Articles

Hypertension remains a leading cause of cardiovascular morbidity and mortality. Although effective antihypertensive therapies are available, sustained blood pressure control remains suboptimal due to inconsistent medication use. Most adherence research is quantitative and offers limited understanding of how individuals interpret lifelong treatment within daily life, particularly in culturally grounded contexts. To explore the lived experiences of Filipino adults taking antihypertensive medication. A qualitative study grounded in Heideggerian interpretive phenomenology was conducted. Ten Filipino adults diagnosed with hypertension were purposively recruited from outpatient clinics in Manila, Philippines. In-depth semi-structured interviews were transcribed verbatim and analyzed using the six-step IPA framework. Analysis revealed six interconnected themes describing how participants interpreted and sustained medication use: (1) Diagnosis as Disruption; (2) Medication as Protection and Responsibility; (3) The Paradox of the Silent Illness; (4) Everyday Barriers to Sustained Treatment; (5) Constructing Routine and Adaptive Self-Management; and (6) Family as Anchor within Cultural Contexts. These themes reflected emotional adjustment, symptom-driven adherence, financial and work-related barriers, adaptive coping strategies, and strong family-centered motivation. Medication-taking was experienced as an ongoing negotiation shaped by bodily cues, daily demands, and relational obligations. Conclusion: Antihypertensive medication use is shaped by relational, cultural, and socioeconomic contexts, underscoring the need for family-inclusive and culturally responsive hypertension care.

<b>Objective:</b> To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. <b>Methods:</b> We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. <b>Results:</b> A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. <b>Conclusion:</b> Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.

The pachychoroid spectrum is a new entity grouping pathologies with common choroidal features. First described in 2013 by American ophthalmologist Bailey Freund and his team [1]. It is defined by a diffuse or focal increase in choroidal thickness with dilatation of choroidal vessels adjacent to Bruch's membrane, associated with retinal pigment epithelial dysfunction, loss of the choriocapillaris and thinning of Sattler's layer [1, 2]. At present, the pachychoroid spectrum includes well-known pathologies such as central serous chorioretinitis (CSCR) and polypoidal choroidal vasculopathy (PCV), as well as pathologies of more recent description such as epitheliopathy or type 1 neovessels secondary to pachychoroid, pachydrusen, choroidal excavation and peripapillary pachychoroid. The morphological changes of the lens which is a cataract can be unilateral or bilateral and occur symmetrically or not over variable durations. A cataract is said to be mature when the opacification occupies the entire lens, it induces a complete loss of vision. It makes the visualization of the fundus reflection impossible, which explains the impossibility of visualizing hemorrhages and other lesions of the eye with the possibility of concealing a pachychoroid spectrum during the ocular examination in patients. The aim of our study is to describe the symptomatology and therapeutic approach of SPC.

The construction industry remains one of the most hazardous sectors globally, with Nigeria experiencing a high incidence of workplace accidents despite the adoption of Occupational Health and Safety Management (OHSM) frameworks. This study evaluated the effectiveness of OHSM practices in improving workplace safety across construction companies in Nigeria’s coastal cities. A cross-sectional design was employed, combining quantitative surveys of construction workers (n = 1,400) with qualitative interviews of 35 managers and supervisors. Quantitative data were analyzed using SPSS version 28, while thematic analysis was applied to qualitative responses. Findings revealed a generally positive perception of OHSM, with 54.4% of workers rating OHS policy effectiveness as “Good” and 52.0% rating health outcomes as “Good.” However, accident frequency remained a concern, with 46.4% reporting accidents occurred “Occasionally” and 31.9% acknowledging them as “Frequent” or “Very Frequent.” Comparative analysis showed indigenous firms were rated higher in policy effectiveness and health outcomes but also reported slightly higher accident frequencies than international firms. Thematic analysis identified five key monitoring and evaluation strategies including routine inspections, regular training, audits, behavioural reinforcement, and access control, Also, five measures of OHSM effectiveness, including compliance observation, incident tracking, KPIs, employee feedback, and benchmarking. OHSM was found to positively influence project outcomes by reducing compensation costs, enhancing reputation, and improving supervision and quality of work. OHSM practices in Nigeria’s construction sector are perceived as effective in policy and health outcomes, yet accident rates remain a critical challenge. The study underscores the importance of continuous training, stricter enforcement, behavioural reinforcement, and systematic performance evaluation.

