Search Results (88)

Background: The click-evoked Auditory Brainstem Response (ABR) is the gold standard electrophysiological tool for assessing auditory pathway integrity in infants and young children. As normative data are inherently equipment-specific, the absence of pediatric reference values for the NeuroAudio system (Neurosoft, Ivanovo, Russia) represents a significant gap in clinical practice, given that existing normative datasets for this system are restricted to adult populations. Objective: To establish normative data for click ABR recorded with the NeuroAudio system in children under three years of age, stratified by age group according to auditory maturation patterns. Methods: A prospective, cross-sectional study was conducted at the Electrophysiology Laboratory of the Department of Speech Therapy, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), under the approval of the Research Ethics Committee (protocol 7.939.564). A total of 203 children (121 males, 82 females; age range: 2 weeks to 36 months) with confirmed normal peripheral auditory function were included. Click stimuli (0.1 ms, rarefaction polarity) were delivered monaurally via ER-3A insert earphones at 80 dB nHL and a repetition rate of 19.3/s. Two average runs of 2000 artifact-free sweeps were recorded per ear. Absolute latencies of waves I, III, and V, interpeak intervals I–III, III–V, and I–V, and amplitudes of waves I and V were analyzed. Results: Statistical modeling supported the consolidation of 12 initial age bins into three clinically and statistically validated categories: 0–3, 4–12, and 13–36 months. Wave I latency remained stable across age groups, whereas waves III and V and all interpeak intervals showed progressive shortening with increasing age. Wave V amplitude increased progressively with age, while wave I amplitude remained unchanged. Females presented shorter latencies than males for waves III and V and for all interpeak intervals. The right ear exhibited a shorter III–V interpeak interval than the left ear, with a significant ear × age interaction indicating that this asymmetry is modulated during early maturation. Age, sex, and ear-stratified normative values (two SD and three SD reference limits) are reported. Conclusion: This study provides the first pediatric normative dataset for click-evoked ABR acquired with the NeuroAudio system in children under three years of age. The proposed three age stratifications, together with sex- and ear-specific reference values for the III–V interpeak interval, offer a clinically actionable framework for the accurate interpretation of pediatric ABR recordings and for the early identification of auditory pathway abnormalities. Full article

Concussions exert a massive cost on our economic and healthcare systems. Many of the most commonly employed neurocognitive measures in concussion assessment have been shown to be psychometrically problematic. Additionally, norms are established from largely male populations. The present study investigates the use of a validated and reliable measure of concussion sequelae, the mobile half-version of the Connors Continuous Performance Test 3rd Edition (CCPT-3), on a representative population to study the influence of sex and age on normative values collected at baseline. Baseline data were analyzed from 71,976 participants across a wide range of academic and athletic contexts, as well as healthcare settings. Multiple regressions examined the influence of sex as a function of age in different developmental groups: children, adolescents, young adults, adults, and older adults. Sex effects emerged during childhood, peaked during adolescence, and decreased in adulthood. Females showed better accuracy (fewer commission and omission errors), whereas males had faster response speeds (hit-rate RT). Effect sizes were generally in the small to very small range (sex effect sizes ranged from Cohen’s d = 0.02 to 0.39). The findings highlight the importance of accounting for sex and age in cognitive test performance and underscore the impact of correcting for even small effects when working with large samples. Full article

