Search Results (228)

Digital terrain models (DTMs) are essential elevation datasets that represent the morphology of the Earth’s surface and play a critical role in applications, such as urban planning, civil engineering, infrastructure design, and environmental assessment. However, the excessive cost remains the major challenge in obtaining accurate terrain models. Recent advancements in low-cost inertial navigation and motion-sensing technologies offer significant potential to enhance the cost-effectiveness of surveying projects. This study investigates the vertical accuracy and operational usability of a handheld inertial measurement unit (IMU) device (Moasure 2) for DTM generation in urban environments through the comparison with traditional total station and digital levels procedures. It also assesses the device compliance with The American Society for Photogrammetry and Remote Sensing (ASPRS) Positional Accuracy Standards. For this purpose, a comprehensive field survey was conducted in a small urban area characterized by varied terrain morphology. The vertical accuracy of the Moasure 2 was acceptable for many urban mapping applications based on a rigorous analysis of checkpoint data and error patterns, which were quantitatively assessed relative to reference surfaces. Profile-based validation showed that the elevation differences between similar terrain types were mainly within ±25 cm, with minimal bias and symmetric error distributions. The findings indicate that Moasure 2 can be a viable alternative tool for fast DTM generation in low-cost urban projects. It offers significant advantages in terms of portability, ease of use, and reduced fieldwork time compared to conventional methodologies. Furthermore, this study addresses the critical gap in the validation of the new IMU-based surveying technology and provides evidence for choosing appropriate equipment for urban terrain modeling. Full article

Registered dietitian nutritionists (RDNs) have an opportunity to play a central role in improving nutritional outcomes among Mexican American young adult college students by helping them make culturally relevant adaptations to their eating patterns. Previous research has suggested limited representation of Mexican Americans among RDNs; therefore, the cultural competence of RDNs as perceived by Mexican Americans is uncertain. The purpose of this study was to evaluate how young adult college-age Mexican Americans (defined as 18–30 years old) perceive the cultural competence of RDNs. A sample of Mexican American (n = 93) and non-Mexican American (n = 120) young adult college students completed a 19-item online survey, with researchers using a subset of 4 survey items related to perceived cultural competence of RDNs in the present study. Descriptive statistics, Fisher’s exact tests with adjusted standardized residuals, and ordinal regression models were used. Fisher’s exact tests indicated that Mexican American young adult college students, compared to non-Mexican American young adult college students, reported less agreement that RDNs were knowledgeable about a traditional Mexican diet, that RDNs would take time to know students’ food preferences, and that RDNs would take personal preferences into account during nutrition counseling (p < 0.05). These associations, however, became insignificant in adjusted regression models. Rather, results indicated that other variables, such as age and lack of prior experience with an RDN, were associated with poorer perceptions. Full article

Even with the rise in concern over suicide and drug overdose mortality in the United States, gaps in research on at-risk populations still exist. The purpose of this study was to investigate disparities in suicide and drug overdose mortality risk among Washington State workers. Using 2014–2023 Washington State death records and American Community Survey (ACS) data, we calculated rates of suicide and drug overdose mortality by usual industry and occupation while adjusting for age and stratifying by sex and race/ethnicity. We compared the mortality risk among workers in specific industries and occupations to all workers within the same sex and race/ethnicity strata to understand how work differentially affects risk. Working in Construction & Extraction occupations was associated with an increased risk for suicide and drug overdose death for males across all race/ethnicity categories and for drug overdose death among White females. The suicide risk for Asian/Pacific Islander males had the largest increase—Asian/Pacific Islander males working in Construction & Extraction occupations had a rate 4.59 times higher than all Asian/Pacific Islander male workers. The Education, Training, & Library occupation group had significantly lower crude rates and rate ratios. Although the causal pathways that may lead someone to die by suicide or drug overdose are complex, understanding risk profiles among different industries and occupations may lead to more appropriate prevention strategies. Full article

