satisfaction and drive sustainable business growth. By focusing on data-driven insights and continuous improvement, SMEs can deliver more value to customers, strengthen brand loyalty, and achieve long-term success.

Comprehensive framework for data fusion in distributed ledger technologies to enhance supply chain sustainability

This review proposes a comprehensive framework that integrates data fusion with Distributed Ledger Technologies (DLT) to enhance sustainability in supply chain management. In today’s global supply chains, ensuring transparency, efficiency, and environmental responsibility is critical, yet the lack of real-time visibility and data fragmentation presents significant challenges. The framework addresses these issues by merging data from multiple sources, including IoT devices, operational databases, and external environmental factors, using advanced data fusion algorithms. DLT, with its decentralized, immutable, and transparent nature, ensures the integrity and security of the data, allowing all stakeholders to access accurate and tamper-proof information. The fusion of data within a DLT infrastructure not only improves traceability and accountability but also enables the automation of sustainability checks via smart contracts. These contracts can trigger actions based on predefined sustainability metrics such as carbon emissions, energy consumption, and resource efficiency. Furthermore, predictive analytics and machine learning algorithms integrated into the system provide real-time monitoring and optimization of sustainability performance throughout the supply chain. The proposed review offers numerous benefits, including enhanced transparency, reduced operational costs, improved sustainability outcomes, and risk mitigation. It also addresses challenges such as scalability, data privacy, and regulatory compliance, offering solutions to overcome these hurdles. By exploring case studies of successful implementations, this review demonstrates the practical applications and future potential of combining DLT and data fusion for sustainable supply chain management, positioning it as a critical tool for organizations aiming to meet environmental and regulatory demands in an increasingly digital and eco-conscious world.

Burnout in Infection Control Practitioners During Public Health Crisis Events: A Mixed Methods Systematic Review Protocol

Background Infection prevention and control work environments are highly complex in nature and have long been associated with crisis events including serious infectious disease outbreaks. The role of infection control practitioners shifted exponentially during the COVID-19 pandemic and with this rapid and nebulous change came anxiety, emotional exhaustion and ultimately burnout. Burnout at work generally occurs as a response to chronic and prolonged exposure to emotionally challenging events, causing emotional exhaustion, feelings of cynicism, and lack of accomplishment at work. This systematic review aims to investigate burnout in infection control practitioners during public health crisis events (major outbreaks, epidemics, and pandemics) in upper-middle and high-income countries on a global scale. Methods A mixed-methods systematic review will be carried out and will include qualitative, quantitative and primary mixed-methods studies that investigate the different elements of burnout, during public health crisis events. After an initial scoping literature search, up to six databases will be searched for studies on burnout in relation to infection prevention practitioners. Study quality will be checked using standardised JBI critical appraisal tools. The proposed review will follow the JBI convergent integrated approach for mixed methods systematic reviews. Following data extraction, quantitative data will then be converted into ‘qualitized data’ in the form of textual descriptions. Discussion It is well documented that adverse conditions during public health crisis events can lead to burnout. This systematic review will investigate of burnout in infection control practitioners in upper-middle and high-income countries during public health crisis events. The findings will inform healthcare professionals, senior policy makers and researchers and will help contribute to a richer understanding of burnout and associated factors in infection control practitioners. Protocol registration number PROSPERO 2024 CRD42024508996.

