Search Results (1,408)

Background/Objectives: To evaluate risk factors for postoperative neurological deficits following cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) and to determine whether intraoperative neurophysiological monitoring (IONM) can predict neurological compromise. Methods: A multicenter retrospective review was performed on 42 CE-ULBD procedures conducted between 2016 and 2024; 33 cases met the inclusion criteria with available imaging and electromyography data. Demographic, operative, and neurophysiological variables were analyzed. Preoperative stenosis severity was graded using the Kang MRI system. Intraoperative IONM data, including electromyography firing and motor evoked potential (MEP) changes, were correlated with new postoperative weakness. Results: The cohort (69.1% male, mean age 70.2 ± 1.7 years, mean BMI 29.6 ± 1.1) included 56 decompressed levels. The most common operative levels were C3-4 (37%) and C4-5 (24%). Postoperative weakness occurred in four patients (12.1%), all of whom had severe (Grade 3) preoperative stenosis. Among these, 50% exhibited preoperative weakness. Neuromonitoring changes correlated significantly with postoperative weakness (Fisher’s Exact, p < 0.001); 100% of patients with new post-operative weakness had sustained MEP decrease at the time of closure. Conclusions: Patients with severe cervical stenosis and preoperative weakness are at heightened risk of postoperative neurological deficits following CE-ULBD. Elevated epidural pressure from continuous irrigation in a constricted canal may exacerbate cord compression, particularly in those with preexisting myelopathy. IONM changes strongly correlate with new deficits and may exacerbate cord compression, particularly in those with preexisting myelopathy, and may serve as an early warning system for impending neurological injury. Surgeons should exercise caution and maintain low irrigation pressures in patients with severe stenosis undergoing endoscopic cervical decompression. Full article

Background: The subacromial space, measured as the acromiohumeral distance (AHD), is a key determinant of shoulder biomechanics and injury risk. Athletes performing repetitive upper-limb resistance training are particularly exposed to cumulative tendon stress. Musculoskeletal ultrasound (US) enables dynamic, cost-effective assessment, yet its role in strength athletes remains underexplored. The aim of this study was to determine whether young adults engaged in regular upper-limb weight training present a narrower acromiohumeral distance and a higher prevalence of ultrasound-detected tendon abnormalities compared with non-weight-training individuals. Methods: We conducted a post hoc subanalysis of a cross-sectional cohort of 66 young adults (18–45 years; mean 29.6 ± 9.0 years; 27 men/39 women) evaluated with standardized shoulder US. Participants were classified as weight-training (n = 15; 36.2 ± 5.7 years; 11 men/4 women) or non-weight-training (n = 51; 27.6 ± 8.8 years; 16 men/35 women). AHD was measured in millimeters, and abnormalities of the supraspinatus, subscapularis, long head of the biceps tendon (LHBT), and subacromial–subdeltoid bursa were recorded. Between-group comparisons used Welch’s t-test or χ²/Fisher’s exact test; effect sizes were expressed as Cohen’s d or odds ratios (OR). Multiple testing was corrected with the false discovery rate (FDR). Results: Weight-training participants exhibited a significantly smaller AHD (7.13 ± 0.54 vs. 7.49 ± 0.68 mm; t (28) = −2.12, p = 0.038; mean difference −0.36 mm, 95% CI −0.70 to −0.03; Cohen’s d = −0.56). Supraspinatus tendinopathy was more prevalent in weight-training athletes (93.3% vs. 41.2%; OR 17.7, 95% CI 2.16–145.8; FDR-adjusted p = 0.003). Subscapularis tendinitis (40.0% vs. 17.6%; OR 3.58, 95% CI 1.00–12.88; FDR p = 0.14) and LHBT tenosynovitis (20.0% vs. 3.9%; OR 6.82, 95% CI 1.02–45.8; FDR p = 0.09) showed non-significant trends. Conclusions: Upper-limb weight training in young adults is associated with reduced AHD and a markedly higher prevalence of supraspinatus tendinopathy. Ultrasound proved valuable for early detection of structural and morphological alterations in shoulder soft tissues. Preventive strategies focusing on load management, exercise technique, and targeted strengthening should be prioritized. Full article