Background: The American Society of Anesthesiologists Physical Status (ASA-PS) classification is widely used for perioperative communication and research with known variation in agreement amongst assessors. Large language models (LLM) are increasingly considered for uniform decision making due to agreement challenges within clinicians under identical inputs. The study compared four contemporary LLMs against clinician-derived consensus and quantified within-model stability across repeated assessments. Methods: In a cross-sectional vignette study, 228 anesthesiologists from Denmark, England, and India classified 20 standardized perioperative vignettes through online survey. The modal response per vignette was considered as clinician consensus. Four LLMs (ChatGPT-5.2 Plus, Gemini 3 Pro, Perplexity AI Pro, Claude 4 Sonnet) received same set of vignettes through identical prompts. Temporal stability was assessed by repeating each vignette query nine times per model (three-time windows across three nonconsecutive days) in fresh sessions. Primary outcome was exact agreement with clinician consensus. Results: Consensus agreement for modal LLM classifications was 18/20 (90%) for ChatGPT, 17/20 (85%) for Gemini, 17/20 (85%) for Claude, and 15/20 (75%) for Perplexity. Disagreement is clustered in vignettes with weak or split clinician consensus. Stability differed by model: Claude was fully stable across all vignettes (20/20), Gemini 19/20, ChatGPT 18/20, and Perplexity 14/20; instability typically involved adjacent-class shifts. Conclusions: Contemporary LLMs often match clinician modal judgement and are largely temporally stable, with discordance concentrated in clinically ambiguous boundary cases. Full article

Objective: This study aimed to assess whether older American adults with multimorbidity are at higher risk of becoming edentate over time. Methods: We used data from three waves of the Health and Retirement Study (HRS), a longitudinal survey of older American adults aged 50 years and over. Data on multimorbidity was from 2012, while data on complete tooth loss was from 2018. Multimorbidity included five common and serious conditions, namely diabetes, heart conditions, lung diseases, cancer, and stroke. Socioeconomic factor was indicated by total wealth in 2006; behaviour was indicated by smoking in 2012. We used Structural Equation Modelling (SEM) to assess the relationship between multimorbidity in 2012 and complete tooth loss in 2018. Participants with complete tooth loss in 2012 were excluded from the analysis. Results: Among 6286 participants with complete data across all three waves, each additional chronic condition in 2012 was associated with 1.30 times higher odds of edentulism in 2018 (95% CI: 1.12, 1.52). In the SEM, multimorbidity in 2012 was positively associated with being edentate in 2018 (estimate: 0.01, 95% CI 0.01, 0.02); smoking and wealth were also significantly associated with edentulism. Wealth and smoking were also associated with multimorbidity. Conclusions: Older adults with multimorbidity appear to have a higher probability for becoming edentate. The findings highlight the need for oral health promotion activities for those with multimorbidity. Full article

Coronavirus anxiety is defined as a psychological contrast characterized by excessive fear, obsessive thoughts, and reassurance-seeking behaviors associated with COVID-19. As current scales have been tested primarily in North American populations, we aimed to translate and culturally adapt three measures of dysfunctional coronavirus anxiety—the Coronavirus Anxiety Scale (CAS), the Obsession with COVID-19 Scale (OCS), and the Coronavirus Reassurance-Seeking Behaviors Scale (CRBS)—for the first time in Greek-speaking populations. To translate existing scales, we followed best practices for cross-cultural comparisons using forward translation (English to Greek) and backward translation (Greek to English) with expert translation review, prior to conducting pilot testing and confirmatory factor analysis in a bespoke survey population. A total of 405 adults from Cyprus participated in this study. The results indicated that the Greek versions of these measures demonstrated adequate reliability (Cronbach’s alphas > 0.70) and strong factor structure, as supported through confirmatory factor analysis. However, only the CAS exhibited evidence of both convergent and divergent validity. Our study makes several innovative contributions which have broad implications for crisis preparedness, including providing a framework for mental health interventions in future pandemics or Black Swan events. Full article

In June 1942, imperial Japan captured the Aleutian Islands of Attu and Kiska, marking the first and only time since the War of 1812 that United States territory in North America was occupied by a foreign power. The following year saw the imprisonment of Attu’s indigenous Saskinax̂ population, the United States’ effort to expel the invading forces, and the eventual recapture of the two islands. Over eight decades later, however, the story of Attu, and by extension the entire North Pacific theatre of World War II, remains an oft-forgotten chapter of history. In an effort to rectify this situation, the first systematic survey of Attu’s underwater cultural heritage was conducted using a combination of synthetic aperture sonar and underwater video. Among the most significant findings were the discovery of two wartime shipwreck sites, the Japanese army transport Kotohira Maru and the American cable-layer SS Dellwood. The documentation of these sunken vessels not only sheds light on their final moments, but it can also be used to bring renewed awareness of Alaska’s World War II history and inform cultural resource managers on Attu’s submerged heritage. Full article

