Conectar
by Natsuhiro Takahashi, Akihiko Fujita, Yuki Azetsu, Akiko Karakawa, Mie Myers, Masamichi Takami, Masahiro Chatani
Bone loss occurs in astronauts during prolonged spaceflight, thus indicating the sensitivity of skeletal homeostasis to altered gravitational environments. Previous studies have shown that microgravity affects osteoclast differentiation and bone resorption, which suggests that osteoclasts possess mechanisms to sense and respond to gravity-generated mechanical forces. For testing of the related mechanisms, hypergravity can be experimentally reproduced with use of a centrifuge. In the present study, osteoclasts derived from mouse bone marrow were subjected to hypergravity under three conditions: 30G exposure using a non-CO2 centrifuge system, and short- or long-term exposure to 3G or 5G using an incubator-compatible centrifuge system. Cytoskeletal organization and resorptive function were assessed using TRAP (tartrate-resistant acid phosphatase) staining, F-actin visualization, and dentin pit assays. In addition, phosphoproteomic analysis was performed after short-term exposure to 5G hypergravity. Hypergravity exposure for as brief as 30 minutes compromised F-actin ring integrity, reduced fluorescence intensity, and promoted nuclear repositioning toward actin rings, whereas tubulin and vinculin localization remained unchanged, and the structural alterations corresponded to attenuated resorption pit formation. Quantitative phosphoproteomic profiling revealed coordinated hypergravity-dependent changes in phosphorylation across multiple cellular modules, including cytoskeletal organization, membrane trafficking, intracellular signaling, and nuclear regulatory pathways. Together, these results indicate that osteoclasts are sensitive to gravity-generated mechanical loading, with hypergravity rapidly modifying F-actin-associated cytoskeleton properties and reprogramming phosphorylation-dependent signaling networks, ultimately attenuating bone-resorptive activity. These findings provide mechanistic insight into how osteoclasts respond to altered gravitational loading conditions and have implications for skeletal adaptation during spaceflight and under altered mechanical loading conditions on Earth.Although implementing evidence-based interventions has been shown to improve the quality of care, there is limited evidence evaluating how these interventions are implemented. In intensive care settings, the use of evidence-based protocols, guidelines and care bundles has been associated with enhanced care quality and reduced burden on patients.
To identify and map existing evidence on the evaluation of evidence-based intervention implementation in adults' intensive care.
A scoping review was conducted by including original published and unpublished studies in English and Finnish.
The studies were retrieved from five databases (CINAHL, Scopus, Ovid Medline, Medic ja Mednar) from January 2000 to December 2024. The data search was performed on 29 November 2022 and updated on 10 December 2024. The results were synthesized and presented in a tabular and descriptive form.
A total of 19 studies were included in the review. These studies evaluated the implementation of evidence-based interventions, focusing on nurse and patient outcomes. Nurse outcomes included measures such as compliance, knowledge and self-confidence. Patient outcomes included indicators such as body temperature, blood glucose, incidence of pressure ulcers and length of stay.
The evaluation of evidence-based intervention implementation does not consistently extend to the evaluation of the entire implementation process. More consistent research reporting would improve disseminating the evidence. The evaluation implementation makes it possible to show the impact of nurse and patient outcomes. The evaluation results can reveal the success of the implementation. Further research on evaluation implementation, development of systematic and comprehensive evaluation implementation methods, or evaluation matrix is needed.
The review will be useful for nursing professionals in planning evidence of implementation, developing or researching evaluation implementation. Promoting evaluation of evidence-based intervention implementation in Nursing can improve the quality of patient care, improve disseminating evidence and uniformities of care practice.
What Problem Did the Study Address? There is limited evidence of evaluation of evidence-based interventions of implementation. Evaluating evidence-based implementation is important to ensure the quality of patient care and patient safety.
What Were the Main Findings? Evaluation of implementation of evidence-based interventions focused on nurse and patient outcomes. Evaluation of the entire implementation process was not identified, and implementation strategies were not evaluated.
Where and on Whom Will the Research Have an Impact? Evidence-based practice implementation in nursing for researchers, developers, nursing leaders and clinical nursing practitioners who implement and evaluate evidence-based practice implementation.
PRISMA 2020 statement.
No Patient of Public Contribution: This study did not include patient or public involvement in its design, conduct or reporting.
