Search Results (492)

This study investigates time-varying market efficiency and cross-market correlations in cryptocurrency markets across South Korea, the United States, and Japan. Using rolling-window multifractal detrended fluctuation analysis (MF-DFA) and dynamic conditional correlation–generalized autoregressive conditional heteroskedasticity (DCC-GARCH), we analyze 11 cryptocurrency–fiat pairs—Bitcoin (BTC), Ethereum (ETH), Ripple (XRP), and Bitcoin Cash (BCH) denominated in Korean Won (KRW), US Dollar (USD), and Japanese Yen (JPY)—from January 2018 to September 2025. MF-DFA results confirm persistent multifractality and significant time-variation in market efficiency across all markets, consistent with the Adaptive Market Hypothesis (AMH). DCC-GARCH estimates reveal a structural divergence between return integration and efficiency correlations: return-based correlations for same-asset cross-fiat pairs are exceptionally high (mean dynamic conditional correlation of approximately 0.96–0.98), whereas efficiency-based correlations are far more heterogeneous, with cross-asset pairs approaching near-zero synchronization. We interpret the Kimchi Premium as a product of institutional frictions that impede price-level arbitrage while leaving volatility transmission largely unaffected. These findings suggest that cryptocurrency market integration is multidimensional—globally synchronized in risk dynamics, yet locally segmented in the structural quality of information processing. Full article

Background/Objectives: Soil microbiomes in agroecosystems are natural reservoirs of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs), creating conditions for horizontal gene transfer (HGT) to clinically relevant bacteria. Southern West Siberia—a globally significant grain-producing region—lacks metagenomic characterization of its soil resistome. This study aimed to establish the first baseline profile of resistome and mobilome composition for West Siberian agricultural soils. Methods: Twelve composite soil samples were collected from agroecosystems under seven crop types across diverse soil types in southern West Siberia (September 2022). Shotgun metagenomics was performed on an Illumina NovaSeq 6000 platform. Taxonomic profiling used Kraken2/Bracken; ARG annotation used Prokka/DeepARG (identity ≥ 70%, probability score ≥ 0.8); while MGE characterization used Platon, HMMER v3.3.2, and Prokka-based integrase annotation. Resistome load was normalized to the single-copy housekeeping gene rpoB; ARG–MGE associations were defined as co-localization within 10 kb on the same contig. Results: Microbial communities were dominated by Pseudomonadota and Bacillota, with a stable core of Streptomycetaceae, Nitrobacteraceae, and Sphingomonadaceae. Normalized resistome load (N/rpoB 2.30–5.37) indicated moderate anthropogenic pressure. Dominant ARGs included efflux pumps (emrA, drrA, tetA, bcr, fsr), target modification (lnrL), and lipid A modification (arnA) genes. Class 1 integron integrase (intI1/rpoB 0.64–1.59) was detected in all 12 samples, exceeding unity in 9 of 12. ARG–MGE co-localizations were found in 11 of 12 samples. In sample Mg_155, genes emrA–emrB and bcr (NODE_16) and arnA and lnrL (NODE_6) were each independently associated with distinct prophage IntA integrase copies within Pseudomonas contigs, documenting multiple parallel horizontal transfer events encompassing resistance to five antibiotic classes. Conclusions: This work establishes the first metagenomic baseline of resistome and mobilome for West Siberian agroecosystems. The obtained data indicate moderate anthropogenic pressure on soil microbiomes, consistent with temperate agricultural systems with limited organic fertilizer input. The detected ARG–MGE co-localizations and evidence of prophage-mediated transfer of resistance determinants beyond their natural hosts suggest that mobilization potential in the region warrants consideration in future AMR monitoring programs. Full article

