Search Results (191)

Background: Clinical outcomes among older adults hospitalized with heart failure with preserved ejection fraction (HFpEF) in the setting of metabolically healthy obesity (MHO) remain insufficiently explored. This study aimed to evaluate whether MHO status is associated with different rates of major adverse cardiac and cerebrovascular events (MACCEs) during HFpEF-related hospitalizations compared to patients without MHO. Methods: Data from the 2019 National Inpatient Sample (NIS) database was analyzed using relevant ICD-10 codes to identify HFpEF admissions in older adults. Propensity score matching (1:1) was applied to generate balanced cohorts of patients with and without MHO. Multivariable adjustments were performed to assess primary outcomes, including MACCEs, all-cause mortality (ACM), acute myocardial infarction (AMI), dysrhythmia, cardiac arrest (CA), and stroke. Statistical significance was set at p < 0.05. Results: Each MHO cohort included 22,405 patients with a median age of 75 years. The MHO+ group demonstrated a significantly higher risk of dysrhythmia (OR 1.32, 95% CI 1.21–1.43, p < 0.001). Interestingly, an “obesity paradox” was observed, as the MHO+ cohort had lower odds of MACCEs (OR 0.70, 95% CI 0.61–0.81, p < 0.001), ACM (OR 0.66, 95% CI 0.54–0.82, p < 0.001), and AMI (OR 0.71, 95% CI 0.59–0.86, p = 0.001) compared to MHO−. No significant differences were found for CA or stroke between the groups. Conclusions: Although the MHO+ group had an elevated risk of dysrhythmia, they exhibited more favorable outcomes in terms of MACCEs, ACM, and AMI—supporting the concept of an “obesity paradox.” Further research is needed to better understand the role of MHO as a comorbid condition in patients with HFpEF. Full article

The capture of Jerusalem during the First Crusade, the extirpation of various heresies in the twelfth and thirteen centuries, the gradual expansion of Christian rule in the Iberian peninsula, and the mass conversion of Jews to Christianity there during the fourteenth century, all seemed to support a Christian triumphalism that imagined that as the End Time approached, Jews and other infidels would inevitably be absorbed into the Church. Nonetheless, an expanding medieval awareness of the many ‘Others’ beyond Christendom contributed to Christian anxieties that Jews (or Muslims) might expand their number through mass conversion, and not Christians. This paper will examine some sources of this anxiety. Full article

This paper reviews the fundamental principles and techniques of nickel electrodeposition, with a particular focus on metallizing polymeric substrates. It outlines the electrochemical mechanisms involved in depositing nickel from an acidic Watts bath, detailing the roles of key electrolyte components—i.e., nickel sulfate, nickel chloride, and boric acid—and the influence of process parameters, such as current density, temperature, and pH, on deposit quality (density and surface condition) and mechanical properties. In addressing the unique challenges posed by non-conductive polymers, this review compares emerging methods like silver conductive paint, highlighting differences in deposition time, surface resistivity, and environmental impact. Additionally, this paper examines how process parameters affect the as-deposited microstructure, adhesion, and overall mechanical properties (such as hardness, ductility, and tensile strength), while identifying critical issues such as low deposition density and substrate degradation. These insights provide a structured background for optimizing electroplating processes for applications in electronics, automotive, aerospace, and biomedical sectors, and suggest future research directions to enhance deposition uniformity, sustainability, and process control. Full article

Non-alcoholic fatty liver disease (NAFLD) is a common metabolic condition characterized by hepatic lipid deposits, insulin resistance, and inflammation which may progress to non-alcoholic steatohepatitis (NASH) and fibrosis. Protein kinases play an important role in NAFLD development by regulating metabolic and inflammatory pathways. Mitogen-activated protein kinases (MAPKs), protein kinase C (PKC), AMP-activated protein kinase (AMPK), phosphoinositide 3-kinase (PI3K)/AKT, and mechanistic target of rapamycin (mTOR) are all involved in NAFLD and NASH progression. Emerging evidence indicates that Farnesoid X Receptor (FXR) agonists have therapeutic potential by modulating bile acid metabolism, lipid balance, and inflammatory responses. This review examines the mechanistic interplay between FXR agonists and important protein kinases in NAFLD and NASH. FXR agonists activate AMPK, which promotes fatty acid oxidation and reduces hepatic steatosis. They also regulate MAPK signaling, which reduces c-Jun NH2-terminal kinase (JNK)- and p38 MAPK-mediated inflammation. Furthermore, FXR agonists activate the PI3K/AKT pathway, enhancing insulin sensitivity and modulating mTOR signaling to reduce hepatic fibrosis. Clinical studies in NAFLD/NASH indicate that FXR agonists confer metabolic and anti-inflammatory benefits, although optimizing efficacy and minimizing adverse effects remain challenging. Future studies should focus on combination therapies targeting FXR alongside specific kinases to improve therapeutic outcomes. This review highlights the potential of FXR agonists to modulate protein kinase signaling, opening new avenues for targeted NAFLD/NASH therapy. Full article