An effective mentor is critical to the success of an online doctoral student. Researchers have found that online doctoral students prefer frequent interactions with their mentor, while faculty prefer mentees to be autonomous. Transformative online doctoral mentoring (ODM) requires the development of a strong collaborative working relationship between the mentee and mentor, who serves as the link between the student and academia, as well as their guide and working partner throughout the dissertation process. In this paper, I argue that the ultimate objective of ODM, the establishment of such a relation-ship between mentor and mentee, increases the likelihood of student success. I support this contention with a set of principles and practices grounded in relevant models and methods of human development, participative leadership, and collaborative change management that provide insights into the what, why, and how of transformative ODM.

<b>Introduction:</b> Severe pre-eclampsia is a multisystem disorder associated with various ocular complications, however postpartum bilateral serous retinal detachment is uncommon and may threaten vision if not early recognized, thus requiring prompt management in order to prevent permanent visual loss. <b>Clinical Description:</b> A case of a 31-year-old woman, G3P0 with an in vitro fertilization and previous miscarriages, developed severe pre-eclampsia at 34 weeks of gestation. She underwent an emergency cesarean section for maternal indication. On the second postoperative day, she develops sudden unilateral blindness and blurred vision in the contralateral eye. Ophthalmological examination showed normal optics discs while MRI revealed bilateral serous retinal detachment. She was managed conservatively with strict blood pressure control, magnesium sulphate therapy and anticoagulation with full recovery of vision over 3 weeks without need of surgical intervention. <b>Discussion:</b> Postpartum retinal detachment is uncommon, most often serous and reversible. This case highlights that conservative management focusing on strict blood pressure control and supportive care was sufficient to avoid surgical intervention. Timely diagnosis and coordinated multidisciplinary management ensured complete visual recovery. <b>Conclusion:</b> Bilateral serous retinal detachment is a rare but reversible postpartum complication of severe pre-eclampsia. With early recognition, close monitoring and conservative management can lead to complete restoration of vision.

<b>Background:</b> Tobacco endgame, defined as elimination of commercial tobacco sales The U.S. tobacco control landscape is a complex, adaptive system shaped by diverse stakeholders, evolving products and regulations, shifting social norms, and the strategic countermeasures of a powerful industry. Managing such complexity requires more than isolated interventions—it demands a coordinated, enterprise-wide approach that accounts for dynamic interactions, feedback loops, and emergent risks. <b>Objective:</b> Drawing on complex systems thinking, Zachman enterprise architecture model, and public health best practices, we conceptualize tobacco control as an evolving enterprise progressing through six interconnected phases: (1) Conception &#x26; Initiation, (2) Policy &#x26; System Design, (3) Implementation &#x26; Operation, (4) Evaluation &#x26; Adaptation, (5) Consolidation &#x26; Endgame Transition, and (6) Sustainment or Sunset. Each phase incorporates governance structures, performance benchmarks, and transition criteria designed to manage interdependence and reduce systemic vulnerabilities. <b>Results:</b> The lifecycle framing emphasizes how tobacco control in the U.S. can evolve as a complex, adaptive enterprise—integrating public health objectives with legal, operational, and cultural change processes. This model supports strategic sequencing, cross-sector alignment, and risk mitigation against emergent industry tactics, enabling a resilient and measurable pathway to the endgame. <b>Conclusions:</b> Seeing tobacco control as a complex enterprise that operates under a lifecycle model may offer a roadmap for achieving and sustaining the tobacco endgame. Using this approach may enhance policy coherence, resource efficiency, and adaptability, ensuring tobacco endgame is achieved.

A man in his 60s with multiple vascular comorbidities presented with sudden, painless vision loss in one eye. Although he had a high risk for atherosclerotic events, initial evaluation for stroke was negative for acute ischemia, but found to have markedly elevated inflammatory markers. Accordingly, giant cell arteritis was investigated and Ophthalmologic findings and fulfillment of the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria supported the diagnosis of giant cell arteritis, despite a negative temporal artery biopsy. Management included high-dose glucocorticoids and delayed tocilizumab initiation due to the need for multiple vascular surgeries. Vision loss was irreversible, but systemic symptoms resolved and vascular interventions were successful. This case highlights the diagnostic and management complexities of biopsy-negative giant cell arteritis in patients with severe atherosclerotic vascular disease, emphasizing the importance of clinical judgment and established classification criteria when imaging and biopsy results are inconclusive.

