Search Results (2,637)

Background/Objectives: High turnover and staff shortages in nursing pose challenges to professional integration and compromised patient safety. Structured onboarding programs are considered key strategies to enhance adaptation, reduce clinical errors, and promote retention. This study aimed to evaluate the impact of a structured onboarding program compared with the standard routine on early professional adaptation, safety culture, and satisfaction among newly hired nurses and nursing assistants. Methods: A prospective quasi-experimental study was conducted between 2022 and 2024 in three private hospitals in Madrid. A total of 200 newly hired health professionals (128 nurses and 72 assistants) were assigned alternately to either the intervention group (structured onboarding program) or the control group (usual routine). The intervention comprised three consecutive days of guided training with mentorship, simulation-based learning, and digital tool instruction. Adaptation was assessed with the validated GAML scale, and satisfaction was measured through a Likert survey one month later. Statistical analyses included Mann–Whitney U, Chi-squared tests, and linear regression. Results: The intervention group achieved significantly higher scores across all competency domains for both nurses and nursing assistants, with overall medians of 25 [22–27] and 22 [20–23.25], respectively, compared with notably lower values in the control groups (p < 0.001). The greatest improvements were observed in digital tool management, clinical protocol knowledge, problem-solving and decision-making, and patient safety practices, demonstrating the strong impact of the structured onboarding program. In terms of satisfaction, participants in the intervention group also reported higher ratings for the clarity and completeness of information, particularly regarding hospital structure, service-specific orientation, and occupational risk prevention. However, global satisfaction differences were more pronounced among nurses than nursing assistants. Conclusions: The structured onboarding program demonstrated substantial benefits in professional adaptation, safety culture, and perceived preparedness of newly hired staff. These findings support integrating standardized onboarding plans as part of hospital quality and safety strategies, requiring sustained leadership and resource investment for long-term success. Full article

Background/Objectives: Pressure injuries (PIs) are an increasing public health concern, particularly affecting hospitalised patients with limited mobility and chronic illnesses, such as those undergoing cardiac surgery. The EuroSCORE II index, a validated model for predicting operative risk in cardiac surgery, can serve as an accurate PI risk assessment tool for cardiac surgery patients. Methods: A cross-sectional study was conducted on patients undergoing cardiac surgery over a six-month period. The sample consisted of patients selected according to the calculated EuroSCORE II index and admitted for elective surgical procedures. The Braden Scale was used for the standard preoperative and postoperative PI risk assessment. Categorical variables are shown as frequencies with corresponding percentages. Continuous variables are presented as median and interquartile range. Group differences in continuous variables according to EuroSCORE II were analysed using the Mann–Whitney U test, with the Hodges–Lehmann estimator of the median difference and the corresponding 95% confidence interval. Results: The assessment showed that patients with a medium and high EuroSCORE II index (>4.0) were significantly older (M = 73; IQR: 68–77), with a higher preoperative Braden score (M = 20; IQR: 17–21), longer intraoperative total time (M = 6; IQR: 5–7) and overall longer duration of hospitalisation (M = 14; IQR: 10–21). A statistically significant difference (p = 0.043) was observed in the occurrence of PI after the procedure. Within the group of patients with a medium/high EuroSCORE II index, the recorded frequency of PI after the procedure was 30.8%, compared to the group of patients with a low EuroSCORE II index, among whom the observed frequency was 17.6%. Conclusions: The findings of this study show that a higher EuroSCORE II index is significantly associated with an increased risk and incidence of PI in patients undergoing cardiac surgery, highlighting its potential use as a predictive tool for postoperative PI risk stratification. Full article

Background: Periostin can be considered a stimulator of Wnt. Elucidating the relationship between Wnt10a and Periostin in dental pulp stem cells is considered necessary for a deeper understanding of the mechanisms of dental pulp regeneration. Methods: Regenerated dental pulp from ectopic root grafts was double-stained with BrdU and Wnt10a, and the positivity rates were analyzed. Furthermore, the expression levels of Wnt10a, LRP5/6, DKK1, and Periostin within the regenerated tissue were analyzed by PCR. The expression levels of Wnt10a, LRP5/6, DKK1, and Periostin in cells stimulated with Periostin were analyzed by PCR. Wnt10a protein expression was analyzed by Western blotting and ELISA. Similar evaluations were performed with co-stimulation by Periostin and DKK1(Sample size:4). In each experiment, cells not stimulated with periostin served as the control group. Statistical analysis involved confirming the normal distribution of data using QQ plots, followed by one-way analysis of variance and post hoc Turkey’s test. Results: Migrating dental pulp stem cells expressed Wnt10a, and migration was additionally inhibited by its antagonist DKK1. Furthermore, Periostin stimulation increased Wnt10a secretion and suppressed DKK1. Conclusions: Periostin significantly increased Wnt10a expression and DPSC migration, while DKK1 inhibited these effects. Full article

