Search Results (131)

Background: Patient-important outcomes (PIOs) reflect patient values and preferences. Prior studies have elicited a variety of PIOs for diabetes. However, no studies have examined whether, or how, PIOs differ across diabetes care settings. The purpose of this study was to compare the frequencies of PIOs derived from patients with diabetes in primary care (PC), acute care (emergency department (ED)), and post-acute care (post-hospital discharge (PHD)) settings within a large delivery system. Methods: This study was an analysis of 89 interviews with patients in PC, ED, and PHD settings. Participants had moderately to poorly controlled diabetes, defined as follows: presented to the ED with a diabetes-related problem, admitted to the hospital for a diabetes-related problem, or had at least two primary care measurements of hemoglobin A1c (HbA1c) > 7.5 in the prior year. A matrix analysis compared the frequencies of participants’ PIOs across the three settings. Results: Overall PIO frequencies were similar across care settings. PIOs fell into seven domains; all seven domains and 21 of the 26 PIOs were represented within each of the care settings. The most common PIOs included “be healthy”, “eat right”, and “reduce or get off medicines”. Conclusions: Participants identified similar PIOs in all care settings, indicating that recruitment from one or two care settings may often be sufficient for achieving saturation of PIOs. Furthermore, the results inform our understanding of patient priorities across the care continuum. Full article

In this work, Sm³⁺-activated lead phosphate glass has been studied using spectroscopic methods. Based on absorption spectrum measurements, the oscillator strengths for Sm³⁺ ions were determined and compared to those calculated from the Judd–Ofelt theory. This procedure was applied to evaluate some radiative parameters (radiative transition rates, emission branching ratios, radiative lifetime) of Sm³⁺ ions in lead phosphate glass. Further luminescent studies indicate that lead phosphate glass doped with Sm³⁺ emits intense reddish-orange light due to ⁴G_5/2 ⟶ ⁶H_7/2 transition, for which several important spectroscopic parameters like emission linewidth and lifetime, quantum efficiency, peak stimulated emission cross-section, and figure of merit for laser gain were determined. The factors for Sm³⁺ ions in lead phosphate glass are as follows: η = 53%, FWHM = 10.5 nm, τ_exp = 1.925 ms, σ_em = 7.6 × 10⁻²² cm², σ_em × τ_exp = 14.6 × 10⁻²⁵ cm²s. The experimental and theoretical results suggest that samarium-doped lead phosphate glass can be successfully used as a reddish-orange-emitting component in photonic devices. Full article

This work shows that inverse Judd–Ofelt (JO) analysis of relative absorption spectra, anchored by a single lifetime, provides JO parameters and radiative rates without absolute calibration. The method is applied to Er³⁺, Dy³⁺, and Sm³⁺ in a compositionally identical oxyfluoride glass. Three well-resolved ground-state 4f–4f absorption bands were selected. After baseline removal and wavenumber-domain integration, their normalized strengths S_rel,k (k = 1, 2, 3; k∈S) define a 3 × 3 system solved by non-negative least squares to obtain the anchor-independent ordering (Ω₂:Ω₄:Ω₆). Absolute scaling uses a single lifetime anchor. We report lifetime-scaled Ω_t and A_rad, and the normalized fractions p_k within the selected triplets; as imposed by the method, the anchor-independent ordering (Ω₂:Ω₄:Ω₆) is analyzed, while absolute A_rad and Ω_t scale with τ_ref. The extracted parameters fall within the expected ranges for oxyfluoride hosts and reveal clear ion-specific trends: Ω₂ follows Dy³⁺ > Er³⁺ > Sm³⁺ (site asymmetry/hypersensitive response), while the ordering Ω₄ > Ω₆ holds across all ions (oxide-rich networks). Er³⁺ exhibits the largest Ω₄ and the smallest Ω₆, indicative of pronounced medium-range “rigidity” with suppressed long-range polarizability; Sm³⁺ shows the lowest Ω₂ (more symmetric/less covalent coordination); and Dy³⁺ the highest Ω₂ (strong hypersensitive behavior). Uncertainty was quantified by Monte Carlo resampling of the preprocessing steps, yielding compact 95% confidence intervals; the resulting JO-parameter trends (Ω₂, Ω₄, Ω₆) and normalized f_k fractions reproduce the characteristic spectroscopic behavior known for each ion. This method enables quantitative JO outputs from uncalibrated spectra, allowing direct spectroscopic comparisons and quick screening when only relative absorption data are available. Full article