Background: Rapid advances in biotechnology provide researchers with the opportunity to integrate omics profiles (genomics, epigenomics, transcriptomics, proteomics, etc.) with multiple phenotypes or experimental conditions. In cancers such as acute myeloid leukemia (AML), where combination therapies are standard of care, identifying genetic drivers of drug resistance requires evaluating how genes are associated with multiple drug response phenotypes. Statistical analyses associating omics profiles with multiple phenotypes yield multiple significance values and rankings for each of many genes. There is a great need to consolidate these multiple rankings into a consensus ranking to prioritize specific genes for detailed follow-up wet-lab or clinical studies. Methods/Results: Here, we evaluate the well-known Fisher’s method, the sum of squared z-statistics (SSz), and the recently published cellMCD method as tools for gene prioritization. In simulation studies, cellMCD showed very similar or highly superior performance to the widely used Fisher’s and SSz methods. These advantages were also observed in an example application involving a CRISPR drug screen of an acute myeloid leukemia cell line. Conclusions: In summary, our results indicate that cellMCD should be more widely used for prioritizing discoveries from multiple omic association studies. These methods are available as an R package on github. Full article

Background/Objectives: Patients with Idiopathic sudden sensorineural hearing loss (ISSNHL) are often devastated by the unknown etiology coupled with the unknown pathway to recovery. The aim of this study was to evaluate whether abnormalities on the video Head Impulse Test (vHIT) performed early in the course of ISSNHL are associated with poorer hearing recovery. Methods: Forty-four patients with ISSNHL were prospectively enrolled between 2019 and 2022 following exclusion of differential diagnoses on clinical and MRI evaluation. vHIT was performed within 1–14 days of symptom onset and within 48 h of hospitalization. Recovery at six months was assessed both as a dichotomous outcome and by change in pure tone average (PTA). Group differences were analyzed using Fisher’s exact and Mann–Whitney U tests. A two-predictor logistic regression model examined the association between vHIT results, dizziness, and recovery. Results: Twelve patients exhibited abnormal vHIT findings. Abnormal vHIT was strongly associated with the presence of dizziness and with markedly poorer hearing recovery at six months. Patients with normal vHIT demonstrated substantially greater improvement in PTA thresholds compared with those showing abnormal results. Logistic regression further confirmed that abnormal vHIT was an independent predictor of reduced likelihood of hearing recovery, whereas dizziness alone did not independently influence outcomes. Conclusions: Our findings suggest that abnormal vHIT results in ISSNHL patients are linked to poor hearing recovery, which can enhance patient counseling regarding expectations. Although promising as a prognostic tool, we acknowledge our limited sample size and recommend validation in larger prospective cohorts. Full article

Background/Objectives: Rapid sequence intubation (RSI) involves nearly simultaneous administration of a rapid-acting induction agent and a neuromuscular blocking agent (NMBA) to facilitate ideal intubation conditions. The NMBAs most commonly used for RSI are succinylcholine and rocuronium, which cause paralysis for 5–15 min and 45–70 min, respectively. Awareness with paralysis can occur in patients who are given longer-acting NMBAs with delayed initiation of post-intubation sedation or insufficient sedation depth. The previous literature has associated the use of rocuronium with a significantly longer time to sedation and analgesia. However, a recent study found no difference. The purpose of this study was to assess the association between paralytic agent choice and time to initiation of analgesia and/or sedation after RSI in the emergency department (ED) of a large tertiary care hospital. Methods: This study was an institutional review board (IRB)-approved, single-center, retrospective cohort evaluation of adult patients (≥18 years of age) who received succinylcholine or rocuronium following administration of an induction agent in the ED for RSI during the study time period. The primary outcome was time to initiation of post-intubation analgesia and/or sedation. Continuous data were analyzed by using Mann–Whitney U or Student’s t-test, and categorical data were analyzed using the Chi Square test or Fisher’s Exact test. Results: A total of 400 patients were included in this study. The median time to sedation with succinylcholine was 9 min compared to 14 min with rocuronium (p < 0.01). No significant differences were identified in the baseline characteristics or secondary outcomes related to induction agent choice or ED length of stay. Conclusions: The results of this study further support that the use of rocuronium for RSI is associated with a significantly longer time to sedation and/or analgesia, making emergency medicine provider awareness essential for minimizing the risks associated with inadequate post-intubation sedation. Full article

