Climate change is increasingly influencing the water cycle, hindering the effective management of water resources in various sectors. Lazio, central Italy, exhibits a wide range of climatic conditions, stretching from the Tyrrhenian coast to the Apennines. This study assessed a crucial aspect of climate change, focusing specifically on reference evapotranspiration (ETo) and its associated hydrological variables. The seasonal Mann–Kendall (MK) test was used to assess trends in gridded data. The K-means algorithm was then applied to divide Lazio into four homogeneous regions (clusters), each characterized by distinct trends in hydrological variables. The analysis revealed statistically significant increasing trends (p ≤ 0.01) in temperature, solar radiation, and ETo, with more marked effects observed in the coastal and hilly clusters. In contrast, statistically significant decreasing trends (p ≤ 0.01) were observed for relative humidity, while no statistically significant trends (p > 0.01) were observed for precipitation. This study’s methodology, combining trend analysis and clustering, provides a comprehensive view of ETo dynamics in Lazio, aiding in pattern recognition and identifying regions with similar trends. Full article

This study aimed to determine whether the EQ-5D-5L tool captures the most common persistent symptoms, such as fatigue, memory/concentration problems and dyspnea, in patients with post-COVID-19 conditions while also investigating if adding these symptoms improves the explained variance of the health-related quality of life (HRQoL). In this exploratory cross-sectional study, two cohorts of Swedish patients (n = 177) with a history of COVID-19 infection answered a questionnaire covering sociodemographic characteristics and clinical factors, and their HRQoL was assessed using EQ-5D-5L with the Visual Analogue Scale (EQ-VAS). Spearman rank correlation and multiple regression analyses were employed to investigate the extent to which the most common persistent symptoms, such as fatigue, memory/concentration problems and dyspnea, were explained by the EQ-5D-5L. The explanatory power of EQ-5D-5L for EQ-VAS was also analyzed, both with and without including symptom(s). We found that the EQ-5D-5L dimensions partly captured fatigue and memory/concentration problems but performed poorly in regard to capturing dyspnea. Specifically, the EQ-5D-5L explained 55% of the variance in memory/concentration problems, 47% in regard to fatigue and only 14% in regard to dyspnea. Adding fatigue to the EQ-5D-5L increased the explained variance of the EQ-VAS by 5.7%, while adding memory/concentration problems and dyspnea had a comparatively smaller impact on the explained variance. Our study highlights the EQ-5D-5L’s strength in capturing fatigue and memory/concentration problems in post-COVID-19 patients. However, it also underscores the challenges in assessing dyspnea in this group. Fatigue emerged as a notably influential symptom, significantly enhancing the EQ-5D-5L’s predictive ability for these patients’ EQ-VAS scores. Full article

Objectives: Twins resulting from a complicated monochorionic (MC) twin pregnancy are at risk for postnatal evolution of pulmonary hypertension (PH) and cardiac dysfunction (CD). Both pathologies are important contributors to short- and long-term morbidity in these infants. The aim of the present retrospective single-center cohort study was to evaluate the need for vasoactive treatment for PH and CD in these neonates. Methodology: In-born neonates following a complicated MC twin pregnancy admitted to the department of neonatology of the University Children´s Hospital Bonn (UKB) between October 2019 and December 2023 were screened for study inclusion. Finally, 70 neonates were included in the final analysis, with 37 neonates subclassified as recipient twins (group A) and 33 neonates as donor twins (group B). Results: The overall PH incidence at day of life (DOL) 1 was 17% and decreased to 6% at DOL 7 (p = 0.013), with no PH findings at DOL 28. The overall incidence of CD was 56% at DOL 1 and decreased strongly until DOL 7 (10%, p = 0.015), with no diagnosis of CD at DOL 28. The use of dobutamine, norepinephrine, and vasopressin at DOL 1 until DOL 7 did not differ between the subgroups, whereas the dosing of milrinone was significantly higher in Group B at DOL 1 (p = 0.043). Inhaled nitric oxide (iNO) was used in 16% of the cohort, and a levosimendan therapy was administered in 34% of the neonates. One-third of the cohort was treated with oral beta blockers, and in 10%, an intravenous beta blockade (landiolol) was administered. The maximum levosimendan vasoactive–inotropic score (LVIS_max) increased from DOL 1 (12.4 [3/27]) to DOL 2 (14.6 [1/68], p = 0.777), with a significant decrease thereafter as measured at DOL 7 (9.5 [2/30], p = 0.011). Conclusion: Early PH and CD are frequent diagnoses in neonates following a complicated MC twin pregnancy, and an individualized vasoactive treatment strategy is required in the management of these infants. Full article

