Diagnostic characteristics and management outcome in patients with acromegaly: A 15-year experience at a tertiary care hospital in Pakistan.

OBJECTIVE: To assess the diagnostic features of acromegaly, and analyse its management outcomes over a 15-year period in a tertiary care setting. METHODS: The descriptive, cohort, retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of adult patients of either gender diagnosed with acromegaly based on biochemical and radiological evidence between January 2005 and December 2019. Data was retrieved from the medical records. Data was analysed using SPSS 19. RESULTS: Of the 84 subjects, 54(64.3%) were males and 30(35.7%) were female. The overall mean age was 38.69±13.52 years. The patients presented 5.43±4.3 years after the onset of symptoms, with somatic growth features, such as enlarged hands and feet which was the most common complaint 81(96.4%). Of all the patients, 73(86.9%) underwent trans-sphenoidal surgery for the removal of the pituitary adenoma, while 11(13.1%) opted out of the surgical option. Further, 9(12.3%) patients showed biochemical and radiological remission 6 months post-surgery. Out of the remaining 64(87.7%) patients, 38(59.4%) received radiosurgery or radiotherapy, 15(23.4%) underwent repeat trans-sphenoidal surgery, and 11(17.2%) chose medical treatment. CONCLUSIONS: Majority of patients failed to achieve remission after trans-sphenoidal surgery, which is the first line of treatment. Radiotherapy/repeat surgery was generally the options taken by those with persistent disease.

Phenotypic characteristics of the mycelium of Pleurotus geesteranus using image recognition technology.

Phenotypic analysis has significant potential for aiding breeding efforts. However, there is a notable lack of studies utilizing phenotypic analysis in the field of edible fungi. Pleurotus geesteranus is a lucrative edible fungus with significant market demand and substantial industrial output, and early-stage phenotypic analysis of Pleurotus geesteranus is imperative during its breeding process. This study utilizes image recognition technology to investigate the phenotypic features of the mycelium of P. geesteranus. We aim to establish the relations between these phenotypic characteristics and mycelial quality. Four groups of mycelia, namely, the non-degraded and degraded mycelium and the 5th and 14th subcultures, are used as image sources. Two categories of phenotypic metrics, outline and texture, are quantitatively calculated and analyzed. In the outline features of the mycelium, five indexes, namely, mycelial perimeter, radius, area, growth rate, and change speed, are proposed to demonstrate mycelial growth. In the texture features of the mycelium, five indexes, namely, mycelial coverage, roundness, groove depth, density, and density change, are studied to analyze the phenotypic characteristics of the mycelium. Moreover, we also compared the cellulase and laccase activities of the mycelium and found that cellulase level was consistent with the phenotypic indices of the mycelium, which further verified the accuracy of digital image processing technology in analyzing the phenotypic characteristics of the mycelium. The results indicate that there are significant differences in these 10 phenotypic characteristic indices ( P < 0.001 ), elucidating a close relationship between phenotypic characteristics and mycelial quality. This conclusion facilitates rapid and accurate strain selection in the early breeding stage of P. geesteranus.

Microbial fungicides can positively affect aubergine photosynthetic properties, soil enzyme activity and microbial community structure.

Background: This study examined the effects of microbial agents on the enzyme activity, microbial community construction and potential functions of inter-root soil of aubergine (Fragaria × ananassa Duch.). This study also sought to clarify the adaptability of inter-root microorganisms to environmental factors to provide a theoretical basis for the stability of the microbiology of inter-root soil of aubergine and for the ecological preservation of farmland soil. Methods: Eggplant inter-root soils treated with Bacillus subtilis (QZ_T1), Bacillus subtilis (QZ_T2), Bacillus amyloliquefaciens (QZ_T3), Verticillium thuringiensis (QZ_T4) and Verticillium purpureum (QZ_T5) were used to analyse the effects of different microbial agents on the inter-root soils of aubergine compared to the untreated control group (QZ_CK). The effects of different microbial agents on the characteristics and functions of inter-root soil microbial communities were analysed using 16S rRNA and ITS (internal transcribed spacer region) high-throughput sequencing techniques. Results: The bacterial diversity index and fungal diversity index of the aubergine inter-root soil increased significantly with the application of microbial fungicides; gas exchange parameters and soil enzyme activities also increased. The structural and functional composition of the bacterial and fungal communities in the aubergine inter-root soil changed after fungicide treatment compared to the control, with a decrease in the abundance of phytopathogenic fungi and an increase in the abundance of beneficial fungi in the soil. Enhancement of key community functions, reduction of pathogenic fungi, modulation of environmental factors and improved functional stability of microbial communities were important factors contributing to the microbial stability of fungicide-treated aubergine inter-root soils.

