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The 7 Functions of Marketing Success [With Case Studies]

Explore how the 7 functions of marketing ensure success through adaptation to digital trends and consumer values.

Marketing is a dynamic field that continuously adapts to new trends and consumer behaviors. The 7 functions of marketing play a crucial role in the success of any business, adapting as market dynamics evolve. With digital transformation at its core, the marketing function in business today heavily incorporates digital tools and platforms, emphasizing the importance of online and social media strategies.

In 2024, the landscape is largely driven by digital content, with a strong focus on video marketing. Short-form videos have become particularly dominant, reflecting their ability to engage fast-paced online audiences effectively. This content format is recognized for offering the highest return on investment, underscoring its critical role in marketing in business. Platforms like TikTok, Instagram, and YouTube are at the forefront of this trend, with investments expected to increase.

Transparency and alignment with consumer values are increasingly important, with 82% of shoppers preferring brands that reflect their own values. This trend highlights the core function of marketing: to forge a connection between businesses and consumers through transparent and value-driven strategies. As B2B marketing functions also evolve, the integration of AI and video marketing becomes essential. Emphasizing these functions of marketing can significantly boost a company’s resonance with its target audience and its overall market success.

Businesses that effectively integrate and adapt to these technological advancements and consumer preferences are more likely to succeed in the competitive market of 2024. Understanding and implementing the 7 functions of marketing will be key to navigating this dynamic environment.

The 7 Functions of Marketing for Exceptional Business Success With Case Studies

Functions of marketing #1: promotion.

Creating Demand: Let’s Talk About the Power of Promotion

Promotion in marketing, a core aspect of the 7 functions of marketing, focuses on communication and visibility to reach and engage potential customers. This vital marketing function in business includes a blend of traditional media such as print, TV, and radio alongside modern digital marketing methods like SEO, SEM, and social media.

Functions of marketing also encompass content marketing through blogs, infographics, and videos, enhancing the core function of marketing by providing valuable information that resonates with target audiences.

Additionally, public relations efforts, including press releases and influencer marketing, along with engagement through events and sponsorships, play a significant role in marketing in business. Each of these strategies is integral to building awareness and generating interest in a product or service, showcasing the dynamic B2B marketing functions required in today’s competitive environment.

Case Study: Apollo Neuro – Enhancing Market Share through Influencer Partnerships

This approach not only broadened Apollo Neuro’s market reach but also solidified its presence in key consumer segments, demonstrating the power of strategic influencer partnerships in amplifying product awareness and driving sales.

Actionable Tips for Promotional Function of Marketing

• Conduct thorough target audience research to tailor your messages.
• Set clear campaign goals and allocate your budget wisely.
• Choose the right channels where your audience is most active.
• Track and measure campaign success through KPIs to optimize future strategies.

Functions of Marketing #2: Selling

Converting Interest into Action: The Art of Selling in Marketing

Selling, a pivotal marketing function in business, extends beyond just closing a sale by nurturing customers through the marketing funnel—from awareness and interest to decision and action.

This process is integral to the 7 functions of marketing, highlighting its role in marketing in business as it transitions potential leads into loyal customers. Effective selling strategies in marketing leverage tools like landing pages and lead magnets, employ email marketing automation, and utilize personalized content and offers, all coordinated through a robust Customer Relationship Management (CRM) system.

These approaches exemplify the core function of marketing and are crucial in both B2C and B2B marketing functions, where understanding and responding to customer needs are essential for success.

Case Study: Artbeads.com – Enhancing Conversion through Targeted Email Campaigns

This case study demonstrates the power of using detailed customer data to segment email lists and tailor communications that resonate with specific customer behaviors and spending patterns. By acknowledging the unique preferences and prior interactions of customers, Artbeads.com successfully increased engagement and conversions among a crucial segment of their audience​.

For businesses looking to replicate this strategy, it’s essential to gather and analyze customer data effectively and to craft email messages that are not only personalized but also directly acknowledge and reward customer loyalty. This approach not only enhances the chances of re-engagement but also fosters a stronger connection between the brand and its customers.

Actionable Tips

• Develop a clear understanding of your marketing funnel and identify stages where customers drop off.
• Use A/B testing to optimize landing pages and email campaigns.
• Analyze data to refine and optimize your selling strategies continually.

Functions of Marketing #3: Product/Service Management

Crafting Compelling Offerings: The Power of Product & Service Management in Marketing

This function, integral to the 7 functions of marketing, revolves around managing a product or service throughout its lifecycle—from conception to decline. It includes aligning the product or service with market needs through rigorous market research, feedback analysis, and strategic differentiation.

This is a classic example of marketing’s core function, which is critical in ensuring that a product meets consumer expectations and remains competitive over time.

Moreover, in B2B marketing functions, this aspect of the functions of marketing becomes even more significant, as it directly impacts product development and positioning strategies critical to the role of marketing in business.

This lifecycle management is fundamental not just in conceptualizing products but also in evolving them in response to market dynamics and customer feedback.

Case Study: Jira Mobile – Harnessing Customer Feedback for Agile Software Development

This case study exemplifies the power of integrating customer feedback into the product development process, particularly in software development, where user needs can evolve rapidly. By employing a structured feedback mechanism, Jira Mobile was able to iterate on their product effectively, leading to improved user satisfaction and a better overall product. This approach is a valuable lesson for any software development team aiming to remain agile and responsive to customer needs.

• Engage in continuous market research to keep your offerings relevant.
• Use customer feedback to fine-tune product features and services.
• Build a strong brand identity that communicates your product’s unique benefits.

Functions of Marketing #4: Pricing

Striking the Right Balance: Mastering the Art of Pricing in Marketing

Pricing is a critical marketing function in a business that significantly affects how a product is perceived in the marketplace. This function, which is vital to the 7 functions of marketing, considers factors like cost, competitor pricing, and customer-perceived value.

Effective pricing strategies include penetration pricing to gain market entry, premium pricing to signal superior quality, and dynamic pricing for flexibility in response to market conditions. These strategies highlight the role of marketing in business by directly influencing sales and profitability, making pricing a core function of marketing.

Additionally, in B2B marketing functions, strategic pricing is crucial as it impacts both the competitive positioning and the value proposition offered to business customers.

Case Study: Amazon’s Penetration Pricing Strategy for Echo Devices

This case study highlights the effectiveness of penetration pricing in entering and dominating new market segments, especially within technology-driven industries. By strategically setting low prices, Amazon was able to overcome barriers to entry, discourage potential competitors, and establish a strong foothold in the smart home market.

• Conduct a thorough cost and competitor analysis to inform your pricing strategy.
• Consider customer perceptions of value to price your products effectively.
• Use dynamic pricing to adjust to market demands and maximize profits.

Functions of Marketing #5: Marketing Information Management

Knowledge is Power: Utilizing Marketing Information Management for Smarter Decisions

Marketing Information Management (MIM) is a key component of the seven functions of marketing. It involves collecting, analyzing, and utilizing data to make informed marketing decisions. This essential marketing function harnesses data from various sources, including market research, customer interactions, digital footprints, and social media engagements.

By doing so, MIM supports the core function of marketing by providing insights that drive strategy and optimize marketing efforts. It plays a significant role in marketing in business, especially within B2B marketing functions, where understanding client needs and behaviors is crucial for tailoring marketing approaches and achieving competitive advantage.

Case Study: Nike’s Data-Driven Marketing Strategy

This case study highlights the importance of Marketing Information Management (MIM) in crafting successful marketing strategies that align closely with consumer preferences and behaviors. By integrating detailed customer data into their marketing efforts, Nike was able to significantly improve the effectiveness and efficiency of their campaigns, leading to better customer engagement and increased profitability.

• Implement systems for effective data collection and analysis, such as CRM and analytics platforms.
• Use segmentation and targeting to personalize your marketing efforts.
• Continuously refine your strategies based on data-driven insights.

Functions of Marketing #6: Financing

Fueling Growth: The Role of Financing in Marketing

Financing in marketing is a pivotal aspect of the 7 functions of marketing. It involves planning and allocating the budgetary resources necessary for executing marketing strategies. This includes budgeting for various marketing activities, analyzing costs, and measuring ROI to ensure efficient use of resources.

As a crucial marketing function in business, financing enables organizations to strategically manage their marketing funds strategically, supporting other functions of marketing such as promotion, distribution, and product development.

Understanding and implementing effective financing strategies is especially vital in B2B marketing functions, where budgeting can be complex due to larger transaction volumes and longer sales cycles.

It reinforces the core function of marketing by ensuring that every dollar spent maximizes the potential return, thus playing a critical role in marketing in business.

Case Study: Templafy’s Marketing Budget Optimization

This case study demonstrates the effectiveness of strategically allocating marketing resources to high-ROI activities. By focusing on targeted advertising and selecting platforms that align closely with their audience profile, Templafy maximized the output from their marketing investments.

• Develop a detailed budget that aligns with your marketing goals.
• Track expenditures and returns to adjust strategies promptly.
• Utilize tools for budget management and ROI calculation to make informed financial decisions.

Functions of Marketing #7: Distribution

Reaching Your Audience: Mastering Distribution Channels in Marketing

Distribution is a critical component of the 7 functions of marketing. It involves making a product or service available to consumers through various channels. Effective distribution strategies consider the best channels based on the target audience, product type, and cost considerations, ensuring products are available where and when customers want them.

This function underscores the role of marketing in business by optimizing the path that products take from manufacturer to market. It supports the core function of marketing by ensuring that accessibility aligns with consumer demand and business objectives. Particularly in B2B marketing functions, strategic distribution is crucial as it directly impacts product availability and customer satisfaction, reinforcing the comprehensive functions of marketing.

Case Study: Starbucks’ Omnichannel Distribution Strategy

This case study underscores the importance of an integrated omnichannel strategy that leverages multiple customer touchpoints to enhance engagement and drive sales. By providing a unified customer experience across digital and physical channels, Starbucks effectively grew its customer base and increased customer loyalty.

• Analyze your target market to determine the most effective distribution channels.
• Consider digital and traditional channels to expand your reach.
• Integrate various channels for a seamless customer experience.

In conclusion, mastering the seven essential functions of marketing is vital for any business aiming for success. These functions work interdependently to create a comprehensive marketing strategy that can adapt to an ever-changing business environment. Embracing these functions fully equips businesses to meet customer needs effectively, ensuring sustained growth and a competitive edge in the market. Take action today by integrating these functions into your marketing strategy and prepare to see substantial improvements in your business outcomes.

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5.1: Case Study: The Importance of Cells

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• Suzanne Wakim & Mandeep Grewal
• Butte College

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Case Study: More Than Just Tired

We all get tired sometimes, especially if we have been doing a lot of physical activity. But for Jasmin, a 34-year-old former high school track star who is now a recreational runner, her tiredness was going far beyond what she thought should be normal for someone who is generally in good physical shape. She was experiencing extreme fatigue after her runs, as well as muscle cramping, spasms, and an unusual sense of heaviness in her legs. At first, she chalked it up to getting older, but her exhaustion and pain worsened to the point where this former athlete could no longer run for more than a few minutes at a time. She also began to experience other unusual symptoms, such as blurry vision and vomiting for no apparent reason.

Concerned, she went to her doctor. Her doctor ran many tests and consulted with several specialists. After several months, Jasmin is finally diagnosed with a mitochondrial disease. Jasmin is surprised. She has an 8-year-old niece with a mitochondrial disease, but her niece’s symptoms started when she was very young, and included seizures and learning disabilities. How can Jasmin have the same disease but different symptoms? Why did she not have problems until adulthood while her niece had symptoms at an early age? And what are mitochondria anyway?

Chapter Overview: Cells

As you will learn in this chapter, mitochondria are important structures within our cells. This chapter will describe cells, which are the basic unit of structure and function in all living organisms. Specifically, you will learn:

• How cells were discovered, their common structures, and the principles of cell theory.
• The importance of size and shape in the functions of cells.
• The differences between eukaryotic cells (such as those in humans and other animals) and prokaryotic cells (such as bacteria).
• The structures and functions of parts of cells including mitochondria, the plasma membrane, cytoplasm, cytoskeleton, nucleus, ribosomes, Golgi apparatus, endoplasmic reticulum, vesicles, and vacuoles.
• How the processes of passive and active transport move substances into and out of cells and help maintain homeostasis.
• How organisms obtain the energy needed for life, including how the sugar glucose is broken down to produce ATP through the processes of aerobic cellular respiration and anaerobic respiration.

As you read this chapter, think about the following questions related to Jasmin’s disease:

• What are mitochondria? What is their structure, function, and where did they come from during evolution?
• Why are fatigue and “exercise intolerance,” such as Jasmin’s extreme exhaustion after running, common symptoms of mitochondrial diseases?
• Why do you think Jasmin has symptoms that affect so many different parts of her body including her legs, eyes, and digestive system?

Attributions

• Tired by Dace Kiršpile licensed CC BY 2.0 via Flickr
• Text adapted from Human Biology by CK-12 licensed CC BY-NC 3.0

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5.2.1: Function Case Study (Lambert)

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• Carey Smith
• Oxnard College

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By Adam Lambert, Zero to MATLAB, 8.1 Basic Functions

Generally, when we make a function we will be using two separate m-files. One m-file will contain the code for the function. A 2nd file (the test file) will call the function.

Two notes of caution:

1. Do not try to run a function file by itself. A function file is different from a script file. If you do try to run a function file, MATLAB or Octave will usually complain that the inputs are not defined. You need to call the function from the test script file.

2. Do not "clear all" inside the function. That would clear your inputs and the function will fail. Only "clear all" in the test script file.

The function syntax can be confusing at first. In simple problems it can seem pointless to implement a function, but  you want to practice creating functions with simple problems. As you begin to write more complex programs, functions become a valuable tool. Take the time to learn the operation with these simple examples.