The Coronavirus disease 2019 (COVID-19) pandemic had a profound global impact, yet children exhibited distinct clinical and epidemiological patterns compared to adults. Pediatric cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were generally characterized by milder disease, lower hospitalization rates, and few long-term sequelae. However, a subset of children developed severe complications such as multisystem inflammatory syndrome in children (MIS-C), highlighting the heterogeneity in disease presentation. Differences in immune system maturity and comorbidities likely contribute to the age-dependent manifestation of SARS-CoV-2 and other respiratory viruses. Persistent SARS-CoV-2 infection, particularly in immunocompromised individuals, has been implicated in the emergence of new viral variants with immune escape characteristics due to ongoing viral replication in the presence of selective pressure. While SARS-CoV-2 evolution in persistently infected adults has been well-documented, it is less clear how the virus evolves during persistent infection in the pediatric population. To address this question, we performed viral whole genome sequencing of longitudinal specimens collected from immunocompetent and immunocompromised pediatric COVID-19 patients. Similarly to what has been observed in adult cohorts, mutations associated with enhanced viral fitness and immune escape arose intra-host over time. Intra-host diversity accumulated at similar rates in immunocompetent and immunocompromised children, though more mutations overall were observed in the immunocompromised cohort due to the longer infection time courses. Overall, we identified similar viral evolutionary trends over the course of infection despite clinical differences in pediatric COVID-19 manifestation and severity. This similarity suggests that persistent infection in children may be an additional, but not unique, source of ongoing viral diversification. Full article

Background/Objectives: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and endometriosis are debilitating conditions that share overlapping features of chronic inflammation and immune dysregulation, yet their epidemiological relationship remains poorly characterized. The objective of this study was to investigate the association between ME/CFS and endometriosis, examining shared risk factors, clinical correlates, and epidemiological patterns. Methods: We conducted a systematic review and meta-analysis. Two independent reviewers screened 236 records after duplicate removal, with seventeen studies undergoing full-text review and thirteen meeting inclusion criteria for meta-analysis. Data were extracted using standardized forms and analyzed using random-effects models in R, with heterogeneity assessed using I² statistics and the risk of bias evaluated using the JBI critical appraisal tool. Results: Our meta-analysis of five studies (n = 2261 participants) revealed that women with endometriosis had 2.79-fold higher odds (95% CI: 2.00–3.89) of developing ME/CFS compared to controls. Similarly, our fixed-effects meta-analysis of two studies assessing the association of ME/CFS and endometriosis yielded a pooled OR of 2.52 (95% CI: 2.45–2.60, p < 0.001). There was minimal statistical heterogeneity (I² = 0.0%, p > 0.7969) for both meta-analyses. Conclusions: This study demonstrates a significant bidirectional association between endometriosis and ME/CFS, driven by shared mechanisms of immune dysregulation and chronic inflammation. Despite high heterogeneity, the consistent effect sizes support clinical vigilance for comorbidity. Future research should prioritize standardized diagnostic criteria to elucidate causal pathways. These findings underscore the need for integrated care approaches to address overlapping symptomatology in affected patients. Full article

Background: To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective. Methods: This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. We identified cases by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive. Results: A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ = 0.55, p < 0.001) and being technology-intensive (ρ = 0.58, p < 0.001) were significantly correlated with treatment costs. Conclusions: In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions was a significant predictor of higher costs. Full article

Obesity presents a significant barrier to transplant eligibility due to increased morbidity associated with higher BMI. Patients with obesity who undergo transplantation face elevated risks of perioperative complications, morbidity from metabolic disease, and delayed graft function. However, recent advances in metabolic and bariatric medicine, endoscopy, and surgery offer promising opportunities for integration with transplant care. This critical review explores the potential benefits of metabolic and bariatric interventions for at-risk transplant patients. Here, we will briefly discuss the implications of obesity in transplant patients, pharmacologic, surgical, and endoscopic interventions, and ultimately, the role of bariatric surgery in different solid organ transplants. The successful implementation of these approaches could dramatically expand access to solid organ transplantation, creating life-saving opportunities for patients who would otherwise be deemed ineligible for this essential treatment. Despite the implications of metabolic and bariatric interventions in transplant care, this review is limited by the need for long-term studies of outcomes to better understand the effects of graft survival and durability of changes in metabolic syndromes. Full article

Chainsaws are widely used in various occupational settings, including forestry, landscaping, farming, and by homeowners for tasks like tree felling, brush clearing, and firewood cutting. However, the use of chainsaws poses significant risks to operators and bystanders. This research quantified and compared occupational and nonoccupational injuries caused by contact with chainsaws and related objects during the period from 2018 to 2022. The emergency department and OSHA (Occupational Safety and Health Administration) data were used to characterize the cause and nature of the injuries. Results suggest that for this five-year period an estimated 127,944 people were treated in U.S. emergency departments for chainsaw-related injuries. More than 200 non-fatal and 57 fatal occupational chainsaw-involved injuries were found during the same period. Landscaping and forestry were the two industries where most of the occupational victims were employed. Upper and lower extremities were the most likely injured body parts, with open wounds from cuts being the most common injury type. The majority of fatal injuries were caused by falling objects such as trees and tree limbs while using a chainsaw. Our suggestions to reduce injuries include proper training and wearing personal protective equipment, as well as making sure any bystanders are kept in a safety zone away from trees being cut. Full article