Bioaccessibility of condensed tannins and their effect on the physico-chemical characteristics of lamb meat.

The bioaccessibility of tannins as antioxidants in meat is essential to maximise their effectiveness in protecting the product. This property determines the amount of tannins available to interact with meat components, inhibiting lipid and protein oxidation and, consequently, prolonging shelf life and preserving the sensory quality of the product. The objective of this study was to evaluate the bioaccessibility of condensed tannins (CT) from Acacia mearnsii extract (AME) and their effect on the physico-chemical characteristics of fattened lamb meat. Thirty-six Dorset × Hampshire lambs (3 months old and 20.8 ± 3.3 kg live weight) were used. The lambs were distributed equally (n = 9) into four treatments: T1, T2, T3 and T4, which included a basal diet plus 0%, 0.25%, 0.5% and 0.75% of CT from AME, respectively. At the end of the fattening period, bioaccessibility was evaluated, the animals were slaughtered and a sample of the longissimus dorsi (LD) muscle was collected to assess colour, lipid oxidation, cooking weight loss and shear force on days 1, 4, 7 and 14 of shelf-life, in samples preserved at -20 °C. In addition, the long chain fatty acid profile was analysed. A completely randomised design was used, and the means were compared with Tukey's test (P < 0.05). The mean lightness (L*), yellowness (b*) and hue (H*) values were higher for T3 and T4. The addition of CT did not affect (P > 0.05) redness (a*), cooking weight loss (CWL) or shear force (SF). T4 decreased (P < 0.05) stearic acid and increased cis-9 trans-12 conjugated linoleic acid (CLA). Bioaccessibility was higher in the supplemented groups (T1 < T2, T3 and T4). In conclusion, supplementing CT from AME in the diet of lambs did not reduce lipid oxidation, but T3 or T4 improved some aspects of meat colour and CLA deposition.

Factors associated with financial risk due to health spending in Argentina.

This article aims to assess the association between household demographic and socioeconomic characteristics and catastrophic health expenditure (CHE) in Argentina during 2017-2018. CHE was estimated as the proportion of household consumption capacity (using both income and total consumption in separate estimations) allocated for Out-of-Pocket Health Expenditure (OOP). For assessing the determinants, we estimated a generalized ordered logit model using different intensities of CHE (10%, 15%, 20% and 25%) as the ordinal dependent variable, and socioeconomic, demographic, and geographical variables as explanatory factors. We found that having members older than 65 years and with long-term difficulties increased the likelihood of incurring CHE. Additionally, having an economically inactive household head was identified as a factor that increases this probability. However, the research did not yield consistent results regarding the relationship between public and private health insurance and consumption capacity. Our results, along with the robustness checks, suggest that the magnitude of the coefficients for the household head characteristics could be exaggerated in studies that overlook the attributes of other household members. In addition, these results emphasize the significance of accounting for long-term difficulties and indicate that omitting this factor could overestimate the impact of members aged over 65.

Characterization and utilization potential of typical molybdenum tailings in Shaanxi Province, China.

Shaanxi Province is located in the most important molybdenum ore district in the world, but a lot of molybdenum tailings have been released, polluting the environment and wasting resources seriously. Taking eleven tailing samples collected at the main molybdenum tailings ponds in Shaanxi Province as the research object, the physical, chemical, and mineralogical characteristics were studied through scanning electron microscope, X-ray fluorescence, X-ray diffraction, inductively coupled plasma mass spectrometer, and others. The ecological risk and utilization potential of molybdenum tailings were investigated through leaching test, geo-accumulation index, potential ecological risk assessment, and other methods. The results demonstrated that the main chemical and mineralogical composition of various molybdenum tailings in Shaanxi Province is similar, and the predominant mineral composition is muscovite, quartz, microcline, and calcite. The potential ecological risk of heavy metals in six molybdenum tailings is high, while Pb and Cd are the main pollution risk elements. Molybdenum tailings contain considerable amounts of critical minerals with huge potential economic value, and molybdenum tailings with high environmental hazards could be converted into a possible source for critical minerals by recovering the critical minerals and repurposing the secondary tailings as an additive or cement substitute. This study provides an innovative idea for the pollution treatment of molybdenum tailings and indicates the prospect of molybdenum tailings as a secondary source for critical minerals.

