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Combined intravenous bolus amino acid supplementation and mobilization on early muscle loss in critically ill adults: a randomized controlled trial
(John Wiley and Sons Inc, 2026) Kohn, Tertius A.; Veldsman, Lizl; Richards, Guy A.
Background: Muscle wasting is a hallmark of critical illness. We evaluated the effect of amino acid supplementation and mobilization on early muscle loss in critically ill patients. Methods: We conducted a randomized parallel-group trial involving adult patients admitted to the surgical intensive care unit of a tertiary hospital. Participants were randomly assigned to two groups, both receiving standard care nutrition and mobilization. The intervention group also received a daily intravenous amino acid bolus with 45 min of cycle ergometry, starting on days 3–4 for a mean of 6 days. The primary co-outcomes were changes in vastus lateralis myofiber cross-sectional area (from biopsies) and ultrasound-derived rectus femoris cross-sectional area, measured between the preintervention (day 2) and postintervention (day 8) time points. Analyses were conducted using mixed-model analysis of variance and least significant difference testing. Secondary outcomes included the protein-to-DNA ratio, muscle echogenicity, whole-body phase angle, muscle strength (Medical Research Council sum score) and physical capability (6-min walk test). Results: Fifty patients (90% male, age 37 ± 12 years) were included. Standard of care participants received 1.23 ± 0.18 g/kg/day protein; intervention participants 1.57 ± 0.27 g/kg/day, including 0.37 ± 0.05 g/kg/day from the supplement. Muscle loss occurred significantly over time (biopsy P = 0.01; ultrasound P < 0.001), with no significant differences between groups. Similarly, no significant differences were observed in protein-to-DNA ratio, muscle echogenicity, phase angle, muscle strength, or physical capability. Conclusion: A short-duration combined intervention of intravenous bolus amino acids and cycle ergometry, limited to the acute phase of critical illness, did not reduce muscle loss or improve muscle quality, strength, or physical capability.
Understanding self-management in teaching and learning: a concept analysis for nursing education
(Elsevier Ltd, 2026) Crowley, Talitha; Kokuro, Mercy; van der Merwe, Anita S
Background The concept of self-management has been examined in healthcare and other sectors such as education, but its definition and uses in nursing education remain unclear. Aim To explore the concept ‘self-management’ in healthcare and teaching and learning literature and apply these insights to nursing education. Design Concept analysis. Methods The eight steps of concept analysis according to Walker and Avant were used. PubMed, EBSCOhost, Medline, Google Scholar, Science Direct and PsycINFO were searched up to 2022 with an updated search in 2024. Content-rich articles on self-management were included if they: (a) discussed the theoretical or conceptual foundation of self-management, (b) were healthcare or education related, (c) were written in English and (d) had the full-text available. Data on attributes, antecedents and consequences were extracted and analysed using thematic analysis. Results Thirty-three articles were included with nine attributes, categorised as personal (self-motivation, self-regulation, self-evaluation, self-efficacy, individual action and skills, self-monitoring, environmental management, continuous task) and combined (partnership). Antecedents were the individual capacity to learn, external motivation, access to learning resources, teaching and learning strategies, and support from educators, family and friends. Consequences were improved quality of life, enhanced coping abilities, empowerment, engagement in self-management behaviours, increased self-efficacy, self-control, satisfaction, independence, self-directedness, and accountability. Negative outcomes may arise from avoiding help due to overconfidence in self-management abilities. Conclusion In combining all nine attributes, a clear definition and understanding of self-management in the teaching and learning context are formulated which can assist nursing students in becoming effective self-managers.
A diagnostic framework for integrated flood risk governance: conceptual foundations and insights from Lagos and Accra
(Elsevier Ltd, 2026) Adeniyi, Daniel Adeoluwa; Okunola, Olasunkanmi Habeeb; Shekhar, Himanshu
Amid escalating urban flood risks driven by climate change and poorly managed urban growth, there is growing recognition of the need to strengthen and integrate flood risk governance systems. However, existing governance arrangements in many cities remain fragmented, siloed, and inadequately inclusive. This paper addresses a critical gap in the literature by proposing and applying an Integrated Flood Risk Governance framework that systematically assesses governance integration through three interrelated dimensions: institutional interaction, actor relationships, and policy mixes. Drawing on policy document analysis and in-depth interviews, the study explores the applicability of the Integrated Flood Risk Governance framework in two high-risk urban settings: Lagos, Nigeria, and Accra, Ghana. The findings reveal that although integration is emphasized in formal policies, practical implementation is hampered by highly centralized governance structures, limited stakeholder participation, and weak coordination mechanisms. In both cities, the private sector remains marginally involved, and policy coherence is often undermined by poor enforcement and funding constraints. This study demonstrates the utility of the Integrated Flood Risk Governance framework in diagnosing governance fragmentation and highlights the need for more inclusive, adaptive, and participatory approaches to flood risk governance.
Isospin mixing in 64,66Ga reexamined via total absorption spectroscopy
(American Physical Society, 2025) Orce, José Nicolás; Parra, Selene; Nacher, Enrique
New measurements of the β decay of 64Ga and 66Ga have been carried out using total absorption spectroscopy at CERN-ISOLDE. The purpose of the study was to determine whether systemic effects such as Pandemonium have affected previous measurements and also determine the degree of isospin mixing in these proton-rich nuclei. Our results show that the β strength distribution of 64Ga was previously underestimated, while that of 66Ga agrees well with previous high-resolution measurements. The results allowed us to determine the amount of isospin mixing in the 0+ → 0+ transitions to the ground states of the daughter nuclei. From the extracted log ft values, we determined the isospin mixing parameter α for the two cases. They were found to be consistent with values for similar transitions in other nuclei. 64Ga exhibits the largest amount of isospin mixing in such nuclei. These findings improve our understanding of beta decay and have implications for nuclear structure models and medical applications of 66Ga in PET imaging.
Concentration of chemical elements in dry mass of Pontederia crassipes Mart. for use as organic fertilizer in small-scale crops
(Universidad Autonoma Metropolitana, 2025) Naidoo, Sershen; Hernández-Fernández, Leslie; Carlos Lorenzo Feijoo, José
Background: the increasing demand and production costs of inorganic fertilizers motivate researchers to explore new ways to obtain organic fertilizers. Pontederia crassipes Mart., is an invasive aquatic plant that grows in a freshwater lagoon (La Turbina), in Ciego de Ávila, Cuba. It is extracted from the water and deposited on the shores of the lagoon, affecting the aesthetic value of the site. Objective: to determine the concentration of chemical elements in the dry mass of P. crassipes (in its floating and emerging growth condition), to recommend its possible use as organic fertilizer or mixed substrate in small area crops. Method: for the analysis of most of the chemical elements, both in the lagoon water and in the dry mass of P. crassipes, inductively coupled plasma optical emission spectrometry was used. Results: the water of a lagoon was characterized by high concentration of Ca. In the dry mass of P. crassipes (floating and emergent), Ca, N, and K had the highest concentrations (mg g-1), followed by Na and Al. Heavy metals had concentrations below the maximum permissible limits for organic fertilizers and substratum of the crop. The eight chemical elements quantified in the lagoon water (Ca, Cu, K, Mg, Na, P, S, and Zn) showed bioconcentration in P. crassipes (floating). Seven chemical elements showed translocation in P. crassipes (B, Ca, K, N, Na, and Sr). Conclusions: The dry mass of P. crassipes can be used as organic fertilizer or as a mixed substrate for small-scale crops. Floating P. crassipes can phytostabilize and phytoextract chemical elements in the La Turbina artificial freshwater lagoon.