Search Results (726)

Intravenous push (IVP) administration of controlled substances in hospital settings presents operational challenges related to medication waste, documentation, and diversion risk. This multi-site observational study aimed to quantify the pharmacy workforce time and associated costs linked to IVP waste management across a 16-hospital health system in Southwest Florida. Data were collected from over 4400 controlled substance transactions involving fentanyl, midazolam, hydromorphone, morphine, ketamine, and lorazepam. Methods included automated transaction analysis, manual chart reviews, and software-based compliance case evaluations. Results indicated patterns of partial dose waste, particularly for midazolam (85.2%) and hydromorphone (78.8%), and identified opportunities where documentation efforts could be further optimized through automation. Manual review of 333 incidents required an average of 6 min and 43 s per case, extrapolating to over 496 h of quarterly pharmacy labor or nearly 1985 h annually. Software-based case reviews added another 32 h per quarter or 130 h annually. Additionally, waste receptacle systems incurred over USD 1.1 million in capital costs and USD 322,500 in annual maintenance, with technician labor contributing further operational burden. These findings underscore the resource demands of IVP waste management and support the need for standardized dosing, enhanced documentation workflows, and pharmacy-led interventions to improve efficiency and reduce diversion risk. Full article

Real-time nitrogen (N) management based on the leaf color chart (LCC) is considered a potential alternative to traditional farmer practices. However, its physiological mechanisms for enhancing rice N utilization and its effects on paddy field N balance remain unclear. We aimed to elucidate the potential enzymatic mechanisms underlying LCC’s influence on rice N use and quantify the impact of LCC on paddy field N balance. In 2022 and 2023, a single-factor randomized block design experiment was conducted during the rice planting season. Four N treatments: no N (ONF), farmers’ conventional practices + urea [FNR] as the control, LCC + urea [SSNM1], LCC + controlled-release urea [SSNM2] were administered. Rice yield and N uptake were positive correlations with nitrate reductase (NR), glutamine synthetase (GS), glutamate-pyruvate transaminase (GPT), glutamate-oxaloacetate transaminase (GOT) and glutamate dehydrogenase (GDH) activities, which were higher under SSNM1 and SSNM2 compared with FNR, but were negative correlation with proteinase activity. Moreover, SSNM1 and SSNM2 increased rice yield by 9.2% and 9.4%, N uptake by 15.4% and 15.3%, and N use efficiency by 46.9% and 65.0%, and reduced reactive N losses by 46.2% and 66.7%, respectively. The annual net soil N inputs under FNR, SSNM1, and SSNM2 were 12.6, 8.9, and 4.2 kg N ha⁻¹, respectively. LCC-based N management increased N uptake and rice yield by enhancing the activities of NR, GS, GPT, GOT, and GDH while reducing protease activity. Moreover, LCC maintained soil N supply capacity even with reduced nitrogen fertilizer application. Full article

This study investigates reading performances and eye movements in individuals with eccentric fixation due to age-related macular degeneration (AMD). Overall, 17 individuals with bilateral AMD (7 males; mean age 77.47 ± 5.96 years) and 17 controls (10 males; mean age 72.18 ± 5.98 years) were assessed for reading visual acuity (VA), reading speed (Minnesota low vision reading chart in Slovene, MNREAD-SI), and near contrast sensitivity (Pelli-Robson). Microperimetry (NIDEK MP-3) was used to evaluate preferential retinal locus (PRL) location and fixation stability. Eye movements were recorded with Tobii Pro-glasses 2 and analyzed for reading duration, saccade amplitude, peak velocity, number of saccades, saccade duration, and fixation duration. Individuals with AMD exhibited significantly reduced reading indices (worse reading VA (p < 0.001), slower reading (p < 0.001), and lower near contrast sensitivity (p < 0.001)). Eye movement analysis revealed prolonged reading duration, longer fixation duration, and an increased number of saccades in individuals with AMD per paragraph. The number of saccades per paragraph was significantly correlated with all measured reading indices. These findings provide insights into reading adaptations in AMD. Simultaneously, the proposed approach in analyzing eye movements puts forward eye trackers as a prospective diagnostic tool in ophthalmology. Full article