A comparative study on cadmium tolerance and applicability of two Solanum lycopersicum L. cultivars.

Solanum lycopersicum L. can be classified into low Cd-accumulating and high Cd-accumulating types based on their accumulation characteristics of cadmium (Cd). There are many common S. lycopersicum varieties available in the market, but their specific Cd tolerance and enrichment abilities are not well understood. This article uses two S. lycopersicum cultivars, Yellow Cherry and Yellow Pearl, as experimental materials. The experimental method of soil pot planting was adopted, and Cd concentrations in the soil were added at 0, 0.6, 1.5, 2.5, 5, and 10 mg/kg. The changes in Cd content, biomass, photosynthetic pigment content, and photosynthetic parameters of the two S. lycopersicum cultivars were analyzed to screen for low-accumulation S. lycopersicum cultivars. The results showed that S. lycopersicum are Cd-sensitive plants. The Cd accumulation, photosynthetic parameters, and other basic indicators of Yellow Cherry basically showed significant differences when the soil Cd concentration was 0.6 mg/kg, and the biomass showed significant differences when the soil Cd concentration was 1.5 mg/kg. Except for the Cd accumulation in the roots and leaves of Yellow Pearl, which showed significant differences at a soil Cd concentration of 0.6 mg/kg, the other indicators basically showed significant differences when the soil Cd concentration was 1.5 mg/kg. When the soil Cd concentration was 0.6 mg/kg, the Cd accumulation in the fruit of Yellow Pearl was 0.04 mg/kg, making it a low-accumulation S. lycopersicum variety suitable for promoting cultivation in Cd-contaminated soil at 0.6 mg/kg. In conclusion, the Cd accumulation in the fruit of Yellow Pearl is significantly lower than that of Yellow Cherry and even below the Cd limit value for fresh vegetables specified in GB2762-2017. Therefore, Yellow Pearl can be grown as edible crops in soils with Cd concentrations ≤0.6 mg/kg. Furthermore, Yellow Cherry demonstrate strong Cd tolerance and can be used for the remediation of Cd-contaminated soils.

Sex Differences in Outcome of Aneurysmal Subarachnoid Hemorrhage and Its Relation to Postoperative Cerebral Ischemia.

BACKGROUND: Whether there is a sex difference in the outcome of aneurysmal subarachnoid hemorrhage (aSAH) remains controversial, and clarifying the role of women in postoperative cerebral ischemic events can help us to understand its relationship with poor prognosis. Therefore, the purpose of this study was to elucidate the relationship between the three aspects of sex differences, postoperative cerebral ischemia, and poor prognosis after aSAH. METHODS: A total of 472 patients admitted within 72 h after aSAH between January 2018 and December 2022 were included. We systematically analyzed the characteristics of sex differences in aSAH and explored the relationship between delayed cerebral ischemia (DCI), surgery-related cerebral infarction (SRCI), and poor prognosis (modified Rankin Scale > 2). RESULTS: Compared with women, men were in worse condition and had more intracerebral hematoma (p = 0.001) on admission, whereas women were older (p < 0.001) and had more multiple aneurysms (p = 0.002). During hospitalization, men were more likely to experience emergency intubation (p = 0.036) and tracheotomy (p = 0.013). Women achieved functional independence at discharge at a similar rate to men (p = 0.394). Among postoperative complications, the incidence of DCI (22% vs. 12%, p = 0.01) and urinary tract infection (p = 0.022) was significantly higher in women. After adjusting for age, multivariable regression analysis showed that hypertension (odds ratio [OR] 2.139, 95% confidence interval [CI] 1.027-4.457), preoperative rerupture (OR 12.240, 95% CI 1.491-100.458), pulmonary infection (OR 2.297, 95% CI 1.070-4.930), external ventricular drainage placement (OR 4.382, 95% CI 1.550-12.390), bacteremia (OR 14.943, 95% CI 1.412-158.117), SRCI (OR 8.588, 95% CI 4.092-18.023), venous thrombosis (OR 5.283, 95% CI 1.859-15.013), higher modified Fisher grades (p = 0.003), and Hunt-Hess grades (p = 0.035) were associated with poor prognosis, whereas DCI (OR 1.394, 95% CI 0.591-3.292) was not an independent risk factor for poor prognosis. The proportion of patients who fully recovered from cerebral ischemia was higher in the DCI group (p < 0.001) compared with the SRCI group, and more patients were discharged with modified Rankin Scale > 2 in the SRCI group (p = 0.005). CONCLUSIONS: Women have a higher incidence of DCI, but there is no sex difference in outcomes after aSAH, and poor prognosis is associated with worse admission condition and perioperative complications. SRCI is a strong independent risk factor for poor prognosis, whereas DCI is not.