The syntax required to build a function is the most complex that we have encountered. It takes some practice to get it organized in your head. Let's dive into a simple example and take some time to discuss all of the pieces.

Example \(\PageIndex{1}\) times_two function

This is a function which will accept a number as input, multiply it by two, and return the result of that calculation as output. This code should be saved in an m-file called times_two.m. The name of the function must be the same as the m-file where it is stored.

function y = times_two(x)     y = 2*x; end

On the first line we see the function command, followed by the expression y = times_two(x). We call this line the declaration. (Some authors call this the function declaration; others call it the function signature. Both declaration and signature mean the same thing.) The function command tells MATLAB that this code is a function. It must be the first command in the file.

The variable x is the input variable for the function. Whatever number that we pass to the function will be assigned to the variable x which can then be used in the calculations inside the function. The variable y to the left of the assignment operator is the output variable. This value must be assigned during the execution of the function. In this simple case, the assignment is the only expression inside the function. As long as the variable is assigned within the function, then the value of the variable will be returned once the code inside the function completes.

The name of the function, times_two, is also the command that we use to execute the function. When we execute a function, we say that we call the function. A line of code in a script that calls a function is often referred to as a function call. In order to call a function, the m-file must be saved in the current directory.

If you look at the structure of the declaration, you can see that it mimics the structure of the code which is used to call it. The output variable is in the position to be assigned a value, and the input variable is in the position to pass a value into the function. Consider this similar expression using a built-in command:

>>z = sin(pi)

The value of pi is passed into the sin function and the result is assigned to the variable z. The declaration of this function would look like this.

function y = sin(x)

Inside there would be an algorithm to calculate the sine of the value of x and assign it to the variable y.

Now that we've had an overview of how functions are made and implemented, let's practice with this simple example to learn more about the behavior.

1. Open up a new m-file and save it in the current directory as times two.m.

2. Type the code from the times two example into the script and save it. Note that the file name and the function name are the same.

3. Now go to the Command Window and call the function at the prompt. We need to input a number, just like if we used one of the trigonometric functions.

>>times two(4)

The function will return the value 8. Note that the variable y is not saved in the Workspace and the value is assigned to the default variable name ans. If you do have a variable y from a previous calculation then clear the Workspace and try again. This is important, because the function only returns a value, not a variable. We'll discuss this in more detail in the next section.

4. We can use a variable to pass the input value into the function. We can also use a variable to store the returned results. Try the following sequence in the Command Window.

>>a = 4; >>b = times two(a);

Note that the variable names are not the same as the names inside the function. They do not have to be, because they are simply passing values in and out of the function. The external variables never interact with the code inside the function.

Let's look back at the code in times two.m and walk through the whole process. First, the input value is assigned to the variable x. This can occur with a number or a variable. If the input to the function is a variable, then MATLAB will look up the value and assign that value to the variable x. Once the variable x is defined, then the code will execute. In this case, x will be multiplied by 2 and the result assigned the to variable y. Then, because all of the code inside the function has completed, the value of the output variable will be returned.

This is the most complex topic that we have covered, so don't be discouraged if this is confusing the first time through. As we move through the chapter and you get more experience, the flow of information will be easier to see.

Add example text here.

Case Study: Structure and Function Prediction of a Protein with No Functionally Characterized Homolog

Cite this chapter.

• Vijayaraj Nagarajan 5 &
• Mohamed O. Elasri 5  

Part of the book series: Studies in Computational Intelligence ((SCI,volume 151))

898 Accesses

The post-genomic era has seen a significant increase in the use of computational prediction methods to gain insights into structure and function of proteins. Prediction tools are used to guide the experimental design to test various hypotheses about structure and function of known proteins. However, these tools are particularly useful when studying putative protein sequences with no known function. The genomic era produced a large number of sequences that are described as either hypothetical proteins or as proteins with unknown function. Current molecular biology techniques are not adequate to efficiently study this vast reservoir of genetic information. However, computer algorithms can process large amounts of sequence data to predict structure and function. These knowledge-based computational tools use available experimental data and are regularly updated to improve their predictive power. The simplest form of function prediction is achieved by comparison of the query sequence to all available sequences using BLAST. If the query sequence is highly similar to previously characterized proteins, then it is likely that the query sequence has similar functions. However, if the query sequence does not have any homologous sequence with known function, then more sophisticated computational tools are necessary to gain insight into structure and function. Various methods have been developed to search for known domains, motifs, patterns, or profiles. The quality of predictions is dependent on the type of tools used and is limited to the closeness of the query sequence to known proteins.

In this chapter, we will describe and discuss methods and tools we used to predict structure and function of a putative protein sequence (Msa) with unknown function. We will address the advantages and limitations of all these approaches by using the Msa protein from the human pathogen Staphylococcus aureus as a case study. Msa is a novel protein that is involved in regulation of virulence. Since Msa has no known homolog, computational tools are being used to predict its structure and mechanism of action. These predictions are used to design experiments to study Msa and explore its use as a therapeutic target to combat antibiotic-resistant infections.

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Phylogenetic and Other Conservation-Based Approaches to Predict Protein Functional Sites

Inferring Function from Homology

Use of designed sequences in protein structure recognition.

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Nagarajan, V., Elasri, M.O. (2008). Case Study: Structure and Function Prediction of a Protein with No Functionally Characterized Homolog. In: Smolinski, T.G., Milanova, M.G., Hassanien, AE. (eds) Computational Intelligence in Biomedicine and Bioinformatics. Studies in Computational Intelligence, vol 151. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-70778-3_16

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4.1 Case Study: The Importance of Cells

Created by: CK-12/Adapted by Christine Miller

Case Study: More Than Just Tired

We all get tired sometimes, especially if we have been doing a lot of physical activity, like the athletes pictured in Figure 4.1.1. But for Jasmin (Figure 4.1.2), a 34-year-old former high school track star who is now a recreational runner, her tiredness was going far beyond what she thought should be normal for someone in generally good physical shape.

She was experiencing extreme fatigue after her runs, as well as muscle cramping, spasms, and an unusual sense of heaviness in her legs. At first, she just chalked it up to getting older, but her exhaustion and pain worsened to the point where the former athlete could no longer run for more than a few minutes at a time. She began to experience other unusual symptoms, such as blurry vision and vomiting for no apparent reason.

Concerned, Jasmin went to her doctor, who ran many tests and consulted with several specialists. After several months, she was finally diagnosed with a mitochondrial disease. Jasmin is surprised. She has an 8-year-old niece with a mitochondrial disease, but her niece’s symptoms started when she was very young, and they included seizures and learning disabilities. How can Jasmin have the same disease, but different symptoms? Why didn’t she have problems until adulthood, while her niece experienced symptoms at an early age? And what are mitochondria, anyway?

Chapter Overview: The Importance of Cells

As you will learn in this chapter, mitochondria are important structures within our cells. This chapter will describe cells, which are the basic unit of structure and function in all living organisms. Specifically, you will learn:

• How cells were discovered, their common structures, and the principles of cell theory.
• The importance of size and shape to the functions of cells.
• The differences between eukaryotic cells (such as those in humans and other animals) and prokaryotic cells (such as bacteria).
• The structures and functions of cell parts, including mitochondria, the plasma membrane, cytoplasm, cytoskeleton, nucleus, ribosomes, Golgi apparatus, endoplasmic reticulum, vesicles, and vacuoles.
• The processes of passive and active transport to move substances into and out of cells and help maintain homeostasis.
• How organisms obtain the energy needed for life, including how the sugar glucose is broken down to produce ATP through the processes of anaerobic and aerobic cellular respiration.
• The phases of the cell cycle, how cells divide through mitosis, and how cancer can result from unregulated cell division.

As you read this chapter, think about the following questions related to Jasmin’s disease:

• What are mitochondria? What is their structure and function, and where did they come from during evolution?
• Why are fatigue and “exercise intolerance” (such as Jasmin’s extreme exhaustion after running) common symptoms of mitochondrial diseases?
• Why do you think Jasmin has symptoms that affect so many different parts of her body, including her legs, eyes, and digestive system?
• Why do you think mitochondrial diseases can run in families like Jasmin’s?

Figure 4.1.1

Difficult competition by Massimo Sartirana on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 4.1.2

Exhausted by Kevin Grieve on Unsplash is used under the Unsplash License (https://unsplash.com/license).

The smallest unit of life, consisting of at least a membrane, cytoplasm, and genetic material.

Human Biology Copyright © 2020 by Christine Miller is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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• Published: 04 June 2024

Case analysis of hepatotoxicity caused by vancomycin

• Jiayao Wu 2 &
• Yulu Zhou 1  

Journal of Medical Case Reports volume  18 , Article number:  267 ( 2024 ) Cite this article

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Although the correlation between liver toxicity and vancomycin is generally considered low, it has been observed that the use of vancomycin can lead to abnormal liver function indicators, such as elevated aspartate aminotransferase, alanine aminotransferase, alpha fetoprotein, and jaundice. To further understand the clinical features associated with vancomycin-induced liver toxicity and to provide clinical guidance, we conducted an analysis of the characteristics and clinical manifestations of vancomycin-induced liver injury.

Patients with liver function injury who received vancomycin treatment at the Third Xiangya Hospital of Central South University and Hunan Maternal and Child Health Hospital between 2016 and 2021 were selected for retrospective analysis of their general characteristics, vancomycin course, dose, liver function index, severity of liver injury, and concomitant medications.

Of the 4562 patients who received vancomycin, 17 patients were finally included, with an incidence rate of 0.37%. Of these patients, 12 were male (70.6%) and 5 were female (29.4%), ranging in age from 17 to 84 years with a mean average age of 45.41 ± 20.405 years. All patients were evaluated using Naranjo’s score, with score ≥ 3. The dosage, time, and plasma concentration of vancomycin were analyzed and it was found that nine patients (52.94%) had abnormal liver function when initially given a dose of 1 g every 12 hours. In total, 14 patients (82.35%) with liver injury were taking vancomycin in combination with two to four drugs, and severe liver injury occurred in patients taking vancomycin in combination with two drugs. The occurrence time of liver injury was 2–12 days after starting vancomycin, with a mean of 4.53 ± 2.401 days. Of these patients, 16 patients (94.1%) showed liver function abnormalities within 7 days of taking the drug, and 2 patients with grade 3–4 liver injury both showed liver function abnormalities within 3 days of taking the drug. Only 4 of the 17 patients (23.53%) had vancomycin blood concentrations within the normal range, and there was no correlation found between blood concentration and severity of liver injury. Analysis of the correlation between the severity of liver injury and vancomycin showed that none of the patients had allergies such as rash, two patients (11.76%) had jaundice, and fatigue occurred in five patients (29.41%). The remaining ten patients (58.82%) had no symptoms related to liver injury. All 17 patients had abnormal aspartate aminotransferase/alanine aminotransferase levels and 9 patients also had abnormal bilirubin levels. In 15 patients (88.24%), the severity of liver injury was grade 1, indicating mild liver injury, and no correlation was observed between the severity of liver injury and creatinine. Of the 17 patients, 1 patient received no intervention, 4 patients stopped taking vancomycin after developing liver injury, 1 patient reduced the dose, and 11 patients (64.7%) were treated with hepatic protectant.

Although the study concluded that the incidence of liver injury was not high, the liver toxicity of vancomycin should still be considered and liver function indicators should be monitored during the clinical use of vancomycin.

Peer Review reports

A preprint has previously been published [ 1 ].

Various drugs can cause injury, including antibiotics, antidiabetic drugs, antipsychotic drugs, antitubercular drugs, and antineoplastic drugs. Among these, antibiotics have been shown to be the most common agent involved in adverse drug reactions in hospitalized patients, with effects ranging from gastrointestinal to organ dysfunction and hypersensitivity reactions [ 2 ]. Vancomycin is a glycopeptide antibiotic that is primarily active against Gram-positive bacteria, such as Staphylococcus aureus , Streptococcus , Clostridium , Actinomycetes , Enterococcus , Listeria , and so on. It does not show cross-resistance with other antibiotics. It exerts antibacterial effects by inhibiting the synthesis of bacterial cell wall glycopeptides, altering the permeability of the bacterial cell membrane and destroying its barrier function, and selectively inhibiting the biosynthesis of bacterial RNA to prevent bacterial replication [ 3 ]. Studies have reported that the incidence of adverse events in the vancomycin group was 12.5%, and the most common adverse reactions were nephrotoxicity, ototoxicity, red man syndrome, allergic reactions, and abnormal liver function indicators, such as abnormal aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alpha-fetoprotein (AFP) level [ 4 ]. Owing to the excretion of more than 80% of vancomycin in the urine in the form of prototype [ 5 ], its nephrotoxicity has also received widespread attention. Although the correlation between liver toxicity and vancomycin is very low, abnormal liver function indicators, such as elevated AST, ALT, AFP, and jaundice, have been observed with the use of vancomycin. A meta-analysis of 20 randomized controlled trial (RCT) studies from 1950 to 2010 showed that 321 patients (6.83%) treated with vancomycin experienced liver function abnormalities, which were mainly mild to moderate increases in serum transaminases [ 6 ]. To further investigate the clinical characteristics of vancomycin liver toxicity, we analyzed the clinical data of patients with vancomycin-induced liver injury.

Data source

A total of 4562 hospitalized patients who received vancomycin treatment in the Third Xiangya Hospital from 2016 to 2021 were selected. According to the inclusion and exclusion criteria, 17 patients were finally included. Inclusion criteria: (1) received vancomycin treatment during hospitalization, (2) blood concentration of vancomycin was monitored during medication, (3) had a Naranjo score of ≥ 3 with vancomycin. Exclusion criteria: patients who did not meet the above inclusion criteria.

