Search Results (181,501)

Online food delivery (OFD) platforms have become embedded in everyday consumption, yet the determinants of continued use in emerging Latin American markets remain underexplored. This study examines continuance intention toward OFD applications in Colombia using an extended UTAUT2 model (LAE-UTAUT2) that incorporates two domain-specific constructs, Delivery Trust and Food Quality Perception. Cross-sectional survey data from 2130 active users were analyzed through covariance-based structural equation modeling, with confirmatory factor analysis, reliability and validity assessment (CR, AVE, HTMT) and a multi-procedure common-method-bias check. The direct-effects model explained 56.0% of the variance in continuance intention. Performance Expectancy was the strongest predictor, followed by Hedonic Motivation, Food Quality Perception, Delivery Trust, Social Influence, and Effort Expectancy, whereas Facilitating Conditions were non-significant. Notably, the two domain-specific constructs outranked two established UTAUT2 predictors, and the pattern of effects remained stable across age, gender, and experience subgroups and among habitual users. Income, included as a control, showed no detectable independent effect under an unadjusted bracket measure. The findings position experiential quality and fulfillment trust as central correlates of OFD loyalty in emerging markets, though the cross-sectional, self-reported, and reduced-form design warrants cautious, non-causal interpretation. Full article

Everyday work with large language models (LLMs) normalizes a practice in which a generated formulation supports judgment before the user has checked its grounds. This crisis of rationality arises not from a single technical defect in the system, but from a shift in justificatory practice in which fluent textual coherence is read as evidence of semantic understanding and rational judgment. The method brings conceptual analysis into contact with 4E cognition and a postphenomenological account of technological mediation. Within this framework, LLMs are described neither as autonomous rational subjects nor as neutral instruments, but as multistable moral-epistemic mediators of human rationality. The analysis distinguishes textual competence from world-involved understanding and relates interface mediation to trust and responsibility. On this basis, the article proposes a four-cluster protocol for the attribution of rationality, which introduces an epistemic pause as a route of verification between a generated formulation and its authorial acceptance as a claim. The central risk lies not in whether machine consciousness has been proven, but in the normalization of practices in which ready-made text acquires the status of a ground before the user has reconstructed its sources and accepted responsibility for what is asserted. Full article

Objectives: Varicella zoster virus (VZV) meningitis is a complication of herpes zoster that causes high rates of residual symptoms. However, prognostic factors and optimal management strategies remain unclear. This study investigated factors affecting functional outcomes, age-related differences, and the impact of prior oral antiviral therapy in VZV meningitis. Methods: This retrospective observational study enrolled patients admitted for aseptic meningitis between 2013 and 2022. The primary outcome was residual symptoms at discharge, defined as a ≥1-point increase in the modified Rankin Scale (mRS) from baseline. Multiple logistic regression identified independent risk factors. Results: Among 176 patients with aseptic meningitis, 60 (34.1%) had VZV meningitis. Patients with VZV meningitis had higher rates of residual symptoms (43.3% vs. 12.9%, p < 0.001). Independent predictors of residual symptoms included delayed intravenous acyclovir initiation (odds ratio [OR] = 1.303, 95% confidence interval [CI] = 1.060–1.601, p = 0.012), corresponding to a 30.3% increase in the odds of residual symptoms for each additional day before treatment initiation, and pre-onset mRS (OR = 2.352, 95% CI = 1.056–5.237, p = 0.036). Patients ≥ 50 years old displayed lower rates of headache (75.0% vs. 96.9%, p = 0.020), neck stiffness (25.0% vs. 62.5%, p = 0.005), and CSF pleocytosis (56/μL vs. 142/μL, p = 0.023). Prior oral antiviral therapy was not associated with a rate of residual symptoms (p = 0.795). Conclusions: Delayed initiation of intravenous acyclovir was independently associated with residual symptoms at discharge, whereas older patients often presented with atypical clinical features, requiring heightened clinical suspicion. Given the lack of observed benefit associated with prior oral antiviral therapy, prompt initiation of intravenous acyclovir should be considered when VZV meningitis is suspected. Full article