This study evaluated the multi-scale spatial heterogeneity of soil fertility in walnut orchards in the middle and lower reaches of the Yarlung Zangbo River valley. The investigation focused on Jiacha, Lang, and Milin counties, covering four river terrace levels and three soil depths within the 0–60 cm layer, and further examined the effects of such heterogeneity on walnut fruit quality. Using integrated multivariate statistical approaches and fuzzy comprehensive evaluation, 321 paired soil and fruit samples collected in September and October of 2023 were analyzed. Overall soil fertility was moderate (0.4 ≤ IFI < 0.6) with a mean integrated fertility index (IFI) of 0.527, but showed pronounced spatial variation. PCA-based composite scores indicated the highest fertility in Milin County, followed by Lang County, with Jiacha County ranking lowest. Soil fertility across 11 towns was classified into five grades. Cluster analysis based on ten standardized soil fertility indicators revealed clear regional aggregation patterns, where close towns exhibited similar fertility conditions. Third-level river terraces exhibited significantly higher fertility than other terrace levels. Available phosphorus was widely deficient, while exchangeable magnesium and available zinc were also low, representing key limiting nutrients with strong regional variability. Spatial differences in soil enzyme activities reflected variation in microbially mediated nutrient cycling, with phosphatase activity negatively correlated with available phosphorus, suggesting potential microbial responses to phosphorus-stressed environments. Soil fertility significantly influenced walnut fruit quality, with alkaline hydrolyzable nitrogen, phosphorus, potassium, and exchangeable calcium and magnesium identified as key drivers. These findings provide a theoretical basis for suggesting a zoned precision fertilization strategy, where prioritizing P, Zn, and Mg inputs in deficient areas could be considered alongside organic fertilisation. Such site-specific management strategies are suggested to support the sustainable development of the walnut industry along the Yarlung Zangbo River valley. Full article

Background/Objectives: The role of peroral pancreatoscopy (POPS) in patients with main-duct and mixed-type intraductal papillary mucinous neoplasm (MD/mixed-IPMN) remains unclear. This retrospective multicenter case series aimed to evaluate the feasibility and safety of POPS using the 9-Fr eyeMAX and to describe additional intraductal findings, potential surgical impact, and biopsy–surgery concordance. Methods: Consecutive patients with MD/mixed-IPMN in whom POPS was attempted between May 2023 and September 2025 were retrospectively analyzed. Pre-POPS imaging findings, POPS findings, procedural outcomes, adverse events, surgical outcomes, and concordance between POPS-guided biopsy and surgical pathology were evaluated. Results: Among the 20 patients, 14 were men, and the median age was 74.5 years (range, 46–83 years). IPMNs were classified as main-duct type in five patients (25%) and mixed type in 15 (75%). On endoscopic ultrasonography, mural nodules were identified in 14 patients (70%), with a median diameter of 11 mm (range, 3–25 mm). Endoscopic papillary intervention was performed in 6 patients (30%). The technical success rate of POPS insertion was 95% (19/20). Mural nodules were detected by POPS in 17 patients (85%), and biopsy under POPS guidance was performed a median of 5 times (range, 1–10). The adequate tissue sampling rate was 86% (88/102). Mild post-ERCP pancreatitis occurred in 1 patient (5%). Twelve patients (60%) underwent surgery. The concordance rate between POPS-targeted biopsy and surgical pathology was 45% (5/11); however, R0 resection was achieved in 11 patients (92%). Conclusions: In this small retrospective case series, POPS using the 9-Fr eyeMAX was feasible and provided additional intraductal information in selected patients. However, its diagnostic role remains adjunctive because POPS-guided biopsy showed limited reliability. Full article

Perioptic meningiomas pose a therapeutic challenge due to their proximity to critical visual structures. Single-fraction stereotactic radiosurgery is known to effectively control the growth of meningiomas, but this subgroup carries the risk of optic neuropathy, which is minimized with the introduction of dose hypofractionation. The Leksell Gamma Knife Icon has perfected fractionated stereotactic radiosurgery, maintaining submillimeter accuracy in each dose fraction without the need for an invasive frame. This study analyzes the feasibility, safety, and efficacy of multi-fraction Gamma Knife Icon radiosurgery for perioptic meningiomas, taking into account tumor control rates, visual preservation, and treatment-related toxicity. We conducted a retrospective analysis of 100 patients with a perioptic meningioma treated with fractionated Gamma Knife Icon radiosurgery between September 2017 and December 2022. A total of 80 Patients were female, and 20 were male; the mean age was 61.7 years (range 35–84). The most frequent anatomical locations included: cavernous sinus (35 pts), anterior clinoid (17 pts), sphenoid wing (14 pts) and olfactory groove (11 pts). The median tumor volume was 5.6 mL (range 0.12–31.7 mL). Most patients (89%) received 25 Gy in five fractions. Tumor control was achieved in 98% of cases, with a mean radiological follow-up of 41.2 months. Tumor volume did not predict radiological shrinkage (p = 0.639). Tumor shrinkage was observed more frequently in the no prior surgery group (p = 0.035). The mean clinical follow-up was 45.3 months. Among symptomatic patients (35 pts) at baseline, symptoms remained stable in 27 (77%) cases, improved in 5 (14%), and worsened in 3 (9%). No new symptoms were observed in asymptomatic patients. Overall clinical deterioration occurred in three (3%) patients—one because of tumor progression; although, without statistical evidence (p = 0.217), worsened patients had notable larger mean tumor volumes (12.6 mL vs. 6.8 mL). The dosimetric advantages of Gamma Knife technology are empowered by the biological benefits of fractionation and the convenience of non-invasive immobilization. Excellent tumor control rates and positive visual outcomes favor its routine application in properly selected patients. Full article