This literature review delves deeply into the epidemiology, structural and cultural challenges, and management strategies of status epilepticus (SE) in sub-Saharan Africa (SSA). Incidence rates of SE vary significantly between countries, with notable disparities associated with socio-economic contexts, healthcare infrastructures, and cultural perceptions of epilepsy. The management of SE in this region is often hindered by constraints in medical infrastructure, inadequate access to specialist diagnostics such as electroencephalogram, and limited availability of essential anti-epileptic drugs, which are frequently out of reach for rural populations. These challenges are further exacerbated by the social stigma and cultural beliefs surrounding epilepsy, impeding access to care and widening inequalities. Moreover, the scarcity of qualified medical personnel undermines the efficient and prompt management of this neurological emergency. The review underscores the pressing need to enhance healthcare infrastructures, boost the capabilities of healthcare professionals, and conduct community awareness initiatives to destigmatize epilepsy and lessen prejudice. Additionally, practical recommendations are put forward for enhancing local capacity, fostering equity in care access, and mitigating regional health disparities in SSA.

Knee osteoarthritis (KOA) is a chronic degenerative joint disorder that significantly impairs mobility and quality of life. While surgical interventions such as total knee arthroplasty (TKA) are effective in severe cases, conservative treatments are critical for early and intermediate disease management. This review evaluates the efficacy, safety, and clinical applications of both conservative and surgical treatment approaches, including lifestyle modifications, physical therapy, pharmacological interventions, regenerative medicine, and surgical procedures. The integration of a multidisciplinary approach is emphasized as a key strategy for optimizing clinical outcomes and tailoring interventions to disease severity.

Recent advancements in the screening, diagnosis, and management of obstructive sleep apnea (OSA) have significantly improved patient outcomes. For screening, the use of home sleep apnea testing (HSAT) has become more prevalent, offering a convenient and cost-effective alternative to traditional in-lab polysomnography. HSAT devices have shown good specificity and sensitivity, particularly in patients with a high pre-test probability of OSA. In terms of diagnosis, advancements in wearable technology and mobile health applications have enabled continuous monitoring of sleep patterns and respiratory parameters. These tools provide valuable data that can be used to identify OSA more accurately and promptly. Additionally, machine learning algorithms are being integrated into diagnostic processes to enhance the accuracy of OSA detection by analyzing large datasets and identifying patterns indicative of the condition. Management of OSA has also seen significant progress. Continuous positive airway pressure (CPAP) therapy remains the gold standard, but new developments include auto-adjusting CPAP devices that optimize pressure settings based on real-time feedback. Mandibular advancement devices and hypoglossal nerve stimulation are emerging as effective alternatives for patients who are CPAP-intolerant. Furthermore, lifestyle interventions such as weight management, positional therapy, and exercise have been shown to complement medical treatments, leading to better overall outcomes. This review article highlights these advancements that collectively contribute to improved patient adherence, reduced symptoms, and enhanced quality of life for individuals with OSA.

<b>Background</b>: Disasters such as typhoons, floods, and earthquakes frequently impact the Philippines, placing nurses at the forefront of response and care. Given these recurring threats, ensuring that nurses possess adequate awareness, knowledge, and skills is crucial to mitigate risks, enhance preparedness, and promote effective disaster management. <b>Aim/Objectives</b>: This study sought to (1) assess the current levels of awareness, knowledge, skills, and involvement of private hospital nurses in Rizal Province across four phases of disaster management—mitigation and prevention, preparedness, response, and rehabilitation and recovery; and (2) propose a contingency and training plan based on identified gaps. <b>Methods</b>: A descriptive correlational design was employed. A total of 350 nurses from Level 1, 2, and 3 hospitals participated by completing a validated questionnaire. Data were analyzed using descriptive statistics, analysis of variance, and correlation tests to identify differences and relationships among variables. <b>Results</b>: Overall, the nurses reported very high levels of awareness and skills, coupled with a high level of knowledge and significant involvement in disaster-related activities. Nurses in larger (Level 3) hospitals exhibited higher practical readiness and engagement, while those in Level 1 and 2 facilities had comparatively lower scores. Positive correlations emerged between higher levels of awareness, knowledge, and skills and increased engagement in disaster initiatives. <b>Conclusion</b>: Building on these findings, a targeted contingency and training plan was designed using Pucel’s Performance-based Instructional Design, emphasizing hands-on simulations, structured policy briefings, and collaborative efforts with local disaster risk reduction offices. Addressing these specific gaps can bolster hospital preparedness, strengthen community resilience, and ensure more effective disaster response and patient care.