Background: Burnout is a relevant occupational health concern in Emergency Medical Services (EMSs), with potential implications for workforce well-being, occupational health, and the sustainability of prehospital care. Although burnout has been widely studied among healthcare professionals, evidence concerning Emergency Medical Technician (EMT) students remains limited. This exploratory study aimed to estimate high burnout prevalence among EMT students and practising EMT professionals in Madrid, Spain, describe burnout dimensions in both groups, and examine sociodemographic correlates of high burnout status. Methods: A cross-sectional comparative study was conducted between March and June 2024 using a convenience sample of 85 participants: 43 EMT students and 42 practising EMT professionals. Burnout was assessed using validated Spanish versions of the Maslach Burnout Inventory: the MBI-SS for students and the MBI-HSS for professionals. Because these instruments are population-specific and rely on different norms and thresholds, between-group comparisons of raw scores were interpreted as exploratory. Descriptive analyses, between-group comparisons with effect sizes, correlation analyses, and an exploratory binary logistic regression model were performed. Results: High burnout was identified in 22 EMT students (51.2%) and 23 practising EMT professionals (54.8%), with no statistically significant between-group difference detected (p = 0.73; Cramer’s V = 0.04). Between-group comparisons of burnout dimensions showed small effect sizes for Emotional Exhaustion (Cohen’s d = 0.17), Depersonalisation (Cohen’s d = 0.24), and Personal Accomplishment (Cohen’s d = −0.26). Age was positively associated with Emotional Exhaustion (r = 0.29, p = 0.008) and Depersonalisation (r = 0.24, p = 0.028), and negatively associated with Personal Accomplishment (r = −0.26, p = 0.019). In the exploratory adjusted logistic regression model, age was associated with high burnout status (OR = 1.05; 95% CI 1.01–1.10; p = 0.017), whereas group and sex were not significant correlates. Conclusions: High burnout levels were observed in both EMT students and practising EMT professionals in this regional exploratory sample. However, the findings should be interpreted cautiously due to the cross-sectional design, convenience sampling, modest sample size, limited statistical power, and use of population-specific burnout instruments. These results suggest that burnout-related distress may be relevant across the EMT training-to-practice pathway and support the need for larger longitudinal and multicentre studies incorporating occupational, educational, and organisational variables. Full article

The project aimed to explore the psychosocial impact on parents of receiving a false-positive outcome following a positive newborn bloodspot screening (NBS) result for SCID for their child. A mixed-methods design was employed using semi-structured interviews and standardised health-related questionnaires (EQ-5D-5L, ITQOL-47, and GAD-7). The participants were recruited from six National Health Service hospital trusts in England involved in the NHS England In-Service Evaluation of Screening for SCID. A total of 22 interviews were conducted with 28 parents. Health-related questionnaire data were collected from 26 of these parents. The interviews were analysed using a reflexive deductive approach to thematic analysis. For the health-related questionnaire data, a comparison of group means against population norms was undertaken using t-tests with unequal variances. The findings from the interviews showed that receiving a false-positive outcome following a positive NBS SCID result could cause parents to have an enhanced view of their child’s vulnerability in the short term. However, negative sequelae were largely mitigated as parents viewed their child’s exposure to ‘normal’ infections as evidence of a functional immune system. The health-related questionnaire data showed that the parents had significantly worse health than the population norm (as indicated by EQ-VAS: p = 0.0296); however, all the other measures were non-significant. More research is needed to explore the potential longer-term psychosocial impact of a false-positive screening result for SCID on parents beyond their child’s first year of life. Full article

(1) Background: The local divergence exponent (LDE) is a sensitive measure of walking stability deterioration and risk of falling in older adults. We aim to determine the validity the LDE measured using a mobile phone and to assess its ability to discriminate between healthy young and older adults; (2) Methods: 20 older adults (76.4 ± 4.6 years) and 20 young adults (29.1 ± 6.5 yrs) walked for 6 min on a 20-m walkway while wearing a research-grade inertial measurement unit (IMU) and a mobile phone placed on the sternum to record 3D acceleration data. The LDE was calculated using data from both devices for 3D, vertical (VT), mediolateral (ML), anteroposterior (AP), and norm (N) accelerations. ICC (3,1) was used to determine the validity of the mobile phone’s LDE. Mann–Whitney U tests were used to determine age-group discriminability of LDE measures; (3) Results: LDEs demonstrated excellent absolute agreement between the wearable IMU and mobile phone (ICC = 0.844). Mobile phone-derived LDEs demonstrated excellent validity relative to the wearable IMU (ICC > 0.75). No significant age-related differences in LDE were observed; wearable or mobile sensors (both p > 0.05); (4) Conclusions: LDEs measures obtained with a mobile phone are valid. No age group differences were identified. Full article