Emerging research has shown that pharmacist-led comprehensive medication management (CMM) can be an effective strategy for controlling hypertension. A synthesis of the evidence on the overall effects of CMM on clinical, quality, and economic outcomes could help inform and contribute to improvements in programming and practice. Presently, such a synthesis is limited in the literature. To address this gap, we conducted a scoping review of CMM effects on these outcomes, organized by 4 domains: therapeutic, humanistic, safety and economic. Using predefined search terms for articles on studies published between 2010 and 2024, we performed a literature search utilizing these terms to search the MEDLINE, Cochrane Library and CINAHL databases. For each of the identified studies, we applied a multi-stage screening process to extract data, chart results, and synthesize findings. The process took into account methodology of study design, patient population involved, CMM implementation, relevance of outcomes to clinical improvement, and factors that were deemed relevant to study selection. In total, 49 experimental, observational, and simulation-based studies were included in the scoping review. The synthesis focused on outcomes most frequently reported and those rigorously evaluated by the studies in the review. They included clinical measures of blood pressure reduction and control, frequency and duration of healthcare visits, and changes in medication therapy regimen and medication adherence. Overall, CMM interventions were found to have significantly favorable effects on systolic blood pressure reduction, hypertension control, and medication changes. Other outcomes, which showed positive effects, included self-reported patient experience and behaviors, emergency department visits, hospitalizations, mortality, and program costs and related savings from implementing a CMM program. Some results, however, were mixed. For example, a number of studies reported outcomes data without significance testing and many generally lacked consistent characterization of their programming and implementation processes. Future research and practice evaluations should include these elements in their documentation. Furthermore, a more consistent approach to implementing CMM in the field may lead to better support of program delivery fidelity, helping to optimize CMM, moving it from demonstrated efficacy to intervention effectiveness in the real world. Full article

Background: Dissection around the superior mesenteric artery (SMA) is a key step for local clearance of periampullary cancers in pancreaticoduodenectomy (PD). Since the 2000s, SMA-first approaches have gained popularity in open surgery to allow early vascular control and resectability assessment. With the rise of robotic pancreaticoduodenectomy (RPD), various SMA dissection techniques have been adapted to the robotic setting. Objective: To map current evidence on SMA dissection techniques in RPD and summarize technical variations. Eligibility Criteria and Sources of Evidence: A PubMed search identified 116 records. After title and abstract screening and full-text review, 27 studies focusing on SMA dissection for periampullary tumors in RPD with sufficient technical detail were included. Studies on open/laparoscopic PD, lacking technical description, or reporting duplicate techniques were excluded. Charting Methods: Data were charted based on the SMA approach type, surgical details, and institution. Results: Among the 27 included studies, multiple approaches were identified—anterior, right posterior, left posterior, uncinate, and mesenteric—each adapted to the robotic platform. Techniques varied in exposure, lymphadenectomy, and vessel control. Conclusions: This scoping review reveals diverse SMA dissection strategies in RPD. While technical innovation is progressing, further studies are warranted to standardize approaches and assess their oncologic and surgical outcomes. Full article

This paper aims to study the potential of whey, a by-product in the dairy industry, to be used as a sustainable and health-promoting ingredient in baking. In this regard, whey powder (WhF) was produced and incorporated into three composite flours consisting of wheat flour and whey powder in proportions of 5% (WhWF5), 10% (WhWF10), and 15% (WhWF15). These composite flours were then used to produce bread. The nutritional properties (proximate composition, macro and microelement content) and bioactive compounds (total polyphenols and antioxidant activity) were assessed for both the composite flours and the resulting breads. In addition, the rheological behavior of the dough was evaluated using the Mixolab system, while the microstructural characteristics and physical properties of the composite flours were analyzed using Small/Wide Angle X-ray Scattering (SAXS/WAXS) and Fourier Transform Infrared Spectroscopy (FTIR). Sensory evaluation of the breads was also performed. The results demonstrated a positive effect of the whey powder addition on the nutritional profile of both composite flours and bakery products, particularly through increased protein levels (25.24–37.77% in fortified flours vs. 11.26% in control; 16.64–18.89% in fortified breads vs. 14.12% in control) and enhanced mineral content (11.27–80.45% higher compared to white wheat bread), alongside a reduction in carbohydrate content. Bread fortified with 15% whey powder showed higher monolement with increases of 27.80% for K, 7.01% for Mg, and 28.67% for Ca compared to control bread without whey. The analysis of the Mixolab charts confirmed the progressive influence of whey powder on dough rheology. While water absorption remains high, other functional parameters, such as gluten quality, kneading capacity, and starch viscosity, were negatively affected. Nonetheless, the nutritional advantages and reduced retrogradation tendency may offset these drawbacks in the context of developing functional bakery products. Formulations containing 5–10% whey powder appear to offer an optimal balance between technological performance, nutritional quality, and sensory acceptance. Full article

