Search Results (61,432)

Background/Objectives: Falls are a major public health concern among older adults, often resulting in injury, mortality, and loss of independence. Understanding fall-related risk factors is essential for developing effective prevention strategies. This study examined the multifactorial risk assessment of falls among Thai community-dwelling older adults, aiming to identify and prioritize modifiable risk factors for targeted interventions in the Thai context. Methods: A cross-sectional study was conducted among 5694 adults aged ≥60 years who attended a comprehensive geriatric clinic in Bangkok, Thailand, between March 2019 and December 2023. All participants underwent a comprehensive geriatric assessment and fall history screening. Logistic regression analysis was performed to identify independent predictors of falls and recurrent falls. Results: Among the 5694 participants, 17.7% reported at least one fall in the past year, and 4.1% experienced recurrent falls. Independent risk factors for falls included female sex (OR = 1.74), unsteadiness (OR = 1.54), fear of falling (OR = 1.22), sedative drug use (OR = 1.38), and low gait speed (<1 m/s; OR = 1.70). Recurrent falls were additionally associated with urinary incontinence (OR = 1.78). Most falls occurred outdoors (58.5%), primarily due to environmental hazards such as slippery floors and uneven surfaces. The Clinical Test of Sensory Integration of Balance (CTSIB) showed no difference between fallers and non-fallers, except under the eyes-open on firm surface condition, where recurrent fallers exhibited significantly greater postural sway (p = 0.048). Conclusions: In community-dwelling Thai older adults with robust or pre-frail status, the three key questions for fall risk screening appear to be the most effective tool. Modifiable risk factors strongly associated with fallers and recurrent fallers include sedative use, urinary incontinence, and unsteadiness. Accordingly, medication review, urinary incontinence screening, and balance assessment may help prevent falls. The CTSIB may have only limited value in differentiating fall risk between fallers and non-fallers in this population. Full article

Background: Multiple Myeloma (MM) is the most common type of blood cancer among black individuals. CAR-T therapy is crucial, but often inaccessible to many black patients and those from underserved communities. The University of Kansas Health System administers over 100 CAR-T treatments annually and aims to evaluate barriers to CAR-T therapy access related to the social determinants of health in the Midwest area. Methods: This study examined patients with MM referred for CAR-T therapy from January 2021 to December 2023, assessing how race, socioeconomic status, and insurance influenced eligibility for leukapheresis. Data on income and travel were gathered from the 2022 US Census and analyzed using R software. Results: The study included 271 referrals for MM CAR-T therapy involving 179 patients, with a median age of 66 years (51% male). Demographics: 80% white, 16% black, 2.2% other races, 1.8% Asian, with a median income of $70,644. Nearly half lived more than 30 min from the center (Mainly from Kansas, Missouri and Nebraska). Apheresis rates were similar across racial groups: 54% for whites, 54% for blacks, and 50% for others, while none of the three Asian patients proceeded. Nine patients (5%) could not proceed because of caregiver or insurance barriers, and cell collection rates were comparable regardless of distance (34% vs. 35%). Conclusion: This study showed that black representation in CAR-T access matches local demographics, indicating less disparity among minorities. Unlike national reports, distance, income, and insurance do not significantly affect access, suggesting the need for a national study on the social determinants impacting CAR-T access for multiple myeloma. Full article

Introduction: The number of older adults living with frailty undergoing gastrointestinal cancer surgery is increasing. To address the unique needs of the population, a whole pathway perioperative geriatrics strategy—PRIME—was developed to integrate geriatric principles into surgical care. The objective of this study was to evaluate the implementation of PRIME using validated structural, process, and outcome quality indicators. Materials and Methods: This retrospective cohort study included 106 consecutive patients aged 70 years and older who underwent gastrointestinal surgery for cancer or pre-cancerous lesions at a single institution between 1 July 2020 and 5 October 2023. The whole pathway perioperative geriatrics strategy, PRIME, includes preoperative comprehensive geriatric assessment (CGA), collaborative care between surgery, geriatrics, and anesthesia, and post-operative co-management. Implementation was evaluated using validated structural, process, and outcome quality indicators. Results: Most structural indicators (five of eight) were implemented. In terms of process indicators, 96.2% (n = 102) received CGA prior to or within 24 h of admission. Adherence to screening was high: 97.2% for dementia, 96.2% for functional status, and 95.3% for frailty. The median number interventions resulting from CGA was 17 (IQR 14–20). Serious complication, delirium, and functional decline occurred in 19.8%, 27.1%, and 19.8%, respectively. Conclusions: Implementation of a perioperative geriatrics strategy for older adults undergoing gastrointestinal cancer/pre-cancer lesion surgery is feasible, with high adherence to structural and process quality indicators. Full article

