Navigating Quiet Quitting Among Critical Care Nurses in the Digital Era: The Impact of Techno‐Stress and Digital Resilience

ABSTRACT Background The digitalisation of healthcare introduces both opportunities and stressors for nurses, especially in critical care settings where technological complexity is high. Excessive digital demands can cause techno‐stress, potentially eroding engagement and promoting quiet quitting behaviours. Conversely, digital resilience may protect nurses against such effects. Aim To examine the relationship between techno‐stress and quiet quitting among critical care nurses and to assess the moderating role of digital resilience. Study Design A descriptive cross‐sectional study was conducted among critical care nurses from 12 intensive care units in five tertiary hospitals. Validated Arabic versions of the Techno‐Stress Questionnaire, Quiet Quitting Scale and Digital Resilience Scale were used. Data were analysed using PROCESS Macro Model 1 regression controlling for education, experience and working hours. Results Data were analyzed from 392 critical care nurses participated in the study, who reported a moderate level of techno‐stress ( M  = 3.50 ± 0.32), quiet quitting ( M  = 3.53 ± 0.52) and digital resilience ( M  = 3.37 ± 0.42). Techno‐stress positively correlated with quiet quitting ( r  = 0.55, p  < 0.001), whereas digital resilience correlated negatively with both. Regression analysis confirmed techno‐stress as a significant predictor of quiet quitting ( B  = 0.348, 95% CI [0.27–0.43], p  < 0.001). Digital resilience reduced disengagement ( B  = −0.492, 95% CI [−0.58 to −0.40], p  < 0.001) and moderated the techno‐stress–quiet quitting relationship (interaction B  = 0.182, 95% CI [0.09–0.27], p  < 0.001). The model explained 48.2% of variance in quiet quitting. Conclusions Techno‐stress significantly increases quiet quitting among critical care nurses; however, digital resilience mitigates this effect. Quiet quitting may represent an early behavioural signal of digital overload. Relevance to Clinical Practice Strengthening nurses' digital resilience through structured training, supportive leadership and user‐friendly technologies can reduce techno‐stress and disengagement. Policies should integrate digital well‐being and resilience strategies to sustain workforce engagement and safeguard mental health in technology‐driven healthcare systems.

Beyond the Black Box: Pathologist Responsibility and Pragmatic Explainability in AI ‐Driven Oral Pathology

Autonomic Profile Changes After Pulsed‐Field Versus Thermal Ablation in Patients With Atrial Fibrillation: A Systematic Review and Meta‐Analysis

ABSTRACT Background Catheter ablation is an established therapy for atrial fibrillation (AF), with thermal ablation as a standard modality. Pulsed‐field ablation (PFA) is a nonthermal alternative that selectively ablates myocardium while sparing collateral tissue. Its comparative autonomic impact relative to thermal ablation remains unclear. The study aims to compare autonomic changes following PFA and thermal ablation in AF patients, focusing on heart rate (HR), heart rate variability (HRV), bradyarrhythmias, and arrhythmia recurrence. Methods We systematically searched MEDLINE, EMBASE, and Cochrane CENTRAL through August 2025 for randomized and nonrandomized studies reporting pre‐ and post‐ablation HR or HRV. Data were pooled using random‐effects or fixed‐effects models, depending on the presence of heterogeneity. Results Six studies (800 patients, PFA: 407, thermal: 393) were included. Thermal ablation was associated with a significantly greater rise in resting HR compared with PFA (mean difference ‐7.57 bpm, 95%CI: ‐11.66‐3.48, p = 0.0003; I 2 = 90% indicating high heterogeneity). HRV indices were consistently better preserved after PFA. SDNN at 12 months was approximately 150 ms with PFA versus 115 ms with thermal ablation (p<0.001 in one study). The overall incidence of bradyarrhythmias did not differ significantly, though transient intraprocedural bradycardia was more frequently observed with PFA. Arrhythmia recurrence rates were comparable between groups (OR 0.96, 95% CI 0.47‐1.99, p = 0.92; I 2 = 0%). Acute pulmonary vein isolation was achieved in >95% of patients. Conclusions PFA attenuates autonomic perturbation relative to thermal ablation, preserving resting HR and HRV while maintaining comparable arrhythmia outcomes. These findings support PFA as an effective and autonomically sparing strategy for AF ablation.