The U.S. ironmaking sector plays a key role in global greenhouse gas emissions, mainly due to long-standing practices such as blast furnaces (BFs) and direct reduction (DR). In this work, we develop a new mathematical approach to estimate future CO₂ emissions from the U.S. ironmaking industry through 2050. Our approach uses historical data from 2005 to 2021 and incorporates economic and energy use indicators to explore how emissions might change over time. According to our results, unless significant technological improvements and stronger energy policies are implemented, the industry is likely to continue producing large amounts of CO₂. These findings highlight the pressing need to adopt cleaner alternatives—such as hydrogen-based direct reduction—to help meet international climate goals. Supporting the transition to low-emission technologies contributes to broader efforts in sustainable industrial development and long-term climate resilience. Full article

This study evaluates the predictive performance of advanced machine learning models, including DeepBoost, XGBoost, CatBoost, RF, and MLP, in estimating the Ω₂, Ω₄, and Ω₆ parameters based on a comprehensive set of input variables. Among the models, DeepBoost consistently demonstrated the best performance across the training and testing phases. For the Ω₂ prediction, DeepBoost achieved an R² of 0.974 and accuracy of 99.895% in the training phase, with corresponding values of 0.971 and 99.902% in the testing phase. In comparison, XGBoost ranked second with an R² of 0.929 and accuracy of 99.870% during testing. For Ω₄, DeepBoost achieved a training phase R² of 0.955 and accuracy of 99.846%, while the testing phase results included an R² of 0.945 and accuracy of 99.951%. Similar trends were observed for Ω₆, where DeepBoost obtained near-perfect training phase results (R² = 0.997, accuracy = 99.968%) and testing phase performance (R² = 0.994, accuracy = 99.946%). These findings are further supported by violin plots and correlation analyses, underscoring DeepBoost’s superior predictive reliability and generalization capabilities. This work highlights the importance of model selection in predictive tasks and demonstrates the potential of machine learning for capturing complex relationships in data. Full article

A BaF₂ single crystal co-doped with Er³⁺ and Yb³⁺ was grown by the vertical Bridgman technique and investigated for its optical and dielectric properties. Judd–Ofelt analysis yielded intensity parameters Ω₂ = 0.59, Ω₄ = 0.38, and Ω₆ = 0.27 (×10⁻²⁰ cm²), with a quality factor χ = 1.41, indicating strong radiative transitions. Under UV and near-UV excitation, emissions at 321, 405, 518, and 536 nm were observed, with radiative lifetimes ranging from 1.1 to 3.4 ms. A single dielectric relaxation process was identified, with activation energy of 0.58 eV and associated with trigonal NNN dipoles. The NNN dipole concentration was estimated at ~2.5 × 10¹⁸ cm⁻³. These results support the suitability of Er³⁺,Yb³⁺ co-doped BaF₂ crystals for luminescent and dielectric applications in advanced photonic materials. Full article

Background/Objectives: Acute kidney injury (AKI) is a common complication of coronavirus disease-19 (COVID-19), but the impact of baseline kidney function and care processes on outcomes is not well understood. We hypothesized that baseline kidney health status may influence courses and outcomes of AKI. Methods: This is a multinational, multicenter, retrospective cohort study. We included hospitalized adult COVID-19 patients with kidney disease (AKI, end-stage kidney disease (ESKD), chronic kidney disease (CKD), or kidney transplant (KT) recipients) from 1 January 2020 to 31 March 2022, across 52 centers in 23 countries. Patients with no prior kidney function information were classified as acute kidney disease (AKD) if estimated glomerular filtration rate (eGFR) at admission was <60 mL/min/1.73 m² and as no known kidney disease (NKD) if eGFR was ≥60 mL/min/1.73 m². We defined combined outcome as death or non-kidney recovery at hospital discharge. Multivariable binary regression models were applied. Results: Among 4158 patients, 882 had ESKD, and 3038 developed AKI. AKI patients were categorized as NKD (31.8%), AKD (38.6%), CKD (23.3%), and KT recipients (3.3%). NKD patients had higher AKI severity and more intensive care unit care needs. In the multivariable analyses, the risk of the combined outcome was higher in AKD (OR 1.459 [1.061, 2.005]) or CKD (OR 1.705 [1.206, 2.410]) patients, although the risk of in-hospital mortality was similar to NKD. Among the survivors at hospital discharge, the risk of partial or non-recovery was higher in CKD (OR 5.445 [3.864, 7.672]) or KT recipients (OR 4.208 [2.383, 7.429]) compared to NKD. These findings were consistent across income categories. Conclusions: Among AKI patients with COVID-19, nearly two-thirds had underlying kidney dysfunction, with 55% identified as having baseline AKD, which had higher risk of death or non-kidney recovery at discharge compared to NKD. Full article