An updated understanding of the U.S. oral health care system is essential for addressing the burden of oral disease, high dental expenditures, and persistent inequities in access. This narrative review synthesizes current evidence on the prevalence of major oral diseases, dental care delivery, financing, dental workforce, and public health initiatives, and highlights the challenges and future opportunities in the U.S. A comprehensive search of PubMed, Google Scholar, and reports from U.S. federal agencies and professional organizations was conducted between September 2025 and March 2026. Following the latest National Health and Nutrition Examination Survey, untreated caries remains widespread, affecting 11% of children (ages 2–5), 10% of adolescents (ages 12–19), 21% of adults (ages 35–49), and 12% of older adults (ages 65–74). Periodontal diseases are common, with 42% of adults aged 30 years or older having periodontitis. Oral cancer incidence stands at 11.5 per 100,000 and increases sharply with advancing age. Edentulism among older adults (ages 65–74) was approximately 11%. The U.S. dental workforce includes over 200,000 dentists, yet shortages affect rural and low-income areas, with 62 million Americans living in Dental Health Professional Shortage Areas. Dental care is primarily delivered through private practices, supplemented by community health centers. Financing relies mostly on private insurance and out-of-pocket payments, while the coverage of public programs like Medicaid varies across states, and Medicare generally excludes routine dental care for older adults. Water fluoridation remains widespread, yet ongoing debates highlight persistent challenges. School-based dental sealants and topical fluoride programs are widely recognized as cost-effective and scalable, offering substantial benefits at the population level. Nevertheless, community-based preventive measures are often hindered by resource constraints, inequitable access, and in some cases political conflicts. In summary, oral diseases remain prevalent in the U.S. Limited public coverage, workforce shortages in rural or underserved areas, and uneven access to dental care highlight the need for systemic reforms to improve oral health equity. These findings point to the importance of strengthening dental public health research and coordinated policy action to reduce structural barriers and expand access to dental care. Full article

Background/Objectives: Genetic testing in Human Epidermal Growth Factor Receptor 2-negative (HER2−) metastatic breast cancer (mBC) is necessary to enable optimal treatment choices including poly(ADP-ribose)polymerase inhibitors (PARPis). The present study evaluated the implementation of genetic testing in a real-world setting to reveal and subsequently allow targeting of potential inadequacies and risk factors for low testing frequency. Methods: We performed a retrospective analysis including HER2− mBC patients treated at a single academic center starting from 10 April 2019 (date of European Medicines Agency (EMA) approval of Olaparib for germline breast cancer gene mutant (gBRCAm) HER2− mBC) to 7 September 2021. The primary objective of the study was to evaluate the rate of HER2− mBC patients that were recommended to undergo genetic testing by the multidisciplinary tumor board (MTB). The secondary objective was to identify factors that were associated with a higher likelihood of having undergone genetic testing. Results: In total, 47.6% (109 of 229) of HER2− mBC patients had been recommended to undergo genetic testing by the MTB. Of these informed patients, 89.0% (97 of 109) underwent genetic testing, of which 11.6% (11 of 95) had a germline BRCA mutation (gBRCAmut) and were eligible for PARPi treatment. In multivariate analysis, younger age (p-value: 0.0007), hormone receptor positive (HR+)/HER2− subtype (p-value < 0.0001) and positive family history for breast and ovarian cancer (p-value: 0.0001) were significantly associated with the performance of genetic counseling. Conclusions: The present study demonstrated low genetic counseling rates of HER2− mBC patients, especially in individuals without specific risk factors for hereditary breast cancer. Informed patients showed a high willingness to undergo genetic testing. Genetic testing revealed targetable mutations in over 10% of tested patients. Full article

