Search Results (31,752)

We argue that quantitative analysis of community-based speech data furnishes an indispensable adjunct to theoretical and experimental studies targeting the acquisition of relativization. Drawing on a comparative sociolinguistic approach, we make use of three corpora of natural speech to investigate second-language (L2) speakers’ acquisition of restrictive relative clauses in English. These corpora comprise: (i) spontaneous L2 speech; (ii) a local baseline variety of the target language (TL); and (iii) L2 speakers’ first language (L1), French. These complementary datasets enable us to explore the extent to which L2 speakers reproduce the discursive frequency of relative markers, as well as their fine-grained linguistic conditioning, in the local TL baseline variety. Comparisons with French facilitate exploration of possible L1 transfer effects on L2 speakers’ production of English restrictive relative clauses. Results indicate that evidence of L1 transfer effects on L2 speakers’ restrictive relative clauses is tenuous. A pivotal finding is that L2 speakers, in the aggregate, closely approximate TL constraints on relative marker selection, although they use the subject relativizer who significantly less often than their TL counterparts. We implicate affiliation with, and integration into, the local TL community as key factors facilitating the propagation of TL vernacular norms to L2 speakers. Full article

Background: Gamification may enhance engagement and higher-order learning in health-care profession education, but evidence from undergraduate nursing programs—particularly in the Middle East—is limited. We evaluated whether integrating structured gamified activities into an anatomy and physiology course improves class engagement and knowledge-based critical thinking. Methods: In this pragmatic, nonrandomized, section-allocated quasi-experimental study at a single Saudi institution, 121 first-year female nursing students were assigned by existing cohorts to traditional instruction (control; n = 61) or instruction enhanced with gamified elements (intervention; n = 60) groups. The intervention (introduced mid-semester) comprised time-limited competitive quizzing with immediate feedback and aligned puzzle tasks. Outcomes were measured at baseline, mid-semester, and end-semester using a four-item Class Engagement Rubric (CER; scale 1–5) and a 40-item high-cognitive multiple-choice (MCQ) assessment mapped to course objectives. Analyses used paired and independent t-tests with effect sizes and 95% confidence intervals. Results: No attrition occurred. From baseline to end-semester, the intervention group had a mean CER increase of 0.59 points (95% CI, 0.42 to 0.76; p < 0.001)—approximately a 15% relative gain—and a mean MCQ increase of 0.30 points (95% CI, 0.18 to 0.42; p < 0.001), an ~8% relative gain. The control group showed no material change over the same interval. Between-group differences in change favored the intervention across CER items and for the MCQ outcome. Semester grade-point average did not differ significantly between groups (p = 0.055). Conclusions: Embedding a brief, structured gamification package within an undergraduate nursing anatomy and physiology course was associated with measurable improvements in classroom engagement and modest gains in knowledge-based critical thinking, with no detectable effect on overall semester GPA. Given the nonrandomized, single-site design, causal inference is limited. Multi-site randomized trials using validated critical-thinking instruments are warranted to confirm effectiveness and define dose, durability, and generalizability. Full article

Intra-articular injections form a substantial element of the temporomandibular joint disorder (TMD) therapy. Given the role played by IL-1β in pathology, the use of autologous conditioned serum (ACS) is well-founded. Despite years of effective use in different locations, data regarding the intra-articular administration of ACS in TMD is scarce, and the strategy itself is not routinely applied. This study aims to provide preliminary evidence on the therapeutic efficacy of administering intra-articular ACS in treating TMD. Patients with TMD who received intra-articular ACS were included. More invasive co-interventions, such as arthroscopy, were excluded. Final searches were conducted on 17 June 2025, using five databases (ACM, BASE, DOAJ, PubMed, and SciELO). Risk of bias was evaluated using the RoB 2 tool. The results were tabulated. Only one study met the inclusion criteria. When compared to dextrose prolotherapy in internal TMD, ACS therapy resulted in greater improvement in mouth opening, pain, and joint-sound reduction. The small sample size, head-to-head design, and limited blinding suggest a highly cautious interpretation of the findings. ACS is a promising, but still experimental, therapeutic strategy addressing critical mechanisms in TMD. However, the currently available data is insufficient to confirm the effectiveness and safety of such an approach, and further high-quality studies are needed. This study received no funding. PROSPERO registration number: CRD420251069310. Full article