Retrospective research methods were used to read and sort the patient records, and to extract information, such as sex, age, site of infection, vancomycin dosage, blood concentration, adverse reaction time, symptoms, indicators, treatment measures, and outcomes.

Observation indicators

The purpose of using vancomycin in enrolled patients; time of adverse reactions; symptoms; liver function indicators: AST, ALT, direct bilirubin, indirect bilirubin; renal function: creatinine; plasma concentration; outcomes; and concurrent diseases and medications.

Statistical methods

SPSS 22.0 was used for statistical analysis.

General situation

A total of 17 patients with liver injury were included with an incidence rate of 0.37%, including 12 males (70.6%) and 5 females (29.4%) aged 17–84 years with an average age of 45.41 ± 20.405 years. Among the 17 patients, 1 patient had a history of cholecystectomy, 1 patient had a history of hepatitis B, and 1 patient had a history of alcohol consumption. Overall, 6 patients had aggravated liver injury and the remaining 11 patients had new-onset liver dysfunction. Naranjo’s assessment scale was used to evaluate all patients for the correlation of adverse reactions and score ≥ 3, which was very likely relevant in ten patients and possibly relevant in seven patients. Physicians discontinued vancomycin in all patients. The general information of the patients is presented in Table  1 , and the clinical information of the patients is presented in Table  2 .

Analysis of dosage, time, and plasma concentration of vancomycin in patients with liver injury

Vancomycin dosage and treatment course.

Among the 17 patients, 9 patients (52.94%) were given vancomycin at a dose of 1 g every 12 hours, among which four patients had higher-than-normal blood concentrations of vancomycin, and one patient had liver injury severity of grade 4; the severity of liver injury was grade 1 in three cases, which was lower than normal. In total, four patients (23.53%) were given 1 g every 8 hours after the initial administration of 1 g every 12 hours. Out of these four patients, the blood concentration of vancomycin was higher than the normal value in one patient, two patients were lower than the normal range, and one case had a normal range with grade 3 liver injury severity. The dose adjustment of all patients was based on their vancomycin blood concentration. The average administration time was 6.82 ± 3.264 days, ranging from 3 to 15 days. There were four patients (23.53%) who received vancomycin for 3–6 days, and one of them had grade 4 liver injury. Overall, six patients (35.28%) received vancomycin for 6–9 days, and one case had grade 3 liver injury (Table  3 ).

Concomitant medication

The study examined the effect of drug combination in 17 patients. The mean number of concomitant medications was 2.82, and 14 patients (82.35%) used two to four drugs at the same time (Table  3 ), of which five patients (29.41%) used two drugs, another five patients (29.41%) used three drugs, and four patients (23.53%) used four drugs; two patients with grade 3–4 liver injury were treated with two drugs at the same time.

The time of liver damage after medication

The time of liver damage occurrence in 17 patients was analyzed. Abnormal liver function indexes appeared within 2–12 days after patients began taking vancomycin, with an average onset of 4.41 ± 2.293 days. In total, 16 patients (94.1%) showed abnormal liver function within 7 days after drug administration (Table  3 ), 1 patient had abnormal liver function 12 days after treatment, and 2 patients had grade 3–4 liver injury 3 days after treatment.

Vancomycin plasma concentration

After vancomycin administration, the plasma concentration of all patients was determined by high-performance liquid chromatography (HPLC). The blood drug concentration ranged from 1.20 to 37.19 μg/ml, with an average of 14.8906 ± 11.21257 μg/ml. Among them, six patients (35.29%) did not reach effective blood concentration. Overall, seven patients (41.18%) had a vancomycin level beyond the normal range. Among these seven patients, six patients (85.71%) had a Naranjo’s score indicating a possible reaction, and one case had a probable reaction. However, only one patient with grade 3–4 liver function damage had a blood drug concentration above the upper limit of normal, which is grade 4 liver function damage, suggesting that there may be no correlation between severity and plasma concentration.

Correlation analysis between the severity and vancomycin

Whether there is drug rash with eosinophilia and systemic symptoms (dress) syndrome.

DRESS syndrome, also known as drug hypersensitivity syndrome or drug eruption syndrome with eosinophilia and systemic symptoms. It has been reported that the typical clinical manifestations of DRESS syndrome induced by vancomycin include extensive rash, fever, eosinophilia, and involvement of multiple organ functions. Among these, rash and fever are the main clinical manifestations [ 7 ]. In this study, 13 patients developed fever, which was initially attributed to an infection, but none of them displayed clinical manifestations related to allergy, such as rash.

Changes of liver and kidney function and severity of liver injury

Among the 17 patients, yellow skin staining was present in 2 patients (11.76%), with 1 of them having multiple organ failure, while 5 patients (29.41%) experienced fatigue. The remaining ten patients (58.82%) showed no evidence of liver function damage. All 17 patients had abnormal liver function indexes, mainly including increased AST/ALT and increased direct/indirect bilirubin levels. All 17 patients had abnormal AST/ALT levels, with 14 patients (82.35%) having both elevated AST and ALT levels, only 2 patients had an elevated AST level, and 1 patient had an elevated ALT level. In total, nine patients (52.94%) showed abnormal bilirubin levels, with four cases (23.53%) displaying abnormal AST/ALT and bilirubin levels. Among the 17 patients, 7 patients (41.18%) had AST/ALT ≤ 3 upper limit of normal (ULN), while 2 patients (11.76%) had 3 ULN < AST/ALT ≤ 5 ULN, 7 patients (41.18%) had 5 ULN < AST/ALT ≤ 20 ULN, and 1 patient (5.88%) had ≥ 20 ULN.

Among these 17 patients, 5 patients (29.41%) had increased creatinine levels, 3 patients had AST/ALT between 5 ULN and 20 ULN, and 1 patient had AST/ALT above 20 ULN. In total, three of these patients had grade 1 liver injury and one had grade 3 liver injury with an AST/ALT ratio between 5 ULN and 20 ULN. There was no correlation between the severity of liver function injury and increased creatinine level. According to the grading standard of the severity of drug-induced liver injury [ 8 ], the liver function of the patients was evaluated, revealing that the severity of liver injury in 15 patients (88.24%) was grade 1; 2 patients with grade 3–4 liver injury showed systemic skin jaundice. Only one patient with vancomycin blood concentration beyond the normal range had grade 4 liver function injury (Table  4 ).

Interventions and outcomes

Among the 17 patients, 1 patient did not receive any intervention, 4 patients stopped taking vancomycin after experiencing liver injury, 1 patient was given a reduction in vancomycin dosage, and 11 patients (64.7%) were treated with hepatic protectants. Among the patients receiving treatment, seven patients were treated with reduced glutathione, three patients were treated with two kinds of hepatic protectants (phosphatidylcholine + adenosylmethionine, magnesium isoglycyrrhizinate + reduced glutathione, reduced glutathione + polyene phosphatidylcholine), one patient was treated with three kinds of hepatic protectants (reduced glutathione, enephosphatidylcholine, and adenosylmethionine). Overall, 11 patients (64.71%) were treated for 3–29 days, with an average of 12.27 ± 9.76 days, and 12 patients (70.59%) showed improvement in liver function after intervention. Among them, eight patients (47.06%) returned to the normal level of liver function index and four patients (23.53%) had continued to decline, but did not return to the normal level during hospitalization. In total, two patients (11.76%) were discharged upon request by their family members without any signs of improvement, with no follow-up data available, and three patients (17.65%) died owing to multiple organ failure caused by the progression of the primary disease, including two patients with respiratory failure and one patient with acute cardiac failure.

When administered intravenously, vancomycin can be distributed through most of the body’s tissues and fluids. It can achieve effective bacterial concentrations in serum, pleural fluid, pericardial fluid, ascites, urine, and atrium, but not in bile. At the same time, the medication is not metabolized in the body and is ultimately excreted in the urine as a prototype. In patients with kidney dysfunction, vancomycin excretion will be mitigated, and studies have shown that abnormal liver function affects the pharmacokinetics of vancomycin. Previous pharmacokinetic studies have shown levels of vancomycin in liver tissue and bile to be below the detection limit [ 5 ]. In a Japanese study, vancomycin-conjugated monoclonal antibodies were used to target vancomycin molecules in the kidney and liver of rats, and immunohistochemistry was used to monitor the uptake of vancomycin in the kidney and liver of rats. The study showed that vancomycin is not metabolized by the liver [ 9 ].

Compared with nephrotoxicity, even though the correlation between hepatotoxicity and vancomycin was low, abnormal markers of liver function, such as AST, ALT, elevated AFP, and jaundice, were associated with the use of vancomycin. Results of a meta-analysis of 20 RCTs conducted between 1950 and 2010 showed that patients who received vancomycin had a significantly higher incidence of abnormal liver function, especially serum transaminases, compared with patients who did not receive vancomycin. Although the levels are elevated, most are mild to moderate [ 6 ]. In a retrospective cohort study of patients receiving vancomycin with hepatic impairment, it was observed that 237 patients with no or mild hepatic impairment and 171 patients with moderate-to-severe hepatic impairment were observed. Patients with hepatic impairment had very high mean concentrations, lower clearance rates, longer half-lives, and higher rates of acute renal damage [ 10 ]. Another study demonstrated the significant impact of liver function on vancomycin pharmacokinetics [ 11 ] and showed that patients with acute or chronic liver failure are at a higher risk of reduced survival rates [ 12 ]. At present, the cause of abnormal liver function indices caused by vancomycin remains unclear; however, timely use of regular doses of vancomycin in patients with liver damage may result in increased blood concentrations [ 13 ]. Studies have shown that higher intensive care unit (ICU) mortality rates are observed when the average plasma concentration of vancomycin is 15–20 mg/L or > 20 mg/L [ 14 ], and greater incidences of nephrotoxicity are observed when the trough concentration of vancomycin is > 15 mg/L [ 15 ]. For the Chinese population, the guidelines recommend that the plasma concentration of vancomycin in adult patients be no higher than 20 mg/L [ 16 ]. In this study, through a detailed retrospective analysis of the case data of patients with vancomycin-induced hepatotoxicity, the characteristics of vancomycin hepatotoxicity, including occurrence time, blood concentration, intervention measures, and liver function indicators, were described in detail. In this study, 0.37% of the patients had liver function impairment. Consistent with previous findings, most patients had mild liver injury, mainly characterized by mild to moderate transaminase abnormalities; however, no correlation was observed between the severity of liver injury and blood drug concentration or kidney injury. To confirm whether there was a correlation, the correlation between the time of administration of vancomycin, the total dose, and the blood level was assessed in 17 patients. The results showed that there was no correlation between the increase in liver function indices and the administration time, total dose, and blood concentration of vancomycin, which may be related to the small sample size. Further work is required.

Similar to nephrotoxicity, the mechanism of hepatoxicity is also linked to oxidative stress and mitochondrial malignant lesions [ 17 ]. The reason for the large difference between vancomycin nephrotoxicity and hepatotoxicity may be related to the different types of transporters on liver cells and renal tubular cells. Vancomycin nephrototoxicity primarily causes damage to kidney cells by affecting renal tubular mitochondria. While the majority of drug delivery to mitochondria requires transmembrane transport proteins. Recent studies have shown that the expression of Oat1/3 and Oct2 was observed in the rat vancomycin renal injury model, which may play an important role in the transport of vancomycin to the renal proximal tubule cells. At the same time, vancomycin can inhibit the expression of oats 1, oats 3, and oct2, leading to decreased transport of endogenous toxins and increased kidney injury [ 18 ]. In the liver, members of the organic anion transporter (OAT) family involved in vancomycin transport are less expressed, which can be the main cause of nephrotoxicity and hepatotoxicity. At the same time, studies have shown that vancomycin can be detected in the hepatic sinusoidal endothelial cells of the liver for up to 8 days after injection, while it was not detected on the surface of hepatocytes and bile capillaries with the therapeutic dose of vancomycin in rats, indicating that vancomycin cannot pass through cells and enter the liver [ 9 ]. The study also demonstrates that the vancomycin-bound carrier is absent from the surface of the hepatic cell membrane. At the same time, some studies have shown that the genes of oats and OCT are expressed in certain rat hepatocytes [ 19 ], which can be related to the onset of vancomycin hepatotoxicity.

During this study, 17 patients were assessed for liver damage caused by the use of vancomycin. The general condition, severity of liver injury, liver function indices (AST/ALT, direct bilirubin/indirect bilirubin), and liver injury were assessed. The correlation between the severity and vancomycin was analyzed. In all patients, the type of liver injury was mainly asymptomatic abnormal liver function indicators, two patients had jaundice and eventually died of systemic multi-organ failure due to concurrent disease progression. The dosage, time, and blood concentration were analyzed and nine patients (52.94%) had abnormal liver function when they initially used vancomycin with a conventional dose of 1 g every 12 hours. Most of the patients had one to three complications and were necessarily treated with two to four drugs at the same time, including antibacterial drugs, antiviral drugs, antihypertensive drugs, and a few patients were treated with antitumor drugs, which may exacerbate hepatotoxicity and severe liver injury in patients who used two drugs. Overall, 94.1% of patients reported abnormal liver function within 7 days of taking vancomycin. In 76.47% of patients, the blood concentration was out of the range of effective blood concentration. Among the seven patients who exceeded the normal value, the Naranjo’s score of 85.71% patients was probably related, suggesting that higher blood concentration may lead to the occurrence of abnormal liver function, but no linear relationship between blood concentration and liver injury was found. In this study, the hepatic toxicity induced by vancomycin was described in detail, and patient data were analyzed to provide a baseline for the clinical use of vancomycin. However, owing to the small amount of data and large patient differences, more data are needed for more in-depth analysis.