Fisheries management in the Mediterranean Sea faces persistent challenges due to the prevalence of data-poor and data-limited stocks, small-scale multi-species fisheries, and limited long-term monitoring programs. Effective assessment methodologies are critical to ensuring sustainable exploitation, yet traditional data-rich stock assessment models remain infeasible for many Mediterranean fisheries. This review provides a comprehensive synthesis of current methodologies developed and applied to assess data-poor fisheries in the Mediterranean context. We examine catch-only approaches, length-based methods, empirical indicators, and multi-indicator frameworks increasingly adopted by the General Fisheries Commission for the Mediterranean (GFCM) and the EU’s Data Collection Framework (DCF). Special attention is given to case studies from the western, central, and eastern Mediterranean that demonstrate the opportunities and limitations of these approaches. We further explore emerging tools, including integrated modeling frameworks, simulation-based harvest control rules, and participatory approaches involving fishers’ local knowledge, to highlight innovations suited to mixed, small-scale Mediterranean fisheries. The review concludes by identifying key gaps in data collection, assessment capacity, and institutional coordination, and proposes a roadmap for improving data-poor fisheries management under Mediterranean-specific ecological, socio-economic, and governance constraints. By consolidating methodological advances and practical lessons, this review aims to provide a reference framework for researchers, managers, and policymakers seeking to design robust, adaptive strategies for sustainable fisheries management in data-limited Mediterranean contexts. Full article

Background: Tumors of the pineal region account for less than 1% of supratentorial neoplasms in adults and represent a distinct neuro-oncological challenge. Their management requires a multidisciplinary and multimodal approach. Traditionally, direct surgical resection was considered the primary treatment modality. Recent advances in minimally invasive techniques and onco-radiotherapy have paved the way for safer and more personalized treatment strategies, in line with the principles of precision medicine. This study aims to present our institutional approach, which relies on a combination of endoscopic and radiotherapy-based techniques. Methods: A retrospective, single-center clinical study was conducted involving 28 adult patients who underwent endoscopic third ventriculostomy and biopsy of a pineal region tumor between January 2014 and March 2025. Descriptive statistics, permutation tests with bootstrap-derived confidence intervals, Fisher’s exact test, and Kaplan–Meier survival analysis were applied for data evaluation. Results: Endoscopic intervention resulted in clinical improvement in 78% of cases. A significant increase in performance status was observed in the postoperative period (<0.001) compared to preoperative results. Radiotherapy contributed to either tumor regression or disease stabilization. Conclusions: Based on our findings, the combination of endoscopic intervention and personalized radiotherapy represents a safe and effective treatment strategy, offering a compelling alternative to direct surgical resection, which is reserved as a second-line treatment. Full article

Background: Evidence on COVID-19 convalescent plasma (CCP) is mixed. We examined associations between CCP administration and in-hospital outcomes among patients hospitalized during early pandemic waves in Poland. Methods: We conducted a retrospective, single-center cohort study of adults hospitalized with COVID-19 between October 2020 and January 2021. Patients receiving CCP were compared with contemporaneous controls without CCP. Primary outcomes were in-hospital mortality and discharge alive. Requirement for invasive mechanical ventilation/intubation was summarized descriptively because timing of intubation was not reliably available. Group comparisons used χ²/Fisher’s exact tests and t-test/Mann–Whitney U tests as appropriate. Associations with mortality and discharge were evaluated using logistic regression: (i) a prespecified age-adjusted model and (ii) an exploratory prognostic model including in-hospital treatments and severity markers (systemic glucocorticoids, remdesivir, oxygen therapy, and antibiotic use), interpreted prognostically rather than causally. Results: The cohort included 224 patients (CCP, n = 92; controls, n = 132); outcome status was missing for eight controls. Baseline demographics, comorbidities, and admission laboratory values were broadly comparable between groups. Crude in-hospital mortality was 25% in the CCP group (23/92) versus 42% in controls (52/124; p = 0.010), and discharge alive occurred in 66% versus 50%, respectively (p = 0.022). Invasive mechanical ventilation/intubation was required in 12.0% of CCP recipients and 4.5% of controls (p = 0.071). In age-adjusted models, CCP was associated with lower odds of in-hospital death. In exploratory prognostic models incorporating systemic glucocorticoids, remdesivir, oxygen therapy, and antibiotic use, CCP remained associated with lower odds of death and higher odds of discharge alive. Conclusions: In this early-wave retrospective cohort, CCP administration was associated with lower in-hospital mortality and higher discharge rates. Exploratory analyses adjusted for concomitant in-hospital therapies and severity markers should be interpreted as prognostic associations rather than evidence of causal efficacy. Full article