In the present investigation, carbon dioxide (CO₂), carbon monoxide (CO), hydrocarbons (HC), nitric oxides (NO_X), particulate matter (PM), and fuel consumption were measured in a compression ignition internal combustion engine on a road route cycle in Quito, Ecuador. We used premium diesel and a mixture of diesel and cerium oxide at a concentration of 250 ppm. This research aimed to investigate the impact of cerium oxide on fossil fuels in terms of CO₂, CO, HC, NOx, PM, and fuel consumption. Five repetitions were performed for each fuel, and the results obtained were statistically analyzed using control charts. The experimental results showed a 27.1% reduction in PM, a 24.9% increase in NOx, and a 24.2% increase in HC, along with a 1% decrease in fuel consumption compared to the premium diesel case. We observed that the reduction in PM was due to the catalytic action of CeO₂, which enhances carbon oxidation. On the other hand, the increase in NOx was related to the higher temperature in the combustion chamber resulting from the improved thermal efficiency of the engine. This study provides guidelines for controlling air pollutants originating from vehicle emissions in high-altitude (over 2000 masl) road operations using cerium oxide as an additive. Full article

The kynurenine (KYN) metabolic pathway sits at the crossroads of immunity, metabolism, and neurobiology, yet its clinical translation remains fragmented. Emerging spatial omics, wearable chronobiology, and synthetic microbiota studies reveal that tryptophan (Trp) metabolism is regulated by distinct cellular “checkpoints” along the gut–brain axis, finely modulated by sex differences, circadian rhythms, and microbiome composition. However, current interventions tackle single levers in isolation, leaving a key gap in the precision control of Trp’s fate. To address this, we drew upon an extensive body of the primary literature and databases, mapping enzyme expression across tissues at single-cell resolution and linking these profiles to clinical trials investigating dual indoleamine 2,3-dioxygenase 1 (IDO1)/tryptophan 2,3-dioxygenase (TDO) inhibitors, engineered probiotics, and chrono-modulated dosing strategies. We then developed decision-tree algorithms that rank therapeutic combinations against biomarker feedback loops derived from real-time saliva, plasma, and stool metabolomics. This synthesis pinpoints microglial and endothelial KYN hotspots, quantifies sex-specific chronotherapeutic windows, and identifies engineered Bifidobacterium consortia and dual inhibitors as synergistic nodes capable of reducing immunosuppressive KYN while preserving neuroprotective kynurenic acid. Here, we highlight a framework that couples lifestyle levers, bio-engineered microbes, and adaptive pharmaco-regimens into closed-loop “smart protocols.” By charting these intersections, this study offers a roadmap for biomarker-guided, multidisciplinary interventions that could recalibrate KYN metabolic activity across cancer, mood, neurodegeneration, and metabolic disorders, appealing to clinicians, bioengineers, and systems biologists alike. Full article

Background/Objective: Penicillin allergy labels (PALs) contribute to broad-spectrum antibiotic use. Thorough documentation can help prescribers identify and remove unnecessary PALs. We aimed to improve documentation of PALs in three pediatric urgent care (PUC) clinics, using a nurse-initiated quality improvement (QI) approach. Methods: QI interventions included a survey to assess prescriber and nurse confidence, an online educational module, and an algorithm to aid in clarifying PALs. We measured the percentage of PALs with a clarified reaction severity as our primary outcome using annotated control charts. Descriptive and inferential statistics evaluated survey responses between nurses and prescribers. Results: Clarified PAL reaction severity had a sustained upward shift from 58.5% to 63.3% following implementation of our interventions. Of 129 nurses and prescribers, 87 (67.4%) respondents completed the survey. Prescribers and nurses reported feeling knowledgeable about PALs but experienced different challenges to clarifying PAL documentation. Prescribers reported time pressures as a barrier to PAL clarification more often than nurses (IQR [3, 4], p = 0.001). Nurses reported higher confidence in ability to document a PAL compared to prescribers (IQR [3.25, 5], p = 0.010). Respondents requested family education and practice guidance to aid PAL clarification. No consistent differences were noted in PAL documentation by sociodemographic characteristics. Conclusions: The nurse-initiated QI approach demonstrated improved PAL documentation in PUCs. Engaging nurses in antibiotic stewardship initiatives can provide new perspectives and broaden the approach to intervention design and implementation. Future efforts should focus on improving electronic health record and interprofessional workflow processes to build on these improvements. Full article