Rising global temperatures and more frequent heat waves pose a growing threat to public health, particularly among older adults. Age-related declines in thermoregulatory capacity such as reduced sweating, impaired vasodilation, and diminished hypothalamic responsiveness make it more difficult to cope with elevated nighttime temperatures. These thermal challenges disrupt sleep by prolonging sleep onset, fragmenting slow-wave and REM sleep, and suppressing melatonin secretion. Importantly, sex-related differences in thermoregulatory aging—particularly menopause-associated vasomotor instability in women and testosterone-related autonomic changes in men—further modulate individual vulnerability to heat-induced sleep disruption. Beyond sleep, heat-induced stress affects metabolic, cardiovascular, and immune systems, promoting insulin resistance, endothelial dysfunction, sympathetic overactivation, and chronic inflammation. Socioeconomic disparities, urban heat island exposure, and differential access to cooling infrastructure function as critical environmental modifiers that amplify biological vulnerability, particularly in disadvantaged older populations. This narrative review aims to synthesize current knowledge on the specific thermoregulatory mechanisms of sleep disruption induced by heat stress in older adults. Understanding these interactions is crucial for developing effective interventions, including environmental cooling, circadian-aligned behaviors, and targeted public health strategies, to mitigate the compounded risks of heat exposure and preserve healthy sleep in aging populations. However, many proposed mechanistic pathways are primarily derived from animal models, and controlled human studies specifically targeting heat-exposed older adults remain scarce. Full article

Objective: This paper investigates how Generation Z students perceive the quality, accessibility, and capacity of higher education in the Czech Republic, with relevance for the wider Visegrád (V4) region and for the design of educational platforms. Methodology: The study draws on a questionnaire survey of 819 students and analyses 38 Likert-type statements aggregated into five domains: digitalisation and technology, innovation in teaching, practical orientation and mobility, support and well-being, and capacity constraints and infrastructure. The analysis combines descriptive statistics, reliability and dimensionality checks, Pearson correlation analysis with normality and robustness diagnostics, and subgroup comparisons by gender, level of study, field of study, institution type, and age group. Results: Students report the strongest agreement with digitalisation and technology (M = 3.90) and practical orientation and mobility (M = 3.89), while support and well-being (M = 3.40) and capacity constraints and infrastructure (M = 3.36) remain weaker. Perceived adequacy of the student–teacher ratio is positively associated with perceived teacher availability (r = 0.37) and emotional support (r = 0.34), while teacher availability is positively associated with emotional support (r = 0.44). Subgroup tests indicate limited but meaningful differences, particularly by institution type, field of study, and age group. Conclusion: The findings suggest that Generation Z students value digitally enabled, practice-oriented and innovative educational platforms, but sustainable quality improvement also requires investment in human capacity, teacher availability, and student-facing support systems. Full article

Background/Objectives: Working memory declines with age, particularly under conditions of high cognitive load. Emotional information can modulate performance depending on its task relevance and on individual cognitive and emotional resources. This study investigated the dissociable contributions of cognitive reserve (CR) and emotional intelligence (EI) to accuracy and response dynamics in an emotional n-back task in older adults. Methods: Forty-five healthy older adults completed an emotional n-back task under low (1-back) and high (2-back) cognitive load. Task relevance was manipulated by requiring judgments either on facial expressions (Emo task) or on age-related features (Age task). Accuracy and reaction times were analyzed using mixed-effects models, with CR and EI entered as continuous covariates. Results: Higher cognitive load was associated with reduced accuracy and slower reaction times. Emotional modulation of performance emerged primarily when emotional information was task-relevant. Happy facial expressions were associated with faster reaction times and higher accuracy than angry expressions, particularly under high cognitive load. CR was positively associated with overall accuracy across conditions, without interacting with task demands or emotional content. In contrast, EI did not predict accuracy but selectively modulated reaction times as a function of task relevance and emotional valence, with opposite effects observed across tasks for positive stimuli. Conclusions: These findings indicate that emotional modulation of working memory in older adults is strongly context-dependent. CR supported accuracy in a domain-general manner, whereas EI selectively modulated response speed in emotionally salient contexts without conferring a direct accuracy advantage. Cognitive and emotional resources thus contributed to distinct yet interacting components of working memory performance in ageing, suggesting that successful functioning in later life depends not only on preserved processing capacity but also on the flexible regulation of emotionally salient information. Full article

