To measure the association between job satisfaction and perceived quality of care among nurses on labor and delivery (LD) units.

Nurses constitute the largest segment of the US healthcare workforce. Low job satisfaction is a critical factor in nurse turnover and quality of care.

A web-based survey was distributed across LD units in the United States. We used logistic regression to assess the association between job satisfaction, as measured by the employee net promoter score (eNPS), and perceived indicators of quality of care.

Among 1021 LD nurses who responded, those characterized as passive or detractors had greater odds of rating that the quality of care on their LD unit was fair or good rather than excellent (adjusted odds ratio [aOR] 3.45, 95% CI: 2.44-4.88 and aOR 6.58, 95% CI: 4.08-10.75, respectively, with both p < 0.0001), agreeing that nurses were spending less time with laboring patients suspected or confirmed to have COVID-19 (aOR 1.42, 95% CI: 1.04-1.95, p = 0.0288; aOR 2.08, 95% CI: 1.33-3.28, p = 0.0014) and reporting that professional labor support was frequently or always missed during the pandemic (aOR 2.19, 95% CI: 1.49-3.20, p < 0.0001; aOR 1.82, 95% CI: 1.09-3.03, p = 0.0217) compared to respondents characterized as promoters.

Higher nursing job satisfaction as measured by the eNPS is associated with higher perceived quality of care on the LD units.

eNPS is a one-question survey that is easy to deliver, simple to interpret, and is associated with perceived quality of care. Nursing management can use it to track progress over time and understand reasons for job dissatisfaction on their units.

To evaluate the association between albumin administration as volume replacement and mortality in adult ARDS patients, we performed this meta-analysis and trial sequential analysis (TSA).

We searched databases including PubMed, Science Direct, Scopus, Web of Science databases and Cochrane Central Register of Controlled Trials up to 12 December 2024. We screened trials that included adult ARDS patients and compared albumin with crystalloid. The 28-day mortality served as the primary endpoint, while the oxygenation change, the length of ICU stay and the length of hospital stay were designated as secondary outcomes. To clarify the differing concentrations of albumin, we formed two distinct subgroups: the hyper-oncotic albumin subgroup (≥20%) and the iso-oncotic albumin subgroup (4%∼5%). Statistical synthesis was performed with Cochrane Review Manager 5.4.1, employing random-effects models. To mitigate random errors, TSA was implemented with α = 0.05 and β = 0.20 parameters.

The analysis incorporated 5 publications: 3 randomized controlled trials (RCTs) and 2 non-randomized studies (NRSs). Overall mortality was lower in the albumin group (33.2%, 97/292) than in the crystalloid group (44.9%, 133/296) (OR = 0.61, 95%CI 0.43-0.85, p = 0.004). RCTs (n = 204) showed no benefit (OR = 0.83, p = 0.54), but NRSs (n = 384) demonstrated reduced mortality (OR = 0.52, p = 0.002). Hyper-oncotic albumin was associated with lower mortality in NRSs (OR = 0.40, p = 0.02) but not in RCTs (OR = 0.74, p = 0.57). Iso-oncotic albumin showed no benefit (OR = 0.88, p = 0.72). Regarding the impact of albumin on oxygenation, significant improvements in oxygenation were observed only on the first (p = 0.05) and second days (p < 0.0001). The TSA indicated a continued need for high-quality RCTs.

Our analysis suggests that hyper-oncotic albumin may reduce mortality and improve early oxygenation in ARDS patients compared to crystalloids. Larger RCTs are urgently needed to validate these findings and define their potential role in clinical management.

Coronavirus disease 2019 (COVID-19) imposed substantial health and social burdens worldwide, disrupting healthcare delivery and challenging public health governance. Korea's early, coordinated response was associated with low mortality and maintained essential services, yet the prolonged pandemic exposed structural inequalities, workforce strain, and psychosocial impacts. To comprehensively understand these multidimensional effects, this review synthesizes systematic and narrative evidence on the clinical, epidemiologic, and societal consequences of COVID-19 in Korea. We conducted a combined systematic and narrative review of Korean evidence (2020-2025). The systematic review included studies from PubMed, Embase, KoreaMed, and KMbase, supplemented by manual journal searches. Eligible studies addressed key epidemiologic indicators, including seroprevalence, mortality among patients with comorbidities, severe outcomes in high-risk groups, and vaccination coverage by comorbidity. Quality was assessed using Joanna Briggs Institute tools. We additionally examined government white papers, national reports, policy briefs, and peer-reviewed articles to contextualize epidemiologic findings, synthesizing materials across health burden, healthcare system changes, social consequences, and policy responses. Twenty-four epidemiologic studies and 72 narrative sources were included. Seroprevalence remained below 1% during the early pandemic, increasing sharply after omicron's emergence. Patients with chronic illnesses consistently experienced higher risks of severe outcomes and mortality, while high-risk groups showed elevated odds of intensive care use and complications. Alongside clinical patterns, national data documented substantial reductions in outpatient visits, elective procedures, emergency care, and pediatric services. Burnout and psychological distress intensified among healthcare workers, while prolonged distancing and economic disruption contributed to widening social fatigue. Policy responses and vaccination improved population outcomes, although gaps persisted in communication strategies and addressing disparities across age, socioeconomic status, and comorbidity groups. Korea's experience underscores that preparedness must align clinical efficiency with social equity. Strengthening primary and emergency care, ensuring fair compensation and workforce protection, and maintaining transparent risk communication are essential for building a resilient, inclusive public health system to withstand future pandemics.