Background/Objectives: Prior studies using administrative data have found that antenatal anemia is a risk factor for severe maternal morbidity (SMM). However, administrative definitions, including the commonly used definition from the Centers for Disease Control and Prevention (CDC), have a poor positive predictive value for some SMM components. We tested the relationship between hemoglobin level at delivery admission and SMM, as defined by gold-standard chart review. Methods: This was a retrospective case–control study of deliveries at a high-acuity hospital in Los Angeles, California, from 2016 to 2019. Administrative data were screened to identify patients with CDC SMM. Control-patients were selected at random from screen-negative individuals. Medical records for all individuals were reviewed for gold-standard SMM criteria, and clinical data were abstracted. Confirmed-positive and confirmed-negative patients were compared using bivariate analyses. Multiple logistic regression models were developed to test the relationship between admission hemoglobin level and gold-standard SMM. Results: Of 4202 eligible individuals, 275 (6.5%) screened positive for SMM. Of these, 107 (38.5%) met gold-standard SMM criteria; 285 confirmed-negative controls were retained for analysis. Case-patients were more likely than control-patients to have anemia on delivery admission (43.9% vs. 24.2%, p < 0.01) and had lower admission hemoglobin levels (11.2 ± 1.7 g/dL vs. 11.9 ± 1.3 g/dL, p < 0.01). After controlling for covariates, admission hemoglobin was independently and inversely associated with gold-standard SMM (aOR = 0.76, 95% CI 0.60–0.96, p = 0.02). Conclusions: Lower hemoglobin level at delivery admission was associated with an increased risk of developing gold-standard SMM. Full article

Background: The primary effect of Botulinum toxin (BoNT) is to cause weakness in the injected muscles by inhibiting the release of acetyl choline from presynaptic nerve terminals. Its effect on sensorimotor integration (SMI) has largely been confined to small studies. The aim of this review is to highlight effect of BoNT on SMI in the context of Parkinson’s disease (PD), Cervical dystonia (CD), and Writer’s cramp (WC). Methods: Using keywords “Botulinum toxin” and “sensorimotor integration” or “Freezing of gait (FOG)” or ‘Tremor”or “Cervical dystonia” or “Parkinson’s disease”, or “Writer’s cramp”, PubMed database was searched for relevant articles supporting our view. The abstracts of all resultant articles (case reports, case series, randomized trials, observational studies) were reviewed to look for evidence of effects of botulinum toxin on SMI. The relevant articles were charted in excel sheet for further full text review. Results: In FOG, chronic BoNT injections may alter central motor patterns with inclusion of alternative striatal systems, cerebellum, and its connections. In tremor, the afferent proprioceptive input may be modified with reduction of intracortical facilitation and increment of intracortical inhibition. In CD, BoNT can restore disorganized cortical somatotrophy, the key pathophysiology behind cervical dystonia. Similarly, in WC, both the deficient sensory system and abnormal reorganization of the sensorimotor cortex may be altered following chronic BoNT injections. Conclusions: There is preliminary evidence that BoNT may modulate SMI in PD, CD, and WC by altering inputs from the muscle spindles in short term and modifying circuits/particular anatomic cerebral cortices in the long term. Properly conducted randomized trials comparing BoNT with placebo or prospective large-scale studies to look for effect on various surrogate markers reflective of changes in SMI should be the next step to confirm these findings. Targeting the system of afferents like spindles and golgi tendon organs in muscles may be a better way of injecting BoNT, with lower amounts of toxin needed and potential for lesser side-effects like weakness and atrophy. However, this needs to be proven in controlled trials. Full article

Accurate parametric modeling of lithium-ion batteries is essential for battery management system (BMS) design in electric vehicles and broader energy storage applications, enabling reliable state estimation and effective thermal control under diverse operating conditions. This study presents a detailed characterization of lithium-ion cells to support advanced BMS in electric vehicles and stationary storage. A second-order equivalent circuit model is developed to capture instantaneous and dynamic voltage behavior, with parameters extracted through Hybrid Pulse Power Characterization over a broad range of temperatures (−10 °C to 45 °C) and state-of-charge levels. The method includes multi-duration pulse testing and separates ohmic and transient responses using two resistor–capacitor branches, with parameters tied to physical processes like charge transfer and diffusion. A weakly coupled electro-thermal model is presented to support real-time BMS applications, enabling accurate voltage, temperature, and heat generation prediction. This study also evaluates open-circuit voltage and direct current internal resistance across pulse durations, leading to power capability maps (“fish charts”) that capture discharge and regenerative performance across SOC and temperature. The analysis highlights performance asymmetries between charging and discharging and confirms model accuracy through curve fitting across test conditions. These contributions enhance model realism, thermal control, and power estimation for real-world lithium-ion battery applications. Full article

