Search Results (22,669)

Background: Hepatitis C virus (HCV) remains a major cause of preventable liver-related mortality in the United States despite highly effective direct-acting antivirals (DAAs). Contemporary assessment of mortality trends and disparities is essential for elimination efforts. Methods: Using CDC WONDER multiple cause-of-death data (1999–2023), we identified HCV-related deaths using ICD-10 codes for acute and chronic HCV (B17.1, B18.2) and calculated age-adjusted mortality rates (AAMRs) per 100,000 (2000 US standard). Rates were stratified by sex, race/ethnicity, census region, and 2013 NCHS urban–rural classification. Joinpoint regression quantified temporal inflection points and annual percent changes (APCs). Results: Overall HCV-related AAMR increased from 1.8 (1999) to a peak of 5.0 (2014), then declined to 2.3 (2023), with a marked post-2014 decrease (APC −8.2%). Mortality was consistently higher in males than females (2023 rate ratio 2.57). In 2023, American Indian/Alaska Native individuals had the highest mortality (AAMR 8.7; rate ratio 3.48 vs. non-Hispanic White), followed by non-Hispanic Black individuals (AAMR 6.2; rate ratio 2.48). Mortality remained highest in the West and was higher in non-metropolitan than metropolitan counties (AAMR 2.8 vs. 2.3; rate ratio 1.22), with a slower post-2014 decline in non-metropolitan areas. Conclusions: Our findings indicate that while the DAA era has been associated with a substantial reduction in HCV-related mortality at the national level, this progress has not been uniform across all populations. Persistent excess mortality among Native American and non-Hispanic Black individuals may reflect inequities in the HCV care cascade, including screening, confirmatory testing, linkage to specialty care, insurance-related restrictions, and the high cost of antiviral therapy. These results highlight the need for policies and public health strategies that improve equitable and affordable access to curative HCV treatment. Full article

Elite women’s rugby has often been analysed using the male performance model as a reference, despite evidence that women’s rugby presents distinct game demands and potentially different risk profiles. This study aimed to compare the frequency of key contact-related events between elite men’s and women’s rugby. An observational, retrospective, comparative cohort study was conducted using official performance data from 135 international matches from the men’s and women’s Six Nations Championships. Variables were grouped into three categories: Open-Play, Static Phases, and Discipline. Independent samples t-tests, Mann–Whitney U tests, and Linear Discriminant Analysis were used to identify sex-based differences. The results showed that men presented a higher frequency of rucks lasting more than 6 s (p < 0.001), whereas no significant differences were found in total tackles (p = 0.378) or total rucks (p = 0.634). In Static Phases, women’s teams recorded significantly more scrums (p < 0.001). In Discipline, women conceded fewer free kicks (p = 0.003) but received more red cards (p = 0.020). In conclusion, elite women’s rugby shares some open-play characteristics with the men’s game but differs in scrum frequency and disciplinary profile, supporting the existence of a distinct contact and risk exposure profile that should be considered when designing training and prevention strategies. Full article

Background: The impact of climate change on birds’ migration and ticks’ reservoir habits is contributing to the spread of Crimean–Congo hemorrhagic fever (CCHF), caused by CCHF virus (CCHFV), to new continents and countries. CCHF is endemic to the Eastern Mediterranean Region, including Iraq, and is witnessing a substantial surge in confirmed cases with considerable disparity and gaps in managing CCHF cases. The increasing CCHF spread across Asia, Africa, and Europe, including Spain and Turkey, highlights the danger of its expansion. Developing high-confidence diagnostic criteria, identifying risk factors, and accurate predictors of CCHF outcomes are critical to managing suspected and confirmed cases of CCHF and to reducing the current case fatality rate of CCHF, which is the goal of this study. Methods: We completed a retrospective evaluation of 61 confirmed cases of CCHF in Basrah (Iraq). The cases were screened according to the clinical presentation, and CCHF cases were identified by ELISA and validated by PCR. Data was analyzed using SPSS version 22. T-tests, chi-square/Fisher exact tests, and Pearson’s correlation were used, with significance set at p < 0.05 and high significance at p < 0.01. Results: We found that repeated exposure to animals during animal slaughtering was a significant risk factor. In addition, 5% of the patients with confirmed CCHF, mainly from rural areas, reported exposure to rats. Clinical presentations included fever, headache, gastrointestinal problems, eye and orbital symptoms, and hemorrhagic complications. Predictors of death included advanced age, decreased platelet counts, and neuropsychiatric symptoms such as delusions and confusion. Conclusions: Our findings identify clinical and laboratory features of CCHF cases in Iraq, which will help to implement the most effective interventions to manage CCHF cases and protect the public in all Iraqi governorates. In summary, this study highlights a recent and significant rise in CCHF cases in Basrah Governorate, Iraq. Notably, 5% of confirmed cases reported contact with rats. The paper also proposes diagnostic criteria and identifies key predictors of mortality to support improved clinical management of CCHF. These findings underscore the urgent need for strengthened public health interventions, including enhanced infection prevention and control measures, increased awareness, and improved surveillance systems. The findings have important implications for improving control procedures, guiding therapeutic development, informing vaccine strategies, and supporting evidence-based policy alongside future research efforts. Full article