Remote sensing technologies are critical for analyzing the escalating impacts of global climate change and increasing urbanization, providing vital insights into land surface temperature (LST), land use and cover (LULC) changes, and the identification of urban heat island (UHI) and surface urban heat island (SUHI) phenomena. This research focuses on the nexus between LULC alterations and variations in LST and air temperature (T_air), with a specific emphasis on the intensified SUHI effect in Kharkiv, Ukraine. Employing an integrated approach, this study analyzes time-series data from Landsat and MODIS satellites, alongside T_air climate records, utilizing machine learning techniques and linear regression analysis. Key findings indicate a statistically significant upward trend in T_air and LST during the summer months from 1984 to 2023, with a notable positive correlation between T_air and LST across both datasets. MODIS data exhibit a stronger correlation (R² = 0.879) compared to Landsat (R² = 0.663). The application of a supervised classification through Random Forest algorithms and vegetation indices on LULC data reveals significant alterations: a 70.3% increase in urban land and a decrement in vegetative cover comprising a 15.5% reduction in dense vegetation and a 62.9% decrease in sparse vegetation. Change detection analysis elucidates a 24.6% conversion of sparse vegetation into urban land, underscoring a pronounced trajectory towards urbanization. Temporal and seasonal LST variations across different LULC classes were analyzed using kernel density estimation (KDE) and boxplot analysis. Urban areas and sparse vegetation had the smallest average LST fluctuations, at 2.09 °C and 2.16 °C, respectively, but recorded the most extreme LST values. Water and dense vegetation classes exhibited slightly larger fluctuations of 2.30 °C and 2.24 °C, with the bare land class showing the highest fluctuation 2.46 °C, but fewer extremes. Quantitative analysis with the application of Kolmogorov-Smirnov tests across various LULC classes substantiated the normality of LST distributions p > 0.05 for both monthly and annual datasets. Conversely, the Shapiro-Wilk test validated the normal distribution hypothesis exclusively for monthly data, indicating deviations from normality in the annual data. Thresholded LST classifies urban and bare lands as the warmest classes at 39.51 °C and 38.20 °C, respectively, and classifies water at 35.96 °C, dense vegetation at 35.52 °C, and sparse vegetation 37.71 °C as the coldest, which is a trend that is consistent annually and monthly. The analysis of SUHI effects demonstrates an increasing trend in UHI intensity, with statistical trends indicating a growth in average SUHI values over time. This comprehensive study underscores the critical role of remote sensing in understanding and addressing the impacts of climate change and urbanization on local and global climates, emphasizing the need for sustainable urban planning and green infrastructure to mitigate UHI effects. Full article

In this paper, a new axial-type magnetic gear with an auxiliary flux-enhancing structure (AFS-AMG) is proposed. Compared to conventional AMGs, it has a higher torque density and higher permanent magnet (PM) utilization factor. Firstly, the design rules and operating principles of the proposed AFS-AMG are elaborated. Then, the mapping relation between the radial-type magnetic gears (RMGs) and AMGs are elucidated. Compared to its counterparts in RMGs, the AFS-AMG achieves a small size. Then, the geometrical parameters of the AFS-AMG are optimized to obtain better electromagnetic performance, where the torque density per volume and per PM volume is adopted as the evaluation standard. Finally, three different AMG topologies are constructed in finite element analysis (FEA) software for comparison. It is proven that the AFS-AMG has the largest torque density per volume and per PM volume. Full article

School systems in Australia, and internationally, are focused on improving classroom teaching and learning to enhance student outcomes. Middle leaders (MLs) are increasingly required to lead school-based development initiatives to improve classroom practices. Informed by previous research on middle-leading and the theory of practice architectures, a survey instrument was created to understand who Australian school MLs are (n = 199) and ascertain their perceptions of the practices central to leading teaching and learning in their school sites. Through descriptive, exploratory, and confirmatory factor analyses, this paper reports on the reported practices of Australian MLs, and, through the analysis, a revised ML practice model is proposed. The results confirm that ML practices are orientated to the people they lead in their school site, who they support, collaborate with, and advocate for, with practising leading upwards to the school principal identified as an important ML practice. Full article