Vaccination remains an effective intervention for reducing coronavirus disease 2019-related deaths, while the population-level evidence regarding the association between vaccination dose and mortality remains limited. This study aimed to investigate the association between vaccination status, independent risk factors, and COVID-19 mortality, using population-based surveillance data from Gyeongsangbuk-do, South Korea. A population-based retrospective cohort study was conducted using 698,537 confirmed cases from Gyeongsangbuk-do, between January 2021 and June 2022, including 1008 deaths. Univariable and multivariable logistic regression analyses were performed to identify factors associated with mortality. Additional analyses were conducted among adults aged ≥ 65 years. The overall case fatality rate was 0.14%, increasing to 0.88% among older adults. Older age (≥65 years; OR = 87.262, 95% CI: 67.265–114.472) and underlying disease (OR = 20.394, 95% CI: 17.136–24.270) were strongly associated with mortality. After adjustment for sex, age, and underlying disease, unvaccinated individuals had substantially higher odds of death than vaccinated individuals (aOR = 7.897, 95% CI: 6.903–9.034). Booster vaccination (≥3 doses) was associated with markedly reduced mortality in both the overall population (aOR = 0.094, 95% CI: 0.081–0.109) and older adults (aOR = 0.119, 95% CI: 0.102–0.139). Advanced age, underlying diseases, and lack of vaccination were significant factors associated with COVID-19 mortality during the mass vaccination period. These findings support continued efforts to improve booster vaccination coverage among older adults and individuals with underlying diseases. Full article

Background and Objectives: Unicameral bone cyst (UBC) is a benign cystic lesion originating from the metaphysis, often extending toward the diaphysis as the individual grows. It is more common in boys aged 5–15 years, typically affecting long bones like the humerus and femur. UBC is usually asymptomatic and found incidentally on imaging, with pathological fractures being a common complication. Treatment options include conservative observation, percutaneous injection, and surgery. This study aims to compare the diagnostic, treatment, and follow-up processes of UBC cases across multiple centers in our country. Materials and Methods: This study reviewed 180 UBC cases in patients aged 0–20 from seven clinical centers in our country. Patient demographics, symptoms, diagnostic methods, treatment approaches, and follow-up data were collected. Radiological and histopathological diagnostic accuracy, treatment methods (conservative, percutaneous injection, surgical), and recovery were analyzed using Musculoskeletal Tumor Society (MSTS) scores and Capanna criteria. Results: Among 180 patients, 50% had pain. Most diagnoses were made through radiographic imaging, with 96.1% diagnostic accuracy. The humerus (44.7%) and femur (30.7%) were the most commonly affected bones. Pathological fractures were found in 35% of cases. Treatment included conservative (19%), percutaneous injection (31.8%), and surgery (49.2%). The average follow-up period was 81 months, with early complications being skin issues and late complications primarily limb shortening. Conclusions: The study highlights the effectiveness of different treatment approaches for UBC, showing that surgical treatment offers the best clinical outcomes, while percutaneous injection is a less invasive option. Treatment should be tailored to individual patient needs. Full article

Endoscopic closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) has been increasingly adopted to prevent adverse events. Various devices and techniques, including conventional clips, clips with various technical tips, clip with line, clip with device, special clips, and suturing devices, have been developed, achieving high rates of complete closure (approximately 95% on average), although procedure times and technical complexity vary considerably. Among 14 eligible comparative studies, including randomized controlled trials and retrospective studies published up to April 2026, a meta-analysis was performed to evaluate the efficacy of complete closure after colorectal ESD in preventing delayed bleeding (DB), delayed perforation (DP), and post-ESD coagulation syndrome (PECS). For DB, pooled analysis demonstrated that complete endoscopic closure was significantly associated with a reduced risk of DB (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.60–0.97, p = 0.030, I² = 53.6%). In contrast, no significant differences were observed between the closure and non-closure groups for DP (OR: 0.60, 95% CI: 0.23–1.55, p = 0.290, I² = 0.0%) or PECS (OR: 0.94, 95% CI: 0.65–1.38, p = 0.765, I² = 56.6%). In a literature review, reported risk factors for DB include lesion size >50 mm, an ASA score of III or IV, antithrombotic therapy, age ≥75 years, and rectal location. Severe fibrosis and prolonged ESD procedure time have been reported as risk factors for DP, whereas female sex, age ≥70 years, right-sided colon, and lesion size >24 mm have been associated with PECS. Overall, various closure devices and techniques achieve high technical success rates after colorectal ESD. Complete closure appears beneficial for reducing DB, particularly in high-risk patients, whereas its efficacy for preventing DP and PECS remains uncertain. Further studies are warranted. Full article

Bitter melon (BM; Momordica charantia L.) is rich in phytochemicals and has been widely studied for its pharmacological effects. However, BM is mainly consumed as a tea, and its application in fermented foods remains limited. This study investigated changes in phenolic compounds, bioactive metabolites, antioxidant and enzyme inhibitory activities, and DNA-protective effects in mul-kimchi with bitter melon (MKBM). MKBM was prepared with different BM concentrations (0%, 10%, and 20%) and fermented for 0–12 days. The phenolic profile changed according to BM concentration and fermentation periods. Epicatechin and epigallocatechin gallate were detected from day 3 only in BM-treated groups (MKBM-10 and MKBM-20). On day 12, catechin was detected only in MKBM-20, reaching 64.42 μg/mL, whereas it was not detected in MKBM-0. MKBM-20 also showed the highest total phenolic and flavonoid contents on day 12. Antioxidant and digestive enzyme inhibitory activities increased during fermentation, and DNA protection against oxidative damage was enhanced by day 9. These results suggest that mul-kimchi fermentation can improve the functional potential of BM as a fermented food ingredient. Full article