Background: Robot-assisted laparoscopic radical prostatectomy (RALP) requires prolonged steep Trendelenburg positioning, which increases intraocular and intracranial pressure. Although transient visual field defects have been documented after RALP using objective perimetric testing, data on patient-reported visual outcomes remain limited. We hypothesized that intraoperative optic nerve sheath diameter (ONSD) measurements and hemodynamic variables would be associated with postoperative patient-reported visual symptoms. Methods: This prospective, single-center observational cohort study enrolled consecutive adult patients undergoing RALP between March and September 2023 at Ospedale Santo Stefano, Prato, Italy. Patients with pre-existing glaucoma, ocular disease, or intracranial hypertension were excluded. Intraoperative ONSD was measured by transorbital ultrasound at three time points: before Trendelenburg (t1), 30 min after Trendelenburg (t2), and at end of Trendelenburg (t3). Postoperative visual symptoms were assessed at ≥1 month follow-up using the validated Catquest-9SF questionnaire. Rasch analysis converted ordinal responses to interval-level measures. Logistic regression explored associations between visual complaints and intraoperative predictors (Rasch scores, lowest mean arterial pressure [MAP], maximum ONSD). Results: Fifty-five patients were enrolled. Six patients (10.9%) reported new subjective visual symptoms at follow-up. Rasch-transformed scores were associated with the presence of these symptoms (coefficient 1.38; p < 0.05). Lowest intraoperative MAP (p = 0.081) and maximum ONSD (p = 0.811) did not reach statistical significance as independent factors. Conclusions: Patient-reported visual symptoms occurred in approximately 11% of patients after RALP. Postoperative Rasch-transformed visual function scores correlated with these complaints. While intraoperative ONSD was not associated with visual outcomes, the potential role of intraoperative hypotension requires further investigation in larger, powered cohorts. Full article

Urban coastal wetlands constitute important ecological interfaces where human activities, wildlife, and arthropod vectors interact, potentially increasing the risk of pathogen transmission. In the city of Veracruz, Mexico, several interdunal lagoons have been incorporated into urban areas and are intensively used for recreational activities; however, information on their mosquito fauna remains limited. This study aimed to characterize mosquito species composition, abundance, and diversity in three urban recreational interdunal lagoons in Veracruz. Adult mosquitoes were collected weekly during the rainy season (June–September) 2023 using CDC light traps. Specimens were identified based on morphological characters using standard taxonomic keys, including genitalia dissections for male specimens when necessary. Species richness, sampling completeness, and community structure were evaluated using non-parametric richness estimators, diversity indices, species accumulation curves, and similarity analyses. A total of 1465 adult mosquitoes belonging to 11 species and five genera were collected. Mosquito assemblages were characterized by low species richness and a marked dominance of Culex panocossa and Culex quinquefasciatus across all lagoons. Diversity indices were low, and species composition showed a high degree of similarity among sites. Notably, Uranotaenia apicalis was recorded for the first time in the state of Veracruz, expanding its known geographical distribution. These findings indicate that urban interdunal lagoons support simplified mosquito communities dominated by disturbance-tolerant species, highlighting their potential epidemiological relevance and the need for targeted vector surveillance in urban coastal environments. Full article