Background: Pneumothorax (PTX) develops in 1–2% of neonates, leading to significant morbidity and mortality and requiring providers to be comfortable with management. Our objective was to evaluate whether radiographic measurements of PTX size can be used to predict the need for procedural intervention in neonates in order to help guide the need for the availability of specific personnel. Methods: With the help of a data analyst, 62 patients diagnosed with neonatal PTX between March 2016 and October 2024 were identified. Most babies (46) were born in 2023–2024 when our new electronic health record could more easily identify these infants. PTX size was evaluated using radiographs by calculating the ratio of the widest transverse measurement of the PTX on both anteroposterior (AP) and, when available, lateral decubitus (DECUB) divided by the widest transverse measurement of the hemithorax above the diaphragm. Clinical data were collected, and statistical analysis was performed using need for intervention (thoracentesis (TC), chest tube (CT), or both). Results: We found that a larger PTX size ratio, measured in the AP (p < 0.0001) or DECUB view (p < 0.008), was highly associated with need for intervention in this cohort of infants with PTX. Only 33% of PTXs required intervention. Also, 13/14 (93%) cases who underwent TC ultimately required a CT. PTX was more prevalent in males in general, but sex was not associated with needing intervention. The average gestational age (GA) of the cohort was 36 5/7 weeks, with only 12% being < 34 weeks GA. Univariate analysis indicated that lower GA and birth weight were risk factors for intervention. There was a trend (p = 0.075, by Fisher’s exact test) suggesting that infants with both respiratory distress syndrome (RDS) and PTX may be more likely (60%) to require intervention (no RDS, 29% intervention). Finally, a receiver operator characteristic curve was derived from the AP ratio based on the yes/no intervention which resulted in an area under the curve statistic of 0.902 and the optimal AP ratio cutoff of 0.184. Conclusions: The ratio of the transverse measurement of the PTX/hemithorax size from radiographs was highly predictive for need for intervention in a cohort of primarily term infants with PTX. Smaller and lower GA infants were at a higher risk for requiring procedural intervention. Nearly all infants who had TC also needed a CT. These findings could inform clinical strategies for managing neonatal PTXs, especially in identifying appropriate needed personnel availability if a TC occurs. Full article

Background: Germline alterations in DNA damage repair (DDR) genes represent a clinically important subset of prostate cancer (PCa), but real-world data from Middle Eastern and Turkish populations remain limited. We evaluated the prevalence and clinicopathologic associations of germline DDR variants in a single-center Turkish cohort. Methods: We retrospectively analyzed 122 men with histologically confirmed PCa who underwent germline multigene panel testing. Variants were classified according to ACMG/ClinVar criteria. Patients were grouped as pathogenic/likely pathogenic (P/LP), variants of uncertain significance (VUS), or variant-negative. Patients were grouped as variant-positive (P/LP or VUS/uncategorized) or clinically actionable variant–negative (benign/likely benign or no variant detected). Group comparisons used t-tests, chi-square or Fisher’s exact tests as appropriate. Results: The median age at diagnosis was 65.2 years (mean 64.6 ± 8.78). Overall, 37 patients (30.3%) carried at least one germline variant, including 12 (9.8%) with P/LP alterations and 24 (19.7%) with VUS; one patient (0.8%) harbored an uncategorized variant. The most frequently affected genes were CHEK2 (n = 8), BRCA1 (n = 6), BRCA2 (n = 6), ATM (n = 5), and APC (n = 4). Variant-positive status increased from 10.8% in ISUP 1–2 to 21.6% in ISUP 3 and 76.0% in ISUP 4–5, although this trend was not statistically significant (p = 0.391). Mean age at diagnosis and the prevalence of metastatic disease did not differ between variant-positive and clinically actionable variant–negative patients (64.2 vs. 65.7 years, p = 0.390; 66.7% vs. 64.6%, p = 0.842). Truncating DDR variants (RAD50, BRCA2, MSH3, NBN, CHEK2, ATM) occurred predominantly in ISUP 4–5 tumors. Conclusions: Germline DDR alterations—most notably in BRCA2, CHEK2, and ATM—were present in a substantial subset of Turkish men with PCa and showed a non-significant trend toward clustering in higher-grade disease. The high prevalence of VUS reflects limited genomic annotation in under-represented populations and underscores the need for longitudinal reinterpretation. These data support the clinical value of incorporating germline DDR testing into risk assessment and familial counseling, while larger cohorts integrating somatic profiling are needed to refine genotype–phenotype associations. Full article