Developing highly active and durable Pt-based electrocatalysts is crucial for polymer electrolyte membrane fuel cells. This study focuses on the performance of oxygen reduction reaction (ORR) electrocatalysts composed of Pt-Pd alloy nanoparticles on graphene nanoplates (GNPs) anchored with sulfated zirconia nanoparticles. The results of field emission scanning electron microscopy and transmission electron microscopy showed that Pt-Pd and S-ZrO₂ are well dispersed on the surface of the GNPs. X-ray diffraction revealed that the S-ZrO₂ and Pt-Pd alloy coexist in the Pt-Pd/S-ZrO₂-GNP nanocomposites without affecting the crystalline lattice of Pt and the graphitic structure of the GNPs. To evaluate the electrochemical activity and reaction kinetics for ORR, we performed cyclic voltammetry, rotating disc electrode, and EIS experiments in acidic solutions at room temperature. The findings showed that Pt-Pd/S-ZrO₂-GNPs exhibited a better ORR performance than the Pt-Pd catalyst on the unsulfated ZrO₂-GNP support and with Pt on S-ZrO₂-GNPs and commercial Pt/C. Full article

In our previous studies, we showed that the generation of ovarian tumors in NSG mice (immune-compromised) resulted in the induction of muscle and cardiac cachexia, and treatment with withaferin A (WFA; a steroidal lactone) attenuated both muscle and cardiac cachexia. However, our studies could not address if these restorations by WFA were mediated by its anti-tumorigenic properties that might, in turn, reduce the tumor burden or WFA’s direct, inherent anti-cachectic properties. To address this important issue, in our present study, we used a cachectic model induced by the continuous infusion of Ang II by implanting osmotic pumps in immunocompetent C57BL/6 mice. The continuous infusion of Ang II resulted in the loss of the normal functions of the left ventricle (LV) (both systolic and diastolic), including a significant reduction in fractional shortening, an increase in heart weight and LV wall thickness, and the development of cardiac hypertrophy. The infusion of Ang II also resulted in the development of cardiac fibrosis, and significant increases in the expression levels of genes (ANP, BNP, and MHCβ) associated with cardiac hypertrophy and the chemical staining of the collagen abundance as an indication of fibrosis. In addition, Ang II caused a significant increase in expression levels of inflammatory cytokines (IL-6, IL-17, MIP-2, and IFNγ), NLRP3 inflammasomes, AT1 receptor, and a decrease in AT2 receptor. Treatment with WFA rescued the LV functions and heart hypertrophy and fibrosis. Our results demonstrated, for the first time, that, while WFA has anti-tumorigenic properties, it also ameliorates the cardiac dysfunction induced by Ang II, suggesting that it could be an anticachectic agent that induces direct effects on cardiac muscles. Full article

The IWATE criteria are well-established as a helpful tool to preoperatively estimate the difficulty and perioperative outcome of laparoscopic liver resections. We evaluated the relationship between the IWATE criteria and the perioperative outcomes in robotic-assisted liver resections (RARLs). Methods: We retrospectively analyzed the data of 58 patients who underwent robotic-assisted liver surgery at our center between July 2019 and April 2023. The operative difficulty of every patient was graded according to the IWATE criteria and compared to the perioperative outcome. Results: The median operation time was 236.5 min (range 37–671 min), and the median length of stay was 6 days (range 3–37 min). The majority had no complications (65.5%; n = 38), 18 (31.0%) patients suffered from mild complications (CD ≤ 3A) and 2 patients (3.4%) suffered from relevant complications (CD ≥ 3B). We observed no deaths within 30 postoperative days. The surgery time, postoperative ICU stay and perioperative blood transfusions increased significantly with a higher difficulty level (p = < 0.001; p < 0.001; p = 0.016). The length of stay, conversion to open surgery (n = 2) and complication rate were not significantly linked to the resulting IWATE group. Conclusions: The IWATE criteria can be implemented in robotic-assisted liver surgery and can be helpful in preoperatively estimating the difficulty of robotic liver resections. Whether there is a “robotic effect” in minimally invasive liver resections has to be further clarified. The IWATE criteria can help to develop curricula for robotic training. Full article