Objectives: Virtual reality (VR) has emerged as a promising tool for assessing anxiety-related disorders through immersive exposure and physiological monitoring. This study aimed to evaluate whether multimodal data, including heart rate variability (HRV), skin conductance response (SCR), and self-reported anxiety, collected during VR exposure could classify patients with panic disorder and agoraphobia using machine learning models. Methods: Seventy-six participants (38 patients with panic disorder and agoraphobia, 38 healthy controls) completed 295 total VR exposure sessions. Each session involved two road and two supermarket scenarios designed to induce anxiety. Inside the sessions, self-reported anxiety was measured along with physiological signals recorded by photoplethysmography and SCR sensors. HRV measures of heart rate, standard deviation of normal-to-normal intervals, and low-frequency to high-frequency ratio were extracted along with SCR peak frequency and average amplitude. These features were analyzed using Gaussian Naïve Bayes (GNB), k-Nearest Neighbors (k-NN), Logistic Ridge Regression (LRR), C-Support Vector Machine (SVC), Random Forest (RF), and Stochastic Gradient Boosting (SGB) classifiers. Results: The best model achieved an accuracy of 0.83. Most models showed specificity and precision ≥0.80, while sensitivity varied across models, with several reaching ≥0.82. Performance was stable across major hyperparameters, VR-stimulus settings, and medication status. The patients reported higher subjective anxiety but exhibited blunted physiological responses, particularly in SCR amplitude. Self-reported anxiety demonstrated higher feature importance scores compared to other physiological properties. Conclusion: VR exposure with self-reported anxiety and physiological measures may serve as a feasible diagnostic aid for panic disorder and agoraphobia. Further refinement is needed to improve sensitivity and clinical applicability. Full article

Chronic hepatitis B virus (HBV) infection may influence extrahepatic systems, including endocrine and lipid regulation. In this cross-sectional study, 186 adults were stratified by HBV DNA status and viral load to examine thyroid function, systemic inflammation, and lipid metabolism, with further analyses by age and sex. Thyroid-stimulating hormone (TSH, a pituitary regulator of thyroid function) levels were significantly lower in HBsAg-positive individuals compared with controls; however, this association was attenuated after stratification by viral load, indicating that the relationship is not unequivocally independent of HBV DNA levels, as free thyroxine (FT4, the circulating thyroid hormone reflecting gland activity) levels remained stable. Lipid profiles displayed demographic-specific patterns: males with high viral load exhibited lower HDL cholesterol, whereas younger HBV-positive individuals showed higher LDL cholesterol. CRP levels were unaffected by HBV status or viral load, aligning with the absence of systemic inflammation in early or inactive disease stages. Age was a major determinant across biomarkers, with complex interactions involving sex and viral load. These findings indicate subtle but clinically relevant extrahepatic effects of HBV infection and underscore the need for personalized monitoring and longitudinal studies to clarify metabolic and cardiovascular implications. These subgroup trends should be interpreted with caution given the absence of BMI, liver enzyme, fibrosis, medication, and comorbidity data in this retrospective cohort. Full article

Background/Objectives: Discrimination has wide-ranging implications, affecting patients’ trust in healthcare professionals and their intentions to seek care. It can cause barriers that can affect access to care, especially among racial and ethnic minority groups in mental healthcare settings. Hence, we aim to examine the relationship between racial discrimination and reasons for using telehealth services. Method: Using the 2022 Health Information National Trends Survey (HINTS-6), we isolated 6017 participants who reported on discrimination inquiry. The primary dependent variable in this study is self-reported discrimination in healthcare, while the main independent variable is the reason for the most recent telehealth visit, and several socio-demographic variables were included as covariates, including age, sex, education, income, and marital status. Descriptive statistics were generated, and multivariable regression analysis was estimated as well, with a p-value < 0.05. Results: Non-Hispanic Black individuals had significantly higher odds of reporting discrimination compared to non-Hispanic White individuals (crude OR: 11.85, 95% CI: 7.67–18.309). Similarly, Hispanic individuals (crude OR: 4.626, 95% CI: 2.899–7.384) and individuals of other racial backgrounds (crude OR: 6.883, 95% CI: 4.04–11.729) had significantly increased odds of experiencing discrimination. Conclusions: The findings of this study offer critical insights into the determinants of perceived discrimination within telehealth services. Given the sustained integration of telehealth into healthcare delivery, it is imperative to develop and implement targeted strategies that provide education and resources to promote health equity among Non-Hispanic Black patients. Full article