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) remains the most frequent and clinically relevant adverse event after ERCP. Although several preventive measures are supported by current evidence, their application in routine practice is often fragmented across the pre-procedural, intra-procedural, and post-procedural phases of care. As a result, patients with evolving risk may not receive timely escalation of prophylaxis or appropriately tailored post-procedural monitoring. This review provides a pragmatic clinical framework for integrating evidence-based PEP prevention with early post-ERCP risk stratification. We summarize baseline risk assessment before ERCP, distinguish routinely applicable preventive measures from strategies reserved for selected high-risk situations, and emphasize the importance of intra-procedural reassessment when procedural events such as difficult cannulation or unintended pancreatic duct manipulation increase risk in real time. We further discuss the role of early symptom assessment and post-procedural amylase/lipase measurement in supporting triage decisions, including selective observation, admission, or same-day discharge in appropriately selected patients. This integrated approach may improve consistency in routine ERCP care while highlighting important limitations related to generalizability, local resources, and implementation. Full article

The cardiovascular risk imposed by chronic kidney disease is significantly enhanced, and carotid atherosclerosis is an early indicator of systemic vascular damage. In this review, we summarize available data relative to primary prevention strategies for carotid atherosclerosis in chronic kidney disease (CKD) with a focus on risk-adapted and stage-specific management. We conducted a narrative review of the literature. A structured literature search was performed in major databases (PubMed, Scopus, Web of Science and Google Scholar), focusing on studies published between 2012 and 2025, including observational studies, randomized controlled trials, and international guideline recommendations. The review focuses on blood pressure management, lipid-lowering therapy, glycemic control, antiplatelet therapy, as well as lifestyle interventions and screening strategies in patients with CKD without a history of cerebrovascular events. CKD-specific processes, such as inflammation, endothelial dysfunction and vascular calcification, may influence the progression of carotid plaques, highlighting the need to improve traditional and non-traditional risk factor management. The focus of prevention continues to emphasize blood pressure (BP) and lipid control as well. At the same time, routine carotid screening and systematically implemented antiplatelet therapy have no known benefit, but the potential for elevated bleeding risk, especially in advanced CKD. Primary prevention should therefore focus on optimal medical treatment, as well as disease-specific strategies according to CKD stage. Additional CKD-specific studies with carotid endpoints are necessary. Full article

Background and Objectives: Complicated cholesteatomatous otomastoiditis includes a spectrum of inflammatory, suppurative, and destructive lesions affecting the temporal bone and surrounding critical structures, including the dura mater, labyrinth, facial nerve, sigmoid sinus, and skull base. The selection of appropriate surgical techniques and closure materials is decisive for long-term outcomes, functional preservation, and prevention of life-threatening complications. This systematic review and meta-analysis evaluates the evidence base for surgical approaches, intraoperative technologies, and autologous and synthetic closure materials used in the management of iatrogenic and disease-related fistulas in otomastoid surgery. Materials and Methods: A PRISMA 2020-compliant search was conducted across PubMed, Cochrane Library, Embase, and Scopus (2000–2024). The review was registered in PROSPERO (CRD420261370406). After the systematic screening process, 56 eligible studies involving 4218 patients were selected for inclusion. The primary outcome measures analysed were infection rates, fistula recurrence, preservation of function, and long-term integrity of the closure. Limitations include the predominance of observational studies and the absence of prospective registration prior to data extraction. Results: Autologous materials demonstrated consistently low infection rates (<10%) in contaminated operative fields and therefore remain the preferred first-line option for the reconstruction of small to moderate defects. In contrast, synthetic materials exhibited superior mechanical durability in large sterile defects, achieving closure integrity rates of 85–92% at two-year follow-up. Hybrid reconstructive constructs provided the most favourable overall outcomes, with pooled closure integrity reaching 91.6%, suggesting a synergistic advantage when combining biologic and synthetic components. Furthermore, the adjunctive use of combined microscopic–endoscopic surgical techniques was associated with a significant reduction in residual cholesteatoma rates (OR 0.56, 95% CI 0.38–0.82), supporting the growing role of endoscopic assistance in middle ear and mastoid surgery. When biologic closure strategies were appropriately selected according to defect characteristics and contamination status, functional preservation rates exceeded 90–95%, underscoring the importance of tailored reconstructive approaches. Conclusions: The durability of long-term outcomes is most strongly influenced by complete pathological clearance and by the strategic alignment of biomaterial properties with defect dimensions, contamination status, and surrounding anatomical structures. In response to these findings, an evidence-based algorithmic framework is proposed to facilitate rational intraoperative material selection. Full article

Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures. Full article

Background/Objectives: Musculoskeletal pain represents a frequent and increasingly recognized health issue during adolescence. During this developmental phase, daily habits such as prolonged sitting, sedentary behaviors and the adoption of non-neutral postures may contribute to spinal overload and pain symptoms. This study contributes to the existing literature by focusing on concrete postural behaviors in real-life daily situations, an aspect that is still underexplored despite its relevance for musculoskeletal health. The aim of this study was to investigate the associations between daily habits, postural behaviors and the presence of back and neck pain. Methods: A cross-sectional study was conducted on a sample of 70 adolescents aged 10–20 years. Data were collected using the Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA), administered online. Descriptive statistics and chi-square tests with effect sizes (Cramer’s V) were used to examine associations between postural behaviors, lifestyle factors, and pain outcomes, providing an inferential assessment beyond simple descriptive analysis. Results: Significant associations were found between gender and back pain, sitting posture during daily activities (writing at the desk and talking with friends) and back pain, with flexed or asymmetrical postures more frequently reported among participants with pain, and between back and neck pain (p < 0.05). Conclusions: The findings highlight the relevance of gender and daily postural behaviors as factors associated with musculoskeletal pain in adolescents. By identifying posture-specific behaviors linked to pain, this study provides preliminary evidence that can inform targeted preventive strategies and guide future research on modifiable daily habits in youth. Full article

In response to inherent occupational and operational stress in public safety personnel (PSP), multiple policies and interventions have been implemented, often with sparse or low-quality research. The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard) is a comprehensive framework aimed at promoting mental health and preventing psychological harm in Canadian workplaces. This longitudinal multiple-cohort implementation science project describes mental health strategies implemented and associated organizational outcomes across five PSP organizations implementing change within the standard framework. Data were collected at two levels over a three-year span from the five public safety organizations that identified priority areas for improvement within the Standard based on local data and consultations. The organization selected and implemented a range of proactive mental health interventions, including resiliency training. Individual pre-post surveys assessed a variety of mental health disorders and work-related items. Annual organizational data included sick leave hours and extended health benefits for psychological services. Survey responses were aggregated at the organizational level. Rank-based correlation analyses (Kendall’s tau) described associations among occupational stress, work engagement, stigma, and organizational indicators. Organizations demonstrated multiple indicators of progress in meeting the Standard. Post-mental health symptom scores were positively correlated with extended health costs. Higher organizational stress scores were associated with higher extended health costs (psychological) (τ = 1.0 at pre-intervention; 0.67 post-intervention). Positive changes in organizational stress scores and higher engagement scores over the implementation process were both associated with lower average extended health costs (τ = 1.0/−1.0 respectively). Resilience scores were inversely related to health costs (τ = −0.67), consistent with the protective role of resilience. The Standard can serve as a framework for improving workplace health and safety when integrated with multi-modal action plans and structured resilience programs. Full article

The development of renewable energy is vital for addressing future climate change and environmental degradation. Nevertheless, the irregular and fluctuating essential features of wind power presents a considerable barrier to grid operational stability. Hence, precise prediction of wind energy output is crucial for improving power system management, boosting the reliability of the supply, and minimizing reserve expenditure. This study presents a predictive model designed for predicting short-term wind speeds using a stacking ensemble approach, which is based on an enhanced Multi-Feature Zebra Optimization Algorithm (IZOA-Stacking). In the data preprocessing phase, to minimize computational costs and prevent overfitting, a module tailored to the various features affecting wind power is developed for the IZOA-Stacking model. Grey relational analysis and Pearson correlation analysis are employed to determine and filter feature correlations. Critically, the preprocessing module demonstrates strong robustness: the One-Class Support Vector Machine (OneSVM) model is applied to identify and replace 100% of anomalous wind speed data, which leads to a substantial and measurable increase in feature correlation and overall model performance. For instance, when retaining wind speed features, the One-Class Support Vector Machine (OneSVM) model is employed to eliminate anomalous wind speed data. During model construction, a stacking ensemble learning strategy integrates multiple prediction models, including Long Short-Term Memory (LSTM) net-works, Extreme Gradient Boosting (XGBoost), ridge regression (RR), and Residual Networks (ResNets). This integration leverages the predictive strengths of each model. Additionally, the improved Zebra Optimization Algorithm (ZOA) optimizes the hyperparameters of each constituent model, further enhancing forecasting accuracy. The findings suggest that the proposed model demonstrates better performance than reference competitor models with regard to predictive accuracy. Full article

