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Evaluation of aflibercept treatment outcomes using optical coherence tomography angiography in macular telangiectasia type 1
No full textAbstract Purpose To evaluate the anatomical, functional, and vascular effects of intravitreal aflibercept in macular telangiectasia (MacTel) type 1 using optical coherence tomography angiography (OCTA). Methods This retrospective study included nine eyes of nine patients with MacTel type 1 who underwent a single intravitreal aflibercept injection. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and macular vessel density in superficial and deep capillary plexuses (SVD and DVD, respectively) were measured before and one month after treatment using swept-source OCT and OCTA. Results Mean BCVA improved from 0.4 ± 0.3 to 0.2 ± 0.2 logMAR (p = 0.003) and CMT decreased from 371.4 ± 112 to 237.9 ± 55.1 μm (p = 0.003). Temporal SVD (p = 0.021) and temporal DVD (p = 0.020) showed statistically significant increase. BCVA change showed a strong positive correlation with CMT change (ρ = 0.70, p = 0.034). A moderate negative correlation between the change in BCVA (logMAR) and the change in inferior DVD did not achieve statistical significance (ρ= -0.635, p = 0.066). Conclusion A single intravitreal aflibercept injection led to significant anatomical and functional improvements in MacTel type 1, with a marked increase in vessel density in the temporal quadrant. This study indicates that the characteristics of retinal microvasculature may be modified following aflibercept injection in MacTel type 1 eyes, as observed through OCTA
Immigrant and refugee experiences in the Utah WIC program: a qualitative study
No full textAbstract Background WIC program offers critical nutritional support for low-income families, enrollment and benefit utilization remain suboptimal among eligible immigrant and refugee participants. Understanding the unique challenges they face is essential to improving access, equity, and the effectiveness of WIC services. Methods This qualitative study used in-depth interviews to explore the experiences and perceptions of WIC participation among refugee and immigrant families. The study was conducted across communities in Northern Utah and included 25 participants recruited through WIC clinics, community organizations, and social media. Interviews focused on participants’ experiences with WIC enrollment, benefit utilization, and their suggestions for program improvement, including issues related to program awareness, navigation challenges, cultural relevance, and recommendations for enhancing access and support. All interviews were transcribed, translated as needed, and analyzed thematically using NVivo 14. Results Three main themes emerged: i) Enrollment and Awareness: participants primarily enrolled due to financial need, often through personal networks. ii) Challenges in Utilization: language barriers, transportation, WIC card difficulties, and limited culturally appropriate food options were common. iii) Suggestions for Improvement: participants recommended enhanced multilingual support, culturally flexible food choices, stronger outreach, transportation, and improved education on benefit use. Conclusion and implications Addressing structural and cultural barriers through targeted education, language services, and inclusive support systems and policies can enhance WIC participation and promote equity. Future research should explore the long-term impacts of these efforts and the factors that influence sustained program utilizatio
Prioritizing rehabilitation in Pakistan’s health system: a qualitative policy analysis
No full textAbstract Background Rehabilitation, is a neglected domain in Pakistan’s health system. There are insufficient financial and human resources to address the unmet needs. Despite the increasing demand for rehabilitation and assistive technology (AT) and implications for improving health inequities, it receives little political attention. This analysis identifies the factors that shape the prioritization of rehabilitation in Pakistan’s national health system. Methods We conducted 29 key informant interviews with actors concerned with rehabilitation policy and practice in Pakistan, complemented by a purposeful review of peer-reviewed and grey literature to achieve thematic saturation. The data was triangulated and thematically analyzed using a policy framework on national prioritization of rehabilitation services. Results Based on the framework, we identified three key elements that shape the inadequate prioritization of rehabilitation in Pakistan. First, rehabilitation lacks a consistent problem definition; there is a lack of consensus among key actors regarding the importance and need for rehabilitation and AT in the health system. Second, governance arrangements are fragmented across multiple ministries, with rehabilitation services often being associated with disability and included under the Social Welfare Department, rather than the Ministry of National Health Services, Regulations, and Coordination (MoNHSRC). Third, with respect to structural factors, scarcity of resources in the existing health system, societal stigmas and social inequalities have negatively shaped the abilities of both rehabilitation service seekers and providers. Conclusion Identifying the key components impeding prioritization for rehabilitation in Pakistan’s health system is a crucial first step in advancing the issue within sub-national and national policy agendas and improving equity in access to rehabilitation services. Rehabilitation professionals and other actors responsible for rehabilitation policy and practice should systematically work together to prioritize and integrate rehabilitation services within the current health system structures to advance health equity, enabling all individuals to lead fulfilling lives, regardless of their background or circumstances