Epidemiology of obesity during pregnancy in Europe: a systematic review

Abstract Background Obesity during pregnancy poses inter-generational health risks and places added burden on healthcare systems. Characterising levels of obesity during pregnancy is necessary to guide future research, policy and practice. Methods The systematic review was performed according to PRISMA guidelines. PubMed, Embase and Web of Science were searched. Studies published between 2009 and 2023 that report the prevalence of obesity during pregnancy in countries in the World Health Organization (WHO) European region were eligible. The Joanna Briggs Institute Prevalence Critical Appraisal tool was used. Two reviewers screened studies independently. A single reviewer completed data extraction and quality assessments, a second checked 20% of extractions and a third resolved disagreements. Narrative synthesis was completed. Results 100 studies reporting the prevalence of obesity during pregnancy in the WHO European region were identified. 59% from Western Europe, 36% Northern, 4% Southern and 1% Eastern. Data within the studies was collected between 1950 and 2019. 35% of studies reported national estimates, 65% regional. 39% studies had measured height and weight, 34% did not report how either were ascertained, 6% used self-report for both, 17% had self-reported height but measured weight, 4% a mixture of self-report and measurement. The smallest sample was 157 while the largest was 1,891,097. Estimated prevalence of obesity during pregnancy ranged from 2.3% (Sweden, data collected 1982-1989) to 28.3% (England, 2007). Conclusions This review identifies variation in the prevalence of obesity during pregnancy in the WHO European region. This may reflect diverse sociocultural contexts, different methodological approaches and temporal trends. There was limited evidence available for Southern and Eastern Europe. Key messages • There are high levels of obesity during pregnancy within the WHO European region. • Enhanced primary prevention and resourcing of obstetric services is needed.

Sex differences in mortality associated with heatwaves: a systematic review and meta-analysis

Abstract Introduction The existence of sex and gender differences in the mortality associated with heatwaves remains unclear. Methods A systematic review and random-effects meta-analysis of population-based studies that investigated the mortality associated with heatwaves and reported results stratified by sex/gender was conducted (PROSPERO registration CRD42023430208). Bibliographic databases Medline and Embase were searched from inception to May 2024 with MESH terms for heatwaves/extreme heat and mortality. This was complemented with hand-searching of reference lists of relevant studies. The methodological quality of eligible studies was assessed using the Joanna Briggs Institute critical appraisal tool. Results In total, 931 studies were identified, of which 32 studies were included in the qualitative review and 11 in the meta-analysis. Most studies (20/32) reported a higher risk of heat-related death for women than men even after adjusting for or stratifying by age. Twelve studies showed statistically significant higher risks of death for women than men and 7 studies identified an increased risk of death for women, but the wide confidence intervals precluded making definite conclusions. Two studies reported a higher risk of death for men in comparison to women but only one was statistically significant. The remaining 10 studies found comparable risks for women and men. For the 11 studies included in the meta-analysis, women had an 8% increased risk of death in comparison to men (RR 1.08, 95% CI [1.02 to 1.14]). There was significant heterogeneity (I2=69%, p = 0.001) due to the variability in the definition of exposure, population, and setting. Most studies had a low to moderate risk of bias. Conclusions Women appeared to have an increased risk of death associated with heatwaves in comparison to men. Further research is warranted to understand the underlying factors and ensure the health protection response considers the gendered impact of heatwaves.

Healthcare professionals and students’ knowledge on termination of pregnancy: A systematic review

Abstract Background Providing safe termination of pregnancy (TOP) according to each country’s legalisation is an important public health matter internationally. Healthcare professionals (HCPs) and healthcare students have key roles and need to be aware of legislation and clinical practice guidelines on TOP in their country to facilitate safe and effective care. The main aim of this systematic review was to investigate the level of knowledge on TOP legislation among HCPs and healthcare students. The second objective was to assess the knowledge of TOP methods, procedures and/or potential associated complications. Methods This is a systematic review of qualitative and quantitative peer-reviewed studies published in English or Portuguese until July 2020. Databases included in the search were EBSCO, PubMed, Embase and Scopus. The quality appraisal was done using the CASP Critical Appraisal tools. Results A total of 31 studies were included, published between 2002 and 2020 and from several regions around the globe. No studies were carried out in Europe or the United Kingdom. A total of 22 studies included healthcare professionals and nine studies included students. Overall, all the studies showed poor knowledge of TOP legislation and TOP methods, procedures and complications. Knowledge of special circumstances established in the law where TOP might be legal was also very limited. In studies focussing on medical (MA) and surgical (SA) TOP, knowledge of MA was lower than of SA. Studies reported that practitioners and students have limited training in TOP. Overall, education/training and experience with TOP seem to be the main factors associated with increased levels of knowledge. Similar results were found for student’s knowledge. Conclusions This study highlighted the importance of involving and promoting the participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown. Key messages • TOP training is limited and broadly excluded from medical and healthcare education globally. Students and staff have recognised this issue and the critical impact it has on TOP care provided. • Adequate knowledge and training in TOP ensures service sustainability and preparation of current and future healthcare practitioners to provide high-quality, respectful and compassionate care.