Introduction: Teeth intended for use as autogenous augmentative material may carry microbiological contamination, which can compromise the safety of regenerative procedures in the oral cavity. Therefore, effective disinfection protocols are crucial to ensure the microbiological purity of dentin-derived graft materials. Objective: This study aimed to evaluate the effectiveness of a 30% alkaline ethanol solution containing 0.5 M sodium hydroxide in eliminating microorganisms from dentin material intended for autogenous augmentation. Materials and Methods: The study included 44 extracted teeth that were processed using the Smart Dentin Grinder procedure. The presence of microorganisms was analysed using standard microbiological methods before and after treatment with the disinfectant solution. Additionally, the potential association between tooth eruption status and the effectiveness of the disinfection process was evaluated using Fisher’s exact test, with odds ratios calculated using the Haldane–Anscombe correction to address zero cell counts. Results: Processing dentin in a 30% alkaline ethyl alcohol solution containing 0.5 M sodium hydroxide is an effective method for eliminating microorganisms, thereby rendering the material completely microbiologically pure. Conclusions: The dentine processing procedure used appears to ensure the production of autogenous material free from microbiological contamination, indicating its potential safety in clinical applications. Full article

Background/Objectives: Several imaging scores have been developed for subarachnoid hemorrhage (SAH), but their prognostic performance for long-term functional outcome and post-hospital complications remains insufficiently characterized. We evaluated whether five admission imaging scores (modified Fisher, Claassen, Hijdra, Graeb, IVH) independently predict 12-month functional outcome and major secondary endpoints. Methods: We performed a retrospective cohort study of 479 consecutive patients with atraumatic SAH recorded in a prospectively maintained institutional registry. Admission CT/MRI was scored by two board-certified neuroradiologists blinded to clinical outcomes. The primary endpoint was unfavorable functional outcome at 12 months (modified Rankin scale [mRS] 4–6). Secondary endpoints included 12-month mortality, delayed cerebral ischemia (DCI), post-hemorrhagic epilepsy, shunt-dependent hydrocephalus, return to work, and patient-reported health. Receiver operating characteristic (ROC) analyses and multivariable logistic regression adjusted for established predictors were conducted. Results: All imaging scores were significantly associated with the primary endpoint and demonstrated adequate discrimination (area under the curve [AUC] ~0.70–0.74), with the Graeb and IVH scores performing highest for long-term functional outcome, mortality, and shunt dependence. Associations with DCI and epilepsy were modest. In multivariable analyses, all imaging scores remained independently associated with mRS 4–6. Subgroup analyses showed stronger prognostic performance in good-grade SAH, aneurysmal SAH, and cases with concomitant intraventricular hemorrhage. Conclusions: Admission imaging burden independently predicts 12-month functional outcome, mortality, and shunt dependence after SAH. Incorporating IVH-oriented measures alongside established clinical grading may improve individualized risk stratification, particularly in good-grade and aneurysmal SAH. Full article