Introduction: Understanding children’s physical self-concept is crucial, as it influences motivation, behavior, and physical activity (PA). The Spanish version of the Children’s Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA) assesses the adequacy and predilection for PA, but it is not fully adapted for schoolchildren. Considering the developmental and contextual differences between children and adolescents, adapting and validating this instrument for younger populations is necessary. This study aimed to test the validity and reliability of the CSAPPA for schoolchildren aged 6–12 years (65 boys and 64 girls; mean age 9.63 ± 1.78 years). Method: Comprehension of the CSAPPA was examined through cognitive interviews, and reliability was assessed via a test–retest approach with 129 Spanish schoolchildren. Confirmatory factor analysis (CFA), Cronbach’s alpha, and the intraclass correlation coefficient (ICC) were used to evaluate validity and reliability. Results: CFA confirmed the three-factor structure (Adequacy, Predilection, Enjoyment) in children aged 6–12, with excellent fit indices: Chi-square divided by degrees of freedom (χ²/df) = 1.179; Root Mean Square Error of Approximation (RMSEA) = 0.037; Comparative Fit Index (CFI) = 0.961; Tucker–Lewis Index (TLI) = 0.953. Test–retest reliability ranged from questionable to good (Cronbach’s α = 0.622–0.871), except for items 8 and 14. The ICC values indicated moderate to near-perfect (ICC: 0.453–0.871) temporal stability; items 8 and 14 were excluded. Conclusions: The Spanish CSAPPA demonstrates validity and reliability for assessing self-perceptions related to PA motivation among schoolchildren aged 6–12. As part of the affective domain in the Spanish Physical Literacy Assessment for Children (SPLA-C) model, it shows promise for use in school and sport contexts, supporting the identification of needs and planning interventions to promote active participation and positive development. However, items 8 and 14 demonstrated poor psychometric performance and should be interpreted with caution, requiring further refinement before the instrument can be recommended without reservation. Full article

Background: Systemic inflammation plays a central role in determining postoperative outcomes in patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Traditional inflammatory indices such as the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio have prognostic value; however, their dynamic behavior during cardiopulmonary bypass remains insufficiently characterized. More comprehensive indices, including the systemic immune-inflammation index and the systemic inflammatory response index, may help characterize early intraoperative inflammatory activity; however, their prognostic relevance should be regarded as exploratory and requires prospective validation. Methods: This retrospective nested case–control study included 245 patients who underwent isolated coronary artery bypass grafting, and intraoperative inflammatory indices during cardiopulmonary bypass were evaluated. Because of the nested case–control design, mortality cases were intentionally overrepresented to improve statistical power; therefore, the observed mortality rate does not reflect the true institutional mortality rate. Inflammatory indices (NLR, PLR, SII, and SIRI) were calculated at induction, at the 5th, 45th, and 90th minutes during cardiopulmonary bypass, and in the early postoperative period. Associations between these indices and in-hospital mortality were evaluated using univariate and multivariable logistic regression analyses. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC). Results: The final enriched analytical sample consisted of 51 mortality cases and 194 randomly sampled surviving controls. During cardiopulmonary bypass, inflammatory indices, particularly at the 5th minute, were significantly higher in patients who experienced mortality (p < 0.001 for all major indices). SII demonstrated the strongest predictive performance at the 5th minute (AUC = 0.790), followed by SIRI (AUC = 0.765), PLR (AUC = 0.687), and NLR (AUC = 0.681). In multivariable analysis, SII and SIRI measured at the 5th minute remained independent predictors of mortality. The addition of 5th-minute SII to the limited study-specific clinical model, which included age, ejection fraction, and preoperative creatinine, improved exploratory discrimination for in-hospital mortality (with AUC increasing from 0.698 to 0.797). Conclusions: Early intraoperative assessment of inflammatory indices during cardiopulmonary bypass may provide additional prognostic information in patients undergoing coronary artery bypass grafting. Composite indices, particularly SII and SIRI, showed stronger exploratory discrimination than traditional inflammatory markers in this enriched analytical sample. However, these findings should be considered hypothesis-generating and require prospective external validation before use in perioperative risk stratification or clinical decision-making can be recommended. Full article