Validated instruments assessing gender stereotype endorsement among adolescents are scarce and often overlook contemporary domains like digital privacy. To address this gap, this study developed and validated the Gender Stereotypes and Roles Adherence Battery for Adolescents (GAB-A) in a sample of 2955 Italian adolescents attending public secondary schools in Rome (56.4% male; mean age 14.3 years). The battery comprises three modules: the Gender Stereotyped Attitude Scale (GSAS), Gender Role Activities Scale (GRAS), and Gendered Traits Inventory (GTI). Psychometric analysis confirmed robust factor structures, notably identifying a distinct “Relational Control” factor within the GSAS that assesses beliefs normalizing partner surveillance. The results revealed a stark pattern of gender differentiation: males endorsed prescriptive attitudes (GSAS, d = 1.07) and roles (GRAS, d = 0.88) substantially more than females, particularly regarding violence myths. Conversely, essentialist trait beliefs (GTI) showed negligible gender differences (d = 0.11). Associations between stereotypes and psychological health were gender-moderated; within-group analyses indicated that endorsement predicted higher distress, hostility, and alexithymia in males, while being unrelated to well-being in females. Finally, gender-stratified normative data and operational cut-offs were established. The GAB-A provides a psychometrically sound tool for identifying elevated endorsement profiles and evaluating violence prevention interventions. Full article

This study proposes a new formalized approach to the stabilization of linear transformations in artificial neural networks, based on discrete algebraic properties. In contrast to existing stability methods that rely on spectral norms, regularization techniques, or empirical heuristics, this work introduces the concept of algebraic stabilization—stability that arises from the structural properties of the matrices defining linear operators. The central object of investigation is the class of integer-valued matrices for which exponentiation to a form of the type ${\mathrm{W}}^{\mathrm{k}}=\mathrm{I}+\mathsf{\mu }\mathrm{D}$ is possible, where $\mathrm{D}\in {\mathbb{Z}}^{\mathrm{n}\times \mathrm{n}},\mathsf{\mu }\in {\mathbb{Z}}_{>1}$. A well-known problem in group algebra is considered that guarantees the existence of such an exponent under the condition that $\mathsf{\mu }$ is coprime with the determinant of $\mathrm{W}$. Within this framework, modular arithmetic, reduction modulo $\mathsf{\mu }$, and the group structure of ${\mathrm{G}\mathrm{L}}_{\mathrm{n}}\left({\mathbb{Z}}_{\mathsf{\mu }}\right)$ are employed, thereby linking the proposed method to the theory of finite groups and linear automata. The advantages of the approach are discussed, including formal control over the iterative behavior of transformations, compatibility with quantized and finitely representable networks, the possibility of embedding stabilizing conditions directly into the network architecture, and the potential to improve model interpretability and reliability. At the same time, limitations are identified, particularly those related to constructive implementation, the selection of suitable hyperparameters, and generalization to broader classes of transformations. Full article

Background: South Africa faces the world’s highest HIV burden, disproportionately affecting women, alongside rising Type 2 Diabetes (T2D). Weight gain associated with preferred dolutegravir (DTG)-based antiretroviral therapy may worsen obesity and T2D risk. This process evaluation explored the implementation of a 12-month time-restricted eating (TRE) intervention for weight management in women with HIV and overweight/obesity in Khayelitsha, Cape Town. Methods: Using the RE-AIM framework, the study investigated the implementation journey. Data were collected from three groups: RCT participants, healthcare workers (n = 21), and fieldworkers (n = 3). Methods included structured informal interviews with TRE participants throughout the intervention and semi-structured in-depth interviews (IDIs) with a subset (n = 19) at 12 months. IDIs and focus group discussions were conducted with healthcare staff. Results: Implementation faced significant contextual challenges, including high food insecurity, economic constraints, and high crime levels. Cultural norms around food hospitality also posed barriers. Despite this, TRE was highly feasible and acceptable. Participants reported positive behavioural changes, establishing eating routines and consuming healthier foods. Perceived health benefits included improved appetite control, wellbeing, sleep, and weight management. Key facilitators were the intervention’s flexibility and, importantly, the non-judgmental, empathetic support from fieldworkers, which drove engagement and retention. Healthcare workers expressed willingness to integrate TRE into existing HIV counsellor-led services, and nearly all participants desired to continue TRE post-intervention. Conclusions: This process evaluation demonstrates that TRE is a contextually suitable and acceptable intervention from an implementation perspective. Its success in practice, however, depends on mitigating complex multi-level barriers through a flexible program design and high-quality, relationship-focused support integrated into existing healthcare infrastructure. Trial registration: PACTR202302484999720, 8 February 2023. Full article