Barely Visible Impact Damage (BVID) in heterogeneous polymer-matrix composites remains difficult to detect because subtle damage signatures are often masked by complex architectures, hybrid textures, and overlapping failure morphologies. This study therefore presents an experimentally grounded, physics-aware, and statistically validated vision-based inspection framework rather than a purely detector-centered benchmarking exercise. Real post-impact images were obtained from controlled low-velocity impact experiments on 20 composite architectures and 60 physical specimens, yielding approximately 2000 images across laminated, hybrid, textile-reinforced, and sandwich structures. The dataset was organized using a specimen-disjoint splitting protocol to prevent leakage across training, validation, and test subsets. To improve robustness while preserving physical realism, a physically grounded Albumentations strategy was developed using only physically admissible transformations and explicit exclusion of non-physical operations that could distort damage morphology or surface continuity. Model development was further complemented by a hybrid hardware workflow in which cloud-based GPU training was combined with deployment-oriented inference profiling on resource-constrained edge-like hardware, thereby linking detection accuracy to practical industrial feasibility. In addition, model performance was evaluated under a standardized training budget and validated through repeated runs, Friedman significance testing, and Holm-corrected Wilcoxon signed-rank pairwise comparisons to ensure error-controlled interpretation of inter-model differences. Across the evaluated compact YOLO families, YOLO26s delivered the strongest overall performance, reaching 0.841 mAP@0.5, 0.586 ± 0.004 mAP@0.5:0.95, and an F1-score of 0.809, while YOLO11s achieved the highest precision and YOLO26n remained competitive in recall with nano-level compactness. Overall, the results show that experimentally generated heterogeneous composite data, morphology-preserving augmentation strategy development, leakage-aware dataset design, deployment-oriented computational profiling, and statistically grounded validation together provide a more robust and application-relevant basis for automated BVID detection in polymer-matrix composite structures. Full article

Hyperspectral anomaly detection (HAD) aims to identify rare targets without relying on prior target knowledge. However, background spectra in hyperspectral images often lie on highly complex and nonlinear manifolds, making accurate modeling challenging. Although models with strong nonlinear approximation capabilities, such as Kolmogorov–Arnold Networks (KANs), provide a promising solution for capturing such complexity, self-supervised reconstruction-based HAD methods still suffer from a fundamental issue known as anomaly leakage. When the model has high representation capacity, anomalous signatures tend to be partially reconstructed, which reduces residual contrast and degrades detection performance. To address this issue, we propose a Blind-Spot KAN-based background reconstruction network with prior purification (BKP-Net), which mitigates anomaly leakage from both data and model perspectives. Specifically, we first introduce a Background Prior Purification (BPP) module to construct a cleaner background prior. This module suppresses and replaces potential outlier pixels through spatial clustering and robust weighted mean estimation. We then design a Blind-Spot KAN-based Reconstruction backbone (BKCN) to model complex nonlinear background characteristics while preventing direct information flow from the center pixel, thereby reducing anomaly leakage during reconstruction. In addition, separable convolutions are employed to enhance spatial–spectral feature representation, followed by an attention-guided fusion mechanism to suppress cross-domain interference. Furthermore, a band-wise Guided Reconstruction Refinement (GRR) strategy is introduced in the detection phase to improve structural consistency between the reconstructed background and the original hyperspectral image, leading to more reliable anomaly discrimination. Experimental results on four hyperspectral datasets demonstrate that the proposed method achieves competitive performance compared with several representative traditional and deep learning-based detectors. Full article

