Search Results (18,243)

Background and Objectives: Urinary incontinence (UI) is a prevalent issue among older adults and may require urodynamic studies (UDSs) for accurate diagnosis. However, these procedures can be uncomfortable and time-consuming, especially in a geriatric population, where certain practical restrictions may apply. This study examines whether posture of filling cystometry during UDSs in an older patient group affects diagnostic outcomes and whether a single UDS in one posture is sufficient for a reliable diagnosis or if multiple postures provide added value. Materials and Methods: This is a secondary analysis of the Think Dry: Optimalisation of Diagnostic Process of Urinary Incontinence in Older People study (NCT04094753), a prospective observational cohort study. Each patient underwent both sitting and standing filling cystometry during UDS. The final diagnosis was determined by the referring urologist by integrating results from both the sitting and standing groups alongside all available clinical data. Subsequently, each separate UDS was reviewed independently by a second, blinded, urologist, and a diagnosis was established based on a single UDS. The agreement between these independent diagnoses and the final diagnosis was then evaluated using Cohen’s kappa coefficient (κ). Results: Results from the UDS with the standing filling cystometry had an almost perfect agreement (κ = 0.92) with the final diagnosis, compared to only a moderate agreement (κ = 0.42) while sitting. Conclusions: UDS with standing filling cystometry may be sufficient for an accurate diagnosis, potentially eliminating the need for additional filling cystometry in the sitting position. By streamlining the diagnostic process, this approach could enhance efficiency, reduce patient burden, and optimize resource utilization in older adults. Full article

Wind gustiness at airports, which is generally determined using gust factors, is impactful across a range of considerations from piloting to airport planning. Yet advisory materials to help assess their quality and representativeness, particularly for aviators, are limited. To address this, a climatological analysis of both gust factors is conducted using Automated Surface Observing System (ASOS) wind observations. Data for multi-year periods at selected airports in the United States are used to assess their site representativeness and for turbulence attribution purposes. Both gust factors vary by direction in response to local terrain features and nearby obstructions and are generally not well correlated with each other. The meteorological gust factor is shown to be more responsive to local obstructions in proximity to the ASOS systems. Excluding lower gusts leads to a marked improvement in the correlation between the two gust factors. Due to ASOS’s siting limitations, attributing observed gustiness to turbulence from nearby terrain or structures is difficult. The gustiness is often localized and may not represent conditions across the full airport. Excluding lower gusts increases the aviation gust factor’s sensitivity to local obstructions. This suggests that obstructions may play a meaningful role in shaping the higher observed gust factors. The potential exists to provide pilots and other users of this data with site- and direction-specific metadata regarding observed gustiness, thereby improving situational awareness. Full article

Individuals with severe mental illness face a substantially higher risk of suicide compared with the general population, with drug overdose representing one of the most common and potentially lethal methods. This narrative review explores toxidromes frequently encountered in psychiatric populations, such as opioid, anticholinergic, and serotonergic toxicity, highlighting the clinical presentation in intentional overdose. Emphasis is placed on clinical recognition, antidote-based treatment, and systems-level strategies for the prevention of lethal overdose. We conducted a comprehensive literature search of PubMed, Google Scholar, and Web of Science for English-language articles using combinations of the following keywords: mental disorders; persons with psychiatric disorders; drug overdose; poisoning; serotonin syndrome; neuroleptic malignant syndrome; anticholinergic agents/poisoning; cholinergic antagonists/poisoning; psychotropic drugs/adverse effects; substance-related disorders; drug-related side effects and adverse reactions; polypharmacy; suicide, attempted; emergency service, hospital. By embedding toxidrome awareness into routine emergency and psychiatric practice, we aim to expedite treatment and improve patient outcomes. Full article

Objective: The objective of this retrospective cross-sectional study is to explore how caregiver social determinants of health, appraisal of healthcare provider effectiveness, and insurance coverage influence caregiver ability to have their adolescent child access vision care, including completion of annual vision screening, visiting an ophthalmologist or optometrist, and completion of recommended additional screenings. Study Design: We used National Survey of Children’s Health (NSCH) data for 12–17-year-old adolescents for the years 2022 and 2023 (n = 37,425). Summary statistics for the selected sample were generated and binary logistic regressions were conducted. Outcome variables were the type of vision screening that occurred or not. Covariates were socioeconomic and demographic data of the adolescent’s primary caregiver. Independent variables were insurance coverage and healthcare provider’s skill and effectiveness. Results: Significant associations were reported between visiting an ophthalmologist or optometrist and each of spending enough time with patients; listening carefully to patients; and making patients feel like care is a partnership. Additionally, significant associations were reported between insurance coverage and both successful completion of vision screening and visiting an eye doctor. Conclusions: This study underscores the substantial impact of effectiveness of eye doctors in delivering annual vision exams and insurance adequacy on adolescent vision care engagement. Our results will inform the development of future evidence-based educational interventions to raise awareness on the importance of annual vision screenings in US adolescents and emphasize the need for screening mandates to advocate for this important public health issue. Full article