Despite being well-positioned to promote healthy lifestyles in young children, early years practitioners often face barriers to supporting child weight management. This mixed-methods study aimed to assess the preliminary effectiveness and acceptability of an e-learning toolkit (HealthyWEY) designed to upskill and support multi-agency professionals to promote healthy weight in early childhood. A total of 54 health visitors/community nursery nurses, 38 children’s centre staff and 17 other health professionals engaged with the HealthyWEY e-learning, which drew on self-determination theory and consisted of nine modules that were completed over 7–10 weeks. Non-parametric statistical analysis using Wilcoxon’s signed-rank tests were used to explore participants’ practice-based knowledge, psychological needs satisfaction and motivations for prioritising pre-school child weight from pre- to post-intervention. Focus groups (n = 11) were conducted with a sub-sample of multi-agency professionals (n = 39) to explore the process of implementation across sites, while interviews were also conducted with two parents/carers who took part in consultations with HealthyWEY-trained practitioners. After completing the HealthyWEY e-learning, participants perceived fewer barriers to pre-school child weight management (median change = −0.7; p < 0.001), greater autonomy (median change = 0.7, p < 0.001), competence (median change = 0.8, p < 0.001) and relatedness (median change = 0.4, p < 0.001) and a higher autonomous motivation towards promoting healthy weight (median change = 0.3, p < 0.001). E-learning was perceived to be highly relevant to participants’ roles and congruent with local child weight strategies. Challenges to implementation included time constraints and disruptions related to the COVID-19 pandemic. Recommendations for a better user experience were offered by enhancing the toolkit’s design and interactivity. Engagement with the HealthyWEY e-learning led to promising changes in perceived barriers and motivational variables. The toolkit was perceived to be acceptable amongst multi-agency workforces, albeit challenging to prioritise within time-pressured health and early years settings. Full article

Obesity is characterized by the enlargement of adipose tissue due to an increased calorie intake exceeding the body’s energy expenditure. Changes in the size of adipose tissue can lead to harmful consequences, with excessive fat accumulation resulting in adipocyte hypertrophy and promoting metabolic dysfunction. These adiposity-associated pathologies can be influenced by dietary components and their potential health benefits. Lupeol, a pharmacologically active pentacyclic triterpenoid found in medicinal plants, vegetables, and fruits, has been shown to exhibit antioxidant and anti-inflammatory properties. This study investigated the role of lupeol on adipocyte hypertrophy by evaluating key adipogenic regulators in vitro. First, 3T3-L1 MBX mouse embryonic cells were differentiated into adipocytes and hypertrophy was induced using 500 µM palmitic acid. The treated adipocytes showed a significantly increased lipid droplet size, confirming adipocyte hypertrophy. Both adipocytes and hypertrophied adipocytes were then treated with or without 60 µM lupeol, following a dose-dependent study. Lipid droplet size was assessed and validated by Oil Red O staining. Western blot analysis was performed to measure the expression of adipogenic and inflammatory markers. Differentiated adipocytes showed increased fatty acid-binding protein 4 (FABP4) expression and Oil Red O staining, indicating an increased lipid content. Western blot analysis revealed that lupeol treatment reduced the expression of FABP4, peroxisome proliferator-activated receptor-γ (PPARγ), and adipokines. In conclusion, the results suggest that lupeol reverts the inflammatory and adipogenic markers that are enhanced in adipocyte hypertrophy. Through its anti-inflammatory effects, lupeol offers protective effects against adipocyte hypertrophy and contributes to reducing hypertrophic adiposity. Full article

Squamous cell carcinoma is the most common malignancy affecting the sinonasal tract. Local recurrence is the main pattern of treatment failure, affecting nearly half of patients treated for primary sinonasal squamous cell carcinoma (SNSCC). Due to disease rarity and heterogeneity of practices, there are limited guidelines for how to diagnose and care for these patients. This paper reviews current evidence regarding etiology, pathophysiology, diagnosis, prognostic factors, and treatment modalities of recurrent SNSCC (rSNSCC). Currently, salvage surgery offers the only durable approach for eligible patients. These resections often require robust reconstructive options due to prior surgery or radiation. Chemoradiation is offered as an adjuvant or palliative approach when surgery is not a feasible option. Emerging options such as immunotherapy and particle therapy remain an area of ongoing investigation. Full article