Current consumer trends for meat production with reduced antibiotic use constitute huge challenges in animal farming. Using indigenous raw materials such as aromatic or medicinal plants or their extracts could positively affect or retain animals’ health. The present study aimed to evaluate the effects of medicinal plant extracts and essential oils on pig performance parameters, health indices and meat quality. A phytobiotic mixture (PM) consisting of oregano (Origanum vulgare subsp. hirtum) essential oil, rock samphire (Crithmum maritimum L.) essential oil, garlic flour (Allium sativum L.) and false flax flour (Camelina sativa L. Crantz) was used in pig diets, containing in the experimental trials two different proportions of the oregano essential oil (200 mL/t of feed vs. 400 mL/t of feed). Three groups of weaned pigs were fed either the control diet (CONT) or one of the enriched diets (PM-A or PM-B, 2 g/kg). After a 43-day feeding period, at 77 days of age, blood was taken from the jugular vein for biochemical and hematological tests, and eight pigs were humanely slaughtered. A microbiological analysis of intestinal digesta from the ileum and caecum was conducted. Additionally, meat tissue cuts (biceps femoris, external abdominal and triceps brachii) were collected for a chemical analysis, fatty acid lipid profile and oxidative stability testing. The statistical analysis revealed no differences (p > 0.05) in the body weights and growth rates among the groups. An increase (p < 0.05) in total aerobic bacteria was detected in the ileum of group PM-A, while Escherichia coli (E. coli) counts were reduced (p < 0.05) in group PM-B. In the caecum, reductions in Enterobacteriaceae and Lactobacillaceae counts were observed in groups PM-A and PM-B. Concentrations of malondialdehyde (MDA) as an indicator of lipid peroxidation were significantly reduced (p < 0.05) in triceps brachii and biceps femoris for both groups PM-A and PM-B (day 0). A reduction (p < 0.05) in MDA was noticed in triceps brachii and external abdominal meat samples (day 7) for groups PM-A and PM-B. In addition, the fatty acid profile of the meat lipids (ΣPUFA, h/H and PUFA/SFA ratios) was positively modified (p < 0.05) in the ham and belly cuts. The addition of the PM significantly (p < 0.05) affected the redness of the ham and shoulder meat (a* value increased), the yellowness of only the ham (b* value decreased) and the lightness of both belly (L* value increased) and ham samples (L* value decreased). The meat proximate analysis, as well as hematological and biochemical parameters, did not identify any differences (p > 0.05) between the groups. In conclusion, the two investigated mixtures could be used in weaned pigs’ diets, with positive results in intestinal microbial modulation, oxidative stability, fatty acid profile and color characteristics of the pork meat produced. Full article

Oxidative stress is caused by an imbalance between the formation of reactive oxygen species (ROS) and the activity of antioxidant defense system, which disrupts redox signaling and causes molecular damage. While there are numerous methods to measure oxidative stress, the complex and dynamic nature of ROS production and antioxidant reactions requires a multi-faceted approach. Direct methods such as electron spin resonance (ESR) and fluorescent probes measure ROS directly but are limited by the short lifespan of certain species. Indirect methods such as lipid peroxidation markers (e.g., malondialdehyde, MDA), protein oxidation (e.g., carbonyl content), and DNA damage (e.g., 8-oxo-dG) provide information on oxidative damage, but they do not capture the real-time dynamics of ROS. The antioxidant defense system, which includes enzymatic components such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), further complicates assessment, as it responds dynamically to oxidative challenges. Furthermore, the compartmentalized nature of ROS production in organelles and tissues coupled with the temporal variability of oxidative damage and repair underscores the need to integrate multiple assessment methods. This commentary highlights the limitations of using single assays and emphasizes the importance of combining complementary techniques to achieve a comprehensive assessment of oxidative stress. A multi-method approach ensures accurate identification of ROS dynamics, antioxidant responses, and the extent of oxidative damage, providing crucial insights into redox biology and its impact on health and disease. Full article