Introduction: Early warning systems reduce losses when risk knowledge, forecasting, communication, and response planning operate as an end-to-end chain, yet Gulf Coast warning practice often treats hazard dynamics, ecosystem change, and social vulnerability as separate domains. This study mapped operational early warning systems for climate-relevant hazards across Louisiana, Texas, Mississippi, Alabama, and Florida and examined whether ecosystem protective functions and social vulnerability were integrated into warning thresholds, dissemination design, and preparedness planning. Methods: I conducted a scoping review using the Web of Science Core Collection and Scopus for publications from 2020 through 18 January 2026 and targeted searches of NOAA/NWS/NHC, FEMA IPAWS, CDC/ATSDR SVI, IOOS/GCOOS, USGS, and state coastal agency portals between 15 September 2025 and 18 January 2026. Of 861 identified records, 440 duplicates were removed, 421 titles and abstracts were screened, 121 full texts were assessed, and 25 sources were included in the final charting and synthesis. Results: The review identified 11 operational systems and related platforms spanning the four early warning pillars, but routine socio-ecological integration remained limited. Louisiana showed the strongest documentation of ecosystem monitoring through CPRA and CRMS, while Florida and Texas showed more developed evacuation and dissemination interfaces. Mississippi and Alabama were represented by thinner monitoring and implementation records in the included sample. Across states, ecosystem loss and social vulnerability were used more often as planning context than as repeatable inputs to thresholds, message tailoring, or assistance triggers. Discussion: Gulf Coast practices can be strengthened through formal protocols that connect ecosystem condition and vulnerability indicators to impact-based briefings, multilingual and accessible alert workflows, and tract-sensitive preparedness actions. The findings indicate that implementation can advance by linking existing datasets to defined operational decisions and by evaluating warning performance through reach, accessibility, comprehension, and action feasibility, as well as technical accuracy. Full article

Background/Objectives: Pediatric sarcomas are rare and heterogeneous malignancies for which clinical trials are essential to advance treatment and improve outcomes. However, the characteristics and trends of sarcoma clinical trials enrolling children in the United States have not been comprehensively described. This study aimed to characterize U.S.-based sarcoma clinical trials enrolling pediatric patients and to evaluate trends over time. Methods: ClinicalTrials.gov was searched for interventional sarcoma trials conducted in the United States that enrolled patients ≤ 17 years of age and were posted between 27 September 2007 and 11 January 2023. Trials were categorized as pediatric (maximum eligible age ≤ 21 years) or pediatric/adult (>21 years). Trial characteristics, including phase, intervention type, funding source, geographic scope, and reasons for early termination, were analyzed. Results: A total of 273 eligible trials were identified, of which 79% enrolled both pediatric and adult patients. Most studies were early phase (Phase 1, 2, or 1/2; 59%) and primarily evaluated drug or biologic therapies (73%). Trials involving mixed cancer types were most common (26%). The majority were multi-institutional (66%), non-industry funded (57%) and conducted exclusively in the United States (75%). Trial activations increased over time (p-value = 0.01), with a higher proportion of industry-funded studies initiated between 2016 and 2022 (p-value = 0.009). Twenty-three trials (8.4%) were terminated early, most commonly due to slow accrual (39%). Conclusions: Most sarcoma clinical trials enrolling pediatric patients continue to include both adult and pediatric populations, which may limit the development of therapies tailored to the unique biology of pediatric sarcomas. Improving outcomes will require greater emphasis on pediatric-focused research, enhanced collaboration across institutions, and increased awareness of clinical and regulatory frameworks to support the initiation of industry-funded trials. Full article

Background: Responders to the September 11, 2001, WTC attacks experience high rates of PTSD, and existing treatments often lead to high dropout and low care use. Objectives: This randomized, double-blind, sham-controlled trial assesses the feasibility and acceptability of transcutaneous auricular vagus nerve stimulation (taVNS) as a potential PTSD treatment for 9/11 responders. Methods: A total of 32 WTC responders aged 18+ with PTSD, recruited via the World Trade Center Health Program, participated; those with current psychosis, unstable medical conditions, or recent trial involvement were excluded. Participants were randomly assigned to taVNS or sham groups and asked to use the device for 15 min daily for 8 weeks, with staff and participants blinded. Primary outcomes included recruitment, adherence, retention, and feedback. Secondary outcomes examined changes in depression (PHQ-9), anxiety (GAD-7), and sleep (PSQI). Data were analyzed with mixed-effects models focusing on PTSD and mental health symptoms. Results: The taVNS group showed modest PTSD improvement, with a 10-point CAPS-5 reduction in 40% of stimulation participants versus 28.5% sham; no significant differences in self-reported symptoms were found. Discussion: Daily taVNS over eight weeks is feasible and acceptable, warranting larger studies to detect differences and identify subgroups with greater benefit. Trial registration: “taVNS to Reduce PTSD Symptoms in WTC Responders” (NCT05212714); registered 9 September 2021. Full article