Background: Prevention and clinical management of musculoskeletal injuries have historically focused on the assessment and training of modifiable physical factors, but perceptual decision-making has only recently been recognized as a potentially important capability. Immersive virtual reality (VR) systems can measure the speed, accuracy, and consistency of body movements corresponding to stimulus–response instructions for the completion of a forced-choice task. Methods: A cohort of 26 female college soccer players (age 19.5 ± 1.3 years) included 10 players who participated in a baseline assessment, 10 perceptual-response training (PRT) sessions, a post-training assessment that preceded the first soccer practice, and a post-season assessment. The remaining 16 players completed an assessment prior to the team’s first pre-season practice session, and a post-season assessment. The assessments and training sessions involved left- or right-directed neck rotation, arm reach, and step-lunge reactions to 40 presentations of different types of horizontally moving visual stimuli. The PRT program included 4 levels of difficulty created by changes in initial stimulus location, addition of distractor stimuli, and increased movement speed, with ≥90% response accuracy used as the criterion for training progression. Perceptual latency (PL) was defined as the time elapsed from stimulus appearance to initiation of neck rotation toward a peripheral virtual target. The speed–accuracy tradeoff was represented by Rate Correct per Second (RCS) of PL, and inconsistency across trials derived from their standard deviation for PL was represented by intra-individual variability (IIV). Perceptual Decision Efficiency (PDE) represented the ratio of RCS to IIV, which provided a single value representing speed, accuracy, and consistency. Statistical procedures included the bivariate correlation between RCS and IIV, dependent t-test comparisons of pre- and post-training metrics, repeated measures analysis of variance for group X session pre- to post-season comparisons, receiver operating characteristic analysis, and Kaplan–Meier time to injury event analysis. Results: Statistically significant (p < 0.05) results were found for pre- to post-training change, and pre-season to post-season group differences, for RCS, IIV, and PDE. An inverse logarithmic relationship was found between RCS and IIV (Spearman’s Rho = −0.795). The best discriminator between injured and non-injured statuses was PDE ≤ 21.6 (93% Sensitivity; 42% Specificity; OR = 9.29). Conclusions: The 10-session PRT program produced significant improvement in perceptual decision-making that appears to provide a transfer benefit, as the PDE metric provided good prospective prediction of musculoskeletal injury. Full article

The COVID-19 pandemic exposed critical deficiencies in the United States’ legal system’s handling of emergency injunctions, particularly concerning religious freedom. This article examines the challenges courts faced in balancing public health measures with constitutional rights, focusing on the use of shadow dockets and the frequent dismissal of cases due to mootness. Analyzing key Supreme Court decisions and lower court rulings, we highlight the inconsistencies and delays that arose when addressing First Amendment challenges to pandemic-related restrictions. Arguments for procedural reforms, including expedited hearings and avoiding mootness dismissals in cases of national importance, are provided to protect fundamental rights during future public health crises. Full article