Background: The shift toward precision orthodontics necessitates population-specific cephalometric databases. Reliance on Eurocentric norms for ethnically diverse populations—particularly underrepresented Middle Eastern groups—represents a significant evidence gap. This study establishes initial normative cephalometric data for Yemeni and Northern Turkish Cypriot (NTC) adults. Methods: This retrospective comparative study analyzed 400 lateral cephalograms from skeletal Class I adults (200 Yemeni and 200 NTC; age 18–40; gender-balanced). Twenty standardized parameters were assessed using VistaDent OC™ software (version 4.2.61, GAC Orthodontic Software solutions, Birmingham, AL, USA). Analyses included *t*-tests, MANOVA, effect size computations (Cohen’s *d*), and variance partitioning. The False Discovery Rate method controlled multiple comparisons. Results: Yemeni adults exhibited a more vertical facial growth pattern (indicated by a lower Jarabak ratio: 60.18 ± 4.50% vs. 65.79 ± 5.20%; *d* = 1.15) and pronounced soft-tissue convexity (N-A-Pog: 5.76 ± 1.20 mm vs. 3.82 ± 1.10 mm; *d* =1.69). NTC adults showed a mild skeletal Class II tendency (ANB: 4.51 ± 1.70° vs. 3.35 ± 1.50°; *d* = 0.72). Ethnicity accounted for 21.3% of craniofacial variance (partial η² = 0.213). Conclusions: This study provides foundational cephalometric reference data for two underrepresented populations. The significant morphological distinctions quantified here underscore the necessity of developing population-specific norms. These data should be considered as one component within comprehensive, individualized diagnostic frameworks in orthodontics, rather than standalone diagnostic criteria. Full article

Background/Objectives: Advanced 3D cell culture techniques enhance the physiological relevance of in vitro models, while supporting the 3Rs principles (Reduction, Refinement, and Replacement) of animal experimentation. In this context, 3D collagen-based systems mimic key extracellular matrix properties, enabling more accurate cellular organization and phenotype. However, changes in culture dimensionality can affect RT-qPCR reference gene stability, underscoring the need for careful validation when combining 2D and 3D systems. Methods: AML12 cells were cultured for 7 days under different 2D and collagen-based 3D conditions. The expression stability of nine candidate housekeeping genes was systematically evaluated using established algorithms (BestKeeper, NormFinder, geNorm, RefFinder, and ΔCt method), followed by inter-group statistical and correlation analyses of raw Ct values. Albumin gene expression was used as a target gene. Results: Although all candidate genes initially met acceptable variability thresholds, a stepwise, exclusion-based analysis revealed distinct performance differences. Hprt, Ppia, and Actb emerged as the most stable, showing no intra-group variability or interaction with Albumin expression. Nevertheless, Ywhaz and Rplp0, despite their high stability, were compromised by significant correlation with Albumin. Furthermore, Ywhaz showed significant downregulation under 3D culture conditions. B2M, Gapdh, 18S, and Hmbs exhibited increased variability, likely reflecting metabolic and microenvironmental heterogeneity associated with prolonged 2D cultivation of AML12 cells. Conclusions: Overall, this study highlights the importance of context-dependent, exclusion-based reference gene validation when comparing 2D and 3D models, and demonstrates a new approach for reliable gene expression normalization in complex in vitro culture systems. Full article

This study examined the auditory and cognitive effects of occupational ultrasonic noise exposure through controlled laboratory experiments simulating workplace conditions. A group of 20 participants aged 18–35 underwent pure-tone audiometry (PTA) in both standard (1–8 kHz) and extended high-frequency (9–16 kHz) ranges before and after exposure to airborne ultrasound emitted by an ultrasonic cleaner. The exposure was conducted at two sound pressure levels: at the current permissible occupational limit and at a level 5 dB below it. The results demonstrated statistically significant temporary threshold shifts (TTS) in hearing sensitivity (bilaterally) at 8 kHz and 16 kHz only at the higher exposure level, with mean shifts reaching 3.8 dB and 5.8 dB, respectively. No significant hearing threshold changes were observed at the reduced exposure level. Additionally, participants completed a battery of Abilitest cognitive tests during exposure. Comparisons with standardized normative data showed that reaction times were approximately 20% longer in simple response tasks and 13% longer in selective attention tasks, suggesting a potential deviation in cognitive performance associated with ultrasonic noise. These findings support the need to reevaluate current occupational exposure limits and highlight the potential health and performance risks associated with airborne ultrasound. Full article