We recently identified the U1 small nuclear ribonucleoprotein (U1-snRNP) antibodies in patients with Guillain–Barré syndrome (GBS), which is associated with the breakdown of the blood–nerve barrier (BNB). The objective of this study was to clarify the clinical significance of U1-snRNP antibodies in patients with GBS and its variants. We measured U1-snRNP antibodies using an enzyme-linked immunosorbent assay from the serum samples of patients with GBS (n = 106), Miller Fisher syndrome (MFS) (n = 24), and MFS/GBS overlap syndrome (MFS/GBS, n = 8). We compared the clinical characteristics of U1-snRNP positive and U1-snRNP negative GBS patients (n = 106). The cerebrospinal fluid (CSF)/serum albumin quotient (QALB)/QALBLIM [calculated as(age/15) + 4)] was calculated. The prevalence of U1-snRNP antibody positivity was 39% (41/106) in GBS, 0% (0/24) in MFS, and 50% (4/8) in MFS/GBS. The rate of U1-snRNP antibody positivity in the GBS and MFS/GBS groups was significantly higher than that in the MFS group. Levels of CSF proteins and QALB/QALBLIM were higher in U1-snRNP antibody-positive GBS than in U1-snRNP antibody-negative GBS among all GBS patients, as well as GBS patients with a preceding Campylobacter jejuni infection or AIDP. In conclusion, the U1-snRNP antibody-positive GBS group had a more severe breakdown of the BNB in U1-snRNP antibody-positive GBS patients than in U1-snRNP-negative GBS patients. The presence of U1-snRNP antibodies may be a clinical biomarker for predicting the progression of MFS to MFS/GBS. Full article

Background: Preeclampsia (PE) is a leading cause of maternal and perinatal morbidity, affecting 2–8% of pregnancies worldwide. In Ecuadorian public hospitals, clinical data are often fragmented, limiting the construction of complete datasets for prediction modeling. This study aimed to develop a Machine Learning (ML) framework to predict PE using demographic data from the Isidro Ayora Gynecology and Obstetrics Hospital (HGOIA), Quito, Ecuador. Methods: We proposed a custom automated Machine Learning (C-AutoML) workflow to evaluate six models (Logistic Regression, LightGBM, XGBoost, CatBoost, Multi-Layer Perceptron, and Random Forest) and compared its performance against a weighted ensemble built with Amazon SageMaker Canvas, optimizing for the F1-score. Model interpretability was analyzed using Shapley Additive Explanations (SHAP). Due to the scarcity of clinical variables at HGOIA, a synthetic dataset based on FullPIERS predictors was also generated and modeled. Results: On the hospital dataset, the SageMaker ensemble achieved an F1-score of 0.805, accuracy of 0.934, and AUC of 0.956, while the C-AutoML best single model (LightGBM) yielded comparable results (F1-score: 0.802, accuracy: 0.938, AUC: 0.944). SHAP analysis identified patient age as the most influential feature. On the synthetic dataset, Logistic Regression achieved perfect classification (F1-score: 1.0). Conclusions: The proposed C-AutoML framework matched the performance of the SageMaker weighted ensemble while relying on a single, interpretable model. Despite the current dependence on demographic data, the methodology shows promise for supporting PE diagnosis in resource-limited settings; future integration of clinical variables is expected to further enhance predictive power for risk stratification. Full article

Environmental carcinogenesis is traditionally explained by the accumulation of genetic alterations induced by exogenous carcinogens. However, most exposed cells do not undergo malignant transformation because intrinsic tumor-suppressive mechanisms limit the expansion of damaged clones. Among these mechanisms, cellular senescence represents a major barrier that restricts proliferation following DNA damage, oncogenic stress, and other carcinogen-induced insults. In this review, we examine environmental carcinogenesis within a probabilistic evolutionary framework in which tumor initiation depends not only on mutation acquisition but also on the ability of rare cells to evade senescence-mediated growth arrest. Environmental carcinogens contribute to cancer development by increasing genomic instability, altering tissue microenvironments, and modifying selective pressures, whereas senescence acts as a critical constraint on clonal evolution. We further discuss how aging, immune surveillance, DNA-repair capacity, and tissue-specific factors influence the likelihood of senescence escape and malignant progression. This integrative perspective highlights carcinogenesis as a multistep stochastic process shaped by the interaction between mutational events, cellular fitness barriers, and microenvironmental selection. Understanding how these factors collectively regulate transformation may improve mechanistic models of cancer risk and identify new opportunities for prevention and early intervention. Full article