ICT investment and carbon emission efficiency in regional port groups: evidence from Chinese coastal provinces
No full textAbstract Growing concerns about climate change have intensified scrutiny of port operations as significant contributors to global emissions, prompting ports worldwide to reconcile environmental sustainability with operational efficiency. Yet how digital investments specifically influence environmental performance in regional maritime systems remains insufficiently understood. Existing research has examined ICT’s economic impacts and operational efficiency separately. However, limited empirical attention has been directed towards the relationship between digital transformation and carbon emission efficiency. This gap is particularly notable regarding the differential effects of ICT components and the role of governance structures. This study examines nine Chinese coastal provinces from 2008 to 2019, decomposing ICT capital into hardware, communication equipment, and software components. Using two-way fixed effects models and instrumental variables approaches, we analyse their impacts on carbon emission efficiency within regional port groups. Results indicate that ICT investment significantly enhances carbon emission efficiency, with hardware demonstrating the strongest effect, followed by communication equipment and software. The relationship operates through both direct channels and indirect pathways via functional specialisation. Digital infrastructure enables ports to develop clearer divisions of labour and achieve economies of scale, thereby reducing emissions per unit of throughput. Furthermore, port integration exhibits an inverted U-shaped moderating effect, with optimal integration levels varying across ICT components. These findings advance understanding of environmental returns to digital investment in port infrastructure, offering empirical guidance for policymakers navigating governance challenges in sustainable maritime development
The pro-environmental implications of job insecurity: the significant role of prosocial motivation
No full textAbstract This study examines how job insecurity, a crucial job characteristic in rapidly changing employment contexts, influences employees’ pro-environmental behavior at work (PEBW). Drawing on the Conservation of Resources theory and Social Exchange theory, it proposes that job insecurity exerts an indirect impact on PEBW through employees’ affective commitment, with prosocial motivation acting as a moderating factor. Data were collected in three waves from 231 working adults in South Korea, enabling temporal separation of measures and reducing common method bias. Structural equation modeling and bootstrapping analyses revealed that job insecurity alone did not directly predict PEBW; rather, it weakened individuals’ affective commitment, which in turn lowered their willingness to engage in green actions. Furthermore, prosocial motivation emerged as a significant buffer, alleviating the detrimental effect of job insecurity on affective commitment. These results point to the critical role of employees’ emotional ties to the organization and personal altruistic orientations in shaping ecological behaviors amid perceived employment threats. By integrating multiple theoretical perspectives, the study offers a more holistic explanation of why some employees persist in their environmentally friendly efforts under precarious conditions while others do not. The findings suggest that organizations seeking to foster sustainable practices should carefully manage job insecurity perceptions, reinforce employees’ emotional connection to the firm, and nurture prosocial motivations. In so doing, firms may mitigate the negative impacts of workplace uncertainty on discretionary environmental engagement and support a more resilient and sustainable organizational culture
Exploring the relationship between caring ability and moral awareness among nurses with a gender perspective: implications for psychologists and social workers in healthcare ethics and social practice
No full textAbstract This study investigates the relationship between nurses’ caring ability and moral awareness within the context of Iraq’s public healthcare system, drawing on theoretical frameworks by Jean Watson and Carol Gilligan for caring ability and James Rest for moral awareness. Utilizing a descriptive correlational design, data were gathered between April 5 and May 15, 2024, from a stratified random sample of 190 nurses (101 females, 89 males) working in Baghdad’s two largest public hospitals. The Ability to Care Scale and the Moral Awareness Scale, both validated in the Iraqi context, were employed to measure the constructs. Statistical analysis revealed that nurses demonstrated generally high levels of both caring ability and moral awareness. Female nurses scored significantly higher than their male counterparts in caring ability (t = 3.439, p < 0.001), potentially reflecting culturally embedded gender norms and expectations within Iraqi healthcare settings. A moderate positive correlation was observed between caring ability and moral awareness across the total sample (r = 0.504, p < 0.001), suggesting a meaningful interdependence between the two constructs. These findings emphasize the importance of integrating moral and empathic competencies in nursing education and training, especially in resource-constrained, crisis-affected environments such as Iraq. Tailored interventions that address gender-specific caregiving experiences and moral challenges are essential for strengthening the ethical foundations of care in fragile healthcare systems