Background: Gestational diabetes mellitus (GDM) is a type of diabetes diagnosed during pregnancy and its prevalence is on the rise around the world. GDM increases the risk of serious adverse health outcomes for the mother and child. Multiple types of non-pharmacological interventions have been developed for the management and prevention of GDM; however, there is a lack of clarity regarding their effectiveness. Objective: To summarize the evidence on the efficacy of non-pharmacological interventions in the management and prevention of GDM. Methods: For this integrative review, a comprehensive literature search was conducted in the databases MEDLINE, CINAHL, Embase, Scopus, and Web of Science. The methodology followed the integrative approach outlined by Whittemore and Knafl’s, and study quality was evaluated using the Mixed Methods Assessment Tool. Results: A total of 44 relevant studies were included. Key themes identified for GDM management were (1) nutrition therapy and physical activity, (2) social and psychological support, (3) digital tools, and (4) barriers and facilitators. For GDM prevention, themes were categorized into individual-level approaches, (5) lifestyle and supplements, and population-level approaches: (6) environmental factors, and (7) health in all policies. Conclusions: The growing prevalence of GDM is a major public health concern that requires the implementation of effective multi-level evidence-based strategies. Environmental, socioeconomic, and racial determinants of health have substantial impacts on GDM, highlighting the need to address the root causes of the illness. Further research is needed to support effective preventive and management measures beyond standard pharmacological treatment, so that evidence-based solutions can be applied to enhance and safeguard the health of current and future generations. Full article

Inspired by the free swing of coral tentacles driven by water currents to actively repel microbial attachment, we have identified a unique physical anti-fouling strategy: coral “swinging effect” anti-fouling. Taking the fleshy soft coral (Sarcophyton trocheliophorum) as an example, its surface is covered with numerous soft tentacles. These coral tentacles utilize the force of water current fluctuations to freely sway, resembling a “feather duster” waving to repel microorganisms attempting to settle and establish themselves. Based on this characteristic, this study delves into the living habits of corals, observing the expansion and contraction cycles of their tentacles. Simultaneously, simulations of the anti-fouling performance of coral tentacles were conducted. It demonstrates that the “swinging effect” of the tentacles can effectively prevent the attachment of fouling organisms. Furthermore, this study uses S. trocheliophorum as a biomimetic prototype to design and prepare an artificial coral-mimic substrate (ACMS). It employs the common marine Gram-negative bacterium Paracoccus pantotrophus as a microbial sample to test anti-fouling performance in both pure static water environments and low-flow water environments. The results showed that the 13 mm-long ACMS could bend and overlap the surface of the rear tentacles to the greatest extent under the unidirectional scouring action of low-speed water flow (3.5 m/s), forming an anti-fouling protective layer. Additionally, the “swinging effect” phenomenon generated by the tentacles under water flow scouring demonstrated excellent anti-fouling effects. This study not only provides further evidence for research on coral antifouling performance but also offers new concepts and ideas for antifouling strategies in low-flow water environments, such as stationary ships in ports and underwater infrastructure facilities at docks. Full article

Osteoarthritis (OA) is a major cause of equine lameness, with few effective disease-modifying treatments. This systematic review, conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluated the efficacy of platelet-rich plasma (PRP) for equine OA by analyzing 11 studies (6 clinical, 5 experimental) identified through Web of Science, Scopus, and PubMed (2000–2024). The screening process identified 252 records, of which 136 were duplicates and 105 were excluded based on predefined criteria. The analysis showed that intra-articular PRP injections are generally safe, with transient synovial inflammation occurring mainly when PRP was activated with bovine thrombin. Both leukocyte-rich (L-PRP) and leukocyte-poor (P-PRP) formulations exhibited comparable efficacy, though optimal platelet concentrations (423–658 × 10³/μL) and dosing regimens remain undefined. A PRISMA-based quality assessment highlighted substantial variability in study design, with clinical trials constrained by small sample sizes and high risk of bias. Experimental studies confirmed PRP’s biological activity but showed inconsistencies in preparation methods. The findings indicate that PRP activation is unnecessary and may even be pro-inflammatory, that multiple injections could improve outcomes, and that reporting of cellular composition is inconsistent across studies. The PRISMA framework identified critical evidence gaps, particularly regarding long-term efficacy and protocol standardization. These results emphasize the need for PRISMA-compliant randomized controlled trials featuring standardized PRP protocols, validated outcome measures, and extended follow-up periods to establish evidence-based guidelines for managing equine OA. Full article