Due to the highly individualised presentation of sport-related concussion (SRC), multi-domain assessments examining cognitive, migraine, vestibular, ocular, mood, sleep, and neck-related function have been suggested to assist clinicians with diagnosis, management, and rehabilitation. Normative data on such assessments for female, community players from countries outside the U.S. are needed. This study aimed to (i) describe normative data from community-level Ladies Gaelic Football players using a multi-domain assessment, and (ii) compare findings between adolescent and adult players. A total of 138 LGF players without SRC (101 adults, 37 adolescents) completed a multi-domain SRC assessment including Sport Concussion Assessment Tool 5th Edition, Concussion Clinical Profiles Screening, Vestibular/Ocular Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT^®), Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Pittsburgh Sleep Quality Index, Migraine Disability Assessment, and Neck Bournemouth Questionnaire, and neck dynamometry. Normative data were summarised using descriptive statistics, while differences in test scores between adolescents and adults were examined using parametric or non-parametric tests. While adolescents and adults scored similarly on most measures, adolescents scored worse on ImPACT^® visual–motor speed (d = 0.09) and reaction time (r = 0.52), SCAT5 concentration (V = 0.38), total modified Balance Error Scoring System (r = 0.42), and CP Screen vestibular profile (r = 0.38) (p < 0.05). This is the first study to describe and compare normative data for multidomain SRC assessments in adolescent and adult female, community athletes. Differences in some tests between adolescents and adults highlight the need for demographic-specific normative data when interpreting post-SRC assessment results. Full article

This research examined the mechanical, physical, thermal, and durability properties of plastic-based composites made from MSW, namely ultra-high-temperature (UHT) cartons, plastic bags, aluminum foil, and foil bags under both unweathered and accelerated weathering conditions to evaluate their potential as paving slab materials. Composite samples with varying mixing ratios were fabricated and tested based on an experimental design. Statistical analyses using one-way ANOVA confirmed the significant effects of composition on material performance (p < 0.05). The results demonstrated that the mixing ratio markedly influenced mechanical properties. The composite containing 50 wt% UHT carton and 50 wt% foil bags (U50F50) achieved the highest modulus of rupture (121.20 MPa) and modulus of elasticity (2.98 GPa), as well as compressive strength (28.56 MPa), compressive modulus (2.12 GPa), screw withdrawal resistance (54.25 MPa), and hardness (66.25). Under accelerated weathering, all of the composites showed moderate reductions in strength (10 to 30%) due to plastic degradation and surface cracking. In contrast, the composites containing high paperboard fractions (U80P15A5) exhibited greater WA (3.55%) and TS (3.04%), attributed to the hydrophilic nature of cellulose. The inclusion of foil bags effectively reduced WA and TS by limiting moisture penetration. Density measurements demonstrated a gradual increase (0.99 to 1.05 g/cm³) with higher foil content, while accelerated weathering induced an average 10% density reduction. Abrasion resistance improved in foil-rich composites, with U50F50 showing the lowest weight loss (8.56 to 14.02%), confirming its superior structural integrity under mechanical wear. Thermal analysis indicated low conductivity values (0.136 to 0.189 W/m·K), demonstrating favorable insulation performance compared to conventional paving materials. However, higher foil bag fractions enhanced heat conduction, balancing mechanical strength with thermal functionality. Overall, MSW-derived composites containing 30 to 50 wt% foil bags exhibited optimal mechanical durability, abrasion resistance, and thermal stability, making them promising candidates for sustainable paving slab production with low environmental impact and enhanced service life. Full article