Challenges of environmental impact assessment in addressing environmental risk: insights from Brazilian practice in mining dams

ABSTRACT Environmental Impact Assessment (EIA) and Risk Assessment (RA) are critical tools for assessing and managing environmental impacts and risks of projects. However, their integration remains a challenge. This study examines how EIA practices account for risks in evaluating the environmental feasibility of mining dam projects in the state of Minas Gerais, Brazil. We analyzed licensing processes for projects approved between 2004 and 2022, using data from the state’s environmental agency. Methods included documentary and content analysis of Environmental Impact Statements (EIS) and review reports. Among the 25 cases analyzed, most focused solely on risk control without performing RA. Only two cases included RA, and two others lacked any risk-related information. Review reports revealed that only two went beyond considering risk control when assessing environmental feasibility. This suggests decision-making relies on a narrow focus on risk control. Furthermore, there is a misalignment between the EIS content and the criteria for project acceptability in review reports. Finally, we explore how politicization may undermine the EIA’s role in objective, and evidence-based decision-making. These findings underscore the superficial and fragmented approach to addressing environmental risk in mining dam assessments in Minas Gerais.

Environmental Accounting and Sustainability: A Meta-Synthesis

This study conducts a comprehensive meta-synthesis of review-based research on environmental accounting, spanning from 1995 to 2024. Environmental accounting, also known as green accounting, has evolved as a critical tool for integrating sustainability into corporate financial practices. Using bibliometric methods via Bibliometrix R-package (Biblioshiny—Version 4.2.0) and VOSviewer (Version 1.6.20), the research mainly examines scholarly discussion in review-based studies and identifies dominant themes. The main clusters identified are (1) environmental audits and management, (2) green accounting, financial reporting and sustainable development, (3) CSR, stakeholder engagement, and accountability, and (4) environmental accounting and protection. On the descriptive end, publication trends, prominent authors, articles, and sources are identified. The findings highlight a significant increase in review-based studies since 2022, coinciding with the growing global awareness and importance of sustainability. This study contributes to the field by consolidating fragmented research on environmental accounting, offering a framework for future academic exploration. Practically, it informs policymakers and business leaders on the importance of unified reporting standards across regions; integrating environmental considerations into financial decision-making; promoting transparency, accountability, and sustainability accounting; and disclosure across industries and regions.

Maintaining Agricultural Production Profitability—A Simulation Approach to Wheat Market Dynamics

Profitability is a complex notion, intertwined with theoretical, socio-economic, and modern economic considerations. While traditionally linked to monopoly advantages, contemporary views broaden this to include shareholder value creation. In agriculture, profitability faces impediments such as rising input costs, market volatility, and economic disparities, emphasizing technological innovation, market conditions, and policy as crucial determinants. This study presents an econometric simulation model to analyze and forecast wheat production profitability in Poland from 2023 to 2027, providing insights into production efficiencies, market dynamics, and policy impacts. Using a system of recursive equations, the model forecasts profitability, integrating econometric techniques with expert insights. It examines variables like resource use, production levels, and price changes, validated through FADN data. The findings reveal that price relations and production efficiencies are the key to profitability. The model highlights market volatility, particularly through “price scissors”, as the main factor influencing profitability. Favorable price conditions significantly boost profitability and incentivize production. The model is a critical tool for analyzing wheat profitability, highlighting the influence of market and policy changes. Future work could extend the model’s use to other regions or crops, incorporating advanced technologies to improve accuracy. This study offers valuable insights for agricultural economics, aiding stakeholders in strategic decision-making.