In the clinical setting, the focus should be on the liver toxicity of vancomycin, and the liver function indicators of patients should be monitored.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

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Class 12 Maths: Case Study of Chapter 1 Relations and Functions PDF Download

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In Class 12 Boards there will be Case studies and Passage Based Questions will be asked, So practice these types of questions. Study Rate is always there to help you. Free PDF Download of CBSE Class 12 Mathematics Chapter 1 Relations and Functions Case Study and Passage Based Questions with Answers were Prepared Based on Latest Exam Pattern. Students can solve NCERT Class 12 Maths Relations and Functions  to know their preparation level.

Join our Telegram Channel, there you will get various e-books for CBSE 2024 Boards exams for Class 9th, 10th, 11th, and 12th.

In CBSE Class 12 Maths Paper, There will be a few questions based on case studies and passage-based as well. In that, a paragraph will be given, and then the MCQ questions based on it will be asked.

Relations and Functions Case Study Questions With answers

Here, we have provided case-based/passage-based questions for Class 12 Mathematics  Chapter 1 Relations and Functions

Case Study/Passage-Based Questions

Case Study 1:

A general election of the Lok Sabha is a gigantic exercise. About 911 million people were eligible to vote and voter turnout was about 67%, the highest ever.

Let I be the set of all citizens of India who were eligible to exercise their voting right in the general election held in 2019. A relation ‘R’ is defined on I as follows: R = {(𝑉1, 𝑉2) ∶ 𝑉1, 𝑉2 ∈ 𝐼 and both use their voting right in the general election – 2019}

• Two neighbors X and Y∈ I. X exercised his voting right while Y did not cast her vote in general election – 2019. Which of the following is true? a. (X,Y) ∈R b. (Y,X) ∈R c. (X,X) ∉R d. (X,Y) ∉R
• Mr.’𝑋’ and his wife ‘𝑊’both exercised their voting right in general election -2019, Which of the following is true? a. both (X,W) and (W,X) ∈ R b. (X,W) ∈ R but (W,X) ∉ R c. both (X,W) and (W,X) ∉ R d. (W,X) ∈ R but (X,W) ∉ R
• Three friends F1, F2, and F3 exercised their voting right in the general election 2019, then which of the following is true? a. (F1,F2 ) ∈R, (F2,F3) ∈ R and (F1,F3) ∈ R b. (F1,F2 ) ∈ R, (F2,F3) ∈ R and (F1,F3) ∉ R c. (F1,F2 ) ∈ R, (F2,F2) ∈R but (F3,F3) ∉ R d. (F1,F2 ) ∉ R, (F2,F3) ∉ R and (F1,F3) ∉ R
• The above-defined relation R is __ a. Symmetric and transitive but not reflexive b. Universal relation c. Equivalence relation d. Reflexive but not symmetric and transitive
• Mr. Shyam exercised his voting right in General Election – 2019, then Mr. Shyam is related to which of the following? a. All those eligible voters who cast their votes b. Family members of Mr.Shyam c. All citizens of India d. Eligible voters of India

Answer: 1. (d) (X,Y) ∉R 2. (a) both (X,W) and (W,X) ∈ R 3. (a) (F1,F2 ) ∈R, (F2,F3) ∈ R and (F1,F3) ∈ R 4. (c) Equivalence relation 5. (a) All those eligible voters who cast their votes

Case Study 2:

Sherlin and Danju are playing Ludo at home during Covid-19. While rolling the dice, Sherlin’s sister Raji observed and noted the possible outcomes of the throw every time belonging to set {1, 2, 3, 4, 5, 6}. Let A be the set of players while B be the set of all possible outcomes. A = {S, D}, B = {1, 2, 3, 4, 5, 6}

(i) Let R : B –> B be defined by R = {(x, y) : y is divisible by x} is (a) Reflexive and transitive but not symmetric (b) Reflexive and symmetric but not transitive (c) Not reflexive but symmetric and transitive (d) Equivalence

Answer: (a) Reflexive and transitive but not symmetric

(ii) Raji wants to know the number of functions from A to B. How many number of functions are possible? (a) 6 2 (b) 2 6 (c) 6! (d) 2 12

Answer: (a) 62

(iii) Let R be a relation on B defined by R = {(1, 2), (2, 2), (1, 3), (3, 4), (3, 1), (4, 3), (5, 5)}. Then R is (a) Symmetric (b) Reflexive (c) Transitive (d) None of these three

Answer: (d) None of these three

(iv) Raji wants to know the number of relations possible from A to B. How many numbers of relations are possible? (a) 6 2 (b) 2 6 (c) 6! (d) 2 12

Answer: (d) 212

(v) Let R : B –> B be defined by R = {(1, 1), (1, 2), (2, 2)(3, 3), (4, 4), (5, 5), (6, 6)}, then R is (a) Symmetric (b) Reflexive and Transitive (c) Transitive and symmetric (d) Equivalence

Answer: (b) Reflexive and Transitive

Hope the information shed above regarding Case Study and Passage Based Questions for Class 12 Maths Chapter 1 Relations and Functions with Answers Pdf free download has been useful to an extent. If you have any other queries of CBSE Class 12 Mathematics Relations and Functions Case Study and Passage Based Questions with Answers, feel free to comment below so that we can revert back to us at the earliest possible. By Team Study Rate

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November 5, 2018, by Kate

Functional analysis: A simple worked example of a (fictional!) case

• Functional analysis

Functional analysis is a model of psychological formulation designed to understand the functions of human behaviour. It has its origins in behavioural psychology. At its core, functional analysis assumes that all behaviour is learned, and that all behaviours serve some purpose. This applies equally to challenging behaviours (such as violence or self-harm) as to more socially acceptable acts.

The  NICE  guidelines describe functional analysis as “A method for understanding the causes and consequences of behaviour and its relationship to particular stimuli, and the function of the behaviour”. They recommend the use of functional analysis in the assessment of challenging behaviour in adults with  autism spectrum disorder  and  learning disability . As with any formulation, one of the primary aims of a functional analysis is to guide interventions to help people. This might include things like  positive behavioural support plans .

Functional analysis is a way of helping us to understand  why  someone is acting in a certain way.

So for this example, imagine you are a psychologist working at a medium secure unit. You have been asked to complete a functional analysis for Rob, who has been displaying regular verbal aggression since he came to the unit.

The case background

Rob is a 27 year old man, he has been diagnosed with a mild  learning disability . He is currently detained in a medium secure unit, due to sudden outbursts of verbal aggression and, sometimes, physical violence.

Rob grew up with his mother in the countryside. He was an only child; his father was arrested after hitting his mother when Rob was aged 7. Rob’s mother has described finding his behaviour difficult to manage when he was younger, although she loved him very much.

Rob found primary school difficult. Teachers reported that he found it hard to keep up with the other children, and would ‘act-out’ when he got frustrated. As he got older, his behaviour got worse, including throwing things at teachers and hitting other children. He was eventually transferred to a special school and diagnosed with a learning disability. Rob first got into trouble with the police when he was caught stealing from a local shop as a teenager, he said that his friends had encouraged him to do this. His Mum has said that she thinks some of Rob’s friends were bad influences, as he started smoking to try and impress them. Rob started getting into fights and was eventually arrested after punching a stranger.

Rob’s IQ test (the WAIS-IV) suggests that he has some problems with processing speed. This means that it takes him more time to take in and process new information, and it may take him longer than most people to perform mental tasks. He had a relative strength in verbal comprehension, suggesting he has good skills with words and language.

An assessment of Rob’s adaptive functioning suggested that he had strengths in social skills and leisure activities. However, he had some deficits in communication and practical skills including self-care. He also has some problems with academic skills and limited independence and self-control.

Our job is to try and work out what function verbal aggression is serving for Rob. In order to do this, we need to gather as much information as possible about the behaviour itself. We also need to know what happens immediately before and after. So we need to understand:

Antecedents

What is going on immediately before Rob is aggressive?

What exactly is the behaviour? We need a really clear description in order to be able to monitor and understand it.

Consequences

What happens immediately after the behaviour ?

First of all we need to clearly define the behaviour. So rather than just the general term ‘aggression’ we need to think about what Rob actually does, and explain it in a clear and concise way.

There are lots of different ways to try and gather information, and we want our investigation to be as thorough as possible. So we use different methods to gather information:

Indirect observation – This means asking other people about the behaviour. In this case we might interview Rob himself and speak to nursing staff and people that work with him. There are some helpful (and free!) questionnaires that can help. A couple that I have found useful are:

• The  modified overt aggression scale  which helps to describe and categorise aggressive behaviour and monitor its frequency.
• The  motivation assessment scale  which asks an informant (observer) questions about a behaviour to try and work out the motivations.

There are several others though!

Direct observation – This means that we observe the behaviour ourselves, so in this case we might spend time on the ward so that we can watch Rob’s behaviour in different circumstances. People sometimes use ABC charts   to record the antecedents and consequences of a behaviour of interest. There are lots of examples online, or you can make your own!

So, after gathering data from staff on the ward and completing our own observations, we start to realise that Rob seems to become aggressive more often in loud situations with lots of people present. We come up with the following information:

Antecedents:

• Social situations – Rob becomes verbally aggressive more often when other people are present
• Male staff present – This tends to happen when male staff are on duty
• Loud, noisy environment – This tends to happen at times of day when the ward is more noisy and busy (including mealtimes and medication times)
• Rob stands up, raises his voice and swears at staff who are physically close to him

Consequences:

• Staff typically respond immediately by asking Rob to sit down, lower his voice and stop swearing (verbal de-escalation)
• Rob rarely responds to this, and so staff will then take his arm and escort him to his room or a lower stimulus environment
• Staff will then sit and talk to Rob about his behaviour

Functions of the behaviour

So, now that we have a clearer idea of what’s happening, we need to understand the function. We usually think about several plausible functions:

Gaining attention, affiliation or interaction with other people. For example, someone hurting themselves because they will then receive medical attention – this is positive reinforcement.

Self-stimulation

Gaining an internal positive feeling that is not dependent on other people. For example, getting a buzz from driving too quickly – again positive reinforcement, although sometimes called intrinsic reinforcement.

Tangible rewards

Gaining actual ‘stuff’ that someone wants. For example,  if you give a child sweeties when he/she cries to try and get them to be quiet, they may be louder to get the sweeties! Again this is positive reinforcement.

Escape or avoidance

This is about finding ways to get away from (escape) or not be exposed to (avoid) unpleasant things. For example, a student not attending classes where they have to present as it makes them anxious – this is negative reinforcement.

So in Rob’s case, there are two functions that seem to make sense:

Escape – when he starts shouting he is removed from a noisy, social environment. We know from his case history that it sometimes takes Rob a bit of time to take in information, and that he generally has good social skills. So it makes sense that he might find busy noisy environments stressful, particularly when he is in social settings.

Attention – Another possible function is that when Rob behaves in this way he gets individual attention from male members of staff. We might wonder from his case history whether Rob has had positive male caring figures in his life, and so again this is a plausible function of behaviour.

Depending on the circumstances, it might be that we stop with this functional assessment, and use what we have found out so far to inform our treatment planning. However, there is another step we can take which is to manipulate the antecedents or consequences of Rob’s behaviour in assessment sessions to find out the primary function.

A true functional analysis includes in some way manipulating either the antecedents or consequences of a behaviour, to see if this effects how frequently the behaviour is used. This is an experimental method which allows us to more confidently establish what is causing a behaviour.

This can pose ethical and practical challenges in secure environments, and throughout our practice we have to consider the safety and well-being of everyone.

So in order to get the best data, we could conduct an experiment to test the functions of Rob’s behaviour. This might include devising conditions where Rob is told off when he becomes threatening (attention), or is allowed to stop doing something he does not like when he becomes aggressive (escape). We would then monitor the frequency of the behaviour in each of these conditions (as well as a control condition). We would use this information to establish the primary function. However, in Rob’s case, this behaviour might cause distress for Rob or for other people, and so we have to think about how ethical this is.

One alternative is to use something called naturalistic experiments. This means monitoring behaviour in circumstances that arise naturally. So in Rob’s case, imagine that in order to manage risk he is put on second sitting at mealtimes (meaning that he eats later, with fewer patients present). We know that one time he seems to become verbally aggressive is mealtimes. So we could see what happens if Rob eats with fewer other patients present, but the same number of staff. If the primary function is attention, then we would expect the behaviour to occur as frequently. If the function is to escape a noisy social environment, then we might expect the frequency of the behaviour to reduce.

So we monitor the frequency of Rob’s verbal aggression. We can see that when he is put on second sitting the frequency of verbal aggression decreases. So we conclude that the primary function is to escape an uncomfortable environment.

Applying our findings to treatment plans

Now that we’ve established the function of Rob’s behaviour, we have to design plans to try and reduce the behaviour and increase Rob’s well-being. There are a few different ways we can do this:

• We can consider environmental changes in order to reduce Rob’s exposure to stressful situations. This might include reducing Rob’s exposure to loud busy social environments
• We can think about alternative strategies Rob can use to communicate his distress, and work with him to develop these strategies – for example holding up a red card if he is finding a situation too difficult to manage
• We can consider the ways staff working with Rob respond to his behaviour, to ensure that we all respond in ways likely to reduce aggression.

Once we design our plans, it is really important that we continue to monitor the frequency of the behaviour to see if our plans are working!

Pros and cons of functional analysis

• Leads clearly to treatment recommendations
• Can be used with people who struggle to express themselves verbally
• Has a great deal of research support – it works!
• Focuses on a specific problem behaviour (the people we work with may have multiple presenting difficulties)
• Does not consider underlying factors which may be contributing to the need for the behaviour – e.g. if a behaviour reduces distress then functional analysis should be able to identify this, but it is not able to identify the underlying source of the distress, such as unresolved trauma.