Identification of fecal microbiome signatures associated with longevity through 16S rRNA sequencing in different age groups in China
No full textAbstract The gut microbiota plays a key role in aging and longevity. Therefore, identifying longevity-associated microbes in healthy and long-lived individuals and elucidating the molecular mechanisms through which they influence longevity are essential steps toward developing effective anti-aging interventions. In this study, we performed 16S rRNA sequencing on 301 fecal samples collected across three age groups. Long-lived individuals (≥ 90 years) had more diverse gut microbiota than typical older individuals (60–89 years), with diversity comparable to that of younger adults (45–59 years). Compared with typical older individuals, long-lived individuals exhibited a marked increase in the relative abundance of Bacteroidota and Akkermansia, accompanied by a decreased abundance of Prevotella_9 and Megamonas. Additionally, the microbiota from this age group showed significant enrichment in unsaturated fatty acid metabolism, ketone body synthesis and degradation, and tryptophan metabolism, suggesting that differences in microbiota composition and function may contribute to longevity. Finally, we developed a qPCR-based method to detect differentially abundant microbiota and established a classification model capable of distinguishing between age groups. In conclusion, the unique composition and function of the gut microbiota in long-lived individuals offer insights for identifying methods and targets for anti-aging interventions. Key points • Long-lived individuals exhibited a marked increase in Bacteroidota and Akkermansia • Long-lived individuals exhibited enrichment in unsaturated fatty acid metabolism • We developed a qPCR-based method to detect differentially abundant microbiota
High intensity interval training for older adults – from the laboratory towards a home setting: a co-creation study
No full textAbstract Background Physical exercise can help prolong healthy aging, yet few options enable older adults to exercise at very high intensities at home. A previous gym-based supramaximal High Intensity interval Training (HIT) protocol on stationary bicycles has shown promising results. Core components were supramaximal interval intensity that could be systematically modulated (controlled, individualized, escalated, and de-escalated) and protocol safety. In this exploratory co-creation study with older adults, we aimed to adapt the supramaximal HIT protocol for potential future implementation in older adults’ home settings. Methods Eleven older adults (6 females; ages 69–74) with prior supramaximal HIT experience participated in this two-phase co-creation study. In phase one, co-creators engaged in workshops to identify, explore, and discuss available home-based training modalities. In phase two, co-creators took part in lab tests wherein suitable modalities were tested and compared to stationary bicycling regarding acute physiological responses and safety during a supramaximal HIT session (10 × 10-second intervals with 50-second passive recovery). Results were continuously merged with the protocol’s core components. Results Physiological and emotional reactions to HIT, potential exercise modalities, and necessary protocol adaptations were identified in phase one. When merged with core components three modalities - walking up steps, chair stand, and rubber band cross country double poling - were selected for phase two testing. Of these, chair stand elicited physiological responses most comparable to stationary bicycling, while fulfilling all core components. Conclusions We adapted a researcher-supervised watt-controlled supramaximal HIT-protocol on stationary bicycles to a chair stand protocol with audio metronome-controlled intensity for potential implementation at home. This adaptation is the first step towards a safe and scalable implementation of a home-based supramaximal HIT program for older adults
Effect Modifications by Age, Sex, and Season on the Association Between Multiple Atmospheric Factors and Mental Disorders
No full textAbstract Few studies have empirically examined the hypothesis that age, sex, and season would be acting as effect modifiers in the association between exposure factor and health outcome when the population are simultaneously exposed to multiple air pollutants and meteorological conditions. We couple air pollution and meteorological data with reported mental disorders (MDs) drawn from approximately 1.8 million hospital outpatient visits in Nanjing, China between 2015 and 2019. Subsequent to predicting the illness risks of MDs using deep learning model, SHAP approach quantifies excess risks attributed to the feature being explained. We generally find the effect modifications in the association between air pollutant or meteorological factor and MD risk by comparison of feature-importance estimates for each stratified group. For example, PM10 increases the risk of depression disorder of females by 1.94 (P2.5-P97.5: 1.54, 2.34) visit counts, which is significantly higher than that of males [0.25 (− 0.01, 0.50)]; the female-male difference in the risk of anxiety disorder posed by precipitation associates with 0.50 (0.31, 0.69) visit counts. The findings reasoned that efforts should address the effect of multiple risk factors that simultaneously interact with each other on MDs, as surrounding air pollution and climate change proceed. Graphical Abstrac
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