Search Results (126)

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

This study examined spectroscopic, thermal, and other qualities, such as the lasing parameters, of Sm³⁺-doped glass with the composition 40P₂O₅–30ZnO–20LiCl–10BaF₂. The ellipsometric data were used in a Sellmeier dispersion relation to estimate the refractive index values of the glasses investigated. The measured absorption spectra of the doped glass reveal the presence of various absorption bands assigned to transitions from the ⁶H_5/2 ground state attributed to Sm³⁺-ion-excited states. We studied the decay of the ⁴G_5/2 level of the Sm³⁺ ions in the doped glass by analyzing its absorption and emission fluorescence spectra. The Judd–Ofelt hypothesis allowed us to determine that the quantum efficiency of the ⁴G_5/2–⁶H_7/2 transition is high: 96% and 97% for glass doped with 4.05 $\times$ 10¹⁹ ions/cm⁻³ and 11 $\times$ 10¹⁹ ions/cm⁻³, respectively. Furthermore, this glass exhibits efficient red/orange enhanced spontaneous emission that matches the excitation band of the photosensitizer material used in medical applications. Full article

Background: Exercise rehabilitation programmes are important for long-term health and wellbeing among people with cardiac and pulmonary diseases. Despite this, many people struggle to maintain their physical activity once rehabilitation ends. This repeated measures study tracked changes in physical activity behaviour and motivation during and after completing a community-based exercise rehabilitation programme. Methods: Cardiac and pulmonary exercise rehabilitation patients (N = 31) completed six once-monthly measures of physical activity (MET·min), self-determined motivation, intention, and habit strength for rehabilitation exercise (within rehabilitation sessions) and lifestyle physical activity (outside of rehabilitation sessions). Linear regression and random effects models with estimated marginal means were used to test for associations between physical activity motivation and behaviour and change during and post-rehabilitation. Results: Overall physical activity decreased after rehabilitation (823 MET·min) despite patients becoming more self-determined for lifestyle physical activity during rehabilitation. More self-determined motivation, stronger intentions, and stronger habits were associated with more lifestyle physical activity behaviour. However, none of these motivation variables were significantly associated with rehabilitation exercise behaviour. Conclusions: Among community-based cardiac and pulmonary rehabilitation patients, physical activity levels decreased following exercise rehabilitation programmes. The findings revealed clear distinctions in the motivation of rehabilitation exercise compared to lifestyle physical activity. Exercise rehabilitation programmes might improve the longevity of outcomes by integrating approaches to enhance lifestyle physical activity beyond the clinic. Full article

Detailed analysis covered the optical and structural properties of Eu³⁺-doped NaY₉Si₆O₂₆ oxyapatite phosphors, which were obtained via hydrothermal synthesis. X-ray diffraction patterns of NaY₉Si₆O₂₆:xEu³⁺ (x = 0, 1, 5, 7, 10 mol% Eu³⁺) samples proved a single-phase hexagonal structure (P63/m (176) space group). Differential thermal analysis showed an exothermic peak at 995 °C attributed to the amorphous to crystalline transformation of NaY₉Si₆O₂₆. Electron microscopy showed agglomerates composed of round-shaped nanoparticles ~53 nm in size. Room temperature photoluminescent emission spectra consisted of emission bands in the visible spectral region corresponding to ⁵D₀ → ⁷F_J (J = 0, 1, 2, 3, 4) f-f transitions of Eu³⁺. Lifetime measurements showed that the Eu³⁺ concentration had no substantial effect on the rather long ⁵D₀-level lifetime. The Eu³⁺ energy levels in the structure were determined using room-temperature excitation/emission spectra. Using the ⁷F₁ manifold, the Nv-crystal field strength parameter was calculated to be 1442.65 cm⁻¹. Structural, electronic, and optical properties were calculated to determine the band gap value, density of states, and index of refraction. The calculated direct band gap value was 4.665 eV (local density approximation) and 3.765 eV (general gradient approximation). Finally, the complete Judd–Ofelt analysis performed on all samples confirmed the experimental findings. Full article

In this study, we report the growth and comprehensive spectroscopic analysis of TmF₃-doped CaF₂ crystals, grown using the vertical Bridgman method. The optical absorption and photoluminescence properties of both trivalent (Tm³⁺) and divalent (Tm²⁺) thulium ions were investigated. Optical absorption spectra in the UV-VIS-NIR range reveal characteristic transitions of Tm³⁺ ions, as well as weaker absorption bands corresponding to Tm²⁺ ions. The Judd–Ofelt (JO) formalism was applied to determine the intensity parameters Ω₂, Ω₄, and Ω₆, which were used to calculate radiative transition probabilities, branching ratios, and radiative lifetimes for the Tm³⁺ ions. The emission spectra showed concentration-dependent quenching effects, with significant emissions observed for the concentration of 0.1 mol% TmF₃ under excitation at 260 nm and 353 nm for Tm³⁺ ions and at 305 nm for Tm²⁺ ions. A new UV emission associated with divalent Thulium is reported. The results indicate that higher TmF₃ concentrations lead to increased non-radiative energy transfer, which reduces luminescence efficiency. These findings contribute to the understanding of the optical behavior of Tm-doped fluoride crystals, with implications for their application in laser technologies and radiation dosimetry. Full article

Exploring the intrinsic mechanisms of rare-earth ions entering the crystal phase has great significance for finely tuning the luminescent properties of glass–ceramics. Using Er³⁺ ions as a probe, X-ray diffraction was employed to precisely measure the crystallinity of SiO₂-PbF₂-Er₂O₃ glass–ceramics synthesized under various heat treatment conditions, confirming the occurrence of a rapid crystallization process. Additionally, by combining Judd–Ofelt theory with comprehensive analyses of absorption and fluorescence spectra, we calculated the relative proportions of Er³⁺ ions present in the crystal phase. We found that the crystallization process in the glass–ceramics and the incorporation of Er³⁺ ions into the crystal phase did not occur synchronously. This discovery provides new theoretical foundations and practical guidance for understanding the mechanism of rare-earth ion incorporation into crystal phases, which is significant for the development of functional materials with specific luminescent properties. Full article