Background/Objectives: Diffuse large B-cell lymphoma (DLBCL) exhibits substantial clinical heterogeneity and poor prognosis in relapsed/refractory (R/R) settings. PRO-MIND is a prospective, multicenter real-world study evaluating tafasitamab–lenalidomide followed by tafasitamab monotherapy in patients with transplant-ineligible R/R DLBCL in Italy. This ad hoc, cross-sectional, baseline analysis aimed to characterize health-related quality of life (HRQoL) and symptom burden before tafasitamab–lenalidomide initiation in the PRO-MIND cohort. Methods: Thirty-eight patients across 30 centers completed the EORTC QLQ-C30 and QLQ-NHL-HG29 questionnaires at pretreatment baseline, prior to starting tafasitamab–lenalidomide. EORTC QLQ-C30 scores (0–100) were compared with age-specific normative values for the Italian general population using Welch’s t-test. Differences of ≥5 points were considered clinically meaningful and ≥10 points clearly clinically important. Effect sizes (Cohen’s d) were calculated to complement p-values for between-group comparisons. Results: Compared with normative data, the PRO-MIND cohort had significantly lower EORTC QLQ-C30 functioning scores for physical (Δ 12.7, p = 0.0135), role (Δ 16.1, p = 0.0168), social (Δ 15.2, p = 0.0019), and cognitive (Δ 8.5, p = 0.0460) functioning. Symptom scales revealed worse fatigue (Δ 14.8, p = 0.0097), insomnia (Δ 13.9, p = 0.0291), appetite loss (Δ 9.4, p = 0.0435), and pain (Δ 8.7, p = 0.0430) in the PRO-MIND cohort versus normative data, with effect sizes in the small-to-moderate range. EORTC QLQ-NHL-HG29 scores indicated a high prevalence of concerns about future health (84.2%), disease recurrence (81.6%), and dependency (78.9%), as well as physical symptoms, including lack of energy (71.1%), sleep difficulties (63.2%), and pain or discomfort (60.5%). Conclusions: This cross-sectional, baseline-only analysis of the PRO-MIND real-world cohort showed that patients with transplant-ineligible R/R DLBCL scheduled to receive tafasitamab–lenalidomide already had pronounced impairments in physical, role, social, and cognitive functioning, along with substantial fatigue, insomnia, pain, appetite loss, and psychological concerns. These baseline benchmarks underscore the importance of systematic HRQoL assessment and targeted supportive interventions focusing on these domains before and during treatment. Future longitudinal PRO-MIND analyses will complement these findings by describing how HRQoL evolves after tafasitamab–lenalidomide initiation. Full article