Effect of polyethylene terephthalate plastics on nitrogen, sulphur and chlorine contaminants via sludge pyrolysis and Pb/Cu adsorption properties of biochar.

Pyrolysis is an effective process for disposing of municipal sewage sludge (SS). Plastics can affect the SS pyrolysis behaviour and pyrolysis products due to their low ash and high hydrocarbon ratio. The secondary pollutants from the pyrolysis process may also be affected. Therefore, polyethylene terephthalate (PET), a typical plastic, was chosen to investigate the release characteristics of pollutants containing nitrogen, sulphur, and chlorine via SS pyrolysis, and the changes of biochar to adsorb two typical heavy metals, Pb and Cu. The pyrolysis of PET plastics facilitates the migration of N toward solid and liquid-phase products, S and Cl to the gas-phase products via pyrolysis. Oxygenated compounds of pyrolytic volatiles decreased from 38.18% to 28.43%, concurrently promoting the formation of phenolic compounds. The co-pyrolysis improved the quality of biochar and the ability to adsorb Pb and Cu. This systematic study can provide some support for the further improvement of SS pyrolysis technology, and will also be beneficial for subsequent applications.

Household Transmission of Tinea Infections: Analysis of a Large Commercial Health Insurance Claims Database, United States, 2021.

Among 207 914 multimember households with a tinea case, a secondary case was diagnosed in another household member in 8.5%. Excluding same-day diagnoses (20%), the median time from index case to first secondary case was 138 days. To prevent household tinea transmission, appropriate treatment and strategies to reduce environmental contamination are needed.

Disparities in Obesogenic Environments by Income, Race/Ethnicity, and Rurality Across All US Counties.

Background: Research is needed to explore inequities in physical activity (PA) and access to healthy eating resources for children on a national scale. This study examined disparities in childhood obesogenic environments across all United States (US) counties by income and race/ethnicity and their interaction with county rurality. Methods: Data for four PA variables (exercise opportunities, school proximity, walkability, crime) and six nutrition variables (grocery stores, farmers markets, fast-food restaurants, full-service restaurants, convenience stores, and births at baby-friendly hospitals) were collected for all US counties (n = 3142) to comprise the Childhood Obesogenic Environment Index (COEI). Variables were ranked and allocated a percentile for each county, and a total obesogenic environment score was created by averaging variable percentiles. Analysis of variance was used to assess differences by tertiles of county-level median household income (low/intermediate/high) and percentage of non-Hispanic (NH) White residents (low/intermediate/high). Interaction tests were used to assess effect modification by rurality, and stratified results were presented for all significant interactions. Results: There were significant differences in COEI values according to tertiles of median household income (F = 260.9, p < 0.0001). Low-income counties (M = 54.3, SD = 8.3) had worse obesogenic environments than intermediate (M = 49.9, SD = 7.9) or high (M = 45.9, SD = 8.8) income counties. There was also a significant interaction between rurality and median household income (F = 13.9, p < 0.0001). Similarly, there were significant differences in COEI values according to tertiles of race/ethnicity (F = 34.5, p < 0.0001), with low percentage NH White counties (M = 51.8, SD = 9.8) having worse obesogenic environment scores than intermediate (M = 48.7, SD = 8.4) or high (M = 49.5, SD = 8.5) NH White counties. There was also a significant interaction between rurality and race/ethnicity (F = 13.9, p < 0.0001). Conclusion: Low-income counties and those with more racial/ethnic minority residents, especially in rural areas, had less supportive PA and healthy eating environments for youth. Targeted policy and environmental approaches that aimed to address concerns specific to underserved communities are needed.

Multi-omics analyses and botanical perfumer hypothesis provide insights into the formation and maintenance of aromatic characteristics of Dendrobium loddigesii flowers.