Digital therapeutics (DTx) play a transformative role in diabetes management by leveraging technology to provide personalized, data-driven medical interventions. These tools enhance self-management by offering continuous monitoring and real-time feedback on glucose levels, diet, and physical activity. This personalized approach helps patients adhere to treatment plans and make informed lifestyle changes, leading to improved clinical outcomes such as reduced HbA1c levels and better overall diabetes control. The importance of DTx lies in their ability to make diabetes care more accessible and convenient. Mobile apps and telemedicine platforms enable patients to receive support and guidance from anywhere, reducing the need for frequent in-person visits. Additionally, DTx often include behavioral support features like reminders, educational content, and motivational tools, which are crucial for maintaining healthy habits and managing stress. Currently, the dynamics of DTx in diabetes are rapidly evolving, with increasing integration of artificial intelligence and machine learning to further personalize and optimize care. As the adoption of these technologies grows, they hold the potential to significantly improve patient outcomes and revolutionize diabetes management on a global scale. This article will focus on the benefits of novel digital therapeutics for prevention and management of type II diabetes that are currently available in the market.

<b>Background</b>: Telomere length is a critical biomarker of cellular aging and overall health. While childhood socioeconomic status (SES) indicators such as education and poverty can have long-lasting effects on biological aging, research has shown contradictory results regarding the impact of adulthood SES on future telomere length, particularly in racially and ethnically diverse individuals. This study investigates the effects of baseline adulthood SES indicators such as education and poverty on telomere length nine years later in women, using data from the Future of Families and Child Wellbeing Study (FFCWS). <b>Methods: </b>We analyzed data from the FFCWS, a longitudinal cohort study. The sample included baseline adulthood SES and follow-up telomere length measure of women (n = 2,421) with varying socioeconomic conditions. Telomere length was measured from saliva samples nine years after the baseline measure of adulthood SES. Education, poverty, and marital status at baseline were assessed. Multivariate linear regression models were used to examine the association between adulthood SES indicators at baseline and future telomere length, controlling for potential confounders. <b>Results:</b><b> </b>From the total 2,421 women, 675 were Latino White, 1,158 were non-Latino Black, and 588 were non-Latino White. Our findings indicate that for non-Latino White women poverty at certain level, and childbirth weight, and for non-Latino Black maternal age were predictors of telomere lengths nine years later. <b>Conclusion:</b><b> </b>Poverty at a specific level, maternal age and childbirth weight serve as predictors of telomere lengths nine years later in some women. These findings underscore the importance of socioeconomic factors and early-life influences in understanding telomere dynamics and aging processes among women from varied racial and ethnic backgrounds.

High-Performance Computing (HPC) is indispensable for large-scale scientific simulations, but achieving optimal performance on modern supercomputers is increasingly challenging. As HPC systems scale toward exascale, they face escalating complexity in hardware, software, and workloads. Traditional optimization methods (manual tuning and heuristic algorithms) struggle to cope with dynamic workloads and intricate system behaviors. Artificial Intelligence (AI) techniques offer a promising approach to address these challenges. This article provides an overview of AI-powered optimization in HPC, focusing on how machine learning and related AI methods enhance performance, efficiency, and scalability of scientific simulations. We survey key AI techniques applied to HPC optimization including machine learning for performance modeling, deep reinforcement learning for resource management, and AI-driven surrogate models for accelerating simulations and illustrate their impact through case studies in domains such as job scheduling and fluid dynamics. We discuss the practical applications of these techniques, highlighting reported performance gains (e.g., substantial reductions in simulation run time and improved resource utilization). We also examine the challenges in integrating AI with HPC (such as training overhead, data movement, and reliability concerns) and outline future directions for research. The convergence of AI and HPC is poised to produce “smart” simulation workflows that intelligently adapt and optimize in real time, pushing the frontiers of scientific computing.

The role and contribution of women in modern organisations have been phenomenal. However, societal norms and other patriarchal values continue to stifle the progress of women leaders. The study's overall purpose was to examine the leadership styles of female leaders in managing senior high schools in the Central Region of Ghana. The study adopted non-numerical data and used a purely qualitative research approach. A phenomenological design supported the study framework, and the required data was collected through interviews. The target population for the study were female headmistresses and assistant headmistresses in the various Senior High Schools in the Metropolis. The study involved all six female headmistresses and eight assistant headmistresses in the Metropolis. The participants were sampled using the census to meet the study objectives. The data were analysed thematically. The study revealed that married couples use the participatory leadership style, but those who are single use the assertive style. The study also concluded that women leaders who are single and are farther from 60 years old are more likely to have problems in the discharge of their duties as leaders since men, per societal influence, will always try to resist the control of women leaders. The Ghana education service should package special incentives for women who aspire to achieve the utmost leadership role of becoming heads of senior high schools. It will motivate the young women generation. It is also recommended that women in leadership positions in the Ghana Education Service are advised to learn by updating their skills and competencies to grow in confidence and share ideas with colleagues in the same field to adopt and adapt leadership styles that have worked in other institutions to handle institutional challenges.