Functional analysis can be an incredibly useful tool, but often it is part of a wider formulation. For example in Rob’s case, we might have successfully identified the function of his verbal aggression and be able to design interventions to reduce this. However, we might be interested in other aspects of the case. Rob’s father was violent, it might help to understand his early attachment relationships and associated core beliefs (or cognitive schema). It looks like social relationships come up a lot in this case, so we might also be interested in his social self-esteem and vulnerability to peer pressure.

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Folic acid supplementation improves erectile function in patients with idiopathic vasculogenic erectile dysfunction by lowering peripheral and penile homocysteine plasma levels: a case-control study

Affiliations.

• 1 Department of Dermatology and Venereolgy and Andrology, Al-Azhar University, Cairo, Egypt.
• 2 Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• 3 Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Giza, Egypt.
• PMID: 31237081
• DOI: 10.1111/andr.12672

Background: Erectile dysfunction (ED) has common risk factors with many cardiovascular (CV) impairments. In view of these facts, hyperhomocysteinemia (HHcys) has been postulated for involvement in endothelial dysfunction.

Objectives: We evaluated peripheral and penile homocysteine (Hcys) plasma levels before and after folic acid supplementation in idiopathic vasculogenic erectile dysfunction (ED) patients.

Materials and methods: This study included 50 consecutive patients and 50 consecutive healthy controls that were recruited from December 2017 to December 2018. The patients received folic acid (FA) daily for 3 months and were evaluated by the abridged 5-item International Index of Erectile Function (IIEF-5) and penile duplex before and after therapy, in addition to plasma Hcys levels.

Results: Our study showed improvement in the severity of ED in our patients as all of them became mild to moderate ED after folic acid administration. Additionally, the median scores of IIEF-5 significantly increased from 6 to 14, respectively (p < 0.001). Furthermore, the median peripheral and penile Hcys plasma levels (μmol/l) significantly decreased after folic acid administration as 39 patients with moderate ED and 11 patients with severe ED were 0.62, 0.34, 5.37, 0.37, respectively, became mild to moderate ED with their median peripheral and penile Hcys plasma levels became 0.19, 0.15, p < 0.001, <0.001, respectively. Peripheral Hcys level correlates significantly with penile Hcys before and after folic acid administration (r: -0.06 p: 0.8, r: 0.9, p < 0.001, respectively).

Discussion and conclusion: Recently, an emerging body of evidence suggests a role for Hcys and folate in erectile function. Interestingly, our interventional study is one of the first that evaluated the effect of folic acid supplementation on HHcys where it demonstrated a significant decrease in peripheral and penile Hcys plasma levels after folic acid administration. Thus, FA should be prescribed concomitantly with phosphodiesterase type 5 inhibitors in ED patients.

Keywords: erectile function; folic acid administration; penile duplex; peripheral and penile homocysteine (Hcys) plasma levels; the abridged 5-item International Index of Erectile Function (IIEF-5).

© 2019 American Society of Andrology and European Academy of Andrology.

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• Parkinson's Disease Risk and Hyperhomocysteinemia: The Possible Link. Al-Kuraishy HM, Al-Gareeb AI, Elewa YHA, Zahran MH, Alexiou A, Papadakis M, Batiha GE. Al-Kuraishy HM, et al. Cell Mol Neurobiol. 2023 Aug;43(6):2743-2759. doi: 10.1007/s10571-023-01350-8. Epub 2023 Apr 19. Cell Mol Neurobiol. 2023. PMID: 37074484 Free PMC article. Review.
• Effects of Growth Hormone on Adult Human Gonads: Action on Reproduction and Sexual Function. Zhou XY, Ma JN, Shen YY, Xie XR, Ren W. Zhou XY, et al. Int J Endocrinol. 2023 Apr 7;2023:7492696. doi: 10.1155/2023/7492696. eCollection 2023. Int J Endocrinol. 2023. PMID: 37064267 Free PMC article. Review.
• Association between erectile dysfunction and Helicobacter pylori , folic acid, vitamin B12, and homocysteine: a cross-sectional study. Xu J, Xu Z, Pan H, Zhou Z. Xu J, et al. Sex Med. 2023 Mar 1;11(2):qfac018. doi: 10.1093/sexmed/qfac018. eCollection 2023 Apr. Sex Med. 2023. PMID: 36910702 Free PMC article.
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• Al-Hunayan A, Thalib L, Kehinde EO, Asfar S. (2008) Hyperhomocysteinemia is a risk factor for erectile dysfunction in men with adult-onset diabetes mellitus. Urology 71, 897-900.
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Factors associated with family function in school children: Case-control study

Alejandro botero-carvajal.

a Universidad Santiago de Cali, Cali, Colombia

Ángela María Jiménez Urrego

b Universidad de San Buenaventura seccional Cali, Cali, Colombia

Ana G. Gutierrez-Posso

c Master in Mental Health of Children and Adolescents, Professor at the Pontificia Universidad Javeriana Cali, Colombia

Mario Calero-Flórez

d Fundación Universitaria San Martin Cali, Cali; Colombia

Mauricio Hernandez-Carrillo

e Universidad del Valle, Universidad Libre, Escuela Nacional del Deporte, Cali, Colombia

Associated Data

Family functionality is that which promotes the integral development of its members, as well as a favorable state of health in them; fulfilling the basic parameters of adaptation, participation, growth, affection, and resources. Family dysfunction is understood as the failure to comply with any of these functions due to an alteration in one or more of the subsystems.

There is little research on variables related to family functioning with a case-control design, for this reason, we present the family functioning of school students, identify variables found to be related to family functioning, and describe a model of variables related to family dysfunction.

Materials and methods

Analytical study of cases and controls. The sample was made up of 290 students. The APGAR scale was used to identify family dysfunction. The statistical processing was done in Epi-Info 7.0 and STATA 14.

The variables that were considered were

Municipality, area, age, sex, school grade, mother's age, disability, and displacement.

The factors associated with adequate family function were: displacement, (OR = 0.17, CI: 0.03–0.99). You are followed, your parents pay attention and listen to you (OR = 0.25, CI: 0.08–0.74), you talk to your mother every day (OR = 0.35 CI: 0.16–0.74), you spend free time with your parents (OR = 0.41, CI: 0.20–0.86), play sports at least once a week (OR = 0.42, CI = 0.20–0.91), and finally, attend religious services (OR = 0.51, CI: 0.29–0.90). While the factors associated with family dysfunction were: your parents punish you by forbidding you things (OR = 2.98, CI: 1.32–6.71) and you have friends close to where you live followed by an (OR = 2.60, CI: 1.13–5.96).

Conclusions

Dysfunctionality was evident in the four municipalities of the Valley. Among the main factors associated with dysfunctionality was punishment by parents for forbidding things and having friends near the schoolchild's home.

1. Introduction

The emphasis on the family can be traced back to social system theoretical models [ 1 ], in the growing interest in understanding how family members exhibit behaviors and interactions with each other [ 2 ]. Interactions are understood within a system, in which the family adjusts to the subsystems in which it interacts, adapting to the social rules of the time [ 3 ].

The family theory is assumed as a system, in which the interaction between family members defines patterns of health and illness among members. For this reason, identifying which factors affect family functioning is key because family functioning reflects the social structure of the family environment, related to levels of cohesion, support, conflict, organization, and quality of communication. A functional family is one where the family environment allows for clear communication, affective regulation, defined roles, and cohesion. On the contrary, family dysfunction is a family environment characterized by the absence of defined roles, a high level of conflict, and poor regulation of behavior and emotions [ 4 , 5 ].

2. Family functioning and APGAR

This set of elements related to decision making and family support among family members is known as family functioning. Family functioning is established according to the degree of compliance with the basic parameters of family functioning (APGAR): Adaptation, Participation, Gain or Growth, Affection, and Resources [ 6 , 17 ].

The instrument investigates the perception of each component of the family function on a Likert-type scale. The adaptation describes the use of internal and external family resources to solve problems affecting family balance. Participation refers to the sharing of responsibilities and how shared decisions are made. Likewise, gain or growth is the reciprocal support that helps family members to self-actualization, and emotional and physical maturity. On the other hand, affection expresses the relationships of love and care within the family. Finally, resources describe the decisions to share physical space, health, time, and other resources with family members [ 7 ].

From an evaluative perspective of the family function [ 4 ], how family members perceive their functioning is addressed in recent studies with the family APGAR, due to its psychometric properties and sensitivity in the screening of family members [ [8] , [9] , [10] , [11] ].

Family functioning is related to health status [ 12 ] where the family influences the health process of its members, according to the decisions made within the family group about the beliefs transmitted and the type of help provided [ 13 , 14 , 25 , 56 ].

3. Family dysfunction has been linked to mental health issues

Previous studies point to the relationship between family dysfunction and mental health [ [15] , [16] , [17] ]. Subjects with a history of family dysfunction are more vulnerable to sexual abuse and neglect [ 18 , 19 ]; relationships between family dysfunction and emotional intelligence [ 20 ]; academic achievement [ 21 ]; effectiveness of family functionality [ 22 ]; usefulness of family APGAR in identifying family function [ 7 , 23 ].

However, although the relationship between family function and health has been widely documented, there is insufficient evidence as to what factors are associated with its functioning. For this reason, we present the factors associated with family function and family dysfunction in four municipalities of Valle del Cauca.

In conclusion, spending free time with the parents, talking every day with the mother, attention and listening on the part of the parents, attending a religious service, and playing sports at least once a week are factors associated with family functioning. While prohibitive punishments by parents, and having friends close to where you live, are factors associated with family dysfunction.

4. Materials and methods

This was an analytical case-control study. A secondary source used in a previous study was used [ 24 ].

5. Participants

The study population came from the secondary database provided by the Departmental Health Secretariat, which is made up of school children enrolled in grades 6 to 11, who attended official educational institutions in the municipalities of Candelaria, Florida, Jamundí, and Pradera. Valle del Cauca, Colombia.

6. Instruments

In the case study, a questionnaire was applied that contained questions about the family relationship and the social environment of the schoolchild. The APGAR scale was used to identify family dysfunctions. Cronbach's alpha for the family APGAR was 0.90 in Colombia, suggesting that it represents unidimensional construct validity: family function [ 25 ].

The items of the scale are scored as never, rarely, sometimes, almost always, and always. Total scores range from 0 to 20; the higher the score, the better the family functionality [ 26 ].

The family relationship was measured using dichotomous questions, about living with their parents, free time shared with them, and talking with them daily; in addition, the physical and verbal punishment that was administered in the upbringing of the schoolchild was investigated.

The variables that were taken into account were: Municipality, area, age, sex, school grade, mother's age, disability, and displacement. The social environment was measured using questions about their immediate environment in terms of place of residence.

There was no bias in the identification of the exposure since the items measured were provided in the same way and confidentiality was guaranteed at the time of completion. As for the measurement of the result (family dysfunction), there was the disadvantage of lack of sample to determine a cut-off point to avoid bias of bad classification, given the continuity of the score in the identification of bullied schoolchild and non-bullied schoolchild according to the CISNEROS self-test GI.

6.1. Procedure

The family APGAR is a test carried out in the form of a questionnaire and consists of 5 questions. The participant must select the degree to which he or she perceives to be within his or her family unit. The score ranges, for each of the 5 items, between 0 and 4 points, following a classification of five options that varies from "never" to "always", so that the minimum possible score would be 0 and the maximum 20:

Normal family function: 17–20 points.

Mild dysfunction: 16–13 points.

Moderate dysfunction: 12–10 points.

Severe dysfunction: 9 points or less.

Considering the evaluation of the APGAR Family, we defined as cases (students with family dysfunction) those school children who presented scores less than or equal to 16, and controls (students without family dysfunction) with scores greater than 16 points. The distribution of the sample is presented in Table 1 .

Distribution of the sample, by the municipality of the school children enrolled in grades 6 to 11 in four municipalities in Valle del Cauca, Colombia. The year 2009.

A 1:1 analysis was conducted, paired by the municipality. This study was carried out from an analytical approach of paired cases and controls, the raw and adjusted Odds Ratio (OR) were calculated (using conditioned logistic regression).

A descriptive exploratory analysis was carried out to evaluate the behavior of the variables and to identify possible extreme values, which were not presented in the present analysis; therefore, the behavior of these variables was within the expected values according to the literature. To evaluate the different exposures from the sociodemographic and social fields, a bivariate analysis was carried out using statistical tests (with probability values lower than 0.05) and by calculating raw OR to describe the relationship of the dependent variable (IE) with the exposure variables.

To determine which variables were included in the logistic conditioned regression model, a statistical criterion was taken into account, and the variables that presented statistical significance were included with p ≤ 0.2. The 0.2 criteria are used for the input of variables in the modeling process, following the procedure described in previous studies (Aguayo-Albasini et al., 2014; [ 24 ].

The aim was to obtain a parsimonious model that had an adequate classification of family dysfunction and that also presented statistical significance in the epidemiological association of its variables.

Several models were made with the variables that presented statistical significance in the bivariate analysis of family dysfunctionality in school children. Each new model was compared with the immediately previous one using the log-likelihood test, the Pseudo R2, the Akaike's Information Criterion (AIC), and the Bayesian Information Criterion (BIC), to determine the model's fit according to the variables included. The most parsimonious model was selected, with the best fit and with the epidemiological association in most of its explanatory variables.

Opportunity reasons (OR) with IC95% were determined, to establish the association between the variables contained in the database and the presence of family dysfunction. The data were processed in the statistical package R version 3.5.0.