Dendrobium loddigesii, a member of the Orchidaceae family, is a valuable horticultural crop known for its aromatic qualities. However, the mechanisms responsible for the development of its aromatic characteristics remain poorly understood. To elucidate these underlying mechanisms, we assembled the first chromosome-level reference genome of D. loddigesii using PacBio HiFi-reads, Illumina short-reads, and Hi-C data. The assembly comprises 19 pseudochromosomes with N50 contig and N50 scaffold sizes of 55.15 and 89.94 Mb, respectively, estimating the genome size to be 1.68 Gb, larger than that of other sequenced Dendrobium species. During the flowering stages, we conducted a comprehensive analysis combining volatilomics and transcriptomics to understand the characteristics and biosynthetic mechanisms pathways of the floral scent. Our findings emphasize the significant contribution of aromatic terpenoids, especially monoterpenoids, in defining the floral aroma. Furthermore, we identified two crucial terpene synthase (TPS) genes that play a key role in maintaining the aroma during flowering. Through the integration volatilomics data with catalytic assays of DlTPSbs proteins, we identified specific compounds responsible for the aromatic characteristics of D. loddigesii. This integrated analysis of the genome, transcriptome, and volatilome, offers valuable insights into the development and preservation of D. loddigesii's aromatic characteristics, setting the stage for further exploration of the botanical perfumer hypothesis.

Recognition of screening out hierarchical toxic contaminants tuned by quantified pseudo-components from complex engineering co-combustion.

Co-combustion of industrial and municipal solid wastes has emerged as the most promising disposal technology, yet its effect on unknown contaminants generation remains rarely revealed due to waste complexity. Hence, six batches of large-scale engineering experiments were designed in an incinerator of 650 t/d, which overcame the inauthenticity and deviation of laboratory tests. 953-1772 non-targeted compounds were screened in fly ash. Targeting the impact of co-combustion, a pseudo-component matrix model was innovatively integrated to quantitatively extract nine components from complex wastes grouped into biomass and plastic. Thus, the influence was evaluated across eight dimensions, covering molecular characteristics and toxicity. The effect of co-combustion with biomass pseudo-components was insignificant. However, co-combustion with high ratios of plastic pseudo-components induced higher potential risks, significantly promoting the formation of unsaturated hydrocarbons, highly unsaturated compounds (DBE≥15), and cyclic compounds by 19 %- 49 %, 17 %- 31 %, and 7 %- 27 %, respectively. Especially, blending with high ratios of PET plastic pseudo-components produced more species of contaminants. Unique 2 Level I toxicants, bromomethyl benzene and benzofuran-2-carbaldehyde, as well as 4 Level II toxicants, were locked, receiving no concern in previous combustion. The results highlighted risks during high proportion plastics co-combustion, which can help pollution reduction by tuning source wastes to enable healthy co-combustion.

Biomechanical design optimization and experimental verification of Bezier curve based two-sectional cervical pillow with variable-density cellular structure.

The fundamental function of an optimal cervical pillow is to provide sufficient support to maintain normal spinal alignment and minimize biological stress on the contact surface throughout sleep. The recent advancements in cervical pillows have mainly focused on the subjective and objective evaluations of support comfort, as well as the relationship between pillow height and cervical vertebrae posture. However, only a few studies have addressed shape design guidelines and mechanical performances of the pillows themselves. In this study, a two-sectional contour cervical pillow comprising an arc and a Bezier curve is designed to support the head and neck. The design of the arc-shaped neck section incorporates the Cobb's angle and Borden value from healthy individuals to reflect the consistency of normal cervical anatomical features. The Bezier curve-based head section takes the head length and neck depth into account as significant individual differences. Static analysis and lattice optimization are performed in ANSYS Workbench to develop a variable-density cellular structure, aimed at improving air permeability and reducing the risk of pressure ulcers associated with the cervical pillow. The rapid prototyping technique fused deposition modeling (FDM) and thermoplastic material polylactic acid (PLA) are employed for fabricating different cellular structures. The results demonstrate that the neck section experiences less stress and greater deformation in comparison to the head section, indicating good comfort and support provided by the designed cervical pillow. Additionally, the compressive, bending, and cushion properties of the 3D-printed cervical pillow with variable-density cellular structure are experimentally validated, further confirming its effectiveness.

Assessment of the migration characteristics and source-oriented health risks of heavy metals in the soil and groundwater of a legacy contaminated by the chlor-alkali industry in central China.