Background/Objectives: In recent years, the use of gamification has been growing in health education. In undergraduate nursing programs, it aims to enhance motivation, engagement, knowledge retention, and professional competencies. However, the evidence often combining nursing students with other disciplines or focusing on specific tools rather than the broader concept. This systematic review will synthesize the impact of gamification strategies on educational outcomes in undergraduate nursing education. Methods: This protocol was written according to PRISMA-P guidelines and is registered in PROSPERO (CRD420251117719). Eligible studies will include randomized controlled trials, quasi-experimental, and observational designs involving undergraduate nursing students exposed to gamification interventions in classroom, online, or clinical training settings. Comparators may include traditional lecture-based instruction or other non-gamified methods. We will search the PubMed, CINAHL, PsycINFO, Web of Science, Scopus, and Google Scholar databases, covering January 2010 to July 2025, without language restrictions. Two reviewers will independently screen studies, extract data, and assess risk of bias using Cochrane RoB-2, ROBINS-I, and JBI Critical Appraisal Tools. Where possible, a meta-analysis will be conducted; otherwise, findings will be synthesized narratively. Results: Not applicable; this is a protocol. Findings will be synthesized as specified in the Methods. Conclusions: This review will provide a comprehensive synthesis of gamification’s effectiveness in undergraduate nursing education, identifying the most effective strategies and the contexts in which they perform best. Full article

Background/Objectives: Triple-negative breast cancer (TNBC) is an aggressive subtype lacking ER, PR, and HER2 expression, with limited targeted therapies and poor outcomes. Epigenetic dysregulation, particularly aberrant DNA methylation, is a key driver. Decitabine, a DNA methyltransferase inhibitor (DNMTi), shows promise by reactivating silenced tumor suppressor genes and modulating immune responses. This systematic review evaluates preclinical and clinical evidence on decitabine’s efficacy, mechanisms, and translational potential in TNBC. Methods: A PRISMA-2020 compliant search of PubMed, EBSCO, Web of Science, and Semantic Scholar was conducted up to April 2025. Included studies assessed decitabine alone or in combination in TNBC preclinical or clinical settings. Risk of bias was assessed using QUIPS and RoB 2.0 tools. Results: Twenty-five studies were included. In vitro, decitabine-induced growth inhibition, apoptosis, and re-expression of silenced genes (such as BRCA1 and CDH1). In vivo, it reduced tumor burden and enhanced anti-tumor immunity through MHC-I, PD-L1, and STING pathway upregulation. Synergy was noted with anti-PD-1, HDAC inhibitors, and chemotherapy. Resistance mechanisms included persistent DNMT activity, low DCK, and miRNA-driven escape (miR-155–TSPAN5). Conclusions: Decitabine demonstrates strong preclinical and early clinical potential in TNBC via epigenetic reprogramming and immune activation. Future strategies should focus on biomarker-based selection and resistance mitigation. Full article

Postoperative edema is a nearly universal consequence of aesthetic surgery, yet its clinical implications and potential progression to lymphedema remain underexplored. This review examines the prevalence, pathophysiology, diagnostic criteria, and management strategies for edema and lymphedema following aesthetic procedures. A comprehensive search of PubMed, Embase, and Cochrane databases identified studies involving adult patients undergoing aesthetic surgeries with documented postoperative edema or lymphedema. The review found that while edema is expected postoperatively and is generally self-limiting, persistent or disproportionate swelling may indicate early lymphedema. Risk factors include extensive liposuction, body contouring, and procedures involving lymphatic disruption. Despite its significance, lymphedema remains underdiagnosed due to a lack of standardized diagnostic criteria and low clinical suspicion. Emerging imaging modalities, such as indocyanine green lymphography, enhance early detection, while conservative treatments, such as manual lymphatic drainage, compression, and physical therapy, remain first-line interventions. Increased awareness among surgeons and incorporation of lymphatic-preserving techniques are vital to reducing morbidity. This review underscores the importance of distinguishing transient edema from chronic lymphedema and calls for further research to establish evidence-based guidelines for diagnosis, prevention, and management of postoperative lymphedema in aesthetic surgery. Full article