This study investigates the influence of different effective precipitation (P_e) estimation methods on drought index performance in a humid region of Türkiye. The standard precipitation index (SPI) and the reconnaissance drought index (RDI) were compared with their effective precipitation-based counterparts, Agricultural Standardized Precipitation Index (aSPI) and Effective Reconnaissance Drought Index (eRDI), using four P_e estimation methods: USBR (U.S. Bureau of Reclamation), USDA-(Simplified and CROPWAT) (U.S. Department of Agriculture), and FAO (Food and Agriculture Organization). Data from three closely located meteorological stations (Çanakkale, Bozcaada, and Gökçeada) were analyzed across multiple time scales (1-, 3-, 6-, 12-month, and annual). Statistical metrics—coefficient of determination (R²), root mean square error (RMSE), and Nash–Sutcliffe efficiency (NSE)—were used to assess the indices, and trend analyses were conducted using the Mann–Kendall and Sen’s Slope tests. The USDA-Simplified method consistently showed the highest accuracy across all stations and time scales (R² ≈ 0.99; lowest RMSE ≈ 0.09; NSE > 0.95), while the FAO method performed poorly, particularly at the 1-month scale. Drought frequency and severity were found to increase with time scale, contrary to trends observed in arid regions. Trend analysis revealed no significant changes at short time scales, but statistically significantly increasing drought severity was detected in longer scales, especially in Çanakkale, with slopes reaching up to –0.018 per year. The findings highlight the importance of selecting appropriate P_e estimation methods for accurate drought assessment, even in humid climates, and support the use of aSPI and eRDI with the USDA-Simplified method. Full article

This paper examines the relationship between economic growth and rural unemployment in Brazil and Mexico, incorporating the effects of climate variability and spatial interactions. Okun’s Law serves as the theoretical framework, and a dynamic spatial panel model is applied to estimate short-term causal effects. The analysis uses data from Brazil’s IBGE, Mexico’s INEGI, and the U.S. NCEI. The results indicate that Okun’s Law is only partially validated in Mexico, where lagged income growth reduces rural unemployment, while in Brazil, the relationship is not statistically confirmed. Climate variables also play a critical role: higher local temperatures reduce unemployment in Brazil and, with a lag, in Mexico, although temperature increases in neighboring regions raise unemployment in Mexico. Rainfall has a consistent positive effect on rural unemployment in both countries, highlighting the disruptive impact of extreme weather events. From a spatial perspective, no contemporaneous effects are observed. However, lagged spatial effects are negative in Brazil and positive in Mexico, suggesting different adjustment dynamics across territories. Overall, the findings reveal that climate variability influences the growth-unemployment nexus differently depending on the national context and temporal dimension. These results underscore the importance of designing public policies that integrate territorial coordination, address the differentiated impacts of climate variability, and strengthen the adaptive capacity and resilience of rural areas in Latin America. Full article

Background: The purpose of this study was to evaluate the effects of a structured barefoot walking program on menopausal symptoms, sleep quality, stress, and quality of life in middle-aged women experiencing menopausal symptoms. Methods: A quasi-experimental design with a nonequivalent control group and pretest-posttest was used. Community-dwelling women aged 45 to 65 years residing in Wonju, Republic of Korea, were recruited and assigned to either an experimental (n = 29) or control group (n = 31). The intervention consisted of 12 weeks of barefoot walking (three times per week, 60 min per session). Outcome measures included the Menopause Rating Scale (MRS), Verran and Snyder–Halpern Sleep Scale, Stress Response Inventory, and WHOQOL-BREF. In addition, changes in participants’ body composition before and after the intervention were assessed using a bioelectrical impedance analyzer (InBody 770). Data were analyzed using the Mann–Whitney U test, repeated measures ANOVA, ANCOVA, and other relevant statistical methods, with the level of significance set at p < 0.05. Results: Compared with the control group, the experimental group showed significant improvements in menopausal symptoms (z = −5.59, p < 0.001), stress (z = −3.58, p < 0.001), and quality of life (z = −3.47, p = 0.001). A significant time-by-group interaction effect was observed for sleep quality (F = 7.53, p = 0.008). No significant changes were found in body composition. Conclusion: Barefoot walking represents a promising, low-cost, community-based intervention for alleviating menopausal symptoms, enhancing sleep quality, reducing stress and improving quality of life in middle-aged women experiencing menopausal symptoms. Further randomized controlled trials are warranted to confirm these findings. Full article