Background/Objectives: Medium- and long-chain triacylglycerol (MLCT) and 2′-fucosyllactose (2′-FL) are functional ingredients abundant in human milk; however, their effects on small intestinal development and health remain largely unknown, and no research has explored their potential combined effects. Methods: In this study, growing C57BL/6 mice (3 weeks old) were fed diets without or with 2.5 g/100 g of MLCT, 2′-FL, or the combination (MLCT + 2′-FL; 5:1) for 21 days. Body weight, major organ indices, small intestinal morphology-related indicators (small intestinal length, villus height, crypt depth, villus height/crypt depth (V/C) ratio, and epithelial cell proliferation), and intestinal barrier function markers (goblet cell and Paneth cell count, protein expression of ZO-1 and occludin, and levels of sIgA and LPS) were measured. Results: In addition to the shared promotion of epithelial cell proliferation, MLCT intervention raised villus height and crypt depth, while 2′-FL intervention elevated Paneth cell count and sIgA levels. Notably, MLCT + 2′-FL intervention offered additional advantages (increasing the V/C ratio, goblet cell count, and expression of ZO-1 and occludin) without affecting crypt depth. 16S rRNA sequencing analysis of cecal contents revealed that all three interventions mainly affected beta diversity rather than alpha diversity, and enriched differentially abundant bacterial taxa: Erysipelotrichaceae, Faecalibaculum, UBA1819, and Faecalitalea in the MLCT group; Enterobacteriaceae, Escherichia, and Allobaculum in the 2′-FL group; Bifidobacterium, Romboutsia, Clostridia, and several other bacterial taxa in the MLCT + 2′-FL group. Conclusions: These results indicate that MLCT and 2′-FL interventions alone appear to provide different benefits for small intestinal development, and their combination may confer more comprehensive advantages. Full article

Epidemics caused by respiratory infections have become a global and systemic threat since humankind has become highly connected via modern transportation systems. Any new pathogen with human-to-human transmission capabilities has the potential to cause public health disasters and severe disruptions of social and economic activities. During the COVID-19 pandemic, we learned that proper mask-wearing in closed, restricted areas was one of the measures that worked to mitigate the spread of respiratory infections while allowing for continuing economic activity. Previous research approached this issue by designing hardware–software systems that determine whether individuals in the surveilled restricted area are using a mask; however, most such solutions are centralized, thus requiring massive computational resources, which makes them hard to scale up. To address such issues, this paper proposes a novel decentralized, federated learning (FL) solution to mask-wearing detection that instantiates our lightweight version of the MobileNetV2 model. The FL solution also ensures individual privacy, given that images remain at the local, device level. Importantly, we obtained a mask-wearing training accuracy of 98% (i.e., similar to centralized machine learning solutions) after only eight rounds of communication with 25 clients. We rigorously proved the reliability and robustness of our approach after repeated K-fold cross-validation. Full article

This paper investigates federated learning (FL) for cross-site scripting (XSS) detection under out-of-distribution (OOD) drift. Real-world XSS traffic involves fragmented attacks, heterogeneous benign inputs, and client imbalance, which erode conventional detectors. To simulate this, we construct two structurally divergent datasets: one with obfuscated, mixed-structure samples and another with syntactically regular examples, inducing structural OOD in both classes. We evaluate GloVe, GraphCodeBERT, and CodeT5 in both centralised and federated settings, tracking embedding drift and client variance. FL consistently improves OOD robustness by averaging decision boundaries from cleaner clients. Under FL scenarios, CodeT5 achieves the best aggregated performance (97.6% accuracy, 3.5% FPR), followed by GraphCodeBERT (96.8%, 4.7%), but is more stable on convergence. GloVe reaches a competitive final accuracy (96.2%) but exhibits a high instability across rounds, with a higher false positive rate (5.5%) and pronounced variance under FedProx. These results highlight the value and limits of structure-aware embeddings and support FL as a practical, privacy-preserving defence within OOD XSS scenarios. Full article

