Characteristics of refractory disease and persistent symptoms in inflammatory arthritis: Qualitative framework analysis of interviews with patients and health care professionals.

Objectives: This study aims to explore patients' and clinicians' understanding and experiences of refractory disease (RD) and persistent physical and emotional symptoms (PPES) in patients with inflammatory arthritis (IA), namely rheumatoid arthritis or polyarticular juvenile idiopathic arthritis from their perspectives through interviews and/or focus groups.

Design: A qualitative study was conducted, following a pragmatic epistemology approach with framework analysis employed.

Methods: Semi-structured interviews or focus groups with IA patients (n = 25) and multi-disciplinary rheumatology HCPs (n = 32) were conducted at one time point to obtain participants respective understanding and experiences of managing RD/PPES, and its impact on the patient-professional relationship.

Treatment and Survival Disparities in Asian Americans With Hepatocellular Carcinoma: The Need to Disaggregate a Diverse Cohort.

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death in the United States and globally. The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population has often been studied as one homogenous cohort despite its heterogeneity. We aim to understand differences in treatment modality and mortality among AANHPI patients with early-stage HCC.

A recipe for health: A descriptive qualitative study examining paternal influence and the establishment of children's healthy eating habits in Singapore.

This study aimed to explore Singaporean fathers' perceived influence over their children's eating habits. A descriptive qualitative study design was used. Convenience sampling was used to recruit fathers of children aged 3-21 years old from a general paediatric outpatient clinic in a tertiary public hospital.

Development and pilot testing of a theory-driven and evidence-based advance care planning training programme for nurses in acute care settings.

Purpose: To develop and pilot-test a novel training programme for nurses in acute care settings to improve their decision-making support skills, knowledge, attitudes, and confidence in conducting advance care planning (ACP).

Methods: A single-group repeated measures design was employed. This study was conducted in two phases.

Aged and Obscured Wildfire Smoke Associated with Downwind Health Risks.

Fine-mode particulate matter (PM) is a highly detrimental air pollutant, regulated without regard for chemical composition and a chief component of wildfire smoke. As wildfire activity increases with climate change, its growing continental influence necessitates multidisciplinary research to examine smoke's evolving chemical composition far downwind and connect chemical composition-based source apportionment to potential health effects. Leveraging advanced real-time speciated PM measurements, including an aerosol chemical speciation monitor in conjunction with source apportionment and health risk assessments, we quantified the stark pollution enhancements during peak Canadian wildfire smoke transport to New York City over June 6-9, 2023.

Vaccines for immunological defense against traumatic brain injury.

Unlabelled: Traumatic brain injury (TBI) and subsequent neurodegeneration is partially driven by chronic inflammation both locally and systemically. Yet, current clinical intervention strategies do not mitigate inflammation sequalae necessitating the development of innovative approaches to reduce inflammation and minimize deleterious effects of TBI. Herein, a subcutaneous formulation based on polymer of alpha-ketoglutarate (paKG) delivering glycolytic inhibitor PFK15 (PFKFB3 inhibitor, a rate limiting step in glycolysis), alpha-ketoglutarate (to fuel Krebs cycle) and peptide antigen from myelin proteolipid protein (PLP139-151) was utilized as the prophylactic immunosuppressive formulation in a mouse model of TBI.

Lessons learned from a case of phlegmasia cerulea dolens treated with thrombolysis and iliac vein stenting.

Phlegmasia cerulea dolens is a rare manifestation of massive deep vein thrombosis with threat to limb and life. A patient with a background of ovarian malignancy in remission and pelvic radiotherapy presented with left lower limb phlegmasia cerulea dolens as a result of extensive acute left lower limb deep vein thrombosis, extending from the popliteal vein to the inferior vena cava. While initial rapid thrombolysis and left iliac vein stenting were successful, she developed significant hemorrhagic complications from her right radial intra-arterial line with compartment syndrome requiring fasciotomy.

A new genus for the small shore crab previously known as Brachynotus spinosus (H. Milne Edwards, 1853) (Crustacea: Brachyura: Varunidae), with two new species from southern Australia and Samoa.

The Australian southern temperate shore crab known as "Brachynotus spinosus" is found to be an endemic new species. The true B. spinosus (H.