The knowledge layer: the role of key messages for translating data into meaning

Abstract The large volume of data generated by health information systems often remains siloed within the institutions that produce it, posing significant challenges to its reuse and interpretation. This fragmentation can result in conflicting information on critical health topics, complicating the decision-making process for policymakers. To address this issue, Belgium has initiated the ‘Health Status Report’ website, hosted at healthybelgium.be. This website aims to synthesize and present health data in a manner that supports evidence-based policy formulation. The website adopts a structured approach to data integration and interpretation: initially, we identify and prioritize key health topics based on their relevance and the quality of available data. Subsequently, we merge and analyze data from diverse sources to discern patterns and trends that are crucial for public health monitoring. The insights gained are then presented through both narrative texts and interactive visualizations, facilitating access and understanding for a broad audience. Crucial to this process is ongoing communication with experts and stakeholders, ensuring that the data is not only accurately interpreted but also aligns with the needs and expectations of its users. We also aim to translate the raw data into meaningful key messages by consulting with internal and external experts. This interactive platform thus serves as a critical tool for translating complex health data into actionable knowledge, enabling informed public health strategies and interventions.

Innovative system to maximize methane production from fruit and vegetable waste.

Anaerobic digestion of fruit and vegetable waste (FVW) offers an environmentally friendly alternative for waste disposal, converting it into methane for energy recovery. Typically, FVW digestion is conducted in a continuously stirred tank reactor (CSTR) due to its ease of use and stability with solid concentrations between 5 and 10%. However, CSTRs are limited to organic loading rates (OLRs) of about 3kg COD/m3.day, resulting in large reactor volumes, low methane productivity, and costly wet digestate handling. This work introduces a novel method for methane production from FVW using a high-rate reactor system. The proposed approach involves grinding, centrifuging, and/or pressing the FVW to separate it into liquid and solid phases. The liquid phase is then digested in an up-flow anaerobic sludge blanket (UASB) reactor, while the solid phase undergoes digestion in a dry methanization reactor. A model incorporating all biological reactors was implemented in the Anaerobic Digestion Model 1 (ADM1) to provide a theoretical basis for the experimental development of this system. The current simulation scenarios offer initial references for operating the experimental system, which will, in turn, generate data for further model refinement. For instance, constrained liquid-gas mass transfer was considered for dry fermentation, with additional potential biochemical kinetic limitations to be incorporated following on experimental evidence. The success of this system could enable energy recovery in 72 Central Wholesale Markets across Brazil, offering a critical tool for planning, operating, and optimizing such systems.

Factors influencing adherence to Physical Exercise in patients with multiple sclerosis: a systematic review focusing on Exercise over General Physical Activity.

While the barriers and facilitators of physical activity adherence are well-defined, there is a limited number of studies focusing specifically on exercise adherence, which is crucial to identify in patients with multiple sclerosis (MS) due to its known disease-modifying effect. To investigate the factors affecting adherence to physical exercise in MS patients. Literature search was conducted in PubMed, Cochrane, Web of Science, and Scopus electronic databases up to the current date. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for quantitative studies and the McMaster Critical Appraisal Tool for qualitative studies, with evidence synthesis conducted using the Modified Bakker Scale. The systematic review incorporated thirteen studies, consisting of seven qualitative and six quantitative ones. These studies' methodological quality was high; 12 were high, and the other was medium (unclear). In all reviewed studies, the primary patient-related and environmental barriers with high levels of evidence regarding exercise adherence included fatigue (38%), false beliefs (18%), cost (18%), and lack of time (15%). Barriers identified in very few studies included cognitive problems (3%), bladder-bowel problems (3%), and family support and advice (3%), indicating a necessity for further research to reveal their impact on exercise adherence. The scarcity of studies on exercise barriers in MS is partly due to the absence of reliable assessment methods for evaluating exercise adherence, along with the prevalent emphasis on physical activity. Future research should prioritize the development of adherence scales tailored to physical exercise and shifting focus towards less explored barriers.