The chlor-alkali industry (CAI) is crucial for global chemical production; however, its operation has led to widespread heavy metal (HM) contamination at numerous sites, which has not been thoroughly investigated. This study analysed 122 soil and groundwater samples from a typical CAI site in Kaifeng, China. Our aim was to assess the ecological and health risks, identify the sources, and examine the migration characteristics of HMs at this site using Monte Carlo simulation, absolute principal component score-multiple linear regression (APCS-MLR), and the potential environmental risk index (Ei). Our findings revealed that the exceedance rates for Cd, Pb, Hg, and Ni were 71.96%, 45.79%, 49.59%, and 65.42%, respectively. Mercury (Hg) displayed the greatest coefficient of variation across all the soil layers, indicating a significant anthropogenic influence. Cd and Hg were identified as having high and extremely high potential environmental risk levels, respectively. The spatial distributions of the improved Nemerow index (INI), total ecological risk (Ri), and HM content varied considerably, with the most contaminated areas typically associated with the storage of raw and auxiliary materials. Surface aggregation and significant vertical transport were noted for HMs; As and Ni showed substantial accumulation in subsoil layers, severely contaminating the groundwater. Self-organizing maps categorized the samples into two different groups, showing strong positive correlations between Cd, Pb, and Hg. The APCS-MLR model suggested that industrial emissions were the main contributors, accounting for 60.3% of the total HM input. Elevated hazard quotient values for Hg posed significant noncarcinogenic risks, whereas acceptable levels of carcinogenic risk were observed for both adults (96.60%) and children (97.83%). This study significantly enhances historical CAI pollution data and offers valuable insights into ongoing environmental and health challenges.

Air pollution mitigation and suspended particulate matter retention potential of selected plant species across seasonal variation in the urban area.

Air pollution is a pressing environmental concern in urban areas, especially in densely populated cities like Delhi, India. However, plant species can effectively capture airborne suspended pollutants. Given this, the present study aimed to investigate the seasonal variations (pre- and post-monsoon) in the pollution-mitigating potential, biochemical characteristics, and suspended particulate matter (SPM) capturing capacities of select plant species in Delhi. Also, using biochemical parameters, plant morphology, and socioeconomic factors, the study computed tolerance indices such as the Air Pollution Tolerance Index (APTI) and Anticipated Performance Index (API). Ficus religiosa L. exhibited the highest APTI value of 11.94, while Polyalthia longifolia (Sonn.) Thwaites displayed the lowest 7.99 APTI value during the pre-monsoon. Ficus benghalensis L. showed the maximum SPM adhesion on the leaves, with a deposition of 1305.46 µg/cm2, whereas F. religiosa exhibited the lowest SPM deposition of 56.62 µg/cm2. Moreover, the statistical analysis indicated a positive correlation between ascorbic acid and chlorophyll content (R2 > 0.6) with APTI. Also, F. religiosa demonstrated a significant Pearson's correlation (P < 0.05) between chlorophyll content and SPM deposition during the pre-monsoon. The study highlighted the dynamic nature of plant-based air pollution mitigation. It offered valuable insights into the potential of green infrastructure as a sustainable solution for addressing air quality concerns in urban environments. The results emphasized the significance of selecting adequate plant species and considering seasonal variations in developing urban greening strategies to combat air pollution.

Characteristics of soy films as affected by transglutaminase cross-linking and inclusions of pectin and protein enhancers.

Previously, we showed that water extract (soymilk, except pH was increased to 8 from 6.5) of whole soybean could be used directly as a raw material for producing edible soy films by deposition of the film-forming solution (soy extract with enhancers). However, the strength of such soy films needed improvement because they were weak. The purpose of this study was to investigate how transglutaminase (TG) cross-linking reactions and film enhancers, including pectin (low- and high-methoxyl pectin), whey protein isolate (WPI), and soy protein isolate (SPI), improve the physical properties of soy films. Soy films prepared with TG had tensile strength (TS) of 3.01 MPa and puncture strength (PS) of 0.78 MPa, which were higher by as much as 51% and 30% than that of soy films without TG treatment, respectively. Pectin showed significant effects on the mechanical properties of TG-added soy films in terms of TS, PS, and % elongation. On the other hand, only TS and PS were increased by the addition of WPI or SPI. Heat curing had a significant effect on soy film's physical properties. TG treatment significantly reduced film solubility when soaked in water and various levels of acid (vinegar) and base (baking soda) solutions. Under the experimental conditions of 35 unit TG and 28 min of reaction, the degrees of cross-linking were evidenced by the disappearance of individual protein subunits, except the basic subunit of glycinin, and the reduction of 21% of lysine residues of the proteins. HIGHLIGHTS: Edible soy films were made with transglutaminase and about 21% lysine cross-linked. The mechanical strength of soy films was increased by incorporating film enhancers. Transglutaminase enhanced the mechanical properties of soy films.