Background: Older adults (aged 65 and older) faced a disproportionate burden of mortality during the COVID-19 pandemic, yet substantial geographical and sociodemographic disparities in vaccine uptake persisted within this vulnerable population. Objective: To examine the temporal dynamics of COVID-19 vaccination rates among older adults and investigate the association between vaccination uptake and neighborhood-level social determinants of health (SDOHs), including disability and poverty. Methods: COVID-19 vaccination data for older adult residents in Jefferson County, Kentucky, were obtained from the Kentucky Immunization Registry (KYIR). ZIP-code-level vaccination rates were calculated at three time points: 28 February 2021 (Q1), 31 May 2021 (Q2), and 31 May 2022 (Q6). The rates were linked to 2021 American Community Survey (ACS) ZIP code-level estimates of disability, poverty, and household composition. Two-dose COVID-19 vaccination rates stratified by race, ethnicity, and geographic region were used as outcome measures. Pearson correlation coefficients, bivariate, and multivariate linear models were used to estimate the association between COVID-19 vaccination rates and the SDOHs at the ZIP code level. Results: Among the estimated 139,222 older adults, overall two-dose vaccination rates rose from 22.4% in Q1 to 77.5% by Q6. Significant regional disparities were observed early in the campaign, with Q1 rates ranging from 12.6% in the Southwest to 35.4% in the Inner East county regions. Bivariate analyses showed ZIP-code-level disability and poverty rates were negatively associated with ZIP-code-level vaccination uptake in Q1 (disability slope: −0.38; 95% CI, −0.63 to −0.13; poverty slope: −0.36; 95% CI, −0.65 to −0.07). By Q6, the negative association between disability and vaccination had weakened significantly and was no longer statistically significant, while the negative association between poverty rate and vaccination rate remained persistent across all time points. Conclusions: The disability-associated gaps in older adults’ vaccination rates were dynamic and narrowed over time, whereas the poverty-associated gaps remained persistent and static. The low uptake observed among Black and Hispanic older adults in historically underserved areas suggests that understanding the specific factors that most negatively associate with vaccination rates in these populations, such as specific disabilities, may mitigate structural barriers. Future public health interventions should prioritize socioeconomically disadvantaged neighborhoods and account for the evolving association of functional impairments and healthcare access. Full article

Background/Objectives: Socio-cultural adversities and health disparities across Asian American origin groups remain understudied, particularly in early childhood. This limits the development of culturally responsive prevention and intervention strategies. A family-based Asian American epidemiologic study is essential to address these gaps and to inform tailored solutions. As an initial pilot effort, this pilot study was designed primarily to assess feasibility and generate preliminary data to inform future hypothesis-driven, large-scale epidemiologic research. The study objectives were to evaluate the feasibility of a remote study protocol and to collect preliminary data on child development and parental factors among Asian Indian, Filipino, and Korean American families with young children. Methods: A remote pilot study was conducted in 2024–25 among 48 mother–father–child (age 1–4 years) triads residing in Illinois, including 18 Asian Indian, 12 Filipino, and 18 Korean American mothers. Parents completed an online survey, and children wore an ActiGraph accelerometer on their hips. Analyses were conducted to describe child development, parental experiences, and parenting practices among the three ethnic groups. Results: Of the 48 mothers, 29 (60%) were US-born, and all but 1 had at least a bachelor’s degree. All parent pairs completed the survey, whereas only 34 children (71%) provided valid accelerometer data. Disaggregated data showed that, compared to children of Asian Indian mothers, children of Filipino mothers had higher daily screen time (p < 0.10) and higher sleep problem scores (p < 0.05), and children of Korean mothers had higher child–caregiver interaction scores (p < 0.05). Across all three groups, more favorable parenting practices were associated with lower sleep problem scores, higher wellbeing scores, and higher child–caregiver interaction scores (p < 0.01). Conclusions: The remote study protocol was generally feasible; however, child compliance with hip accelerometer wear was suboptimal. Preliminary data revealed differences in children’s physical behaviors and social-emotional development across Asian ethnic groups. A full-scale study should enhance the engagement of socioeconomically diverse families and refine wearable data collection methods to improve data representativeness and completeness. Full article