Groundwater is undeniably crucial to people's lives, particularly in coastal regions. Therefore, it is imperative to address this vital water source strategically and implement a management plan to maintain its optimal state. The salinization of groundwater poses a significant challenge for coastal communities, stemming from factors like excessive groundwater extraction from coastal aquifers, reduced recharge, rising sea levels, climate change, and other causes. Saltwater intrusion (SWI) is a prevalent issue that needs attention, as it significantly threatens groundwater quantity and quality. SWI happens when saline water infiltrates coastal aquifers, contaminating freshwater supplies. This review article aims to define SWI, explore its causes and influencing factors, and discuss various monitoring techniques. Additionally, it examines different modeling methods and management tools, including remote sensing, field surveys, modeling approaches, and optimization techniques. To mitigate the adverse effects of SWI, several control measures are outlined, along with their pros and cons. The final section reviews previous SWI studies and case studies from the Nile Delta, Sinai Peninsula, and North-West coast in Egypt. These studies offer suggestions, adaptations, and mitigation measures for future research.

Consumer behavior is evolving, demanding a wide range of products with fast shipping and reliable service. The automotive aftermarket industry, worth billions, requires efficient distribution systems to stay competitive. Manufacturers strive to balance growth with product and service excellence. Distributors and retailers face the challenge of maintaining competitive pricing while keeping inventory levels low. An adequate supply chain and accurate product data are crucial for product availability and reducing stock issues. This ultimately increases profits and customer satisfaction.

The purpose of this study was to examine the challenges faced by students of Colleges of Education (CoEs) in developing their Information Literacy skills. The study adopted the post-positivism paradigm. Descriptive survey research design used in this study Survey. The population for this study comprised all Level 200 students at Wiawso CoE, Enchi CoE, and Bia Lamplighter CoE in the Western North Region. Purposive, stratified, and convenience sampling techniques were used to select colleges of education and level 200 students. The three (3) colleges of education were stratified and purposively selected while 256 level 200 students were stratified and conveniently sampled. The study employed questionnaires to collect data from the sampled students. Questionnaires (open and closed-ended questions) focused on the challenges faced by the students in developing their<b> </b>Information Literacy (IL) skills. The quantitative data was captured, analysed, and presented in descriptive statistics such as percentages, and frequency tables, to determine the objective of the study. It is recommended that to improve digital literacy and academic pursuits, the college management should improve access to desktop computers and the Internet in the library and computer centre. It is also recommended that Management and librarians of the Colleges of Education ensure that students have access to these devices at the library and can use them to develop their IL skills and help them manage their references more effectively.

Modern organizations leverage highly distributed, global deployments to provide high availability and resiliency for cloud-first applications. By hosting these applications across multiple geographic locations and relying on highly available services, organizations can prevent disruption to their business and reduce complexity by employing the scale of infrastructure offered by major cloud providers. Global deployments in the cloud are built on well-known models such as failover, load balancing, and scalability. However, traditional methods used to recover from regional failure—while effective—can be complex. Typical multi-region recovery and high availability system architectures have latency and cost risks that should be considered when facing other limitations such as deployment models in the cloud. This document describes the different traffic management techniques that can be applied to multi-region strategies, focusing on trade-offs and costs. The introduction of new traffic management techniques being applied to the traditional global architectures now allows organizations to adopt cloud services more efficiently. Traffic management is much more straightforward in some environments, while others have started to leverage their traffic management platform via routing. In multi-region deployments, active-active and active-passive are the most common architectural models, allowing organizations to seamlessly handle failover, scalability, and global distribution based on business goals and requirements. However, traffic management for these infrastructures is critical to ensure just data distribution and efficiency, maintaining costs under control and workloads rerouted when necessary. Using the new traffic management techniques will allow organizations to evolve system architectures easily based on business requirements, taking advantage of cost benefits from multiple infrastructures. In these scenarios, traffic management becomes a crucial backbone of success to ensure that traffic is being efficiently and intelligently distributed [1].