New Leaders

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Senile purpura is characterized by the recurrent ecchymoses following minor trauma [1]. This condition arises due to the weakening of the structural integrity of dermal collagenous tissues and increased fragility of blood vessels. Therapeutic approaches that restore the structural support of the dermal extracellular matrix (ECM) in patients with senile purpura may lead to progressive improvements. Calcium hydroxylapatite (CaHA) has been used as a dermal filler and is known to improve skin quality by inducing mechanotransduction, a process in which mechanical stimuli are converted into biochemical signals [2]. The transcriptional regulator YAP has been highlighted as a key cellular mechanotransducer that exerts influence over collagen synthesis and skin regeneration [3]. A 65-year-old male and a 67-year-old male presented with recurrent bruises on the dorsum of hands (Figure 1a). Despite the regular use of moisturizers and physical protection, purpura continued to worsen. Consequently, 1.5 cc of CaHA (Radiesse; Merz, Raleigh, NC) was diluted in a 1:1 ratio with 0.1% lidocaine and injected subdermally into the dorsum of the hand using a proximal-to-distal fanning technique. The injection was performed on the left hand at baseline, while the right hand remained untreated to serve as a comparison control. After 3 months, gross examination revealed clinical improvements in senile purpura, skin texture, and volume, compared to the baseline (Figure 1a,b). Two punch biopsy specimens were obtained for histopathological examination. The treated side tended to have greater epidermal thickness compared to the control side. Additionally, special stains demonstrated more prominent collagen and elastic fibers in the treated area (Figure 1c–e). Immunohistochemistry analysis also revealed the number of cells exhibiting increased YAP expression after the treatment (Figure 1f,h). The expression of vascular endothelial growth factor is higher in the treated side compared to the control (Figure 1g,i). Given that YAP regulates collagen production in fibroblasts and mediates feedback mechanisms in cellular mechanotransduction, these findings suggest that ECM synthesis following CaHA treatment occurs via a mechanotransduction pathway involving YAP activation. In both patients, CaHA was also administered to the control hand at 3 months, with follow-up for another 3 months post-procedure. Both hands demonstrated sustained improvement in hand volume and skin quality, with favorable clinical results up to 6 months. To address whether CaHA modulates the YAP-mediated mechanotransduction pathway, we performed a 3-dimensional spheroid culture experiment using benign immortalized human dermal fibroblasts and retinal pigment epithelium-1 (RPE1) cells (Supplementary Text, available via Mendeley at https://doi.org/10.17632/b2j2rdxv5n.1), more relevant to the in vivo condition (Figure 2 and Supplementary Figure 1) [4]. Cells exhibiting high levels of nuclear YAP enrichment, indicative of YAP activation, were more frequent in the condition where CaHA was supplemented, compared to the control (Figure 2b,c). Fibroblasts adhering to CaHA microspheres exhibited actin cytoskeletal remodeling (Figure 2c), which is known to strongly influence YAP activity. Our study shows that injecting diluted CaHA into the dorsum of the hand improves senile purpura, accompanied by histological evidence of epidermal and dermal proliferation, increased collagen and elastic fiber density. This dermal ECM reinforcement likely stabilizes fragile vasculature [3]. Notably, we observed a significant increase in YAP-positive cells in the dermis post-CaHA injection, supported by in vitro spheroid culture. Since YAP regulates ECM homeostasis and is suppressed in aged fibroblasts due to reduced mechanical cues, CaHA may restore dermal stiffness and activate YAP-dependent mechanotransduction, promoting neocollagenesis and skin integrity [5]. Nevertheless, this study represents a preliminary and exploratory observation intended to stimulate further controlled trials. Moreover, the clinical inference of our findings is limited by the sample size, male sex homogeneity, and a short follow-up period. While further studies are required to determine whether CaHA can provide long-term improvement for senile purpura, its use may be considered a treatment option for patients unresponsive to conservative therapies. This study was supported by a research grant from Merz Asia Pacific Pte. Ltd. The patient provided written informed consent for the use of clinical images and related data for research and publication purposes. The authors declare no conflicts of interest. The data that supports the findings of this study are available in the supporting information of this article.

The COVID-19 pandemic triggered unprecedented disruptions in teacher education worldwide, compelling programs to rapidly implement technological alternatives, reimagine clinical practices, and adapt mentoring systems while confronting equity challenges. Examining these emergency responses through theoretical frameworks of systemic resilience reveals that while institutions demonstrated remarkable adaptability, sustainable transformation requires addressing persistent concerns around equity access, faculty burnout, and the need for evidence-based program redesign. This critical juncture offers not merely a return to pre-pandemic models but an opportunity to fundamentally reimagine teacher preparation systems that are more responsive, inclusive and resilient for the future—moving beyond crisis management toward intentional reform that leverages unexpected innovations while addressing the limitations exposed during this global educational experiment.

Collaborations spanning multiple domains, including academic practice partnerships, are crucial for advancing nursing informatics education, bridging the gap between academic preparation and real-world application in a rapidly evolving health care landscape. These partnerships ensure nursing professionals can thrive in a digital, data-driven environment. Rapid technological advancements in health care have created a pressing need for practice-ready nurses proficient in informatics and digital tools. The gap between theoretical knowledge and clinical application often leaves nurses unprepared for these demands. This article presents 5 strategies and Implementation activities for developing effective collaborations. The authors also provide several examples of integrating nursing informatics into education and practice. Emphasis is placed on fostering leadership, addressing challenges such as resource constraints and technostress, and preparing the workforce for future demands through structured collaborations with academic institutions, hospitals, health information technology vendors, and professional organizations. Well-implemented collaborations are essential for preparing a skilled and resilient nursing workforce. They address workforce gaps, enhance informatics competencies, and improve staff outcomes by aligning education with current needs.