The association between adverse childhood experiences (ACEs) and depression has been the focus of a number of prevalent studies in recent years—particularly among high-risk youth. Depression remains a significant mental health issue among justice-involved youth. There is a well-established correlation between depressed mood and conduct problems (e.g., conduct disorder and oppositional defiant disorder) during childhood and adolescence, which tends to become more prevalent during adolescence. Studies of justice-involved youth reveal high prevalence rates of depression and other mood disorders. Drawing on the relevant literature, we conducted multigroup structural equation model (SEM) analyses to assess the relationships between experiencing ACEs, sexual assault victimization, and depression among male (n = 226) and female (n = 98) youth entering a post-arrest intake facility in the Florida, U.S.A. juvenile justice system in 2024–2025. The youths averaged 15 years in age, and most were attending middle school or high school. Confirmatory factor analyses (CFAs) were completed to estimate a latent variable labeled depression. Sexual assault victimization and ACEs were hypothesized to be related to each other and were specified as predictors of depression. This trauma/stress experiences and depression model was estimated in two multigroup analyses, across birth gender groups (male or female) and race groups (non-Black or Black) for the youth in this study. The results indicated that there are several notable conclusions from the SEM analyses. First, depression was a scalar invariant in the two multigroup analyses, permitting clearer comparisons of the specified predictors of this construct across groups. Second, for the race-based SEM, experience of sexual assault and the total ACE score were significantly related only in the model for Black youth. The fit of the model was “poorest” among non-Black youth, although even in this case, sexual assault experiences were a significant predictor of depression. Finally, for the gender-based model, sexual assault and ACEs were significant predictors of depression among both male and female youth. Model fit results underscore the important role of abuse trauma and ACEs in understanding these youths’ depression symptoms, and they help contribute to the literature on this topic. Full article

We conducted in situ Raman spectroscopy measurements on goethite (α-FeOOH) under simultaneous high-pressure and high-temperature conditions using an externally heated diamond anvil cell (EHDAC). Our study investigates spectral changes associated with the α-FeOOH-to-ε-FeOOH phase transition up to ~11 GPa and 563 K. The phase transition was identified based on high-temperature Raman spectra collected at 473 K, 523 K, and 563 K. A key indicator of the transition is the disappearance of a characteristic shoulder peak near 410 cm⁻¹ which occurs near 4.7, 6.0, and 6.6 GPa for temperatures of 473 K, 523 K, and 563 K, respectively. From this, we estimate a linear phase boundary where the transition pressure increases with temperature at a rate of 2.3 ± 0.5 GPa per 100 K. Extrapolation to room temperature (300 K) yields a transition pressure of 0.3 ± 3.1 GPa. These findings extend existing high-pressure Raman data from ambient to elevated temperatures up to 563 K, improving our understanding of hydrogen-bearing phases relevant to Earth’s deep interior. Full article

Background: This study evaluated the impact of diabetes mellitus (DM) and its treatments on cardiovascular outcomes in prostate cancer (PC) patients aged 66 years and older, with or without androgen deprivation therapy (ADT) exposure. Methods: Using the SEER-Medicare database (2009–2017), two cohorts were created: Cohort 1 included all PC patients enrolled in Medicare Parts A and B; Cohort 2 was a subset of Cohort 1 receiving ADT and enrolled in Medicare Part D. Exposures were DM and DM medications. Outcomes included cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm), and all-cause mortality, analyzed using multivariable Fine-Gray and Cox models. Results: Cohort 1 included 150,647 PC patients (32% with DM, median age 72). DM was associated with higher risk of CVE (subdistribution hazard ratio [sHR] 1.20, 95% CI 1.17–1.22), CVm (sHR 1.35, 1.28–1.43), and all-cause mortality (adjusted HR [aHR] 1.22, 1.19–1.26) (all p < 0.001). Non-Hispanic Blacks (NHBs) and patients from lower socioeconomic (SES) and education areas experienced comparable or worse outcomes. In Cohort 2 (n = 14,938), DM patients on non-metformin therapies had higher all-cause mortality (aHR 1.33, 1.11–1.25; p = 0.002) than those on metformin, particularly in NHB and low education groups. Sensitivity analyses with follow-up limited to two years showed consistent results as overall. Conclusions: Diabetic PC patients, especially NHB, lower SES and lower education subgroups, were associated with worse cardiovascular and all-cause mortality outcomes. Metformin may be associated with better outcomes in these populations, warranting further research on the disparities in PC and diabetes, and cardioprotective effects of DM medications across different subpopulations. Full article