Limited research has examined how increasing extreme precipitation affects active transportation across the United States. This study assesses the longitudinal relationship between extreme precipitation and walking and cycling to work in the context of rising extreme weather and flooding. We conducted a county-level longitudinal analysis using data from the National Environmental Public Health Tracking Network (2005–2018). Five-year estimates of walking and cycling to work among adults aged 16 years and older were obtained from the American Community Survey, and annual population-weighted averages of days with extreme precipitation (≥2 inches) were derived from the North American Land Data Assimilation System. Mixed-effects models with restricted maximum likelihood estimation assessed associations with active transportation, accounting for county-level clustering and adjusting for year, region, poverty rate, water cover, metropolitan status, and park access. Across 3142 U.S. counties, extreme precipitation days increased over time, while walking and cycling to work declined. Each additional extreme precipitation day was associated with a 12.3% decrease in walking and a 3.7% decrease in cycling at baseline, with stronger negative associations over time. Effects were most pronounced in non-metropolitan and Midwestern counties. Findings underscore the importance of climate-resilient transportation planning for sustaining low-carbon, equitable mobility and advancing sustainable development. Full article

Background/Objectives: Type 2 diabetes (T2D) affects more than 38 million Americans and remains a leading public health challenge. Behavioral self-management is central to glycemic control but is often undermined by dysregulated and addictive-like eating behaviors. Continuous glucose monitoring (CGM) offers immediate feedback that may strengthen self-regulation, yet the psychological processes linking CGM use, food addiction (FA), and behavior change are poorly understood. This secondary mixed-methods study examined how CGM-supported group medical visits (GMVs) influence glycemic outcomes and FA symptoms in adults with diabetes. Methods: Adults with T2D participated in a 14-week GMV program integrating CGM review with education on nutrition, physical activity, sleep, stress, and intermittent fasting. Thirteen participants had paired CGM summaries and psychosocial data. Quantitative outcomes included mean glucose, glycemic variability, time-in-range (TIR), and symptoms of food addiction using the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0). Qualitative data came from open-ended surveys analyzed using reflexive thematic analysis. Integration followed a convergent design, merging individual change trajectories with thematic interpretations and case vignettes. Results: Mean glucose decreased by 21 mg/dL and TIR improved by 9 percentage points. Among six participants with baseline FA symptoms, all showed reductions in self-reported mYFAS 2.0 symptom counts. Four moved from mild to no symptoms, one from moderate to no symptoms, and one from severe to no symptoms. Across the full sample, the mean change was a reduction of 1.2 in the mYFAS 2.0 symptom counts per participant. Thematic analysis identified four interrelated psychological mechanisms: enhanced awareness of food–glucose relationships, increased accountability through shared tracking, motivation via gamified self-monitoring, and relief from cognitive burden associated with dietary uncertainty. Conclusions: Integrating CGM feedback into GMVs was associated with improvements in glycemic metrics and reductions in addictive-like eating symptoms in this pilot sample. These findings position CGM as a behavioral intervention tool that complements its traditional monitoring role and highlight the value of combining real-time biofeedback with group-based support in diabetes care. Full article

This study explores how hospital location (rural/non-rural) may moderate the nurse staffing ratio’s impact on three hospital-acquired infections. This study used data from 2022 to 2024 on nurse staffing and hospital characteristics from the American Hospital Association Annual Survey and data on hospital-acquired infection rates from the Medicare Care Compare dataset provided by the Centers for Medicare and Medicaid Services. After removing missing values, the final dataset included 7997 hospital-year observations across the US. Independent variables include rural hospital designation, nursing hours per patient day, and RN FTE per adjusted day. The dependent variables included infection rates of Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and Methicillin-Resistant Staphylococcus aureus. Multiple regression was performed in Stata 18. Our research found that across all three infection types, an increase in nursing hours per patient day is significantly associated with a decrease in the infection rate, and that impact was not moderated by hospital rurality. Extra time spent with patients in either a rural or non-rural hospital decreased hospital-acquired infection rates. While RN FTEs were included in the model, total nursing hours per patient day emerged as the more consistent predictor of lower hospital-acquired infection rates. Full article