A set of experimental field single-borehole dilution tests were completed in the Motril–Salobreña detrital aquifer (Spain) in a sector with coarse material in four different moments under variable hydrological conditions. The comparative study of the tracer washing, and the temperature profile patterns for the tests carried out in two wells located hundreds of m from each other, revealed the presence of ascending vertical flows in one of the wells (not detected by other means) that compromises the reliability of the tracer test. The values of both the apparent horizontal velocity and hydraulic conductivity obtained in the affected well were less than half of those estimated in the well not affected by the upward vertical flows. The repetition of the test eight times during different seasons showed that the hydraulic conductivity calculated from the apparent horizontal velocity can vary; therefore, to approximate to a representative hydraulic conductivity value, using this method is recommended to carry out tests under different hydrological conditions and average the results. The difference generated by the changes in conditions for the specific setting of the study area was 25%. Taking this into account, it was considered that an approximation to the more representative value would be an average under variable hydrological conditions, resulting in a horizontal velocity of 6.7 m/d and hydraulic conductivity of 337 m/d. This information is critical for the management of the aquifer as it has strategic resources against droughts that are becoming more frequent in the Mediterranean area. Full article

The interactions between topology and algebraic geometry expose various interesting properties. This paper proposes the deformations of topological n-manifolds over the automorphic polynomial ring maps and associated isomorphic imbedding of locally flat submanifolds within the n-manifolds. The manifold deformations include topologically homeomorphic bending of submanifolds at multiple directions under algebraic operations. This paper introduces the concept of a topological equivalence class of manifolds and the associated equivalent class of polynomials in a real ring. The concepts of algebraic compositions in a real polynomial ring and the resulting topological properties (homeomorphism, isomorphism and deformation) of manifolds under algebraic compositions are introduced. It is shown that a set of ideals in a polynomial ring generates manifolds retaining topological isomorphism under algebraic compositions. The numerical simulations are presented in this paper to illustrate the interplay of topological properties and the respective real algebraic sets generated by polynomials in a ring within affine 3-spaces. It is shown that the coefficients of polynomials generated by a periodic smooth function can induce mirror symmetry in manifolds. The proposed formulations do not consider the simplectic class of manifolds and associated quantizable deformations. However, the proposed formulations preserve the properties of Nash representations of real algebraic manifolds including Nash isomorphism. Full article

Currently, research in youth soccer consists of methodological choices that can raise activity volumes and exercise intensity to promote proper training for youth soccer demands. Therefore, the present cluster randomised trial aims to evaluate the effects of the dynamic–ecological approach on the physical performance parameters compared with a traditional one in a group of sub-elite U13 players. Thirty-five male children (age 12.16 ± 0.55 years; weight 45.59 ± 7.15 kg; height 145.5 ± 4.2 cm; BMI 15.8 ± 2.1 kg·m⁻²) were recruited for this trial from two teams belonging to sub-elite soccer schools and randomly assigned to a dynamic–ecological approach (DEA) or a traditional training (TTG) group. The training program lasted six weeks and consisted of 18 training sessions of 90 min each (3 sessions per week). The sample was evaluated by the standing long jump (SLJ), hop test (HT), 10 m sprint (10 m), 10 × 5 m shuttle run test (SRT), and leg raise test (LR). The DEA group showed significantly higher results in the SLJ (p < 0.001), HT left leg (p < 0.001), 10 m sprint (p < 0.001), and SRT (p < 0.001). In conclusion, the dynamic–ecological approach provides higher performance adaptations. Therefore, this approach can be considered a suitable method to optimise pre-pubertal player training, mainly when no fitness or strength coach is available. Full article