The growth in the production and use of biodegradable plastics, positioned as an environmentally friendly alternative to traditional polymers, has led to an increase in their distribution in the environment. However, in conditions other than industrial composting facilities, biodegradable polymers can persist for a long time, fragment, and form biodegradable micro- and nanoplastics (BioMNP) with potential toxicity. Unlike traditional microplastics, the impact of BioMNP on human health has been poorly studied. This review summarises the available data on the cytotoxicity of BioMNP, including mechanisms of interaction with human cells, routes of entry into the body, induction of inflammation, oxidative stress, and cellular dysfunction. Particular attention is paid to the interaction of microplastics with cells of various body systems, including the digestive, respiratory, immune, and urogenital systems, as well as with the skin. The identified knowledge gaps highlight the need for further research to assess the risks associated with the impact of BioMNP on humans and to develop safer forms of biopolymers. Among biodegradable plastics, PLA-based particles tend to exhibit stronger cytotoxic effects. Nanoplastics generally induce more severe cellular responses than microplastics. Organs such as the liver and lungs appear particularly vulnerable. Full article

Background: The hypopharyngeal region is among the most aggressive sites of head and neck squamous cell carcinoma, often presenting at an advanced stage with poor survival outcomes. However, there are only a limited number of biomarkers available to predict the prognosis of this aggressive disease. Recent interest has focused on immunonutritional biomarkers that may improve prognostication. The C-reactive protein–albumin–lymphocyte (CALLY) index has emerged as a composite biomarker integrating systemic inflammation, nutritional status, and immune competence. However, its clinical relevance in hypopharyngeal cancer has not been established. Methods: This retrospective, single-center study included patients with histologically confirmed hypopharyngeal squamous cell carcinoma treated with definitive chemoradiotherapy between 2010 and 2024. Patients were excluded from the study if they had incomplete laboratory data, had a concomitant malignancy, were undergoing induction chemotherapy, or had diseases affecting inflammatory and immunological markers. The CALLY index was calculated using pre-treatment laboratory values. Receiver operating characteristic (ROC) analysis determined the optimal cut-off value for overall survival (OS). Kaplan–Meier survival estimates and Cox regression analyses were used to assess associations between the CALLY index and progression-free survival (PFS), local recurrence-free survival (LRFS), and OS. Results: A total of 71 patients were included. The optimal CALLY cut-off was 1.47 (AUC = 0.70, p = 0.006). Patients with a CALLY index ≥ 1.47 had significantly improved median PFS (37 vs. 9 months, p = 0.003), LRFS (39 vs. 9 months, p = 0.002), and OS (61 vs. 11 months, p = 0.002). In multivariate analysis, the CALLY index and T stage remained independent prognostic factors of all three survival outcomes. Conclusions: The pretreatment CALLY index is a practical, accessible biomarker that independently predicts survival in hypopharyngeal cancer. Its integration into clinical practice may enhance risk stratification and guide individualized management strategies. Full article

This study examines how educational attainment and creative-class identity influence public library use among Black homeowners in Ward 8, Washington, D.C., a historically disinvested, yet resilient, Black community. Using an adapted theoretical framework (Chatman’s Small World Theory, Florida’s creative class theory, and Crenshaw’s intersectionality), the research investigates how symbolic capital informs institutional engagement in a racially homogeneous but economically stratified setting. A survey of 56 Black homeowners examined the relationships among education, income, creative-class identity, and library use. Logistic regression analysis revealed that higher educational attainment was a significant predictor of identification with the Black Creative Class^TM. However, neither income nor creative-class identity significantly predicted public library use. These findings challenge the assumption that middle-class status or creative-class affiliation ensures participation in educational or cultural institutions. Instead, they suggest that deeper dynamics, such as cultural relevance, perceived alignment, and trust, may shape engagement with public libraries. The study advances knowledge in library and information science (LIS) and urban studies by demonstrating how spatial context and class distinctions within Black communities shape library engagement. The results underscore the need for culturally responsive library strategies that recognize class-based variation within racial groups, moving beyond monolithic models of community outreach. Full article

Juniperus, a genus shaped by long-term climatic and geological processes, thrives in Yunnan but its community structure and future habitat dynamics remain poorly understood. We investigated Juniperus community composition, phylogenetic diversity, population structure, and projected suitable future habitats using MaxEnt modeling. Seven distinct community types were identified, all dominated by Juniperus species. They were characterized by low species richness, strong dominance patterns, and uneven species distribution. Most communities displayed a multi-layered vertical structure, except Type 6. Phylogenetic analyses revealed overdispersion (NRI < 0) in most communities, indicating habitat filtering as the primary assembly process, while Type 2 (NTI > 0) comprised more closely related species, potentially due to external disturbance. Population structures varied: J. pingii var. wilsonii exhibited an inverse J-shaped DBH distribution, J. formosana and J. squamata had unimodal patterns, and other species showed multimodal distributions. Climate projections forecast a 4.5–41.9% loss of suitable habitat, with current nature reserves covering only 13.6–35.1% of stable refugia, highlighting the need for targeted conservation. These findings provide an essential basis for the conservation, afforestation, and restoration of Juniperus-dominated ecosystems in Yunnan. Full article