Aging is a complex biological process influenced by internal and external factors, with diet and gut microbiota emerging as pivotal, interconnected modulators. This review explores their triangular relationship, emphasizing how they dynamically interact to shape health across the lifespan. Aging involves notable shifts in gut microbiota, including reduced diversity, increased pro-inflammatory taxa, and impaired production of key metabolites, like short-chain fatty acids. These changes contribute to systemic inflammation, immune-senescence, and age-related conditions, such as cognitive decline and metabolic disorders. Diet, particularly Mediterranean and plant-based patterns, plays a critical role in modulating gut microbiota by enhancing beneficial microbes and their metabolic functions. In contrast, Western-style diets rich in saturated fats and processed foods promote dysbiosis and accelerate aging. The review synthesizes evidence from human studies, animal models, and interventions to show how microbiota mediates diet-driven effects on aging. It also explores the role of specific nutrients, fiber, omega-3 fatty acids, and polyphenols in influencing microbial and host aging biology. Emerging therapies, including probiotics, prebiotics, and precision nutrition, show promise for promoting healthy aging by restoring microbial balance. However, gaps remain, including the need for long-term, age-specific studies, standardized microbiome protocols, and integrated omics approaches to support targeted longevity strategies. Full article

This study proposes a hybrid deep learning framework for predicting vehicle crash frequency (F_i) using nationwide traffic accident and traffic volume data from the United States (2019–2022). Crash frequency is defined as the product of exposure frequency ($N_a$) and crash risk rate ($\lambda$), a structure widely adopted for its ability to separate physical exposure from the crash likelihood. $N_a$ was computed using an extended Safety Performance Function (SPF) that incorporates roadway traffic volume, segment length, number of lanes, and traffic density, while $\lambda$ was estimated using a multilayer perceptron-based deep neural network (DNN) with inputs such as impact speed, road surface condition, and vehicle characteristics. The DNN integrates rectified linear unit (ReLU) activation, batch normalization, dropout layers, and the Huber loss function to capture nonlinearity and over-dispersion beyond the capability of traditional statistical models. Model performance, evaluated through five-fold cross-validation, achieved R² = 0.7482, MAE = 0.1242, and MSE = 0.0485, demonstrating a strong capability to identify high-risk areas. Compared to traditional regression approaches such as Poisson and negative binomial models, which are often constrained by equidispersion assumptions and limited flexibility in capturing nonlinear effects, the proposed framework demonstrated substantially improved predictive accuracy and robustness. Unlike prior studies that loosely combined SPF terms with machine learning, this study explicitly decomposes F_i into $N_a$ and $\lambda$, ensuring interpretability while leveraging DNN flexibility for crash risk estimation. This dual-layer integration provides a unique methodological contribution by jointly achieving interpretability and predictive robustness, validated with a nationwide dataset, and highlights its potential for evidence-based traffic safety assessments and policy development. Full article

Background: Speckled lentiginous nevus (SLN), also known as nevus spilus (NS), is a variant of congenital melanocytic nevus. Although historically considered to have low malignant potential, recent studies have reported melanoma arising within SLN. This study presents a systematic review of multiple melanomas occurring in association with SLN and includes a representative clinical case. Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was performed from 1957 to 2025 using the terms “melanoma” and “nevus spilus” or “speckled lentiginous nevus.” Filters were applied for original reports, case series, and case reports. Studies were selected based on predefined criteria, with data independently extracted by two reviewers. A case of a 66-year-old male with three melanomas (two within and one outside SLN) over nine years is also presented. Because the evidence base consisted almost exclusively of case reports and small series, meta-analysis and formal risk-of-bias assessment were not feasible; findings were therefore synthesized qualitatively. Results: We first describe an illustrative case of a 66-year-old male who developed three melanomas (two within and one outside SLN) over a nine-year period, underscoring the challenges of diagnosis and long-term monitoring. In the systematic review, we identified 41 eligible publications describing 51 patients, and in our illustrative case, we identified a total of 52 with melanoma on SLN; 9/52 (17.3%) developed multiple melanomas (24 total), and in our illustrative case, we identified a total of 52. Most were male (seven of nine), with the first melanoma diagnosed at a mean age of 52.4 years. The majority (21/24) occurred within SLNs ≥5 cm and were of the superficial spreading type (16/17 where specified). Of 24 tumors, 19 (79.2%) were synchronous, and among the 16 invasive melanomas, the mean Breslow thickness was 1.17 mm (median 0.95 mm, IQR 0.56–1.40 mm). Conclusions: Large or segmental SLNs may carry a clinically relevant risk for developing multiple melanomas. Regular full-body skin examinations and dermoscopic monitoring are recommended for early detection and management. As the synthesis is based mainly on case reports and small series, these conclusions are necessarily descriptive and exploratory, providing a qualitative mapping of the available evidence rather than definitive risk estimates. Full article