Childhood cancer survival rates are not equal for all, with disparities existing both between and within low- and middle-income countries and high-income countries, particularly among ethnic minorities and children with migrant backgrounds. Factors such as cultural misunderstandings, language barriers and limited support networks can lead to delays in diagnosis and treatment challenges, which can result in poor health outcomes. Social determinants of health (SDoH), such as housing insecurity and poverty, may worsen these disparities. This protocol outlines a systematic review to examine childhood cancer survival in children with migrant backgrounds compared with non-migrants and to explore the SDoH associated with these survival outcomes.
We will search MEDLINE (PubMed), Scopus, Web of Science, and Embase for relevant studies, with secondary searches of grey literature. Two reviewers will screen for observational studies, including longitudinal cohort, case–control, cross-sectional and registry-based studies, that report childhood cancer survival outcomes (eg, survival rates, HRs) for both migrant and non-migrant populations. A narrative synthesis will explore SDoH and their association with survival outcomes. If data allow, we will perform random-effects meta-analyses to estimate pooled survival outcomes. Subgroup analyses will examine factors such as geographic region, migration status and type of cancer.
Understanding factors contributing to childhood cancer survival disparities in migrant populations is critical for informing the development of targeted strategies to address them, ensuring all children, regardless of their migration status, have an equitable opportunity for effective care and improved outcomes.
Ethical approval is not required for this study as it is based on previously published data and does not involve primary data collection. We will publish the results in peer-reviewed journals and present at academic conferences.
CRD42024547239.
To present the process of establishing a Doctor of Nursing Practice (DNP) policy analysis project option at one nursing school, offering examples of diverse student and graduate analyses to guide other institutions.
Nurses are skilled patient advocates, and their advocacy forms a crucial foundation for influencing health policy. This, in turn, enhances population health and addresses health disparities, particularly for vulnerable groups. DNP students are educated to use innovative methods to integrate current evidence to inform practice and policy, yet some nursing schools lack resources to support comprehensive DNP policy analysis projects.
The article presents a case example of how one institution developed a pathway and instructional support to formally offer DNP students the option to perform a DNP policy analysis project.
Essential elements to support students' successful completion of a DNP policy analysis project include adequate faculty expertise in health policy and a structured institutional framework. Residency activities must deepen a student's understanding and knowledge about policy and the health problem trying to be solved with policy. Clear documentation of these unique residency activities is crucial. There is a strong emphasis on the need for clear communication and guidance between programme faculty, programme mentors and students. DNP policy analysis projects enrich students' knowledge, skills and networks, fostering future policy leaders and facilitating collaboration with clinical experts across diverse research fields.
Nurturing DNP students completing policy analysis projects is vital for translating evidence into practice, developing future nurse policy leaders and ensuring health equity and access to quality healthcare.
DNP policy projects can positively influence nursing practice and policy. Expanding upon previous DNP students' policy analysis projects also provides a unique opportunity to build and broaden nursing's impact on policy development.
by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan
BackgroundUnintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.
MethodsA cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.
ResultThe lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.
ConclusionThis study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.
by Smail Acila, Nora Allioui, Samir Derouiche
Heavy metal contamination poses a significant threat to agricultural productivity. This study investigated the physiological and biochemical responses of Cucurbita pepo seeds to cadmium (Cd) and copper (Cu) stress (100–200 µM) during germination. Although germination rates remained high (86.67–93.33%), seed vigor indices declined significantly under metal stress. Cadmium exhibited stronger growth inhibition, reducing total seedling length by 63.02% at 200 µM, whereas copper primarily affected biomass accumulation, reducing the seedling weight-based vigor index (SVIW) by 40.4%. Biochemical analyses revealed metal-specific impacts on reserve mobilization. Cadmium exposure (200 µM) decreased soluble sugars in cotyledons by 16%, while maintaining protein content at 106% of control levels, indicating inhibition of protein degradation and impaired reserve utilization. In contrast, copper at 100 µM increased cotyledonary sugars by 63%, reflecting its dual role as both a micronutrient and stressor. Principal component analysis confirmed the greater toxicity of Cd, which explained 79.7% of the variance in metabolic disruption. These findings demonstrate that cadmium consistently impairs seedling establishment by disrupting nutrient mobilization pathways, while copper exhibits concentration-dependent effects, being stimulatory at low concentrations but inhibitory at higher levels. This study provides crucial insights into heavy metal phytotoxicity mechanisms and underscores the importance of monitoring metal pollution in agricultural systems to enhance crop resilience.Birth timing decisions, a type of reproductive decision-making (RDM), have yet to be explored in the RDM literature through an ethnological lens. Existing literature has generally observed reproductive decisions across broad racial categories, which has not allowed for a nuanced understanding of the cultural factors influencing birth timing decisions. This scoping review aims to answer the following questions: (1) How do different ethnic groups approach birth timing decisions? (1a) What social and structural factors influence birth timing/spacing decisions for different ethnic groups? (1b) What cultural logics emerge during these decision-making processes? Specifically, these questions are explored within the geographical context of the USA, as its diverse demographics, size and availability of data make it an ideal case. This scoping review thus makes two key contributions to the health literature: (1) it explores trends in birth timing decisions, which is a type of RDM that has typically been overlooked in favour of topics such as birth control use and timing, abortions and miscarriages, and wrongful births, and (2) it explores birth timing decisions from an ethnological perspective in a highly relevant context, expanding beyond homogenising race-based categorisations, toward a nuanced understanding of cultural considerations in family planning decisions across the USA.