The effect of practice environments and psychological empowerment perceptions of nurses on their care behaviours: A cross-sectional study.

AIM: The aim of this study was to examine the effect of professional and individual characteristics, practice environments and psychological empowerment perceptions of nurses on their care behaviours. DESIGN: The study used a cross-sectional research design following the STROBE guidelines. METHODS: The sample of this descriptive and correlational study consisted of 584 nurses working in a university hospital in Turkey. The data were collected between January and June 2023 using the Nursing Information Form, the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Psychological Empowerment Scale (PES), and the Caring Behaviours Scale-30, and analysed using descriptive statistics, Spearman's correlation and multiple linear regression. RESULTS: It was determined that PES-NWI, PES and Caring Behaviours Scale (CBI-30) scores of nurses were higher than the average. The study revealed that certain professional and individual characteristics of nurses, practice environments and psychological empowerment perceptions had an effect on their care behaviours. CONCLUSION: The results of the study showed that nurses' PES-NWI, PES and CBI-30 scores were higher than the average, and that certain professional and individual characteristics of nurses, practice environments and psychological empowerment perceptions had an effect on care behaviours. Nursing service managers, in particular, are required to understand the importance of this relationship and create appropriate working conditions which are integrated with psychological empowerment to improve caring behaviours of nurses.

Variation in Excess Mortality Across Nursing Homes in the Netherlands During the COVID-19 Pandemic.

OBJECTIVES: Nursing home residents constituted a vulnerable population during the COVID-19 pandemic, and half of all cause-attributed COVID-19 deaths occurred within nursing homes. Yet, given the low life expectancy of nursing home residents, it is unclear to what extent COVID-19 mortality increased overall mortality within this population. Moreover, there might have been differences between nursing homes in their ability to protect residents against excess mortality. This article estimates the number of excess deaths among Dutch nursing home residents during the pandemic, the variation in excess deaths across nursing homes, and its relationship with nursing home characteristics. DESIGN: Retrospective, use of administrative register data. SETTING AND PARTICIPANTS: All residents (N = 194,432) of Dutch nursing homes (n = 1463) in 2016-2021. METHODS: We estimated the difference between actual and predicted mortality, pooled at the nursing home level, which provided an estimate of nursing home-specific excess mortality corrected for resident case-mix differences. We show the variation in excess mortality across nursing homes and relate this to nursing home characteristics. RESULTS: In 2020 and 2021, the mortality probability among nursing home residents was 4.0 and 1.6 per 100 residents higher than expected. There was considerable variation in excess deaths across nursing homes, even after correcting for differences in resident case mix and regional factors. This variation was substantially larger than prepandemic mortality and was in 2020 related to prepandemic spending on external personnel and satisfaction with the building, and in 2021 to prepandemic staff absenteeism. CONCLUSIONS AND IMPLICATIONS: The variation in excess mortality across nursing homes was considerable during the COVID-19 pandemic, and larger compared with prepandemic years. The association of excess mortality with the quality of the building and spending on external personnel indicates the importance of considering differences across nursing home providers when designing policies and guidelines related to pandemic preparedness.

Exploring the Clinical Characteristics and Comorbid Disorders of Borderline Intellectual Functioning.

Borderline intellectual functioning (BIF) is characterized by cognitive impairment and deficits in adaptive functioning. Despite affecting a significant proportion of the population, BIF still remains underdiagnosed and poorly understood. In addition to cognitive impairments across a range of domains, individuals with BIF face a greater risk of academic failure and often require special educational support. They suffer from emotional problems, such as difficulties with emotional awareness, anxiety, depressed mood, and unhappiness. Individuals with BIF are more likely to have an impairment of social and adaptive functioning. Furthermore, individuals with BIF are at higher risk of physical and mental health problems, often receive inadequate treatment, and have a poorer prognosis. This review aims to enhance the understanding of clinicians, educators, and policymakers by providing an overview of the characteristics of BIF and its associated challenges, ultimately contributing to the improvement of support systems for individuals with BIF.