Background/Objectives: Although the benefits of breastfeeding on the development and health of the infant are well known, the relationship between breastfeeding, oral health and attachment style or emotional bonding is not fully known. This research sought to explore, from a comprehensive perspective, the associations between breastfeeding history and children’s attachment styles, as well as the relationships between breastfeeding history and oral health indicators within conceptual psychophysiological frameworks discussed in the literature. Methods: This was a cross-sectional (descriptive and analytical) and correlational study. In this work, the associations of breastfeeding with attachment and oral health were analyzed in 100 children between 9 and 11 years old at a primary school in the municipality of José Azueta, Veracruz, Mexico, from December 2023 to September 2024 by a clinical history, dental examinations (Oral Hygiene Index-Simulated (OHI-S), Dental Caries History (DEOPT) and Detection of Malocclusions (DAI)) and the Attachment and Interaction Styles Instrument. Results: Significant differences were found in the security and closeness attachment style, the oral-hygiene index, the caries index, and occlusion by type of breastfeeding, showing better values in boys and girls who were exclusively breastfed. Likewise, both in the correlation analysis and in the multiple regression model, associations were observed between having been exclusively breastfed and the attachment style and oral indices. Conclusions: Our data show the importance of breastfeeding in pubertal children, since it was associated with better attachment and oral health; however, these findings reflect patterns of co-occurrence and should not be interpreted as causal relationships. Full article

Wolves (Canis lupus) have recolonized Belgium after more than a century of absence, raising concerns about interactions with livestock in densely populated regions such as Flanders. Empirical field-based documentation of wolf behavior near protected livestock in such landscapes remains limited. This study presents a short-term, descriptive camera-trap case study documenting wolf presence near a temporary sheep pasture protected by electric fencing and livestock guardian dogs (LGDs). Nineteen camera traps monitored the pasture perimeter within a military training area in northeastern Flanders over a 16-day period in September 2023. Sheep were present for 11 days and accompanied by six LGDs. Twenty-three wolf images were recorded, corresponding to eight distinct detection events. Wolves were detected shortly after fence installation and following sheep removal. Occasional close approaches and fence inspection behavior were observed, but no fence crossings or predation events occurred. Most wolf detections occurred when sheep and LGDs were absent, although wolves were also recorded near periods of human activity. Given the observational design, causal inference is not possible. The study provides baseline documentation of wolf–livestock–LGD interactions in a densely populated European landscape. Full article

Background: Although burnout among respiratory therapists (RTs) is well documented, qualitative insights into their lived experiences in Saudi Arabia remain limited. This study explored RTs’ experiences of burnout, systemic and organisational drivers of professional strain, and strategies for resilience and retention within Saudi hospitals. Methods: A qualitative descriptive design was employed. Purposive sampling was used to recruit 11 RTs from diverse regions across Saudi Arabia. Semi-structured interviews were conducted in Arabic between September and November 2025, audio-recorded, and transcribed verbatim. Data management and analysis followed a hybrid approach using NVivo 12 software alongside manual coding to support deep immersion in the data. Analysis was guided by Braun and Clarke’s reflexive thematic analysis. Methodological rigour was enhanced through reflexive memoing, peer debriefing, and adherence to a 15-point trustworthiness checklist. Results: Analysis generated one overarching theme, “Caught Between Care and Collapse: The Human Cost of Institutional Burnout,” alongside three interrelated themes. Participants described (1) “Living within a system that drains the self,” highlighting sustained physical and emotional exhaustion driven by understaffing and extended shifts; (2) “Losing meaning and recognition,” illustrating how organisational neglect eroded professional passion and replaced it with obligation and frustration; and (3) “Coping strategies and informal support,” reflecting quiet resilience through self-regulation, peer solidarity, and humane leadership. Many participants framed their endurance as an act of moral defiance rather than passive resignation. Conclusions: These findings suggest that RT burnout reflects not individual failure but a structural outcome of sustained strain and deficits in reciprocity. Burnout emerges as an institutional crisis in which therapists remain deeply committed to patient care while being pushed toward professional collapse by systemic neglect. Culturally informed, system-level interventions are urgently needed to preserve this essential workforce. Full article