Background/Objectives: School violence represents a significant concern for educational communities worldwide, affecting student well-being and academic development. While prior research has documented prevalence rates and risk factors, limited studies have examined social–cognitive factors associated with antisocial behavior specifically within vocational education contexts using integrated analytical approaches. This exploratory cross-sectional study examined social–cognitive factors—specifically self-reported attitudes about aggression norms, prosocial attitudes, and school climate perceptions—associated with violence-supportive attitudes among Greek vocational students. Methods: A cross-sectional design employed validated self-report instruments and traditional statistical methods. The sample comprised 76 vocational high school students (38.2% male; ages 14–18; response rate 75.2%) from one school in Patras, Greece. Validated instruments assessed attitudes toward interpersonal peer violence (α = 0.87), peer aggression norms across four subscales (α = 0.83–0.90), and school climate dimensions (α = 0.70–0.75). Analyses included descriptive statistics, Pearson correlations with bootstrapped confidence intervals, MANOVA for multivariate group comparisons, independent samples t-tests, propensity score matching for urban–rural comparisons, polynomial regression for developmental patterns, and path analysis for theoretical model testing. Results: Strong associations emerged between perceived school-level and individual-level aggression norms (r = 0.80, p < 0.001, 95% CI [0.71, 0.87]), representing one of the strongest relationships documented in school violence research. Violence-supportive attitudes demonstrated inverse associations with prosocial alternative norms (r = −0.37, p < 0.001, 95% CI [−0.55, −0.16]). Significant gender differences emerged for teacher–student relationships (d = −0.78, p = 0.002), with females reporting substantially more positive perceptions. Propensity-matched urban students demonstrated higher aggression norm endorsement compared to rural students across multiple indicators (d = 0.61–0.78, all p < 0.020). Polynomial regression revealed curvilinear developmental patterns with optimal teacher relationship quality during mid-adolescence (ages 15–16). Path analysis supported a sequential association model wherein school-level norms related to individual attitudes through prosocial alternative beliefs (indirect effect β = −0.22, p = 0.002, 95% CI [−0.34, −0.11]). Conclusions: This preliminary investigation identified social–cognitive factors—particularly normative beliefs about aggression at both individual and environmental levels—as strongly associated with violence-supportive attitudes in Greek vocational education. The exceptionally strong alignment between school-level and individual-level aggression norms (r = 0.80) suggests that environmental normative contexts may play a more substantial role in attitude formation than previously recognized in this educational setting. Gender and urban–rural differences indicate meaningful heterogeneity requiring differentiated approaches. Future research should employ longitudinal designs with multi-informant assessment and larger multi-site samples to establish temporal precedence, reduce method variance, and test causal hypotheses regarding relationships between normative beliefs and behavioral outcomes. Full article

We construct the free group over a non-Archimedean fuzzy metric space $(X,M,\wedge )$ in the sense of George and Veeramani where ∧ is the minimum t-norm. The two main tools used are the concept of a scheme (for every non-empty subset S of $\mathbb{N}$ of even cardinal, a permutation $\phi$ on S is a scheme for S if it is idempotent, with no fixed points and, additionally, $i<j<\phi \left(i\right)<\phi \left(j\right)$ does not hold for every $i,j\in S$), and the notion of a fuzzy prenorm on a fuzzy topological group. As a consequence of our results, we prove that every non-Archimedean fuzzy metric space $(X,M,\wedge )$ in the sense of George and Veeramani is isometric to a closed subspace of a non-Archimedean fuzzy metric free (Abelian) group and also that every metric space $(X,d)$ is uniformly isomorphic to a closed subspace of a non-Archimedean fuzzy metric free (Abelian) group. Our results also apply to non-Archimedean fuzzy metric spaces in the sense of Kramosil and Michálek. Full article

Binge drinking (BD) is defined as a pattern of alcohol consumption that results in a blood alcohol concentration of 0.08 g/dL or higher, typically achieved after consuming approximately 70 g of pure alcohol (about five drinks for men) or 56 g (about four drinks for women) within roughly two hours. It is highly prevalent among adolescents and young adults and has significant physical, psychological, and social consequences. Despite numerous interventions to reduce BD, there is limited systematic evidence on their effectiveness. This study presents a systematic review of randomized controlled trials (RCTs) evaluating interventions to reduce BD, focusing on their impact on frequency, intensity, and associated physical, psychological, or social outcomes. The review followed PRISMA 2020, and the protocol was registered with PROSPERO (CRD42024623481). A comprehensive search was conducted in multidisciplinary and specialized databases. Included studies were RCTs targeting BD in clinical or community populations of any age. Non-empirical and observational studies, or studies not specifically focused on BD were excluded. The risk of bias was assessed using RoB 2, and a total of 21 studies (N = 14,754 participants) were included, showing high variability in design, format, and theoretical basis. Brief, individual digital interventions predominated, although face-to-face group and multimodal interventions proved more effective. Eleven studies reported significant reductions in BD frequency or prevalence; fewer addressed intensity. Interventions based on motivational and cognitive behavioral approaches, especially in structured programmes with prolonged follow-up, were the most effective. Improvements were observed in psychosocial variables (e.g., negative consequences, self-efficacy, expectations, social norms, and intention to consume), but not in physical health or consumption of other substances. Most studies had a moderate risk of bias, and few demonstrated long-term effects. More robust, comparative, and longitudinal studies are needed. Full article