C-type lectins in organisms play an important role in the process of innate immunity. In this study, a C-type lectin belonging to the DC-SIGN class of Micropterus salmoides was identified. MsDC-SIGN is classified as a type II transmembrane protein. The extracellular segment of MsDC-SIGN possesses a coiled-coil region and a carbohydrate recognition domain (CRD). The key amino acid motifs of the extracellular CRD of MsDC-SIGN in Ca²⁺-binding site 2 were EPN (Glu-Pro-Asn) and WYD (Trp-Tyr-Asp). MsDC-SIGN-CRD can bind to four pathogen-associated molecular patterns (PAMPs), including lipopolysaccharide (LPS), glucan, peptidoglycan (PGN), and mannan. Moreover, it can also bind to Gram-positive, Gram-negative bacteria, and fungi. Its CRD can agglutinate microbes and displays D-mannose and D-galactose binding specificity. MsDC-SIGN was distributed in seven tissues of the largemouth bass, among which the highest expression was observed in the liver, followed by the spleen and intestine. Additionally, MsDC-SIGN was present on the membrane of M. salmoides leukocytes, thereby augmenting the phagocytic activity against bacteria. In a subsequent investigation, the expression patterns of the MsDC-SIGN gene and key genes associated with the TLR signaling pathway (TLR4, NF-κB, and IL10) exhibited an up-regulated expression response to the stimulation of Aeromonas hydrophila. Furthermore, through RNA interference of MsDC-SIGN, the expression level of the DC-SIGN signaling pathway-related gene (RAF1) and key genes associated with the TLR signaling pathway (TLR4, NF-κB, and IL10) was decreased. Therefore, MsDC-SIGN plays a pivotal role in the immune defense against A. hydrophila by modulating the TLR signaling pathway. Full article

Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7–10 days from symptom onset. In the first hours or days after hospital admission, before an ELC procedure, the patient’s medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics. Additionally, concomitant conditions such as choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications must be recognized and adequately treated. The importance of ELC is related to the frequent recurrence of symptoms and complications of gallstone disease in the interval period between the onset of AC and surgical intervention. In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients. In this review, we provide a practical diagnostic and therapeutic approach to AC, even in specific clinical situations, based on evidence from the literature. Full article

The last few decades have witnessed significant advances in the development of polymeric-based foam materials. These materials find several practical applications in our daily lives due to their characteristic properties such as low density, thermal insulation, and porosity, which are important in packaging, in building construction, and in biomedical applications, respectively. The first foams with practical applications used polymeric materials of petrochemical origin. However, due to growing environmental concerns, considerable efforts have been made to replace some of these materials with biodegradable polymers. Foam processing has evolved greatly in recent years due to improvements in existing techniques, such as the use of supercritical fluids in extrusion foaming and foam injection moulding, as well as the advent or adaptation of existing techniques to produce foams, as in the case of the combination between additive manufacturing and foam technology. The use of supercritical CO₂ is especially advantageous in the production of porous structures for biomedical applications, as CO₂ is chemically inert and non-toxic; in addition, it allows for an easy tailoring of the pore structure through processing conditions. Biodegradable polymeric materials, despite their enormous advantages over petroleum-based materials, present some difficulties regarding their potential use in foaming, such as poor melt strength, slow crystallization rate, poor processability, low service temperature, low toughness, and high brittleness, which limits their field of application. Several strategies were developed to improve the melt strength, including the change in monomer composition and the use of chemical modifiers and chain extenders to extend the chain length or create a branched molecular structure, to increase the molecular weight and the viscosity of the polymer. The use of additives or fillers is also commonly used, as fillers can improve crystallization kinetics by acting as crystal-nucleating agents. Alternatively, biodegradable polymers can be blended with other biodegradable polymers to combine certain properties and to counteract certain limitations. This work therefore aims to provide the latest advances regarding the foaming of biodegradable polymers. It covers the main foaming techniques and their advances and reviews the uses of biodegradable polymers in foaming, focusing on the chemical changes of polymers that improve their foaming ability. Finally, the challenges as well as the main opportunities presented reinforce the market potential of the biodegradable polymer foam materials. Full article

Histone demethylases, enzymes responsible for removing methyl groups from histone proteins, have emerged as critical players in regulating gene expression and chromatin dynamics, thereby influencing various cellular processes. LSD2 and LSD1 have attracted considerable interest among these demethylases because of their associations with cancer. However, while LSD1 has received significant attention, LSD2 has not been recognized to the same extent. In this study, we conduct a comprehensive comparison between LSD2 and LSD1, with a focus on exploring LSD2’s implications. While both share structural similarities, LSD2 possesses unique features as well. Functionally, LSD2 shows diverse roles, particularly in cancer, with tissue-dependent roles. Additionally, LSD2 extends beyond histone demethylation, impacting DNA methylation, cancer cell reprogramming, E3 ubiquitin ligase activity and DNA damage repair pathways. This study underscores the distinct roles of LSD2, providing insights into their contributions to cancer and other cellular processes. Full article