Nomex honeycomb composites (NHCs) are highly sensitive to the abnormal wear state of disc tools during cutting, leading to poor product quality. This paper proposes a real-time anomaly detection method combining a novel CNN–GRU–Attention (CGA) deep learning model with an Exponentially Weighted Moving Average (EWMA) control chart to monitor sensor data from the disc tool. The CGA model integrates an improved CNN layer to extract multidimensional local features, a GRU layer to capture long-term temporal dependencies, and a multi-head attention mechanism to highlight key information and reduce error accumulation. Trained solely on normal operation data to address the scarcity of abnormal samples, the model predicts cutting force time series with an RMSE of 0.5012, MAE of 0.3942, and R² of 0.9128, outperforming mainstream time series data prediction models. The EWMA control chart applied to the prediction residuals detects abnormal tool wear trends promptly and accurately. Experiments on real NHC cutting datasets demonstrate that the proposed method effectively identifies abnormal machining conditions, enabling timely tool replacement and significantly enhancing product quality assurance. Full article

Background: Hamstring strain injuries (HSIs) are among the most common and recurrent injuries in sports involving high-speed running. While eccentric training has demonstrated efficacy in reducing HSI risk, the role of sprint training as a preventive strategy remains underexplored and often misinterpreted as solely a risk factor. Methods: This review aimed to systematically map the available evidence on the role of sprint training in hamstring injury prevention, identifying mechanisms, outcomes, and potential synergies with other strategies. This scoping review was conducted following the Joanna Briggs Institute’s methodology and reported in accordance with PRISMA-ScR guidelines. Seven databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL, SPORTDiscus, CINAHL, and PEDro) were searched up to October 2024. Studies were included if they involved adult athletes and examined the effects of sprint training, ≥80–90% maximal sprint speed (MSS), on hamstring injury prevention, muscle architecture, or functional outcomes. All databases were searched from inception to 15 October 2024, and the screening and data-charting process was completed on 30 April 2025. Results: Twelve studies met the inclusion criteria. Sprint exposure, when combined with eccentric strengthening and biomechanical optimisation, led to injury reductions ranging from 56% to 94%. Eccentric interventions produced fascicle length increases of up to 20% and strength gains of 15–20%. Improvements in sprint technique and neuromuscular control were also reported. Biomechanical risk factors, including pelvic tilt and hip extension deficits, were linked to increased HSI risk. The most common eccentric protocols included Nordic Hamstring Exercises (NHE), Razor Curls, and hip-dominant exercises, typically performed 1–2 times per week for 4 to 8 weeks. Conclusions: High-speed sprint training, when properly programmed and integrated into comprehensive preventive strategies, may enhance tissue resilience and reduce HSI risk. Combining sprint exposure with eccentric strengthening and technical coaching appears to be more effective than isolated interventions alone. Practically, these results support the systematic inclusion of progressive high-intensity sprint exposure in routine hamstring-injury-prevention programmes for field-sport athletes. Full article

Background: Standard visual acuity (VA) is often preserved in early retinitis pigmentosa (RP), limiting its value as a marker of functional impairment. Alternative measures such as low-luminance deficit (LLD) and low-contrast deficit (LCD) may detect earlier changes in cone function. This study aimed to evaluate the diagnostic utility of these measures in RP patients under photopic and mesopic conditions. Methods: A prospective observational study was conducted on 57 RP patients and 54 age-matched controls. Binocular VA was assessed using ETDRS charts at 100% and 10% contrast under photopic (100 cd/m²) and mesopic (1 cd/m²) conditions. LLD and LCD scores were computed from VA differences across conditions. ROC curve analysis was used to determine diagnostic accuracy. Results: RP patients showed significant VA loss under reduced luminance and contrast (p < 0.001), independent of age. LLD under high contrast was reduced, while LLD under low contrast and LCD (both photopic and mesopic) were significantly higher than in controls. The mesopic LCD demonstrated the highest diagnostic capacity (AUC = 0.87), with a threshold of > 13 ETDRS letters yielding optimal sensitivity and specificity. Unlike standard VA, mesopic LCD correlated with functional symptoms and was unaffected by age. Conclusions: Low-contrast VA under mesopic conditions is a simple, reproducible, and sensitive marker for early visual dysfunction in RP. A difference > 13 ETDRS letters may serve as a clinically relevant threshold for disease monitoring and early detection in retinal dystrophies. Full article