This scoping review follows the protocol laid out in the extension of the Preferred Reporting Items for Systematic Reviews and Meta-analysis, for scoping reviews and will use thematic analysis[1]. Using four databases, Medline, Web of Science, the International Bibliography of the Social Sciences and Sociological Abstracts, original research articles have been captured using the attached search strategy, which contains key terms related to both the independent and dependent variables of interest. Results have been filtered to include only studies published in English within the last 20 years (2005 to present) and conducted in the USA. These criteria were implemented using a verified search string. Additional filters for human-only results were applied to the Medline search. All relevant publications have been imported to Covidence, where the authors will independently conduct title/abstract screening and full-text screening, as well as a thematic analysis of the extracted data from the remaining articles that meet the inclusion criteria. The authors aim to organise and synthesise all findings using the attached data extraction table (see supplemental documents).
This study uses existing publications and therefore does not require ethics submission or review. We intend to publish our scoping review in a peer-reviewed journal.
This scoping review protocol has been registered via Open Science Framework (OSF); the preregistration can be found at the following link: https://osf.io/6f4bq
by Wafaa T. ALQadrie, Ali M. Saleh, Sami AL-Rawashdeh, Ola N. Alfuqaha, Suheir I. Abdallah
BackgroundIn recent years, the concept of followership has gained significant attention, challenging the traditional leadership-centric view of organizational management positions. While effective followership is vital to the success of any organization, it has often been overlooked, especially in healthcare, where teamwork is crucial.
AimThe current study aimed to identify the followership styles of nurses in Jordan and examine how these styles relate to nurses’ demographic and work-related characteristics.
MethodA descriptive cross-sectional design was employed. Using a multistage sampling approach, 351 registered nurses were recruited from governmental, private, and teaching hospitals across northern, central, and southern Jordan. Data were collected through an online survey using the validated Kelley Followership Questionnaire–Revised (KFQ-R). Both descriptive and inferential statistical analyses were conducted.
ResultsFindings revealed that the predominant followership style was exemplary (68.7%), followed by the pragmatist (31.3%). Chi square test revealed statistically significant difference between followership style and marital status (χ² (1) = 6.193, p = .013), working area (χ² (2) = 7.405, p = .025), nursing care delivery system (χ² (3) = 13.926, p = .003), and Decision-making style (χ² (3) = 17.173, p = .001). The binary logistic regression was significant, χ² (26) = 67.77, p
The number of patients requiring wound care is increasing, placing a burden on healthcare institutions and clinicians. While negative pressure wound therapy (NPWT) use has become increasingly common, Middle East-specific wound care guidelines are limited. An in-person meeting was held in Dubai with 15 wound care experts to develop guidelines for NPWT and NPWT with instillation and dwell (NPWTi-d) use for the Middle East. A literature search was performed using PubMed, Science Direct and Cochrane Reviews. Prior to the meeting, panel members reviewed literature and existing guidelines on NPWT and/or NPWTi-d use. A wound management treatment algorithm was created. Patient and wound assessment at presentation and throughout the treatment plan was recommended. Primary closure was recommended for simple wounds, and NPWT use was suggested for complex wounds requiring wound bed preparation. NPWTi-d use was advised when wound cleansing is required, if the patient is unsuitable for surgical debridement, or if surgical debridement is delayed. When NPWTi-d is unavailable, panel members recommended NPWT. Panel members recommended NPWT for wound bed preparation and NPWTi-d when wound cleansing is needed. These recommendations provide general guidance for NPWT and NPWTi-d use and should be updated as more clinical evidence becomes available.