Effectiveness of household-level interventions for reducing the impact of air pollution on health outcomes – a systematic review

Background and aimSeveral air pollution mitigation initiatives have been researched worldwide to see how efficient they are at reducing air pollution and the related health benefits. The effectiveness of these interventions for improving health outcomes is key for scaling up and increasing uptake of same by policymakers and people. We aimed to synthesize scientific evidence about the effectiveness of household-level interventions on air quality and health outcomes using a systematic approach.MethodsComprehensive strategy was used to carry out a literature search in PubMed, Cochrane, and Google scholar by two independent investigators using keywords and Medical Subject Heading terms. Research articles published till the year 2021 focusing on interventions for improvement in air quality and health were selected using pre-specified eligibility criteria. All abstracts for inclusion were reviewed independently by two reviewers. In case of doubt, the articles were included for full-text review. Disagreements were resolved by discussion with the third investigator. The quality of the studies and risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool and Cochrane Risk of Bias tool, version 2.0. Effect estimates were reported using odds ratio, relative risks, difference in mean, and percentage changes with 95% confidence intervals. PRISMA guidelines were used to conduct and report the systematic review. The review was registered in PROSPERO (CRD42022295393).ResultsThe search resulted in the identification of 46,809 studies and 18 of them were finally included in the review using eligibility criteria. The household-level interventions were categorized mainly into air purifiers/electric heater use, cookstove use, and behavioural change interventions. These interventions resulted in a decrease in the number of daytime asthma attacks by 33%, an increase in FEV1 by 4.4%, −1.4% and 0.8% overall percent change in microvascular and lung function. PM2.5 was the most commonly reported air pollutant, its concentrations reduced in the range between 31% and 53% across the studies.ConclusionOur review provided consistent evidence for the effectiveness of household-level interventions thus associated with improvements in cardiovascular and respiratory symptoms.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295393, identifier, CRD42022295393

Chinese Version of the Nonverbal Pain Assessment Tool: Critical Patient Reliability and Validity.

To translate and validate the Nonverbal Pain Assessment Tool. Timely assessment of the pain degree of nonverbal intensive care unit (ICU) patients can provide humanistic care. However, there is a lack of pain assessment tools that can meet the needs of patients who cannot use language in ICUs in China. A cross-sectional survey. We conducted forward-backward translation of the Nonverbal Pain Assessment Tool. A total of 300 critically ill patients in the intensive care unit who could not communicate verbally completed the Chinese version of the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. Exploratory and confirmatory factor analyses were performed to verify structural validity, and content validity and reliability analyses were also conducted. The Nonverbal Pain Assessment Tool demonstrated high internal consistency (α = 0.901) and interrater reliability (intraclass correlation coefficient = 0.981), with good split-half reliability. Content validity was established through acceptable item-level content validity index and scale-level content validity index scores. Exploratory factor analysis showed a single factor explaining 71.79% of total variance, and confirmatory factor analysis confirmed good model fit. The Spearman rank correlation coefficient was 0.917 between the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. The Chinese Nonverbal Pain Assessment Tool demonstrated significant differences in scores between different states of consciousness and illness severity, supporting its known-groups validity. The Chinese version of the Nonverbal Pain Assessment Tool is a reliable and valid tool for nonverbal pain assessment in ICU patients in China. The Chinese version of the Nonverbal Pain Assessment Tool can assess the pain of patients who cannot use language in ICU, which provides a new valuable assessment tool for Chinese clinicians and nurses in pain assessment and management. Our study followed the STROBE Checklists. Patients actively cooperated and participated in data collection during the implementation of the study.

Functional Capacity, Functional Performance, and Symptoms in People With Heart Failure: An Integrative Review.

Heart failure (HF) is a clinical syndrome that has a negative effect on functional status, a multidimensional concept characterizing one's ability to provide for the necessities of life. Symptoms might be associated with different aspects of functional status in HF. However, the terms functional capacity and performance have been misused interchangeably, and no previous review has focused on the extent to which symptoms contribute to functional capacity and performance among people with HF. The aim of this study was to comprehensively review and synthesize the existing literature on the relationship between symptoms, functional capacity, and functional performance in people with HF. We conducted an integrated review of observational studies in which authors examined the relationship between at least 1 symptom and at least 1 aspect of functional capacity or performance in people with HF 18 years or older. The Joanna Briggs Institute's critical appraisal tools were used to analyze the quality of studies. We included 23 studies with 7219 participants and an age range of 40 to 86 years. Fifteen symptom measures were used to measure dyspnea, fatigue, pain, insomnia symptoms, depressive symptoms, and anxiety symptoms. Three functional capacity measures were assessed in 9 studies, and 7 functional performance measures were assessed in 17 studies. As often measured with the Six-Minute Walk Test, functional capacity was inversely associated with pain/discomfort, insomnia symptoms, and psychological symptoms. Functional performance, often measured by the New York Heart Association functional class and Medical Outcome Scale Short Form 36, was associated with sleep difficulties, fatigue, depressive symptoms, and anxiety. Four studies combined functional capacity and performance measures to elicit functional status. Depressive symptoms, fatigue, pain, and insomnia symptoms are associated with decreased functional performance and capacity. Commonly, symptoms experienced in HF are associated with declining functional status. However, this finding depends on the measures or metrics used to assess symptoms, functional capacity, and performance. The observed dissimilarities in the relationship between symptoms and functional capacity and performance highlight the conceptual distinctions, suggesting that authors of future studies should judiciously select appropriate dimensions and measures of functional status based on the study's purposes, design, and available resource.