COVID-19 has profoundly affected children's well-being. Resilience was often found to be negatively correlated with COVID-19 impacts. However, the role of resilience in directly shaping COVID-19 impacts on children remains unclear, as studies report conflicting evidence regarding the potential causal direction between COVID-19 impacts and resilience. Higher resilience could reduce COVID-19 impacts, while COVID-19 impacts may also disrupt or enhance resilience. Or it could be the case that the two are simply correlated due to shared underlying common factors. This preregistered study uses a twin-based Direction of Causation modeling approach with data from 1166 twins (age: M = 12.59; 50.78% male; 85.08% White) to explore the causal direction between COVID-19 impacts and resilience. Resilience was assessed using the Child and Youth Resilience Measure (CYRM)-Child Version, a child self-report questionnaire assessing resources available for children's resilience. Findings revealed a causal effect such that resilience resources explained 32% variance in overall COVID-19 impacts, consistently buffering negative outcomes across multiple domains (e.g., social connections, general stress, and COVID-related stress). A reciprocal causal effect was found for economic impacts, with resilience mitigating economic impacts and economic challenges enhancing resilience. SYMMARY: Resilience has been found to be negatively associated with negative impacts of COVID-19. Using a national twin sample, we adopted a twin-based Direction-Of-Causation Modeling approach to examine how COVID-19 impacts and resources for resilience influence each other. We found that resilience resources causally reduce COVID-19 impacts, explaining 32% of the variance in how children experienced the pandemic. Findings in this study inform clinical and educational practice, highlighting the value of resilience-building efforts to support children during and after crises.

When developing clinical prediction models, it can be challenging to balance between global models that are valid for all patients and personalized models tailored to individuals or potentially unknown subgroups. To aid such decisions, we propose a diagnostic tool for contrasting global regression models and patient-specific (local) regression models. The core utility of this tool is to identify where and for whom a global model may be inadequate. We focus on regression models and specifically suggest a localized regression approach that identifies regions in the predictor space where patients are not well represented by the global model. As localization becomes challenging when dealing with many predictors, we propose modeling in a dimension-reduced latent representation obtained from an autoencoder. Using such a neural network architecture for dimension reduction enables learning a latent representation simultaneously optimized for both good data reconstruction and for revealing local outcome-related associations suitable for robust localized regression. We illustrate the proposed approach with a clinical study involving patients with chronic obstructive pulmonary disease. Our findings indicate that the global model is adequate for most patients but that indeed specific subgroups benefit from personalized models. We also demonstrate how to map these subgroup models back to the original predictors, providing insight into why the global model falls short for these groups. Thus, the principal application and diagnostic yield of our tool is the identification and characterization of patients or subgroups whose outcome associations deviate from the global model.

To explore barriers and facilitators experienced by Australian organizational stakeholders in implementing COVID-19 vaccine rollout for health professional students.

A qualitative study using semi-structured interviews with organizational stakeholders, including senior health department staff, university clinical placement coordinators, and clinical educators across Australia from November 21 to December 20, 2022, via ZOOM. An inductive and then deductive thematic analysis was conducted, guided by the Theoretical Domains Framework.

Nineteen participants were interviewed. Five key domains were generated: environmental context and resources, attention, decision-making, and goals, professional role and identity, emotion, and optimism. Barriers included top-down communication, inconsistent messaging, and limited vaccine access, leading to negative emotions. Enablers included teamwork, adaptability, and optimism.

The findings offer insights into operational challenges and support during the vaccine rollout. These lessons should inform strategies to overcome similar barriers in future large-scale health interventions or emergency responses.