To examine the characteristics of the health care needs corresponding to the medical care process and HR-QOL of women with cancer.
A descriptive design was adopted.
The study's participants were 122 women with cancer who completed a survey before and 6 months after treatment initiation. A principal component analysis (PCA) was conducted on a set of 12 health care satisfaction scores at each point. Correlations were examined between the resulting components and HR-QOL indicators, including subjective well-being, symptoms, symptom-related interference, anxiety and depression.
Most participants reported high health care satisfaction in both phases. PCA indicated the presence of 3 distinct domains: satisfaction with health care, health care management and supportive care. In both phases, these domains accounted for about 60% of the variance, while the remaining 40% was unexplained. Only satisfaction with health care was correlated with HR-QOL at both phases, with particularly strong associations observed for subjective well-being and depression at 6 months. Before treatment initiation, the item of ‘nursing care and practice’ received the highest average score, but demonstrated a negative loading on the component of ‘satisfaction with health care management’. The component of ‘satisfaction with supportive care needs’ was retained at both phases.
Health care plays a pivotal role in maintaining patients' quality of life, while supportive care and the integration of nursing practice within health care management remain essential.
High satisfaction scores do not necessarily mean that all health care needs are met. Addressing unmet needs from the perspective of HR-QOL and ensuring continuous supportive care throughout the treatment process is imperative.
Data provided by women with cancer was used.
To uncover perspectives and refine 12 initial program theories concerning the implementation of pain management interventions in intensive care units. Contexts enabling implementation are delineated, and causal mechanisms within these contexts are described.
A realist evaluation approach was employed.
Fourteen purposively selected Australian nurses of variant roles were virtually and individually interviewed between July and September 2023. Participants were presented with initial program theory, and their perspectives were collated. Data were analysed using an integrated approach of context (C), mechanism (M), outcome (O) categorisation coding, CMO configurations connecting and pattern matching.
Pain management interventions work if perceived to be beneficial, precise, comprehensive and fit for purpose. Nurses should be willing to change attitudes and update knowledge. Unit leaders should nurture the development of nurses' professional identity, access to learning, autonomy and self-determination. Organisations should change the infrastructure, provide resources, mitigate barriers, develop shared mental models, update evidence and institute quality assurance. Adherence to interventions is affected by the outcomes of implementation and intrinsic merits of interventions. In these contexts, confidence is boosted; feelings of empowerment, self-efficacy, reflective motivation, trust, awareness and autonomy are developed; and capacity is built. Furthermore, frustration from the variability of practices is reduced, accountability and ownership are augmented, yielding positive implementation outcomes.
Findings have implications on nurses, team leaders and organisations concerned with implementation.
The findings provided a fortified understanding of conditions favouring successful implementation of pain management interventions. Actions should be undertaken at an individual, unit and organisation level to ensure successful implementation.
RAMESES II Reporting Standards for Realist Evaluations informed presentation of study.
Intensive care nurses contributed insights to refine the program theory.
There are challenges involving human resource management, as the selection and evaluation processes for nursing diagnostic labels are time-consuming, resulting in an excessive workload. This, in turn, can lead to insufficient attention being given to patients' medical issues. As a proof of concept, to solve challenges related to nursing diagnoses, we developed an artificial neural network model using progress records and evaluated its performance. Specifically, datasets were obtained from progress record data from the critical care department system in Japan between 2014 and 2019 and the corresponding nursing diagnosis data from electronic medical records. The model was trained, and its performance was evaluated. We compared several methods for vectorizing progress records and evaluated performance with and without oversampling for imbalanced data. We used a naive Bayes classifier for comparison. The model using term frequency–inverse document frequency achieved the highest values for both accuracy and the area under the precision-recall curve across all target nursing diagnoses (accuracy = 0.705–0.911; area under the precision-recall curve = 0.387–0.929). The artificial neural network model outperformed the naive Bayes classifier in both accuracy and area under the precision-recall curve, which indicated its superiority as a classifier. 
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