Donepezil (DNPZ) is a cholinesterase inhibitor used for the management of Alzheimer’s disease (AD) and is dependent on membrane transporters such as ABCG2 to actively cross brain barriers and reach its target site of action in the brain. Located in the brain ventricles, the choroid plexus (CP) forms an interface between the cerebrospinal fluid (CSF) and the bloodstream, known as the blood–CSF barrier (BCSFB). Historically, the BCSFB has received little attention as a potential pathway for drug delivery to the central nervous system (CNS). Nonetheless, this barrier is presently viewed as a dynamic transport interface that limits the traffic of molecules into and out of the CNS through the presence of membrane transporters, with parallel activity with the BBB. The localization and expression of drug transporters in brain barriers represent a huge obstacle for drug delivery to the brain and a major challenge for the development of therapeutic approaches to CNS disorders. The widespread interest in understanding how circadian clocks modulate many processes that define drug delivery in order to predict the variability in drug safety and efficacy is the next bridge to improve effective treatment. In this context, this study aims at characterizing the circadian expression of ABCG2 and DNPZ circadian transport profile using an in vitro model of the BCSFB. We found that ABCG2 displays a circadian pattern and DNPZ is transported in a circadian way across this barrier. This study will strongly impact on the capacity to modulate the BCSFB in order to control the penetration of DNPZ into the brain and improve therapeutic strategies for the treatment of AD according to the time of the day. Full article

Tumor-infiltrating lymphocytes (TILs) represent a subset of immunological constituents within the tumor microenvironment that can influence cancer growth. We retrospectively evaluate the density and pattern of CD3 and CD20 expression in salivary gland tumors and their relation to clinical pathologic parameters. A total of 44 formalin-fixed paraffin-embedded blocks of salivary gland tumors were included. These tumors were stained immunohistochemically with CD3 and CD20. The chi-square test was used to relate immune scoring, intensity, and clinical pathological parameters to different salivary tumors. p-value < 0.05 was considered statistically significant. The intra-tumoral CD3 infiltrating count was high and diffused in (71.4%) of pleomorphic adenomas (PAs) followed by mucoepidermoid carcinomas (MECs) (66.7%). At the same time, adenoid cystic carcinomas (AdCCs) exhibited significantly low infiltration (71.4%) (p = 0.046). The three types of tumors exhibited high tumor-infiltrating counts diffused in peripheral areas with significant differences between malignant tumors (p = 0.047). The intra-tumoral CD20 infiltrating count significantly differed among the tumors (p = 0.002); it was low in all PAs and AdCCs, while MECs showed an equal percentage of expression. However, in the peripheral area, PAs and MECs exhibited significantly (p = 0.007) high infiltrating counts (69.2% and 84.6), and the lowest infiltrating count was predominantly found for AdCCs. The two markers had a significant positive correlation between the mean of CD3 in the intra-tumoral and peripheral regions and CD20 in the peripheral zone across the total samples. In conclusion, the density of CD3 expression is notably higher than CD20 across tumor types. PAs and MECs showed high-density scores, while AdCCs were characterized by low scores. TIL expression was found to be significantly associated with patients’ outcomes in the intra-tumoral area. Full article

Spirituality-centered cognitive therapy refers to the way in which people search for and express the meaning and purpose of their lives, as well as experience connection with themselves, others, nature, and spirituality. This study aimed to determine the effectiveness of spirituality-centered cognitive therapy on body image, sexual function, disease perception, and disturbing thoughts in women after mastectomy. This was semi-experimental research, which was conducted via a pre-test–post-test method and had a control group. The samples included 85 women with breast cancer who had undergone mastectomy, and, based on the inclusion criteria, 78 individuals were randomly selected and were then divided into two groups (39 individuals in the intervention group and 39 individuals in the control group). The intervention group received eight 120 min sessions of spirituality-centered cognitive therapy, and the control group did not receive any training. Data were collected using questionnaires on illness perception, body image, sexual function, and rumination and were then analyzed by multivariate analysis of variance with repeated measurements using SPSS-24. Before the training, there was no significant difference between the intervention and control groups in the scores obtained by the scales. After the intervention, the mean scores in all scales except sexual function were significantly different from the control group. Therefore, spirituality-centered cognitive therapy may be useful for improving negative psychological symptoms among women in Iran with breast cancer after mastectomy surgery. Full article