Background: Human monkeypox is a zoonotic disease caused by the monkeypox virus (MPXV), endemic in Central and West Africa. A significant 2022 outbreak affected 104 countries, driven by increased susceptibility due to the cessation of smallpox vaccination, global travel, and interactions with infected animals. Strengthening surveillance, public health measures, and raising awareness are essential for early diagnosis, vaccination acceptance, and preventing future outbreaks. Methods: The survey was distributed to 645 nursing students of the University of Palermo between July 2022 and August 2022, and we estimated the knowledge, attitudes and behaviors through a KAP Survey. Descriptive statistics were used to summarize the data, while chi-squared, Fisher’s exact, and Student’s t-tests were employed to analyze differences between groups, with statistical significance set at p < 0.05. At least 80% of the students surveyed had already taken the microbiology exam, as microbiology is studied in the first year of the Bachelor of Science in Nursing program at the University of Palermo. Results: The survey showed a predominantly young, female nursing student population with limited knowledge of monkeypox, as only 3.88% demonstrated adequate understanding. Despite this, attitudes toward prevention were positive, with 82.64% scoring adequately and 41.09% expressing strong willingness to get vaccinated. Knowledge improved with academic progression (p = 0.005), while attitudes and behaviors remained consistent. These findings imply a critical gap in education; the limited knowledge, especially regarding transmission and severity, may lead to an underestimation of the risks associated with global infectious diseases. This underscores the need to better prepare future healthcare professionals for public health emergencies Conclusions: The study found that nursing students had limited knowledge of monkeypox, especially regarding epidemiology and disease severity. Despite positive attitudes toward vaccination, some behaviors reflected an underestimation of global infection risks. Knowledge improved with academic progression, underscoring the importance of education. Targeted educational programs are needed to enhance awareness and preparedness for future outbreaks. Full article

Background: Childhood obesity is a persistent global health challenge, often rooted in early-life dietary patterns shaped within the home environment. Objective: To investigate the association between parents’ culinary skills, children’s eating behavior, and the degree of child involvement in family culinary practices. Methods: A cross-sectional, analytical study. In the public and private schools in southern Brazil. A total of 205 families with children aged 3 to 13 years participated. Parents or caregivers answered a structured questionnaire on culinary skills and sociodemographic variables. Children’s eating behavior was assessed through the validated Brazilian version of the Children’s Eating Behaviour Questionnaire (CEBQ). Student’s T test was used to compare means, and Pearson’s chi-square or Fisher’s exact test to compare proportions. Multivariate linear regression was applied to control for potential confounders. Analyses were conducted using SPSS version 27.0 and R software. Results: Most parents (90.7%) reported cooking regularly, and 65.9% involved children in cooking activities. The predominant culinary profile (40%) was classified as “convenience cooking,” marked by frequent use of processed ingredients. Healthier parental cooking practices were positively associated with adaptive eating behaviors in children, reflected by lower food fussiness, satiety responsiveness, food responsiveness and food refusal scores and higher enjoyment of food scores domains of the CEBQ. Conclusions: Despite the high prevalence of routine cooking, convenience-oriented practices remain dominant, reflecting broader sociocultural patterns. Engagement in healthier cooking practices was positively associated with more favorable eating behaviors in children. These findings underscore the importance of promoting culinary education and parental involvement in cooking as strategies to support healthy childhood eating behaviors. Full article

Background: Congenital hearing loss affects 1–3 per 1000 newborns and requires early detection to prevent developmental delays. Although Thailand implements universal screening, fragmented data systems limit effectiveness. To address this, Chiangrai Prachanukroh Hospital introduced a dedicated newborn hearing screening (NHS) database in 2023 to improve tracking, coordination, and monitoring in a resource-limited setting. Objectives: To evaluate the advantages and limitations of NHS database integration on screening coverage, referral rates, follow-up completion, and diagnostic timeliness. Methods: A retrospective analytic study was conducted over 24 months, comparing outcomes before (July 2022–June 2023) and after (July 2023–June 2024) database implementation. Key indicators included screening coverage, follow-up attendance, diagnostic ABR completion, and workflow efficiency, with the study period also encompassing the implementation of the database and adaptations to the screening algorithm. Data were analyzed using the chi-square test and fisher’s exact tests, supplemented by qualitative observations of system performance. Results: Among 8290 newborns, screening coverage before one month increased from 83.47% to 96.64% (p < 0.001), while referral rates decreased from 18.44% to 6.47% (p < 0.001). Diagnostic ABR completion improved from 7.41% to 52.63% within three months (p < 0.001) and from 59.26% to 84.21% within six months (p = 0.06). The database improved workflow coordination, but challenges persisted, including incomplete data, limited interoperability, caregiver-related follow-up barriers, and low hearing-aid uptake. Conclusions: Integration of the NHS database, as well as protocol changes, improved screening coverage, referral accuracy, and diagnostic timeliness, but follow-up and early intervention barriers persisted. Continued progress will require stronger interoperability, improved family engagement, and digital infrastructure investment, with tele-audiology and decision-support tools helping expand access and efficiency. Full article