Introduction: Middle adolescence involves increasingly complex stressors, yet it remains unclear how coping strategies cluster into distinct profiles, how those profiles change across time, and whether profile structure is comparable across gender. We used latent class and transition analysis across three annual waves to identify coping profiles, model transitions, and examine perceived stress, depressive symptoms, and general self-efficacy by profile. Methods: Participants were 964 adolescents (mean age = 16.1 years; 56% female) from public high schools in Texas who completed surveys in spring 2011 with two annual follow-ups. The sample self-identified as Hispanic (32%), White (30%), African American (27%), or other (11%). Latent class/transition models estimated profile membership, transitions, and gender differences in prevalence and transition probabilities. Results: Four coping profiles emerged: Minimal Copers, Maximum Copers, Introverted Approach–Avoidant Copers, and Independent Problem-Solving Copers. Profile structure was comparable for females and males, although prevalence and transition differed. At Wave 4, Introverted Approach–Avoidant Copers reported the highest perceived stress and depressive symptoms, whereas Minimal and Independent Problem-Solving Copers reported lower perceived stress and depressive symptoms. Independent Problem-Solving and Maximum Copers reported higher general self-efficacy, whereas Minimal Copers reported the lowest. Conclusions: Coping in adolescence is heterogeneous and shifts over time, with gender differences in profile prevalence and transitions; findings highlight potential targets for tailored support and self-efficacy enhancement. Full article

Background/Objectives: African American women are less likely to breastfeed in general and to breastfeed exclusively for the first six months of infancy. Racial and ethnic breastfeeding disparities are especially pronounced in the South, particularly in rural communities. These differences are attributed largely to structural lactation impediments that include less breastfeeding support in healthcare settings, workplaces, and communities. While a great deal of research has explored racial differences in breastfeeding, minimal attention has been paid to the social correlates and racial disparities associated with the 2022 U.S. infant formula shortage. Our study explores racial distinctions in the formula shortage’s effect on breastfeeding support among Gulf Coast Mississippians. Methods: We use data from the second wave of the Mississippi REACH (Racial and Ethnic Approaches to Community Health) Social Climate Survey to determine if racial differences are evident in the formula shortage’s influence on breastfeeding support. We predict that the infant formula shortage will have prompted African American respondents to become much more supportive of breastfeeding than their White counterparts, net of sociodemographic controls. This hypothesis is based on the lower prevalence of exclusive breastfeeding among African Americans, thereby indicating a greater reliance on formula. The study uses a general population (random digit dial) sample and purposive (exclusively African American) oversample to analyze validated data from a cross-sectional survey. Sampling took place between September and December 2023, with a sample population of adult male and female Mississippians. A series of binary logistic regression models were employed to measure the association of race with breastfeeding support changes resulting from the infant formula shortage. Results: The study results support the hypothesis, as seen by a positive association between African Americans and increased breastfeeding support directly related to the infant formula shortage. Further, the baseline statistical model reveals African American respondents to be five times more likely than White respondents (p < 0.001) to report that the formula shortage increased their support of breastfeeding. Conclusions: We conclude by discussing this study’s implications and promising directions for future research. Full article

Customer satisfaction (CS) is a cornerstone of competitiveness in the hospitality sector, particularly in restaurants, where service interactions are highly sensory and time-sensitive. Traditional measurement instruments, such as SERVQUAL, SERVPERF, and the American Customer Satisfaction Index, provide valuable diagnostic insights but remain limited by recall bias, social desirability, and delayed feedback. Advances in deep learning now enable non-intrusive, real-time monitoring of customer experience. This study evaluates the feasibility of using a convolutional neural network (CNN) to automatically classify customer satisfaction based on facial expressions captured at the point of payment in a restaurant. From an initial dataset of over 5000 images, 2969 were validated and labeled through a binary self-report mechanism. The CNN, implemented with transfer learning (MobileNetV2), achieved robust performance, with 93.5% accuracy, 92.8% recall, 91.0% F1-score, and an area under the ROC curve of 0.93. Comparative benchmarks with Support Vector Machine and Random Forest classifiers confirmed the superiority of the CNN across all metrics. The findings highlight CNNs as reliable and scalable tools for continuous CS monitoring, complementing rather than replacing classical survey-based approaches. By integrating implicit, real-time signals with traditional instruments, restaurants can strengthen decision-making, enhance service quality, and co-create personalized experiences while addressing challenges of explainability, external validity, and data ethics. Full article