Background: With the increasing popularity of pickleball (PB) has come an increase in upper extremity (UE) injury. This study examines the relationship between PB-related UE injury and player characteristics, typical weekly playing behavior, grip tightness, and stretching or strengthening exercise among recreational PB players. Methods: Players at least 18 years of age who played PB for at least six months were recruited to complete an anonymous online survey. Results: Among the 253 participants, 41% reported at least one UE injury: 10% acute and 37.5% chronic. Chi-square analysis (α = 0.05) was used to determine between group differences. The risk of UE injury was 1.51 to 1.53 times higher among individuals who played longer or more frequent sessions or played on consecutive days. Acute injury was more likely in those who played >two hours at a time, on consecutive days, or maintained a tight baseline grip—with relative risks of 2.38, 4.97, and 2.67, respectively. Chronic injury was more common in those who played >two years, at higher skill level, or >six hours a week. No difference in UE injury and sex, strengthening, or stretching was found. Conclusions: The risk of UE injury was higher for those who play longer, more frequently, or on consecutive days. Additionally, acute injury was more likely when using a tight grip for baseline shots and chronic injury was more common among those who played more years, at a higher skill level, or greater playing volume. Full article

Background/Objectives: The presence of Ehlers–Danlos Syndromes (EDSs) has significant effects on overall health and results in varying levels of pain and disability. The effects of sleep are not well documented in this population. The purpose of this study is to report the sleep characteristics of people with EDS. Methods: An electronic survey regarding sleep characteristics was created and distributed through the EDS website. Results: Sleep disturbance is common in people with EDS, with 65.3% of respondents sleeping fewer than 8 h and 26.2% averaging fewer than 6 h. Those who slept fewer than 6 h reported more days of poor mental and physical health days. Sleep aids were commonly used with 41.40% of patients regularly taking prescription medication to get to sleep. Sleep latency of greater than 30 min was also found in 67.5% of subjects. Conclusions: The results demonstrate an association between people with EDS and poorer sleep duration, increased sleep latency, and increased use of sleep aids including prescription sleep medication compared to the general population. While more research needs to be completed in this area, sleep may be an important aspect to address in the management of EDS. Full article

Parental care increases offspring survival but is typically costly to the parent providing it. Understanding diversity in parental care across animals is a timely topic in evolutionary ecology. Fishes are particularly well suited for studies aimed at understanding the diversity of parental care because parental care in fishes is highly variable across species. In most fish species, no care is provided. When parental care is provided, it is often paternal, although biparental and maternal care occur in some fish species as well. Parental care in fishes ranges from simple guarding of eggs in a territory to prolonged care of young after hatching. Within fishes, gobies are thought to exhibit diverse parental care. In the current manuscript, we begin to synthesize our knowledge of patterns of parental care in gobies by providing a review of the parental care strategies that are exhibited by gobiid species. Our review reveals that parental care in gobies most often includes guarding, fanning, and cleaning, although some species engage in other types of care such as larval release, the production of antimicrobial substances, and the construction of post-mating mounds. Care in gobies is most often paternal, but maternal and biparental care have been documented in some species. Full article

Political polarization in the United States has made conversations across ideological divides increasingly difficult to navigate. This study explores how students at a regional university in the southern U.S. experience and manage these challenges. Based on in-depth interviews with 30 students from diverse social and political backgrounds, we identify four key conversational strategies: disengagement, negotiation, context adaptation, and information processing. Rather than viewing these as surface-level techniques, we argue they represent deeper identity management processes aimed at reducing the social and cognitive risks of political disagreement. Drawing on Self-Categorization Theory and Identity Control Theory, we show how these strategies reflect efforts to maintain identity coherence and manage relational stakes when political identity becomes salient. Our findings suggest that while these strategies may help students avoid conflict in the moment, they may also limit deeper engagement across divides. We conclude by discussing the implications of these findings for dialog practice, highlighting the importance of fostering tolerance for identity discomfort and helping students rediscover the common bonds that unite them across political differences. Full article