As organizations worldwide pivot toward environ- mental sustainability, the integration of artificial intelligence (AI) and machine learning (ML) technologies with green hu- man resource management has emerged as a revolutionary approach to sustainable workforce development. This compre- hensive study presents a novel AI-driven framework for green recruitment selection strategies, combining advanced predictive analytics, natural language processing, and behavioral pattern recognition to identify candidates with optimal environmental alignment. Through extensive empirical research involving 300+ organizations across 15 countries and analysis of over 50,000 recruitment profiles, this paper introduces the Green Recruit- ment Intelligence Quotient (GRIQ) - a proprietary metric for evaluating environmental consciousness in candidates. The study reveals that AI-enhanced green recruitment systems achieve 47% higher accuracy in predicting long-term environmental employee performance compared to traditional methods, while reducing recruitment costs by 34% and improving candidate satisfaction by 41%. Our findings demonstrate that organizations implementing AI-driven green recruitment strategies experience 67% improvement in carbon footprint reduction, 52% increase in sustainable innovation projects, and 38% enhancement in en- vironmental compliance scores. This research contributes break- through insights into the convergence of digital transformation and environmental stewardship in human capital management.

In an era of rapid digital disruption, organizations must evolve not only technologically but also strategically. This thesis explores the critical role of leadership in driving successful digital transformation, emphasizing the need for strategic alignment, inclusive practices, and adaptive capabilities. Through a quantitative survey of professionals across industries, the study examines how various leadership styles—transformational, servant, transactional, and inclusive—impact innovation, organizational culture, and change management. It also investigates leadership development, succession planning, and the integration of diversity, equity, and inclusion in digital contexts. The findings underscore that effective digital transformation is not merely a technological shift but a leadership-driven cultural evolution, requiring vision, agility, and emotional intelligence to build future-ready enterprises.

This comprehensive article explores the transformative impact of real-time data streaming technologies in the financial services sector through four detailed case studies. It examines how leading financial institutions have leveraged modern data architectures, including Apache Kafka, Spark Streaming, AWS Kinesis, and cloud computing platforms, to address critical business challenges. The article demonstrates how these technologies enable instantaneous fraud detection, enhanced customer experience through personalized offerings, streamlined regulatory reporting, and optimized customer acquisition strategies. Throughout the analysis, the article highlights implementation challenges, technical considerations, and valuable lessons learned, providing essential insights for financial organizations seeking to modernize their data infrastructure and maintain a competitive advantage in an increasingly real-time business environment.

Cloud security is under threats of anomalies, which indicate cyber threats. The centralized methods of the traditional system have been struggling with scalability and privacy. This paper presents a hybrid framework combining decentralized federated learning (DFL), secure multi-party computation (SMPC), and hidden Markov models (HMM) for improved anomaly detection. The proposed framework integrates DFL, SMPC, and HMM to achieve enhanced privacy, scalability, and detection accuracy. Real-time anomaly detection with better privacy and accuracy that adapts to the evolving threats. It has achieved 92.8% probability, higher precision, and lower latency than traditional methods. Hybrid model with HMM, SMPC, and DFL is used for secure, scalable, real-time anomaly detection.

Background:Pruritus affects up to 80% of patients with primary biliary cholangitis (PBC) and reduces health-related quality of life (HRQoL). GLIMMER (NCT02966834) was a randomized, placebo-controlled phase IIb study of linerixibat in patients with PBC and pruritus. Using patient-reported outcome data from GLIMMER, we characterize the impact of pruritus in PBC.Methods:To objectively assess HRQoL impact, EQ-5D-5L data from GLIMMER (0–1 scale; 0 = death, 1 = perfect health) were analyzed post-hoc across pruritus severities. Inter-relationships between pruritus severity (0–10 numerical rating scale [NRS]), depression (Beck Depression Inventory-II, post-hoc), and sleep interference (0–10 NRS) and their impact on HRQoL were explored.Results:In patients with PBC (n = 147), severe pruritus was associated with worse HRQoL. EQ-5D-5L scores were lower in those with severe pruritus (≥7–10 NRS) versus mild/moderate pruritus (mean [SD]: 0.49 [0.28] and 0.75 [0.17]/0.76 [0.17], respectively). Among patients with severe pruritus, 31% had severe depression, versus 9/3% with mild/moderate pruritus. Patients with both severe pruritus and depression had a mean EQ-5D-5L score of 0.30. In those with severe pruritus, 54% reported severe sleep interference. Improvements in pruritus were accompanied by stepwise improvements in EQ-5D-5L scores.Conclusions:This analysis of patients in the largest investigational trial of cholestatic pruritus to date shows a clear association between pruritus and impaired HRQoL. Patients with severe pruritus had HRQoL comparable to patients with severe Parkinson’s disease. Severe pruritus alongside depression was associated with extremely poor HRQoL, indicating the importance of evaluating itch and managing depression. Sleep interference appears to be a major cofactor for reduced HRQoL. For each 1-point improvement in NRS HRQoL improved, clinicians should offer appropriate and timely intervention.