The relationship of changes in insulin demand and insulin adequacy over the life course.

Aims/hypothesis: Insulin requirements in the human body undergo continuous changes in response to growth and development. We assessed the life course relationships between insulin demand and insulin adequacy.

Methods: Three independent Chinese cohorts (204 children, aged [mean ± SD] 7.

Postpartum Screening for Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus: A Cost-Effectiveness Analysis in Singapore.

Objectives: In Singapore, diabetes imposes a huge population health and economic burden. Despite that, there is paucity of evidence on the health economics of screening programs for type 2 diabetes, especially in the context of screening after gestational diabetes (GDM). The objective of this study is to assess cost-effectiveness of universal lifelong screening for type 2 diabetes after GDM, which is supported by current guidelines, compared with elective screening where 54% of mothers with GDM undertake one-off screening.

Case report: Dichloroacetate-induced methaemoglobinaemia in a G6PD-deficient neonate.

A 3-week-old neonate with glucose-6-phosphate dehydrogenase (G6PD) deficiency and primary lactic acidosis developed haemolytic jaundice and methaemoglobinaemia following treatment with dichloroacetate (DCA), a standard treatment for primary lactic acidosis. While this mechanism has been reported in the sheep model, it has not been described in humans. Our case reinforces the uncommon observation that a G6PD-deficient individual experiencing oxidative stress may develop concurrent methaemoglobinaemia.

Custom-Made Device (CMD) for the Repair of Thoraco-Abdominal Aneurysm (TAA): Mid-Long Term Outcomes from a Single Southeast Asian Centre Experience in Singapore.

Given the high risk of peri-operative morbidity and mortality associated with open repair, endovascular repair for thoraco-abdominal aneurysms is increasingly performed. This study aims to describe mid to long-term results for patients who were treated with COOK Custom-Made Endograft Device at a single Southeast Asian tertiary centre. Mid to long-term results of patients treated from 2012 to 2022 were retrospectively reviewed.

Sphingosine-1-Phosphate Signalling Inhibition Suppresses Th1-Like Treg Generation by Reversing Mitochondrial Uncoupling.

Inflammatory environments induce the generation of dysfunctional IFNγT-betFOXP3 Th1-like Tregs, which show defective function and are found in autoimmune conditions including multiple sclerosis (MS). The pathways that control the generation of Th1-like Tregs are not well understood. Sphingosine-1-phosphate (S1P) signalling molecules are upregulated in Th1-like Tregs, and in vivo S1P inhibition with Fingolimod (FTY720) inhibits the expression of genes responsible for Treg plasticity in MS patients.

Impact of Heatwaves and Declining NO on Nocturnal Monoterpene Oxidation in the Urban Southeastern United States.

Nighttime oxidation of monoterpenes (MT) via the nitrate radical (NO) and ozone (O) contributes to the formation of secondary organic aerosol (SOA). This study uses observations in Atlanta, Georgia from 2011-2022 to quantify trends in nighttime production of NO (PNO) and O concentrations and compare to model outputs from the EPA's Air QUAlity TimE Series Project (EQUATES). We present urban-suburban gradients in nighttime NO and O concentrations and quantify their fractional importance (F) for MT oxidation.

International Burn Disaster Nursing: Care, Commitment, Compassion, and Cost.

Background: Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care.

Local Problem: On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people.

Long-Term Outcomes of Primary Cemented Total Hip Arthroplasty with Acetabular Bone Graft for Protrusio Acetabuli: Minimum 10-Year Follow-Up.

: This study reports the long-term survivorship of primary total hip arthroplasty (THA) for protrusio acetabuli. : Patients undergoing THA utilising cement and bone graft acetabular reconstruction for protrusio acetabuli in a university teaching hospital during the period 2003 to 2014 were included. Kaplan-Meier survival estimates were calculated with 95% confidence intervals (CI) up to 15 years following surgery.

Bendable non-silicon RISC-V microprocessor.

Semiconductors have already had a very profound effect on society, accelerating scientific research and driving greater connectivity. Future semiconductor hardware will open up new possibilities in quantum computing, artificial intelligence and edge computing, for applications such as cybersecurity and personalized healthcare. By nature of its ethos, open hardware provides opportunities for even greater collaboration and innovations across education, academic research and industry.