Skin involvement is among the leading findings in children with inborn errors of immunity

Abstract Background Primary immunodeficiency diseases (PID) or inborn errors of immunity are a group of inherited disorders characterized by defects in components of innate and/or adaptive immunity. Cutaneous manifestations are common in PIDs. The skin signs are often the initial symptoms which help in the diagnosis. Warning signs that might suggest primary immunodeficiencies primarily focus solely on infectious skin disorders. Methods In a retrospective analysis, our study included patients below the age of 18 who were assessed for an IEI diagnosis from 2011 to 2024. The demographical, clinical, immunological, dermatological and molecular features of patients were obtained from medical records. A total of 111 patients with a confirmed IEI diagnosis were analyzed, among whom 55.9% were male. Results Forty‐two patients (37.8%) exhibited cutaneous manifestations, whereas 17 patients (15.3%) presented with multiple cutaneous lesions. A total of 38 patients, which constitutes 34.2% of the entire patient population with IEIs and represents 90.4% of those patients exhibiting skin lesions, were identified as having skin lesions among the initial signs presented during their first medical evaluations. Infectious skin findings were the most prevalent (36.4%), succeeded by pigmentation disorders (14.5%) and AD (10.9%). Conclusion Based on the findings of this study and related research, we propose that warning signs include noninfectious cutaneous disorders, particularly atopic and IEI‐specific skin conditions. Therefore, the acknowledgment of cutaneous manifestations by dermatologists and pediatricians as potential indicators of inborn errors of immunity (IEI) could substantially enhance the timely identification and management of severe IEI cases.

Genetic Gains in Durum Wheat ( Triticum turgidum ssp. durum ) Across the Globe: Yield, Quality and Adapting for Variable Weather Patterns

ABSTRACT Durum wheat ( Triticum turgidum ssp. durum [Desf.] Husnot) is cultivated globally and used to produce pasta, couscous, bulgur and other semolina products. With the growing world population and increasing food demand, it is pertinent to understand past trends in global food production to shape future endeavours. This review briefly gives an overview of more than a century of durum wheat breeding efforts across the globe, focusing on past genetic gains for not only yield but additional traits, such as biotic and abiotic stress tolerance, grain quality, biomass and nutrient uptake. Historical genetic gains have varied across the globe between breeding programmes, with a short history summarised for countries in the Mediterranean Basin, North and South America and Australia and the international programmes led by CIMMYT and ICARDA. As Early Career Researchers of the Expert Working Group on Durum Wheat Genomics and Breeding of the Wheat Initiative, we understand the importance of highlighting past progress in durum wheat yield to further increase genetic gains and give insight into future research and breeding needs.

The CD163:CD68 Ratio Reflects Splenic Macrophage Remodelling in Murine Chronic Schistosomiasis

ABSTRACT Schistosoma mansoni infection induces marked splenic remodelling, but the phenotype of macrophages driving this process remains unclear. CD163 is frequently used as an M2‐associated marker in chronic helminth infections. This study evaluated whether the CD163:CD68 ratio can serve as a semi‐quantitative indicator of macrophage polarisation in schistosomal splenomegaly. Forty female CD‐1 mice were divided into infected and control groups, and spleens were collected at 7‐, 15‐, and 23‐weeks post‐infection. Histopathology and immunohistochemistry for CD68 and CD163 were quantified in five high‐power fields per animal. Semi‐quantitative scoring, percentage positivity, CD163:CD68 ratios, and correlations with pathological severity were analysed. Chronic infection caused progressive splenic pathology, including white pulp atrophy, red pulp congestion, fibrous septa, extramedullary haematopoiesis, and hemosiderin‐laden macrophages. CD68 + macrophages increased significantly from 20% to 30% in controls to 70%–85% at 23 weeks ( p  < 0.001), while CD163 expression declined from 49.3% in naïve spleens to nearly zero at all post‐infection time points. The CD163:CD68 ratio fell from 1.97 to near zero. CD163 correlated negatively with CD68 ( ρ  = −0.891) and pathology severity ( ρ  = −0.876), whereas CD68 showed a strong positive correlation ( ρ  = +0.912). Chronic S. mansoni infection induces a profound, early, and sustained downregulation of CD163 expression on splenic macrophages despite expansion of the total macrophage pool. While CD163 loss associates with splenic congestion, iron accumulation, and architectural remodelling, the functional implications of this change remain to be fully defined. We therefore propose that disruption of CD163‐dependent homeostatic programmes may contribute to splenic pathology, a hypothesis that warrants future functional and multi‐marker validation in line with current concepts of macrophage plasticity.

Repeated Melatonin Implant Improves Testicular Volume, Testicular Blood Flow, Estradiol, Antioxidant Capacity, and Nitric Oxide Levels in Post‐Pubertal Camels Under Heat Stress Conditions