Background/Objectives: [18F]FDG PET/CT radiomics could improve risk stratification in untreated breast carcinoma. Methods: PubMed Central was accessed for full-text English articles (2015–2025) evaluating radiomic features from pretreatment [18F]FDG PET/CT. The Newcastle-Ottawa Scale (NOS) was used to evaluate the risk of bias. Results: Seven studies (1394 patients with a median cohort of about 150 patients) met the inclusion criteria. Radiomics outperformed conventional metabolic measures at predicting pCR to NAC (with the best AUC 0.83 when combining intra- and peritumoral features); differentiating molecular subtypes (AUC 0.856 luminal vs. non-luminal; 0.818 HER2+ vs. HER2−, and 0.888 triple negative vs. others); and assessing androgen receptor (AR) expression. No additional value was found for ER/PR status. Age influenced SUV and texture metrics, especially in triple-negative lesions. Methodological variation was notable: all studies were retrospective, the majority were single-center, only two provided external validation with different protocols of acquisition and segmentation, and at least four distinct software platforms were used for feature extraction and statistical analysis. Conclusions: [18F]FDG PET/CT radiomics shows good potential for predicting neoadjuvant response and molecular profile in breast cancer. However, small, diverse cohorts and non-standardized methodologies limit the evidence. Prospective multicenter studies with standardized acquisition, segmentation and feature extraction are required before clinical use. Full article

This study investigated relationships between mood profiles, sports injuries, and countermovement jump with arm swing (CMJ) performance in a cohort study of 417 Brazilian athletes using a multi-methods approach during the period from January to November 2023. Six distinct mood profiles were identified, termed the shark fin (28.3%), iceberg (20.4%), submerged (18.7%), inverse iceberg (18.0%), surface (9.8%), and inverse Everest (4.8%). Athletes with the inverse Everest profile had a significantly higher risk of injury (OR = 2.90; 90% CI [1.09–7.55]) compared to those with the iceberg profile. Random forest models showed moderate predictive capability (AUC = 0.651), with vigour (12.7%) and anger (11.5%) as primary predictors. Bayesian analysis confirmed a higher injury probability in athletes with the inverse Everest profile (31.8%). Despite statistical power limitations, the results indicate that negative mood profiles, particularly those with elevated anger and fatigue, are associated with increased injury risk. Mood scores were not associated with CMJ performance variation. These findings highlight the importance of considering mood profiles in athlete monitoring systems, acknowledging the complex interplay between psychological and physical factors in injury risk. Full article

This study develops a ship propeller diagnostic system to address the issue of insufficient ship maintenance capacity and enhance operational efficiency. It uses the Remaining Useful Life (RUL) prediction technology to establish a sensing platform for ship propellers to capture vibration signals during ship operations. The Diagnosis and RUL Prediction Model is designed to assess bearing aging status and the RUL of the propeller. The synchronized signal reshaping technology is employed in the Diagnosis and RUL Prediction Model to process the original vibration signals as input to the model. The vibration signals obtained are used to analyze the temporal and spectral energy of propeller bearings. Exponential functions are used to generate the health index as model outputs. Model inputs and outputs are simultaneously input into a Long Short-Term Memory (LSTM) model for training, culminating as the Diagnosis and RUL Prediction Model. Compared to Recurrent Neural Network and Support Vector Regression models used in previous studies, the Diagnosis and RUL Prediction Model developed in this study achieves a Mean Squared Error (MSE) of 0.018 and a Mean Absolute Error (MAE) of 0.039, demonstrating outstanding performance in prediction results and computational efficiency. This study integrates the Diagnosis and RUL Prediction Model, bearing aging experimental data, and real-world vibration measurements to develop the diagnosis and RUL prediction system for ship propellers. Experiments with ship propellers show that when the bearing of the propeller enters the worn stage, this diagnostic system for ship propellers can accurately determine the current status of the bearing and its remaining useful life. This study offers a practical solution to insufficient ship maintenance capacity and contributes to improving the operational efficiency of ships. Full article