6.2. Ethical considerations

We had the authorization of the Departmental Public Health Secretariat of Valle del Cauca for the use of the database. The research was considered safe according to resolution No. 008430 of 1993. And informed consent was obtained from all participants. At no time was the identity of the participants known, nor was any information available that would allow the schoolchild who filled out the questionnaire to be recognized. The research was approved by the Ethics Committee of the Universidad San Martín, Cali.

The participants in the study were students assigned to the Departmental Health Secretariat; they were 1141 students enrolled in grades 6 to 11, between the ages of 10 and 18, attending official educational institutions in the municipalities of Candelaria, Florida, Jamundí, and Pradera, in Valle del Cauca, a region located in the southwest of Colombia. A questionnaire containing questions on sociodemographic information, family relationship, and the social environment of the schoolchild was applied.

In the bivariate analysis, the variables were compared according to cases and controls, and no statistically significant differences were found in the variables: sex, grade, stratum, disability, displacement, and age in both sexes. While for the variable's area of residence and bullying differences were obtained, which indicates that for these two variables there was different participation in these groups for these two variables ( Table 2 ).

Bivariate analysis. School children enrolled in grades 6 to 11 in four municipalities in Valle del Cauca, Colombia. The year 2009.

The final model was constituted by 12 independent variables of which 8 presented statistical significance, 6 were related to a good family function and 2 to family dysfunction, and the other 4 presented no association ( Fig. 1 ).

Risk model for family dysfunction.

The factors associated with good family function were: displacement, (OR = 0.17, CI: 0.03–0.99). You are followed, your parents pay attention and listen to you (OR = 0.25, CI: 0.08–0.74), you talk to your mother every day (OR = 0.35 CI: 0.16–0.74), you spend free time with your parents (OR = 0.41, CI: 0.20–0.86), play sports at least once a week (OR = 0.42, CI = 0.20–0.91), and finally, attend religious services (OR = 0.51, CI: 0.29–0.90). While the factors associated with family dysfunction were: your parents punish you by forbidding you things (OR = 2.98, CI: 1.32–6.71) and you have friends near where you live followed by an (OR = 2.60, CI: 1.13–5.96) ( Table 3 ).

Multivariate analysis using conditional logistic regression Factors associated with family dysfunction in school children enrolled in grades 6 to 11 in four municipalities in Valle del Cauca, Colombia Year 2009.

* p-value <0.05.

8. Discussion

Family characteristics are shown to be the most significant in predicting mental health problems [ 27 ]. The importance of research lies in pointing out the protective and risk factors for family dysfunction. Among the protective factors for family dysfunction, forced displacement is surprising as a finding, given that it has been linked to adverse effects on populations: increase in delinquency [ 28 ]; rupture of social and labor ties, stress, and psychophysical and identity vulnerability [ 29 ]. However, the research points to forced displacement as a means of protecting families from family dysfunction, which is consistent with previous research that indicates that, in the face of critical situations associated with displacement, families express support and affection among their members [ 30 ].

In addition, the findings of the research indicate the behaviors to be promoted in the family, that is, the dimensions of Adaptation, Participation, Gain, Affection, and Resources, contemplated in the family APGAR can be oriented towards participation in public policies that, in terms of the use of free time, sports practices, and the promotion of good treatment within the family, are available in the municipalities and departments. Given in addition to travel, sharing free time with the school and the parents; talking daily with the mother; attention to the parents and listening to the children; doing some sport at least once a week, and attending a religious service, are protective factors for family dysfunction. In that order of ideas, the protective factors found for family functionality become developmental objectives for national, regional, and local development plans.

It should be noted that sharing free time with parents is a protective factor. Previous research indicates benefits for the psychological development of children when parents share time with them, improving the family climate, increasing emotional ties, and increasing confidence and self-esteem [ 31 ], which suggests that schoolchildren who spend free time with their parents increase the spaces for family interaction and favor the practice of each dimension together with the monitoring of the schoolchildren's free time. This finding also implies that parental company, i.e., decreasing the time the schoolchild is alone, protects them against health problems, such as tobacco use [ 32 ] and loss of sleep [ 33 ].

Talking to the mother every day is an element that favors communication within the family, besides favoring family functioning, she warns that better communication prevents adverse consequences for mental health [ 34 ].

This is related to our finding on paying attention and listening on the part of parents, because, as has been insisted so far, the dimensions of family functioning are crossed by the perception that the member has on whether he is listened to, supported, by his family. Thus, recommending paying attention and listening to children favors family functioning, similar to recent studies by Ref. [ 35 ].

Likewise, religious service favors family functioning, we believe for two main reasons, the first emphasizing family functioning for the functioning of the individual and the second on the characteristics of the individual, on moral aspects of his or her behavior within the family group. These reasons are reported in some studies that relate religious aspects with parental practice [ 36 , 37 ].

Although the study found that playing sports at least once a week is a factor associated with family functionality, the literature indicates that there is no association with family dysfunction in playing or not playing sports, but it does indicate that the influence of parents is decisive in the practice of sports by their children [ 38 ].

However, we think that the finding is related to the use of free timestamp [ 39 ], together with the fact that sports practice emulates the relational structure of society, especially in collective sports. Similarly, there is evidence that the practice of sports contributes to the improvement of mental health, in this framework better states of mental health allow a better relationship with others and with oneself [ [39] , [40] , [41] , [42] ].

Among the factors associated with family dysfunction, punishment through prohibition was shown to be a risk factor, as was having friends near one's place of residence, which coincides with previous studies [ 6 , [43] , [44] , [45] , [46] , [47] ].

Physical punishment shows a negative relationship with family functioning, explained in its negative results for mental health, which intervenes in the recognition of oneself and others, a necessary aspect in social cognition for the maintenance of healthy interpersonal relationships camp [ 48 , 49 ]; physical punishment is frequent in the rural Colombian population, similar to the population included in the study camp [ 50 ].

Although friends near the place of residence in the study are a risk factor associated with family dysfunction, the literature is consistent in pointing out that it is characteristic of dysfunctional families that their children present negative characteristics related to the degree of emotional maturity, mental health disorders, difficulty in building healthy relationships with peers, SPA addiction, conflict with authority, school difficulties, and communication difficulties [ 51 ].

We believe that this is related to the time of interaction of the minor with the family, in which during adolescence the child seeks to belong to a reference group, which in most cases is outside the family. This finding is similar to that found in other studies that suggest that communication and family dynamics change throughout the course of life and the development process of the member's [ 52 ], as well as the current social identity, which explains new readings on the processes of socialization and belonging to the group, which include the dynamics of social networks, which surpasses the concept of having friends close to the physical place to have friends from anywhere in the world [ 53 ].

9. Recommendations and limitations of the study

The literature refers that family support is related to mental health [ 54 ], therefore, family intervention programs can be oriented towards promoting the variables found in the study as significant for family functionality.

It is significant to note that aspects such as the educational level of the mother, the communication of feelings of anger or sadness, and the degree of behavioral regulation affect the child-rearing practices of women who are victims of forced displacement and that for future research these are important variables to include, given that the higher the educational level of the mothers, the greater the assertiveness in child-rearing practices, the greater the manifestation of feelings of anger or sadness, the less communication between mother and child and the greater the regulation of the children's behavior by mothers who have suffered forced displacement [ 30 ].

Social support, a topic not explored in the research, is related to family functionality [ 55 ] and should be included in future studies. As well as the modulating role that social networks can have as a mechanism of contemporary social interaction.

Funding sources

This research has been funded by Dirección General de Investigaciones of Universidad Santiago de Cali under call No. 01-2022.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.heliyon.2023.e14595 .

Appendix A. Supplementary data

The following is the Supplementary data to this article:

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• Inpatient case characteristics of SGLT2 inhibitor-associated diabetic ketoacidosis: a retrospective study
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• http://orcid.org/0009-0008-4991-7190 Zhongpei Yang 1 ,
• Weixia Zhang 2 ,
• Hefeng Chen 2 ,
• Qianwen Peng 2
• 1 Department of Pharmacy , The People's Hospital of QianNan , Duyun , China
• 2 Department of Pharmacy , Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital , Shanghai , China
• Correspondence to Dr Weixia Zhang, Department of Pharmacy, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China; wxzhang2001{at}163.com

Objectives Diabetic ketoacidosis (DKA) is a serious complication in patients treated with sodium-glucose co-transporter 2 inhibitors (SGLT2i). The aim of this study was to investigate the relationship between SGLT2i and the risk of DKA, and to identify high-risk groups and characteristics that should be emphasised.

Methods A retrospective case series study was conducted to collect medical records of inpatients diagnosed with DKA and using SGLT2i before the onset of the disease from September 2022 to September 2023 in a tertiary hospital in Shanghai. Cases that met the inclusion criteria were retrieved through the electronic medical record system. Information was collected to compare the risk of DKA in patients with different characteristics.

Results A total of 21 patients (12 men and 9 women) met the criteria for SGLT2i-associated DKA. The mean diabetes duration was 10.4 years, with 47.6% (10/21) of patients diagnosed with euglycaemic DKA. The drug treatment regimen most commonly used was the combination of SGLT2i and metformin, representing 52.4% (11/21) of cases. The most common clinical symptoms were nausea, vomiting, abdominal pain and malaise. Common predisposing factors were acute infections, acute pancreatitis (predominantly hyperlipidaemic type), dietary inappropriateness, acute cardiovascular and cerebrovascular events and surgery. 71.4% of patients (15/21) had multiple risk factors.

Conclusion The use of SGLT2i in diabetic patients is associated with an increased risk of DKA, particularly in the presence of predisposing factors such as infection. Furthermore, long diabetes duration, decreased pancreatic β-cell function and the combined use of metformin may also contribute to the risk of DKA in patients treated with SGLT2i. The findings of this study provide valuable insights for better identification and management of DKA risks associated with SGLT2i in clinical practice.

• Diabetes Mellitus
• DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS
• HEALTH SERVICES ADMINISTRATION
• Pharmacovigilance
• Substance-Related Disorders

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/ejhpharm-2024-004124

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The state of AI in early 2024: Gen AI adoption spikes and starts to generate value

If 2023 was the year the world discovered generative AI (gen AI) , 2024 is the year organizations truly began using—and deriving business value from—this new technology. In the latest McKinsey Global Survey  on AI, 65 percent of respondents report that their organizations are regularly using gen AI, nearly double the percentage from our previous survey just ten months ago. Respondents’ expectations for gen AI’s impact remain as high as they were last year , with three-quarters predicting that gen AI will lead to significant or disruptive change in their industries in the years ahead.

About the authors

This article is a collaborative effort by Alex Singla , Alexander Sukharevsky , Lareina Yee , and Michael Chui , with Bryce Hall , representing views from QuantumBlack, AI by McKinsey, and McKinsey Digital.

Organizations are already seeing material benefits from gen AI use, reporting both cost decreases and revenue jumps in the business units deploying the technology. The survey also provides insights into the kinds of risks presented by gen AI—most notably, inaccuracy—as well as the emerging practices of top performers to mitigate those challenges and capture value.

AI adoption surges

Interest in generative AI has also brightened the spotlight on a broader set of AI capabilities. For the past six years, AI adoption by respondents’ organizations has hovered at about 50 percent. This year, the survey finds that adoption has jumped to 72 percent (Exhibit 1). And the interest is truly global in scope. Our 2023 survey found that AI adoption did not reach 66 percent in any region; however, this year more than two-thirds of respondents in nearly every region say their organizations are using AI. 1 Organizations based in Central and South America are the exception, with 58 percent of respondents working for organizations based in Central and South America reporting AI adoption. Looking by industry, the biggest increase in adoption can be found in professional services. 2 Includes respondents working for organizations focused on human resources, legal services, management consulting, market research, R&D, tax preparation, and training.

Also, responses suggest that companies are now using AI in more parts of the business. Half of respondents say their organizations have adopted AI in two or more business functions, up from less than a third of respondents in 2023 (Exhibit 2).

Gen AI adoption is most common in the functions where it can create the most value

Most respondents now report that their organizations—and they as individuals—are using gen AI. Sixty-five percent of respondents say their organizations are regularly using gen AI in at least one business function, up from one-third last year. The average organization using gen AI is doing so in two functions, most often in marketing and sales and in product and service development—two functions in which previous research  determined that gen AI adoption could generate the most value 3 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023. —as well as in IT (Exhibit 3). The biggest increase from 2023 is found in marketing and sales, where reported adoption has more than doubled. Yet across functions, only two use cases, both within marketing and sales, are reported by 15 percent or more of respondents.

Gen AI also is weaving its way into respondents’ personal lives. Compared with 2023, respondents are much more likely to be using gen AI at work and even more likely to be using gen AI both at work and in their personal lives (Exhibit 4). The survey finds upticks in gen AI use across all regions, with the largest increases in Asia–Pacific and Greater China. Respondents at the highest seniority levels, meanwhile, show larger jumps in the use of gen Al tools for work and outside of work compared with their midlevel-management peers. Looking at specific industries, respondents working in energy and materials and in professional services report the largest increase in gen AI use.

Investments in gen AI and analytical AI are beginning to create value

The latest survey also shows how different industries are budgeting for gen AI. Responses suggest that, in many industries, organizations are about equally as likely to be investing more than 5 percent of their digital budgets in gen AI as they are in nongenerative, analytical-AI solutions (Exhibit 5). Yet in most industries, larger shares of respondents report that their organizations spend more than 20 percent on analytical AI than on gen AI. Looking ahead, most respondents—67 percent—expect their organizations to invest more in AI over the next three years.

Where are those investments paying off? For the first time, our latest survey explored the value created by gen AI use by business function. The function in which the largest share of respondents report seeing cost decreases is human resources. Respondents most commonly report meaningful revenue increases (of more than 5 percent) in supply chain and inventory management (Exhibit 6). For analytical AI, respondents most often report seeing cost benefits in service operations—in line with what we found last year —as well as meaningful revenue increases from AI use in marketing and sales.