ABSTRACT This current work aimed to determine the impacts of melatonin implants on testicular artery blood flow and Doppler indices, in relation to hormonal profile in post‐pubertal camels ( Camelus dromedaries ) under heat stress and non‐breeding conditions. Post‐pubertal males were categorised into control (C; n  = 7) and melatonin‐treated group (MT; n  = 7; two doses 1 month apart starting in June). Testicular morphometric expressed by testicular volume and testicular echogenicity (TV and TE), Doppler indices as resistance index and pulsatility index (RI and PI) of testicular artery (TA), testicular blood flow volume (TBFV), blood sampling and hormonal (melatonin, follicle stimulating, luteinizing hormone [FSH and LH], estradiol [E2], testosterone [T], and nitric oxide [NO]) analysis and total antioxidant capacity (TAC) measurement were performed weekly. TV was elevated ( p  ≤ 0.05) in the MT group, reaching a peak at week 12, compared to C males, while TE did not change ( p  ≥ 0.05) due to melatonin implants. Melatonin, E2, and NO were increased significantly ( p  ≤ 0.05) from week 2, reaching the peak at wks. 7 and 8 of the implant. In addition, TAC showed the same pattern of elevation ( p  ≤ 0.05). FSH, LH, and T levels showed non‐significant alterations ( p  ≥ 0.05). TA. RI and TA. PI declined from week 4 with an elevation ( p  ≤ 0.05) in TBFV. Melatonin implant improves the testicular vascularization with an elevation of the vasodilator mechanism. This led to a perfect breeding period in camels following the long photoperiod that extended the breeding period by 2–3 months.

Moral Intuitions and Support for Immigration

ABSTRACT Introduction Attitudes toward immigration are often shaped by whether immigrants are perceived as a threat to one's racial, ethnic, or nativity group status. Yet recent research shows that such perceptions vary not only between different groups but also within them. Drawing on Moral Foundations Theory, our study investigates the moral intuitions that lead some individuals to view immigrants as threats and others to see them as deserving of care and support. Methods Using data from a national YouGov survey of 4000 US respondents, we examined the association between moral intuitions and attitudes toward immigration, including whether immigration should be a human right and support for higher levels of immigration. Results We find that people with strong individualizing intuitions—including those emphasizing care and fairness—are more likely to support immigration. In contrast, those with strong binding intuitions—especially those emphasizing a respect for authority and sanctity—are less supportive, likely reflecting concerns about maintaining the rule of law and apprehensions about outsiders. Conclusion These findings highlight the importance of moral frameworks in shaping public attitudes toward immigration. Differences in individualizing versus binding moral intuitions help explain why some individuals view immigrants primarily through a lens of care and fairness, while others emphasize social order and the importance of maintaining boundaries.

Landscapes of HLA Mismatching in Contemporary Unrelated Haematopoietic Cell Transplantation

ABSTRACT Haematopoietic cell transplantation (HCT) with HLA‐mismatched unrelated donors (MMUD) offers access to curative therapy for patients lacking well‐matched donors. Accumulating evidence suggests that functional matching among allele‐mismatched pairs can significantly influence patient outcomes. Therefore, real‐world data on mismatch frequencies in MMUD‐HCT could provide fundamental information for the assessment of patient risks and donor selection strategies. Here, we analysed HLA matching in 28,376 first unrelated transplants reported to the EBMT Registry with available 6‐locus high‐resolution typing. Mismatches at each locus were quantified and characterised at the allelic, antigenic and functional (antigen‐recognition domain, peptide‐binding motif) levels. 25% of the transplants were performed across one (9/10; n  = 6053) or more (< 9/10; n  = 1013) high‐resolution mismatches at the five main HLA loci, a proportion that was markedly higher (43.9%) among transplants performed with post‐transplantation cyclophosphamide (PTCy). Median time from diagnosis to transplant was longer for MMUD compared to 10/10 transplants, but this difference decreased over time (14.9 vs. 11.3 months pre‐2011, p  = 0.003; 8.1 vs. 7.4 months 2021–2022, p  = 0.016). Across transplant eras, single class I mismatches were three times more common than class II mismatches. Conversely, matching for HLA‐DPB1 increased from 15% pre‐2011 to 31% in 2021–2022. The landscapes of allelic mismatches differed markedly between HLA loci. For class II, skewed distributions dominated by frequent combinations result in significantly higher frequencies of functional matching compared to class I in both PTCy and non‐PTCy pairs. Our study constitutes the first large‐scale characterisation of real‐world HLA mismatch frequencies in contemporary unrelated HCT, bearing implications for future clinical outcome studies.

High‐Accuracy Flood Susceptibility Mapping and Risk Assessment in a Touristic Sub‐Basin: Utilizing Analytic Hierarchy Process With the Most Effective Factors

ABSTRACT This study aimed to map flood susceptible areas and assess potential impacts at the sub‐basin scale in a densely populated touristic region. For this purpose, seven flood conditioning factors were selected: slope, land use/land cover, elevation, rainfall, distance from river, soil, and drainage density. Geographic information system‐based analytic hierarchy process (AHP) was used to map flood susceptibility. To validate the flood susceptibility map, a flood inventory map derived from satellite‐based remotely sensed imagery (both optical and synthetic aperture radar) was used, and the validation showed a high accuracy of 93.2%. It was found that urban and agricultural areas are the most susceptible to flooding, and most of the hotels and historical/tourist attractions in the region are at risk. The findings highlight that AHP with widely used factors yields reliable results even in data‐scarce regions. This approach can assist decision‐makers in developing appropriate flood risk management strategies.