Integrating generative artificial intelligence (GenAI) into professional practice has become an important topic for professional instructional design practice and training. Accordingly, the purpose of this multiple-case study was to examine six professional instructional designers’ integration of GenAI into their professional practice and the factors affecting this integration. Research data were collected through semi-structured interviews conducted with professional instructional designers working in corporate or higher education settings. The results were as follows: (a) instructional designers mostly integrate GenAI into instructional design and/or development phases and they think that it also has the largest impact on these two phases; and (b) instructional designers’ integration of GenAI into their professional practice is mainly based on their ambivalent attitudes toward it, which is closely linked to the advantages and disadvantages associated with the technology. Specifically, instructional designers’ basic understanding of GenAI, the efficiency of generating instructional content through GenAI, the inaccuracy of GenAI-created products, instructional designers’ use of GenAI in everyday life, and institutional or company support shape their attitudes towards and integration of GenAI into their professional practice. All these findings suggest that instructional design and development phases are especially vulnerable to and can benefit from instructional designers’ attitudes and use of GenAI. Accordingly, it can be useful to address and enhance attitudes toward GenAI technology in instructional design training, which can promote instructional designers’ acceptance of the technology and effective use of it. Full article

This study analyzes the effects of washing conditions on polycyclic aromatic hydrocarbon (PAH) content in firefighter protective clothing. The analysis involved specially prepared textile packages made of materials used in such clothing: an outer shell, a moisture barrier membrane, and a thermal insulation lining. Package samples were subjected to simulated exposure to a selected group of PAH compounds. Ultra-high-performance liquid chromatography with fluorescence detection (UHPLC/FL) was applied to determine PAH content. The study showed that washing conditions (water temperature and the number of rinses) influenced the effectiveness of removal of chemical contaminants. The most favorable results were obtained for the washing process conducted at 60 °C with three rinse cycles, which resulted in the lowest concentration of total PAHs in the two examined types of textile packages (0.40 µg·g⁻¹ and 0.60 µg·g⁻¹ in the outer shell, 3.9 µg·g⁻¹ and 6.2 µg·g⁻¹ in the membrane, and 0.40 µg·g⁻¹ and 0.41 µg·g⁻¹ in the thermal lining of packages A and B, respectively). The higher washing temperature (60 °C) had a more favorable effect on average washing effectiveness as compared with the lower temperature (40 °C) in both the two- and three-rinse variants. The average washing effectiveness also varied according to the type of material and amounted to 70% and 54% for textile package types A and B, respectively. Full article

Reinforcement learning (RL) is being used more in medical imaging for segmentation, detection, registration, and classification. This survey provides a comprehensive overview of RL techniques applied in this domain, categorizing the literature based on clinical task, imaging modality, learning paradigm, and algorithmic design. We introduce a unified taxonomy that supports reproducibility, highlights design guidance, and identifies underexplored intersections. Furthermore, we examine the integration of Large Language Models (LLMs) for automation and interpretability, and discuss privacy-preserving extensions using Differential Privacy (DP) and Federated Learning (FL). Finally, we address deployment challenges and outline future research directions toward trustworthy and scalable medical RL systems. Full article

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice. Full article

Biomechanical strategies of running gait were compared among healthy and recently injured pediatric and adult runners (N = 207). Spatiotemporal, kinematic, and kinetic parameters (ground reaction force [GRF], vertical average loading rate [VALR]) and leg stiffness (K_vert) were obtained during running on an instrumented treadmill with simultaneous 3D-motion capture. Significant age X injury interactions existed for cadence, peak GRF, and peak joint angles in stance. Cadence was fastest in healthy adults and 2–3% lower in other groups (p = 0.049). Injured adults exhibited higher variance in stance and swing time, whereas injured pediatric runners had lower variance in these measures (p < 0.05). Peak GRF was highest in non-injured adults (2.6–2.7 BW) and lowest in injured adults (2.4 BW; p < 0.05). VALRs (BW/s) were higher among pediatric groups, irrespective of injury (p < 0.05). The interaction for ankle dorsiflexion/plantarflexion moment was significant (p = 0.05). Healthy pediatric runners produced more plantarflexion than all other groups (p = 0.026). Pelvis rotation was highest in healthy pediatric runners and lowest in healthy adults (17.3° versus 12.0°; p = 0.036). Pediatric runners did not leverage force-dampening strategies, but reduced gait cycle time variance and controlled pelvic rotation. Injured adults had lower GRF and longer stance time, indicating a shift toward force mitigation during stance. Age-specific rehabilitation and gait retraining approaches may be warranted. Full article