Inaccuracy: The most recognized and experienced risk of gen AI use

As businesses begin to see the benefits of gen AI, they’re also recognizing the diverse risks associated with the technology. These can range from data management risks such as data privacy, bias, or intellectual property (IP) infringement to model management risks, which tend to focus on inaccurate output or lack of explainability. A third big risk category is security and incorrect use.

Respondents to the latest survey are more likely than they were last year to say their organizations consider inaccuracy and IP infringement to be relevant to their use of gen AI, and about half continue to view cybersecurity as a risk (Exhibit 7).

Conversely, respondents are less likely than they were last year to say their organizations consider workforce and labor displacement to be relevant risks and are not increasing efforts to mitigate them.

In fact, inaccuracy— which can affect use cases across the gen AI value chain , ranging from customer journeys and summarization to coding and creative content—is the only risk that respondents are significantly more likely than last year to say their organizations are actively working to mitigate.

Some organizations have already experienced negative consequences from the use of gen AI, with 44 percent of respondents saying their organizations have experienced at least one consequence (Exhibit 8). Respondents most often report inaccuracy as a risk that has affected their organizations, followed by cybersecurity and explainability.

Our previous research has found that there are several elements of governance that can help in scaling gen AI use responsibly, yet few respondents report having these risk-related practices in place. 4 “ Implementing generative AI with speed and safety ,” McKinsey Quarterly , March 13, 2024. For example, just 18 percent say their organizations have an enterprise-wide council or board with the authority to make decisions involving responsible AI governance, and only one-third say gen AI risk awareness and risk mitigation controls are required skill sets for technical talent.

Bringing gen AI capabilities to bear

The latest survey also sought to understand how, and how quickly, organizations are deploying these new gen AI tools. We have found three archetypes for implementing gen AI solutions : takers use off-the-shelf, publicly available solutions; shapers customize those tools with proprietary data and systems; and makers develop their own foundation models from scratch. 5 “ Technology’s generational moment with generative AI: A CIO and CTO guide ,” McKinsey, July 11, 2023. Across most industries, the survey results suggest that organizations are finding off-the-shelf offerings applicable to their business needs—though many are pursuing opportunities to customize models or even develop their own (Exhibit 9). About half of reported gen AI uses within respondents’ business functions are utilizing off-the-shelf, publicly available models or tools, with little or no customization. Respondents in energy and materials, technology, and media and telecommunications are more likely to report significant customization or tuning of publicly available models or developing their own proprietary models to address specific business needs.

Respondents most often report that their organizations required one to four months from the start of a project to put gen AI into production, though the time it takes varies by business function (Exhibit 10). It also depends upon the approach for acquiring those capabilities. Not surprisingly, reported uses of highly customized or proprietary models are 1.5 times more likely than off-the-shelf, publicly available models to take five months or more to implement.

Gen AI high performers are excelling despite facing challenges

Gen AI is a new technology, and organizations are still early in the journey of pursuing its opportunities and scaling it across functions. So it’s little surprise that only a small subset of respondents (46 out of 876) report that a meaningful share of their organizations’ EBIT can be attributed to their deployment of gen AI. Still, these gen AI leaders are worth examining closely. These, after all, are the early movers, who already attribute more than 10 percent of their organizations’ EBIT to their use of gen AI. Forty-two percent of these high performers say more than 20 percent of their EBIT is attributable to their use of nongenerative, analytical AI, and they span industries and regions—though most are at organizations with less than $1 billion in annual revenue. The AI-related practices at these organizations can offer guidance to those looking to create value from gen AI adoption at their own organizations.

To start, gen AI high performers are using gen AI in more business functions—an average of three functions, while others average two. They, like other organizations, are most likely to use gen AI in marketing and sales and product or service development, but they’re much more likely than others to use gen AI solutions in risk, legal, and compliance; in strategy and corporate finance; and in supply chain and inventory management. They’re more than three times as likely as others to be using gen AI in activities ranging from processing of accounting documents and risk assessment to R&D testing and pricing and promotions. While, overall, about half of reported gen AI applications within business functions are utilizing publicly available models or tools, gen AI high performers are less likely to use those off-the-shelf options than to either implement significantly customized versions of those tools or to develop their own proprietary foundation models.

What else are these high performers doing differently? For one thing, they are paying more attention to gen-AI-related risks. Perhaps because they are further along on their journeys, they are more likely than others to say their organizations have experienced every negative consequence from gen AI we asked about, from cybersecurity and personal privacy to explainability and IP infringement. Given that, they are more likely than others to report that their organizations consider those risks, as well as regulatory compliance, environmental impacts, and political stability, to be relevant to their gen AI use, and they say they take steps to mitigate more risks than others do.

Gen AI high performers are also much more likely to say their organizations follow a set of risk-related best practices (Exhibit 11). For example, they are nearly twice as likely as others to involve the legal function and embed risk reviews early on in the development of gen AI solutions—that is, to “ shift left .” They’re also much more likely than others to employ a wide range of other best practices, from strategy-related practices to those related to scaling.

In addition to experiencing the risks of gen AI adoption, high performers have encountered other challenges that can serve as warnings to others (Exhibit 12). Seventy percent say they have experienced difficulties with data, including defining processes for data governance, developing the ability to quickly integrate data into AI models, and an insufficient amount of training data, highlighting the essential role that data play in capturing value. High performers are also more likely than others to report experiencing challenges with their operating models, such as implementing agile ways of working and effective sprint performance management.

About the research

The online survey was in the field from February 22 to March 5, 2024, and garnered responses from 1,363 participants representing the full range of regions, industries, company sizes, functional specialties, and tenures. Of those respondents, 981 said their organizations had adopted AI in at least one business function, and 878 said their organizations were regularly using gen AI in at least one function. To adjust for differences in response rates, the data are weighted by the contribution of each respondent’s nation to global GDP.

Alex Singla and Alexander Sukharevsky  are global coleaders of QuantumBlack, AI by McKinsey, and senior partners in McKinsey’s Chicago and London offices, respectively; Lareina Yee  is a senior partner in the Bay Area office, where Michael Chui , a McKinsey Global Institute partner, is a partner; and Bryce Hall  is an associate partner in the Washington, DC, office.

They wish to thank Kaitlin Noe, Larry Kanter, Mallika Jhamb, and Shinjini Srivastava for their contributions to this work.

This article was edited by Heather Hanselman, a senior editor in McKinsey’s Atlanta office.

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A generative AI reset: Rewiring to turn potential into value in 2024

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Question 1:

The Government of India is planning to fix a hoarding board at the face of a building on the road of a busy market for awareness on COVID-19 protocol. Ram, Robert and Rahim are the three engineers who are working on this project. ‘A’ is considered to be a person viewing the hoarding board 20 metres away from the building, standing at the edge of a pathway nearby, Ram Robert and Rahim suggested to the film to place the hoarding board at three different locations namely C, D and E. ‘C’ is at the height of 10 metres from the ground level. For the viewer ‘A’, the angle of elevation of ‘D’ is double the angle of elevation of ‘C’. The angle of elevation of ‘E’ is triple the angle of elevation of ‘C’ for the same viewer.

Look at the figure given and based on the above information answer the following:

(i) Measure of ∠CAB = (a) tan –1 (2) (b) tan –1 (1/2) (c) tan– 1 (1) (d) tan –1 (3)

(ii) Measure of ∠DAB = (a) tan –1 (3/4) (b) tan –1 (3) (c) tan –1 (4/3) (d) tan –1 (4)

(iii) Measure of ∠EAB (a) tan –1 (11) (b) tan –1 (3) (c) tan –1 (2/11) (d) tan –1 (11/2)

(iv) A’ is another viewer standing on the same line of observation across the road. If the width of the road is 5 meters, then the difference between ∠CAB and ∠CA’B is (a) tan –1 (1/12) (b) tan –1 (1/8) (c) tan –1 (2/5) (d) tan –1 (11/21)

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Case Study Questions Class 8 Science Cell – Structure and Functions

Case study questions class 8 science chapter 8 cell – structure and functions.

CBSE Class 8 Case Study Questions Science Cell – Structure and Functions. Important Case Study Questions for Class 8 Board Exam Students. Here we have arranged some Important Case Base Questions for students who are searching for Paragraph Based Questions Cell – Structure and Functions.

CBSE Case Study Questions Class 8 Science Cell – Structure and Functions

Case study 1.

Que. 1) Which among the following scientists coined the term “cell” for the very first time?

(b) Robert Brown

Que. 2) (a) Stains

Que. 3) (b) Neuron

Case study 2

Que. 1) The jelly like substance between the nucleus and the cell membrane is called the ………………………………………………………………………………………… .

(c) Mitochondria

Case study 3

Que. 1) The porous membrane present between the nucleus and the cytoplasm is called?

(d) Golgi body

Que. 4) Define the term “gene”.

Que. 4) Answer: Gene is a unit of inheritance in a living organism. It controls the transfer of hereditary characteristics from parents to offspring.

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Function of Beauty uses Pitney Bowes Designed Delivery solutions to meet customer delivery expectations

Unique Challenge

Our Designed Solution

Why Designed Works

Function of Beauty is the world leader in customizable beauty, with hair, skin, and body care products made for you (and only you).

"When we started experiencing exponential growth, we knew we needed a delivery solution that would match our values–putting the needs of our customers first –while supporting our continued growth.”

More About the Challenge

When Function of Beauty , an innovative, digitally native beauty brand, started experiencing exponential growth, the demand for its made-to-order beauty products created a backlog that slowed delivery. Initially, an expedited-only delivery solution helped clear the backlog and drove customer satisfaction—resulting in a 92% volume increase—but it also created a cost burden for the growing brand. Function of Beauty ’s personalized beauty products are primarily available through a custom subscription catered to each of their customers. To continue to provide this high level of customer experience, the company identified two types of delivery needs: first-time buyers who–after having a unique product designed just for their needs–are eager to get their order quickly, and refill customers whose orders are less time sensitive. Function of Beauty needed a solution that could meet the expectations of their new customers while maintaining a cost-effective approach for predictable refill orders.

Rather than using a one-size-fits-all solution, Pitney Bowes designed a blended, customer-driven delivery solution for Function of Beauty’s unique challenge. Their designed solution balances speed and cost by triggering expedited delivery for new customers and standard delivery for repeat customers. The hybrid solution meets Function of Beauty’s customer expectations—no matter who they are—while also aiding in their goals for new customer acquisition and delivery cost savings. Additionally, the Pitney Bowes BOXtour solution empowers Function of Beauty to know where and how their packages are being handled, giving them the power to make the best decisions and pivot when needed.

"Our company was born from the belief that there is no one size fits all and that each person deserves a product just for them. We appreciate that Pitney Bowes treats us with the same care we treat our customers, consulting with us to meet our unique delivery needs rather than limiting us into a one-size solution.”

Function of Beauty’s highly personalized beauty offerings and varying customer needs called for a flexible delivery solution. Pitney Bowes Designed Delivery approach—from configuring a bespoke delivery solution to collaborating on innovative features—allowed Function to continue to grow with peace of mind that Pitney Bowes will continue to flex and grow with them as a long-term partner. Pitney Bowes and  Function of Beauty  look forward to continuing this strong partnership and collaborating hand-in-hand to ensure that we are evolving to meet their needs, sharing ideas and input on new features that will continue to improve the customer experience and enable growth.

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WordPress functions.php File: The Ultimate Guide + Helpful Code Snippets

Not sure what the WordPress functions.php file is or what you can do with it?

In a nutshell, the WordPress functions.php file gives you a way to add code snippets to your site. You can use these snippets in all kinds of helpful ways, so understanding how the functions.php file works can help you build a better WordPress site.

In our ultimate guide to the WordPress functions.php file, you’re going to learn everything that you need to know about this file.

Once you know all about the functions.php file, we’ll also share 17 helpful functions.php code snippets to help you start customizing your site.

What Does the WordPress functions.php File Do?

The WordPress functions.php file is a theme file that you can use to add custom code snippets to your site. You can use these code snippets to modify how different areas of your site function or add new content/code to your site.

Despite being included in your theme, the WordPress functions.php file is not limited to just making customizations to your theme.

You can make adjustments to any part of your site, similar to how plugins work.

Here are some common types of adjustments that you can make using the WordPress functions.php file:

• Change core WordPress behavior, such as how many posts to show on the search results page or what content to include in your site’s RSS feed.
• Create your own custom shortcodes.
• Add new content or scripts to your site, such as injecting a script from your live chat service on certain pages or editing your site’s footer .

This is just scratching the surface…

Because the functions.php file lets you add custom PHP code snippets to your site rather than static HTML , the sky’s the limit when it comes to the types of modifications that you can make.

Where Is the WordPress functions.php File Located?

The WordPress functions.php file is located in your active theme’s folder, along with other theme files . To find the file, you can connect to your server using FTP or a file manager tool and browse to …/wp-content/themes/[active-theme-name]/functions.php

For example, if you’re using the popular OceanWP theme , the functions.php file would be located at …/wp-content/themes/oceanwp/functions.php

How To Safely Work With the functions.php File

Because working with the WordPress functions.php file involves adding code to your website, it’s important to follow some best practices before you start making any edits.

Even something as simple as a missing comma or apostrophe can trigger errors on your site , such as the WordPress White Screen of Death .

In recent versions of WordPress, WordPress has gotten better at handling these errors in a more graceful way, such as showing the “There has been a critical error on your website” message or checking for PHP errors before saving your changes.

But still – to avoid any issues from happening, we always recommend following these best practices…

Test Your functions.php Code on a Staging Site

Before adding any functions.php code snippets to your live WordPress site, we always recommend testing them on a staging version of your site first. This lets you check for any potential errors and verify that the code snippet is working as intended.