Influenza continues to be a major threat to global health and a substantial economic burden. Innovative strategies are needed to tackle the growing resistance to established influenza therapeutics and to develop new therapeutics with novel mechanisms of action. Previous peptide and small molecule designs have been successful only against influenza group 1 hemagglutinin (HA). Here, we report on a CLIPS (Chemical Linkage of Peptides onto Scaffolds)-based approach to design potent peptidic inhibitors of influenza A viruses that now extend to both group 1 and group 2 HAs. This approach merges features of antibodies and small molecules to design constrained bicyclic peptides that engage the highly conserved HA stem. The heavy-chain complementarity-determining region 3 (HCDR3) of human broadly neutralizing antibody FI6v3 was grafted onto functionalized small molecule scaffolds. The designed peptides exhibited in vitro heterosubtypic cross-reactivity in binding to group 1 (H1 and H5) and group 2 (H3 and H7) HAs and in neutralization of H1N1, H5N1, and H7N3 viruses. A crystal structure of the bicyclic peptide with HA from H1N1 A/Puerto Rico/8/1934 (H1/PR8) at 2.35 Å resolution revealed that the designed peptide faithfully mimics the binding mode and functionality of the parent antibody FI6v3 to the highly conserved stem epitope. These structural and functional data illustrate how both group 1 and group 2 influenza A viruses can now be targeted by constrained peptidic ligands that should aid in development of pan-influenza therapeutics.

The coronavirus disease 2019 (COVID-19) pandemic has not only challenged global public health but also generated interest in its neurological basis. A growing number of neuroimaging studies have used quantitative magnetic resonance imaging (MRI) to quantify brain alterations in COVID-19 patients. We conducted a comprehensive review to synthesize brain regions with abnormal MRI metrics of microstructure and function in COVID-19 patients compared to healthy controls. Drawing upon 49 studies sourced from PubMed, Embase, and Web of Science databases, our review showcases structural and functional brain abnormalities across many brain regions in COVID-19. Across multimodal MRI studies, alterations were predominantly in frontal regions, temporal regions, parietal regions, limbic system, and subcortical nuclei. Our findings may help understanding of the neurophysiological basis of acute neurological symptoms and long-term neurological sequelae associated with COVID-19.

Venothromboembolic (VTE) events are considered rare complications following foot and ankle surgery. Most instances of VTE following surgical procedures occur in particularly high-risk patient populations; therefore, VTE prophylactic anticoagulation is initiated based on risk/benefit stratification for each individual patient undergoing foot and ankle surgery. We present a case report on a 40-year-old male who underwent isolated Lisfranc ligament repair and subsequently developed an acute saddle pulmonary embolism and deep vein thrombosis 1 month postoperatively. The patient was on prophylactic Lovenox, yet still developed a life-threatening complication. The patient was found to be on a selective estrogen receptor modulator for the off-label treatment of male infertility. This medication, surgical intervention, and a period of non-weight bearing are believed to be contributory to the patient's relatively increased hypercoagulable state. This case depicts a rare complication of foot and ankle surgery and highlights the importance of VTE prophylaxis during the postoperative period.

Clinical, experimental, and computational evidence of COVID-19 virulence and infectivity has been linked to SARS-CoV-2 shell disorder. A strong link was first discovered using an AI disorder-predicting tool, which detected an unusually hard (low disorder) outer shell among all SARS-CoV-2-related viruses but not in the 2003 SARS-CoV-1. This could account for the high infectivity found in SARS-CoV-2-but not in SARS-CoV-1-as it is believed that hard shells protect viral particles from the onslaught of the antimicrobial enzymes present in the respiratory system and saliva. As a result, much larger quantities of particles are shed by COVID-19 patients. Abnormally hard outer shells (M) are associated with burrowing animals, e.g., pangolins, and SARS-CoV-2 likely acquired these shells due to its long-term evolutionary interactions with pangolins. As for virulence, the inner shell of SARS-CoV-2 (N) has been found to exhibit lower disorder than that of SARS-CoV-1. This lower disorder is consistent with the fact that SARS-CoV-2 is less virulent than SARS-CoV-1, as higher disorder in the inner shell is associated with more efficient protein-protein binding during replication. The link between N/M disorder and virulence or infectivity falls under the umbrella of shell disorder models (SDMs), which can connect virulence, infectivity, and long COVID under one coherent concept. Evidence of the reliability and reproducibility of SDMs as applied to COVID-19 is examined. The hard M that is resisting the antimicrobial enzymes in the respiratory system can be extended to immunological enzymes, especially those found in phagocytes such as macrophages, which can therefore become a reservoir for the virus.