Background: There is a dearth of evidence on the roles and views of stakeholders regarding the sexually transmitted infections (STIs) service provision among key and priority populations (KPPs) within primary healthcare (PHC) settings. Aim: This study assessed the roles and views of stakeholders regarding the STI services scope, content, accessibility, quality, affordability, and availability, as well as associated gaps and successes among KPP within PHC facilities in the Capricorn District of Limpopo Province in South Africa. Methods: An exploratory research design was used. In-depth face-to-face interviews with 18 STI stakeholders were conducted. The STI stakeholders were purposively selected from five PHC facilities. An inductive analytical approach was employed to develop themes and sub-themes. Tesch’s step analysis informed the development of the thematic analysis process. Results: The presence of peer counsellors, home-based caregivers, and the operation of STI services day and night in two selected facilities enhanced access and availability of STI services. Consistent in-service training for service providers was implemented to improve service quality and maintain professional competency. Barriers that prevented adequate STI service provision in this study included staff shortages, inadequate filing systems, lack of advanced-diagnostic equipment, and patients’ noncompliance with treatment regimens. The successes of the STI service provision were effective STI treatment and services integration within the facilities. Conclusion: The findings of this study have unveiled several methods to increase access and availability to STI services among KPPs in the selected PHC facilities. We recommend gathering responses and experiences from STI service users regarding the current STI service provision to foster innovative and targeted approaches within PHC facilities in Limpopo Province. Full article

Citizen science provides a valuable approach for tracking plastic pollution; however, its effectiveness is often limited by methodological inconsistencies, concerns about data quality, and a persistent gap between data collection and policy implementation. This systematic review addresses the key question: What constitutes a comprehensive set of best practices for addressing these issues and enhancing the scientific and societal impact of citizen science in monitoring plastic pollution from source to sea? Analyzing 84 studies, from beach cleanups to microplastic sampling, this review synthesizes best practices and identifies remaining gaps. It presents a structured framework designed to enhance data quality and volunteer participation. Key challenges include the ‘microplastic analytical bottleneck,’ the ‘digital divide,’ and notable geographical and demographic disparities that hinder the integration of policies. While citizen science is effective for large-scale data collection, its main challenge is translating data into actionable policies. The main contribution of this review is a series of practical recommendations aimed at improving methodological consistency, ensuring fair volunteer participation, and facilitating the transition from citizen data to evidence-based environmental management, thereby enhancing the effectiveness and impact of citizen science. Full article

Bioinspired computing methods, such as Artificial Neural Networks (ANNs), play a significant role in machine learning. This is particularly evident in smart manufacturing, where ANNs and their derivatives, like deep learning, are widely used for pattern recognition and adaptive control. However, ANNs sometimes fail to achieve the desired results, especially when working with small datasets. To address this limitation, this article presents the effectiveness of DNA-Based Computing (DBC) as a complementary approach. DBC is an innovative machine learning method rooted in the central dogma of molecular biology that deals with the genetic information of DNA/RNA to protein. In this article, two machine learning approaches are considered. In the first approach, an ANN was trained and tested using time series datasets driven by long and short windows, with features extracted from the time domain. Each long-window-driven dataset contained approximately 150 data points, while each short-window-driven dataset had approximately 10 data points. The results showed that the ANN performed well for long-window-driven datasets. However, its performance declined significantly in the case of short-window-driven datasets. In the last approach, a hybrid model was developed by integrating DBC with the ANN. In this case, the features were first extracted using DBC. The extracted features were used to train and test the ANN. This hybrid approach demonstrated robust performance for both long- and short-window-driven datasets. The ability of DBC to overcome the ANN’s limitations with short-window-driven datasets underscores its potential as a pragmatic machine learning solution for developing more effective smart manufacturing systems, such as digital twins. Full article