If you host with Kinsta, Kinsta offers an easy 1-click staging tool on all plans, which is one of the benefits of using managed WordPress hosting .

If you’re hosting elsewhere, you can check out our guide on setting up a WordPress staging site .

Back Up Your Site Before Making Changes to functions.php

In addition to testing on a staging site, you’ll also want to back up your live website before adding the code snippet to your live site’s functions.php file.

This is a good best practice to follow when editing any WordPress files .

If anything goes wrong with the code snippet, you can restore to this backup point to instantly get your site working again.

If you host with Kinsta, Kinsta automatically backs up your site every day and you can also manually create a backup at any time. If you host elsewhere, you can read our guide on how to back up a WordPress site .

Always Use a Child Theme If You’re Editing the functions.php File

Because the WordPress functions.php file is located in your WordPress theme’s code , your theme will overwrite the functions.php file when you update your theme .

To avoid having the changes that you made to your theme’s functions.php file overwritten, you should always use a WordPress child theme and add your code snippets to the functions.php file in the child theme .

By using a child theme, you’re still able to update the parent theme when needed, but all of your functions.php customizations will never be overwritten.

To learn more, check out our full guide on how to create a WordPress child theme .

2 functions.php File Alternatives That Might Be Better

While the WordPress functions.php file offers an easy way to add code snippets to your site, there are some functions.php alternatives that offer a better solution in most situations:

• Using a code manager plugin
• Storing code snippets in a custom plugin

These alternatives can have a few advantages over using the functions.php file:

• Not tied to your theme – this means that if you ever change themes, your functions.php customizations will still be there.
• Better organization – these alternatives make it easier to organize your code snippets, which can be helpful if you plan to add a lot of code snippets to your site.
• More control – in the case of a code manager plugin, you get helpful options such as enabling/disabling a snippet using a toggle button, only running snippets on the frontend or backend, and more.

Use a Code Manager Plugin

A code manager plugin is a plugin that gives you a user-friendly interface to add and edit code snippets that would otherwise go in the functions.php file.

One of the most popular options is the free Code Snippets plugin , but you can find other plugins that offer similar functionality.

With Code Snippets, you can add your functions.php code snippets from the WordPress dashboard, complete with options to…

• Add a title and description.
• Organize your snippets using tags.
• Only run the snippet on a certain part of your site.

You can then see all of your snippets in a list and easily enable/disable them as needed.

Because Code Snippets is a plugin, all of your code snippets will still be there even if you change WordPress themes .

Create a Custom Feature Plugin

Another alternative to the WordPress functions.php file is to just create your own custom plugin to house the code snippets.

While this might sound complicated, it’s actually a lot simpler than it might seem.

Here’s how it works:

• Create a folder on your local computer for your plugin.
• Create a single .php file inside that folder and edit it with your favorite text editor.
• Add the code template below to the file.
• Add your functions.php code snippets to the file

Then, you just need to install and activate the plugin on WordPress. Here are 2 ways to do that:

• Connect to your server via FTP/SFTP and upload the custom plugin folder to the wp-content/plugins folder. Then, go to the Plugins list and activate the plugin.
• Use your computer to create a .zip file of the folder. Then, go to Plugins → Add New and upload the .zip file to install it just like any other plugin.

How To Access the WordPress functions.php File: 2 Options

There are different ways that you can access and edit the WordPress functions.php file. Here are 2 of the most versatile methods that will work at any host:

• WordPress in-dashboard theme code editor.
• SFTP and your own code editor.

1. Use the WordPress In-Dashboard Theme Code Editor

By default, WordPress lets you edit all of your theme’s code from your WordPress dashboard, including the functions.php file:

• Open your WordPress dashboard.
• Go to Appearance → Theme File Editor .
• Select the Theme Functions (functions.php) file in the Theme Files list on the right-hand side.
• Add your edits in the code editor.
• Click the Update File button to save your changes.

With that being said, many people like to disable WordPress in-dashboard file editing to improve security . In that case, you can use the next method.

2. Use SFTP + Your Own Code Editor

For another way to edit the WordPress functions.php file, you can connect to your server via FTP/SFTP and edit the file that way.

Here’s how:

• Download an FTP client if you haven’t done so already – we’ll use the free FileZilla client for the screenshots.
• Connect to your server using your FTP credentials – here’s how to use SFTP to connect .
• Use the folder structure to navigate to …/wp-content/themes/[your-active-child-theme]
• Right-click on the functions.php file and select Edit .

This should download the file to your local computer and automatically open it in a text editor. You can now add your code snippets to the file.

When you’re finished, save your changes and close the file.

FileZilla should then show a prompt to re-upload the edited version to your server.

Top Useful Functions to Add to Your WordPress functions.php File

Now that you know how to edit the WordPress functions.php file, let’s go over some of the most useful functions.php code snippets that you can add to your site.

Show Last Modified Date on Blog Posts

By default, most themes show the date that you published a blog post. However, if you’re regularly updating and refreshing old content, you might want to also show the last modified date (or replace the publish date with the last modified date).

Not only does this let your human visitors know that you’re still updating the content, but it also shows Google that your content is fresh.

For more details, check out our full post showing the last modified date on WordPress .

Disable the WordPress Toolbar for Certain Users

By default, WordPress shows the WordPress toolbar for all logged-in users using the built-in WordPress user roles . This isn’t necessarily the case for custom roles, such as the Customer user role for WooCommerce stores .

If you want to change this, you can use a functions.php code snippet to hide the WordPress toolbar for certain user roles.

This example would hide the admin toolbar for users with the author user role.

Delay Posts from Appearing In RSS Feed

By default, content appears in your RSS feed as soon as you publish it. This can give content scrapers a chance to scrape your content and index it in Google before Google even indexes your original post.

To avoid having someone else get the credit for your content, you can delay posts from appearing in your RSS feed.

While this won’t completely stop content scrapers, it does mean that you can give Google time to index your content first.

Here’s the code snippet – you can change the number – “30” in this example – to the number of minutes you want the delay to be:

Exclude Certain Categories From RSS Feed

In addition to delaying content from appearing in the RSS feed, you also might have situations where you want to exclude entire categories of blog posts from appearing in your site’s RSS feed.

To achieve this, you can use the following functions.php code snippet:

Make sure to replace the example category ID – “38” – with the actual category IDs that you want to exclude (and don’t remove the minus sign)

Here’s how to find the ID number:

• Go to Posts → Categories to see a list of all the categories on your site.
• Click Edit under the category that you want to exclude.
• Look at the URL of the edit page in your browser address bar. The category ID is the number that comes after ?taxonomy=category&tag_ID=X .

For example, if the URL is https://yoursite.com/wp-admin/term.php?taxonomy=category&tag_ID=38&post_type=post , then the category ID is 38 .

Limit WordPress Revisions by Post Type

To avoid bloating your site’s database, you might want to limit how many post revisions to save.

While one way to limit WordPress post revisions sitewide is to edit your site’s wp-config.php file , you might want to store different numbers of revisions for different post types – e.g. blog posts versus WooCommerce products.

This functions.php code snippet lets you do just that. To make it your own, change the post type – “post” in this example – to the actual post type that you want to control and the number – “5” in this example – to the number of revisions that you want to store.

* Note – you’re editing the “post” that comes immediately after the “if” statement. For example, to target products, that line would look like this:

Disable the WordPress Search Function

If your site doesn’t need search functionality, you might want to disable the WordPress search function to prevent potential abuse.

For example, even if you don’t show a search box on your site, bots can still use the search function by adding ?s=[search-term] to your URL.

To do this, you can add the following code snippet:

If someone tries to use the search function directly, your site will return a 404 page instead.

Create Your Own Custom Shortcodes (E.g. Current Year)

WordPress shortcodes are really handy shortcuts that let you embed dynamic content in your site.

While many WordPress plugins rely on shortcodes to help power their functionality, you can also create your own custom shortcodes using the WordPress functions.php file and the add_shortcode() function .

For example, one common use case is to create a shortcode that displays the current year. This lets you automatically show the current year in all your content without needing to manually update everything every January 1st.

To create such a shortcode, you can use the following code:

Then, when you add the [currentyear] shortcode to your content, it will automatically be replaced with the actual year – e.g. 2023.

Allow Shortcodes in Post Titles

By default, WordPress won’t execute any shortcodes that you place in your post’s title field. If you want to use shortcodes in WordPress post titles, you can enable this functionality by adding a simple code snippet to the WordPress functions.php file.

For example, when combined with the previous code snippet, this would let you automatically include the current year in the post title by adding the [currentyear] shortcode.

Hide Login Errors to Improve Security

By default, WordPress will show an explainer message on failed login attempts. This message can give away some information, such as whether or not a certain email address is registered on your site (even if the password is incorrect).

To avoid leaking any potentially sensitive information, you can hide these login errors by adding the following code snippet to your functions.php file.

This snippet replaces the default login error text with the following message – These are not valid credentials .

You can customize the text according to your preferences – but try to avoid using dashes, slashes, or other characters as it can cause an error (unless you “escape” these characters),

Change the Excerpt Length

By default, the WordPress excerpt shows the first 55 words of a post.

If you want to adjust this, you can add the following code snippet to the functions.php file.

The code snippet above will change the excerpt length to 90 words. If you’d prefer a different number, you can change “90” to the exact number of words that you want to use.

Remove the WordPress Version Number

To make it harder for malicious actors to detect which version of WordPress you’re using, some users like to remove the WordPress version number from appearing anywhere in your site’s frontend code.

To do this, you can add the following code snippets to your functions.php file.

Set Up WordPress Pagination

If you’re not happy with how pagination works in your theme, you can use a functions.php code snippet to adjust pagination behavior or even create your own pagination system.

If you’re interested in this type of modification, we have a full guide to WordPress pagination that includes some example functions.php code snippets for you.

Change How Many Results to Include on Search Listing Page

WordPress gives you an in-dashboard option to control how many posts to list on archive pages ( Settings → Reading ).

However, this changes the number for all archive pages. What if you just want to use a different number for the search results page?

For that, you can add this snippet to your functions.php file – make sure to change the number (“12” in this example) to the actual number of results that you want to display before paginating additional results.

Include Featured Images in the WordPress RSS Feed

If you want to include your posts’ featured images in your RSS feed content, you can add the following snippet to your functions.php file.

As written, the above code snippet will insert the image at full size. To use a different thumbnail size, you can change “full” to a different thumbnail size – e.g. “large” or “medium”.

Add Upload Support for File Types (E.g. SVG)

By default, WordPress blocks you from uploading certain file types, such as SVG files .

To enable support for these blocked file types, you can add the following code snippet to the WordPress functions.php file:

This code snippet only enables SVG uploads, but you can modify it to add support for other file types if needed.

Hide WordPress Update Nags for Non-Administrators

By default, WordPress will show dashboard-wide messages to all users with dashboard access when there’s a new update available .

Even if a user’s role doesn’t allow them to apply the update, the dashboard message will tell that user to contact the administrator.

To adjust this, you can use this code snippet to hide update notifications for all non-Administrator users:

For some other variations, check out our guide on how to disable WordPress update notifications .

Change Automatic JPEG Optimization Quality

Though not everyone knows about this feature, WordPress automatically compresses JPEG images when creating thumbnails for your site after you upload images.

Since WordPress 4.5, WordPress has set the default quality level to 82 (with 100 being zero compression).

If you want to make this quality level higher or lower, you can add the following code snippet to your functions.php file – make sure to change the number (“90” in this example) to the actual quality level that you want to use:

Best Practices for Organizing Your WordPress functions.php File

If you’re just using the WordPress functions.php file to add a couple of code snippets, you probably don’t need to worry about organization.

But if you’re adding a lot of code snippets to your site, it can quickly get unwieldy and complex if you’re not following some functions.php file organization best practices.

Here are a few best practices to keep your code snippets organized…

Add Code Comments to Explain Everything

When you first add a code snippet to your functions.php file, you know exactly what the snippet does and why you added it. But when you look back at the functions.php file a year later, things might not be so clear.

To avoid this, you’ll want to add code comments to each snippet that explain what the snippet does and why you added it.

Code comments are text that isn’t executed by WordPress, but that human users can read to understand what the code snippet is doing.

To add a single-line code comment, you can use this format:

To add a multiple-line code comment, you can use this format:

Here’s an example of how you might use code comments – you can see that the comment before each snippet explains what the snippet does.

Use Include Files to Separate Snippets Into Different Files

If you really have a lot of code snippets, you can store them in separate files instead of using just the functions.php file.

Then, you can include those code snippets in the functions.php file using include or require. Mike Schinkel has a good example of how you might do this on StackExchange.

Consider One of the functions.php Alternatives from Above

If you find your functions.php file getting a bit cluttered, you might prefer one of the functions.php alternatives that we detailed earlier.

For example, the free Code Snippets plugin makes it very easy to organize everything because you can add each code snippet separately, complete with its own title and description. You can also use tags to organize your snippets.

The WordPress functions.php file is a theme-specific file that lets you add PHP code snippets to your website.

If you want to add code snippets to the functions.php file, you should always use a child theme so that your changes don’t get overwritten when you update your theme. We also recommend backing up your site before adding snippets and testing them on a staging site whenever possible.

As an alternative to using the functions.php file, you can also consider a code manager plugin or creating your own custom plugin to house your snippets.

Now that you know how the WordPress functions.php file works, you can start customizing your site in all kinds of helpful ways.

The example functions.php snippets above give you some good places to get started, but the sky’s the limit when it comes to what you can do.

Content & Marketing Editor at Kinsta, WordPress Web Developer, and Content Writer. Outside of all things WordPress, I enjoy the beach, golf, and movies. I also have tall people problems ;).

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