Background: Peritoneal relapse after cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is common. Repeat CRS/HIPEC offers the potential for long-term survival in the appropriately selected patient. Methods: We performed a retrospective review of a single institution database to assess perioperative outcomes after repeat CRS/HIPEC for appendiceal (pAC) and colorectal (pCRC) cancers. Kaplan–Meier and Cox estimates were used to assess survival. Results: Of 157 patients, 103 patients underwent initial CRS/HIPEC for pAC (n = 67) or pCRC (n = 36) histologies. Twenty-seven pAC patients (27/67, 40%) and 23/36 pCRC patients (63%) developed disease recurrence. Relapsed patients had a higher burden of disease (PCI), operative length and blood loss and received adjuvant chemotherapy (all p < 0.05). Nine of the 27 relapsed pAC patients and 5 of the 13 relapsed pCRC patients underwent repeat CRS/HIPEC. The median time to repeat CRS/HIPEC was 18 months (4–26 months), and a CCR-0 and CCR-1 were achieved in 79% and 21%, respectively. The 1-, 3- and 5-year OS for pAC patients who underwent repeat CRS/HIPEC was 88.9%, 88.9% and 77.8%, and the 1- and 3-year OS for pCRC patients was 100% and 25%, respectively. Repeat CRS/HIPEC for pAC was associated with significant improvement in OS (p = 0.03), while for pCRC, no significant difference was observed (p = 0.99). Conclusions: Repeat CRS/HIPEC for isolated peritoneal recurrence is safe and offers the potential for long-term survival. Patient selection is key to ensure optimal cytoreduction when considering repeat CRS/HIPEC. Full article

Pre-trip anxiety is a critical yet understudied factor influencing participation and engagement in Outdoor Experiential Education (OEE) programs. Anxiety can serve as both a motivator and a barrier, shaping participants’ willingness to engage in challenging activities. This study examines the sources, predictors, and temporal progression of pre-trip anxiety among OEE participants, with a focus on experience level, gender differences, and activity type. Using a cross-sectional design, data were collected from students and staff at two Midwestern universities across three time points leading to an OEE program. Measures included the State–Trait Anxiety Inventory (STAI) and a course-specific worry scale assessing concerns such as physical ability, social dynamics, and environmental risks. Results indicate that experience level can predict anxiety, with less experienced participants reporting higher levels of concern. Gender differences were also observed, with female participants exhibiting greater pre-trip anxiety, particularly in water-based activities. However, anxiety remained relatively stable across time intervals, suggesting that interventions may be effective at multiple stages before a program begins. These findings have practical implications for OEE design, including targeted pre-trip interventions, adjusted program marketing, and tailored support strategies to reduce barriers to participation and enhance student preparedness. Full article

This paper introduces Harmonizer, a universal framework designed for tokenizing heterogeneous input signals, including text, audio, and video, to enable seamless integration into multimodal large language models (LLMs). Harmonizer employs a unified approach to convert diverse, non-linguistic signals into discrete tokens via its FusionQuantizer architecture, built on FluxFormer, to efficiently capture essential signal features while minimizing complexity. We enhance features through STFT-based spectral decomposition, Hilbert transform analytic signal extraction, and SCLAHE spectrogram contrast optimization, and train using a composite loss function to produce reliable embeddings and construct a robust vector vocabulary. Experimental validation on music datasets such as E-GMD v1.0.0, Maestro v3.0.0, and GTZAN demonstrates high fidelity across 288 s of vocal signals (MSE = 0.0037, CC = 0.9282, Cosine Sim. = 0.9278, DTW = 12.12, MFCC Sim. = 0.9997, Spectral Conv. = 0.2485). Preliminary tests on text reconstruction and UCF-101 video clips further confirm Harmonizer’s applicability across discrete and spatiotemporal modalities. Rooted in the universality of wave phenomena and Fourier theory, Harmonizer offers a physics-inspired, modality-agnostic fusion mechanism via wave superposition and interference principles. In summary, Harmonizer integrates natural language processing and signal processing into a coherent tokenization paradigm for efficient, interpretable multimodal learning. Full article

Filial cannibalism is the consumption of one’s own viable progeny. It occurs in a range of taxa but is particularly well-documented in fish species. Since parental care in fishes is typically male-biased, it is usually assumed that filial cannibalism is predominantly performed by the parental male while he is providing care to offspring. Filial cannibalism by females is less studied in fish. Video-recorded observations of ten pairs of adults housed in captivity revealed the first documentation of female filial cannibalism in the redhead goby (Elacatinus puncticulatus). Females were observed consuming both their own eggs and larvae. We discuss non-adaptive and adaptive explanations for female filial cannibalism in the redhead goby, including confinement due to captivity, nutritional or energetic need, and a possible lack of kin recognition. Understanding the evolutionary significance of filial cannibalism exhibited by females is an important biological inquiry. Since the redhead goby is a species used in the aquarium trade, understanding the conditions that influence female filial cannibalism in captivity may yield practical implications. Full article