Assessment of socioeconomic and health vulnerability among urban slum dwellers in Bangladesh: a cross-sectional study

BackgroundBangladesh is rapidly urbanizing and approximately half of its urban population resides in deprived slums with limited access to basic needs. However, there is a dearth of information on vulnerability levels among slum dwellers. We aimed to assess the level of vulnerability within and between slums via various socioeconomic and health indicators.MethodsA cross-sectional survey of 810 randomly selected households was conducted in two purposively selected slums, Korail and Shyampur, in Dhaka from November to December 2021. Data was collected on various indicators, including demographics, education, employment, access to utility, and healthcare services. Principal component factor analysis was employed to identify the key indicators to construct the socioeconomic and health vulnerability index for the urban slums of Bangladesh (SEHVI-BD). Kaiser-Meyer-Olkin, Bartlett’s test, and Cronbach’s alpha coefficient test were used to assess indicators’ suitability. The selected indicators were used to generate an index on a scale of 100, with a higher index value indicating a higher level of vulnerability. The estimated scores were used to categorize the vulnerability status into three levels: mild, moderate, and severe vulnerability. The Mann-Whitney-U test and Kruskal-Wallis test were applied between the generated index and other socioeconomic variables to validate the relationship.ResultsA total of 27 socioeconomic and health indicators were identified that explained 60% of the variance. The indicators were then grouped into six domains on the basis of their relevance. The prevalence of severe vulnerability in the Korail slum was approximately 9% and moderate vulnerability was 30% whereas these values were approximately 58% and 37%, respectively, in the Shyampur slum. The difference in the vulnerability level between the two slums was also evident across the domains. Households in the poorest wealth quintile, with lower education levels of household heads, and having irregular income experienced higher levels of vulnerability.ConclusionsThe SEHVI-BD offers a critical tool for policymakers to identify and address vulnerabilities, facilitating more targeted public health interventions in urban Bangladesh and similar low-income settings. This study further emphasizes the importance of integrating comprehensive vulnerability assessments into public health policies to reduce inequalities and improve well-being, especially for the urban marginalized slum population.

Advances in bacterial artificial chromosome (BAC) transgenic mice for gene analysis and disease research.

Transgenic mice, including those created using Bacterial Artificial Chromosomes (BACs), are artificial manipulations that have become critical tools for studying gene function. While conventional transgenic techniques face challenges in achieving precise expression of foreign genes in specific cells and tissues, BAC transgenic mice offer a solution by incorporating large DNA segments that can include entire expression units with tissue-specific enhancers. This review provides a thorough examination of BAC transgenic mouse technology, encompassing both traditional and humanized models. We explore the benefits and drawbacks of BAC transgenesis compared to other techniques such as knock-in and CRISPR/Cas9 technologies. The review emphasizes the applications of BAC transgenic mice in various disciplines, including neuroscience, immunology, drug metabolism, and disease modeling. Additionally, we address crucial aspects of generating and analyzing BAC transgenic mice, such as position effects, copy number variations, and strategies to mitigate these challenges. Despite certain limitations, humanized BAC transgenic mice have proven to be invaluable tools for studying the pathogenesis of human diseases, drug development, and understanding intricate gene regulatory mechanisms. This review discusses current topics on BAC transgenic mice and their evolving significance in biomedical research.