Parkinson’s disease (PD) is a neurodegenerative disorder of the central nervous system with a complex pathogenesis. Current conventional medicines are predominantly symptomatic treatments, which fail to reverse neuronal degeneration and often induce severe motor complications following long-term administration. In this context, the advantages of the multi-target holistic regulation provided by traditional Chinese medicine have become increasingly prominent. As the core active ingredients of Panax ginseng, ginsenosides can penetrate the blood–brain barrier and exhibit broad neuroprotective prospects in PD treatment. This article systematically reviews the neuroprotective mechanisms of different configurations of ginsenosides—mainly including protopanaxadiol (PPD) and protopanaxatriol (PPT) saponins—against PD. Studies indicate that PPD-type saponins (e.g., Rb1, Rg3, Rd) excel in directly inhibiting the abnormal aggregation of α-synuclein (α-syn), reducing oxidative stress, and preventing neuronal apoptosis. Conversely, PPT-type saponins (e.g., Rg1, Re) demonstrate significant advantages in suppressing microglia-mediated neuroinflammation, improving mitophagy, and regulating lipid metabolism networks. Furthermore, this review highlights a novel intervention strategy utilizing ginsenosides based on antioxidation and iron metabolism regulation. By maintaining the homeostasis of iron transport proteins such as DMT1 (Divalent Metal Transporter 1) and FPN1 (Ferroportin 1), and activating the Nrf2/xCT/GPX4 signaling axis, these compounds effectively block the vicious cycle of “iron deposition-oxidative stress-lipid peroxidation (LPO),” thereby inhibiting ferroptosis in dopaminergic neurons. In summary, structurally diverse ginsenosides exhibit distinct characteristics in targeting the core pathological events of PD. The scientific combination of ginsenoside monomers with different mechanisms in the future holds promise for constructing a comprehensive multi-target neuroprotective network, providing a solid theoretical foundation for novel ginsenoside-based combination therapies against PD. Full article

Candida albicans-associated denture stomatitis is a common inflammatory condition in denture wearers. Conventional tissue conditioners provide temporary relief but lack intrinsic antifungal activity, allowing persistent microbial colonization and biofilm formation. Functionalization with bioactive agents represents a promising preventive strategy. This study evaluated the antifungal efficacy and biocompatibility of pterostilbene (PTE), a natural stilbenoid compound, incorporated into a commercially available tissue conditioner. Antifungal activity of PTE against C. albicans ATCC 10231 was evaluated using broth microdilution and XTT biofilm assays. Tissue conditioner discs containing 1% and 2.5% (w/w) PTE were fabricated and tested after 24 h, 72 h, and 1 week using colony-forming unit (CFU) counts and metabolic activity assays. Biocompatibility was assessed by exposing mouse embryonic fibroblast (MEF) cells to conditioned eluates followed by an MTT viability assay. PTE inhibited biofilm formation in a concentration-dependent manner, with significant suppression observed at ≥8 µg/mL (p < 0.001). A time-dependent antifungal effect was observed over one week. PTE-functionalized tissue conditioners significantly reduced fungal adhesion compared with controls at all-time points (p < 0.001). Cell viability remained above 70%, meeting ISO 10993-5 criteria for non-cytotoxicity, indicating potential for localized prevention of denture stomatitis. Full article

Background: Schools are widely recognized as key settings for promoting healthy eating behaviors and supporting childhood obesity prevention. In recent years, increasing attention has been devoted to experiential and interactive nutrition education strategies designed to actively engage children and adolescents in food-related learning processes. These approaches move beyond traditional didactic teaching and include practical and participatory formats, such as cooking activities, school gardening, digital or app-based learning tools, workshops and educational camps, and game-based learning interventions. Objective: This narrative review aims to provide an overview of experiential school-based nutrition education interventions, describing the main types of programs implemented in school settings and summarizing their reported effects on nutrition knowledge, attitudes, and eating behaviors among children and adolescents. Results: Across intervention studies and systematic reviews, hands-on and interactive educational models, including cooking classes, gardening programs, digital learning tools, workshops or camps, and board game-based interventions, frequently report improvements in nutrition knowledge, attitudes toward food, food-related skills, and self-efficacy. These programs seek to strengthen food literacy by combining experiential learning with educational content delivered within the school environment. Evidence regarding changes in dietary intake, diet quality, and anthropometric outcomes is more heterogeneous, with some studies reporting improvements in eating behaviors and others showing more modest or short-term effects. Program outcomes appear to be influenced by several contextual factors, including intervention duration, curriculum integration, teacher involvement, and the availability of resources supporting implementation. Conclusions: Experiential and interactive approaches represent an increasingly adopted strategy in school-based nutrition education. Their effectiveness appears to depend on the quality of implementation, the degree of integration within the school curriculum, and the broader educational context. Future research should further explore how different experiential formats can be optimally integrated into school systems to support the development of food literacy and sustainable healthy eating behaviors among children and adolescents. Full article