Pulse oximetry is a non-invasive, cost-effective, and generally reliable instrument measuring pulse rate and peripheral oxygen saturation (SpO₂). However, these measurements can be affected by the patient’s internal or external factors, including the type of pulse oximeter device (POD). (1) This study’s objective was to identify potential environmental factors that may impact the measurements taken by three PODs. (2) Methods: A descriptive–analytical cross-sectional study was designed. The patients’ SpO2 levels were measured using a standard monitor and two PODs owned by the professionals. The measurements were taken on the patients’ fingers. Concurrently, we evaluated the surrounding environmental conditions, encompassing temperature, humidity, illuminance, and noise. (3) Results: This study involved 288 adult participants in the sample. For each 20-decibel increment in noise, there was a reduction in SpO₂ by an average of 1%, whereas for every additional degree of ambient temperature, SpO₂ decreased by an average of 2% (4) Conclusions: Significant correlations between SpO₂ and age, as well as with noise and ambient temperature, were observed. No significant differences between oxygen saturation and lighting or humidity were observed. This study was prospectively registered with the Clinical Research Ethics Committee of Gran Canaria at the Dr. Negrín University Hospital, with protocol code 2019-247-1, and approved on 24 May 2019. Full article

This research extensively discusses the connection between destination image and films influencing tourism. Despite the worldwide fame of the James Bond saga and extensive publications on the subject, research into the role of tourism promotion in the image of destinations is still scarce, and there is no specific focus on analysing promotional aspects in relation to film-induced tourism. This study focuses on the influence of cinematographic images on the destination image perception and promotion, specifically exploring the case of the James Bond saga as a practical case. With 25 films released since 1962, the James Bond saga provides a basis for evaluating cinematic presence in tourism promotion strategies. This research proposes the content analysis of the official tourist websites of 23 destinations where the James Bond saga was shot, which offer some tourist products linked to the saga. The key findings provide valuable insights into the promotion of James Bond saga tourism destinations, the role of films in promoting destinations, and the tourism products developed from the saga films. The results provide visual outputs about the target image of the film shooting locations, and the text analysis provides keywords linked to the theme. The study’s methodology contributes to the discourse on film tourism and destination image topics and brings practical and theoretical contributions to both academia and destination managers. Full article

Multiple factors may influence parental vaccine hesitancy towards pediatric COVID-19 vaccines and routine childhood immunizations (RCIs). Using the United States National Immunization Survey—Child COVID Module data collected from parents/guardians of children aged 5–11 years, this cross-sectional study (1) identified the trends and prevalence estimates of parental hesitancy towards pediatric COVID-19 vaccines and RCIs, (2) examined the relationship between hesitancy towards pediatric COVID-19 vaccines and RCIs, and (3) assessed trends in parental hesitancy towards RCIs by sociodemographic characteristics and behavioral and social drivers of COVID-19 vaccination. From November 2021 to July 2022, 54,329 parents or guardians were interviewed. During this 9-month period, the proportion of parents hesitant about pediatric COVID-19 vaccines increased by 15.8 percentage points (24.8% to 40.6%). Additionally, the proportion of parents who reported RCIs hesitancy increased by 4.7 percentage points from November 2021 to May 2022 but returned to baseline by July 2022. Over nine months, parents’ concerns about pediatric COVID-19 infections declined; however, parents were increasingly worried about pediatric COVID-19 vaccine safety and overall importance. Furthermore, pediatric COVID-19 vaccine hesitancy was more prevalent among parents of children who were White (43.2%) versus Black (29.3%) or Hispanic (26.9%) and those residing in rural (51.3%) compared to urban (28.9%) areas. In contrast, RCIs hesitancy was higher among parents of children who were Black (32.0%) versus Hispanic (24.5%) or White (23.6%). Pediatric COVID-19 vaccine hesitancy was 2–6 times as prevalent among parents who were RCIs hesitant compared to those who were RCIs non-hesitant. This positive correlation between parental hesitancy towards pediatric COVID-19 vaccines and RCIs was observed for all demographic and psychosocial factors for unadjusted and adjusted prevalence ratios. Parent–provider interactions should increase vaccine confidence, shape social norms, and facilitate behavior change to promote pediatric vaccination rates. Full article