Background/Objectives: Accurate volumetry of the remnant pancreas after pancreatectomy is crucial for assessing postoperative endocrine and exocrine function but remains challenging due to anatomical variability and complex postoperative morphology. This study aimed to develop and validate a deep learning (DL)-based model for automatic segmentation and volumetry of the remnant pancreas using abdominal CT images. Methods: A total of 1067 CT scans from 341 patients who underwent pancreaticoduodenectomy and 512 scans from 184 patients who underwent distal pancreatectomy were analyzed. Ground truth masks were manually delineated and verified through multi-expert consensus. Six 3D segmentation models were trained and compared, including four convolution-based U-Net variants (basic, dense, residual, and residual dense) and two transformer-based models (Trans U-Net and Swin U-Net). Model performance was evaluated using five-fold cross-validation with sensitivity, specificity, precision, accuracy, and Dice similarity coefficient. Results: The Residual Dense U-Net achieved the best performance among convolutional models, with dice similarity coefficient (DSC) values of 0.7655 ± 0.0052 for pancreaticoduodenectomy and 0.8086 ± 0.0091 for distal pancreatectomy. Transformer-based models showed slightly higher DSCs (Swin U-Net: 0.7787 ± 0.0062 and 0.8132 ± 0.0101), with statistically significant but numerically small improvements (p < 0.01). Conclusions: The proposed DL-based approach enables accurate and reproducible postoperative pancreas segmentation and volumetry. Automated volumetric assessment may support objective evaluation of remnant pancreatic function and provide a foundation for predictive modeling in long-term clinical management after pancreatectomy. Full article

Transportation-related greenhouse gas (GHG) emissions in Louisiana have risen significantly, yet the environmental impacts of asphalt mixture production remain underexplored. This study conducted a cradle-to-gate environmental life cycle assessment (LCA) to quantify global warming potential (GWP) for asphalt mixtures produced in Louisiana and establish GWP benchmarks tailored to mixture types. The LCA encompassed material extraction and production, transport to plants, and asphalt mixing, using two datasets: Environmental Product Declarations from the NAPA Eco-label program (21 mixtures) and Job Mix Formulas from the LaPave database at the Louisiana Department of Transportation and Development (DOTD) (207 mixtures). GWP was evaluated using the FHWA LCA Pave tool with TRACI 2.1 factors, and benchmarks were set at the 20th, 40th, 50th percentiles, and the average. Statistical analyses assessed differences across nominal maximum aggregate sizes and traffic levels. Results showed GWP benchmarks from both datasets exceeded U.S. General Services Administration thresholds by an average of 6.5%, with significant variation among mixture types. These findings highlight the need for targeted emission reduction strategies and accurate environmental performance evaluation to promote more sustainable pavement practices and greener infrastructure in Louisiana. Full article

Accurate forecasting of springback continues to pose a significant challenge in sheet metal forming processes. The present paper presents a numerical model designed for the precise prediction of springback, allowing for a deeper understanding of plasticity behavior during cold forming operations in sheet metals. The key contribution of this model is the introduction of a non-associated anisotropic constitutive model featuring nonlinear mixed isotropic–kinematic hardening. This model is derived from Hill’48 quadratic function and it was implemented into ABAQUS 6.13 software environment through the user defined UMAT subroutine. For improved precision, kinematic hardening parameters specific to 5083 aluminum sheet metal were meticulously derived from cyclic shear experiments. Our results demonstrate the model’s strong capability in predicting springback during the U-bending operation, achieving remarkable accuracy. The design of experiments DOE is used as a statistical method to optimize the number of experiments and analyze the effects of key input factors. In this study, sheet thickness, punch speed, and sampling angle relative to the rolling direction (RD) are examined at different levels to assess their impact on folding force and springback. The strong agreement between experimental results and theoretical predictions confirms the accuracy and reliability of the proposed models in estimating folding force and springback. Full article

Background/Objectives: The aim of this study was to evaluate the oral health status of socially vulnerable children and adolescents in Seville and to examine its associations with behavioral and sociodemographic determinants. We hypothesized that greater social vulnerability and suboptimal behaviors would be associated with higher caries experience. Methods: A cross-sectional analytical study was conducted on 250 participants aged 2 to 17 years attending the Luis Séiquer Social Dentistry Foundation between January and March 2025. Clinical examinations followed the WHO Oral Health Surveys: Basic Methods (5th edition, 2013) and were performed by a calibrated dentist. Variables included dental caries indices (dft, DMFT), pulpal treatment needs, and oral hygiene practices. Statistical analyses included Kruskal–Wallis, Mann–Whitney U, Fisher’s exact tests, and multivariate regression models (significance level p < 0.05). Results: Caries prevalence was high across all age groups, particularly in primary dentition (mean dft = 3.05 ± 3.80; DMFT = 2.99 ± 3.66; p < 0.001). Pulp therapy needs were significantly higher among preschoolers (mean = 2.22 ± 2.31). Factors such as low parental education, migrant background, insufficient toothbrushing frequency, and frequent sugar intake were strongly associated with poorer oral health outcomes. Although fluoridated toothpaste use was widespread (>94%), dental floss use remained limited (34.8%). Multivariate analyses confirmed a strong association between social inequalities and oral disease burden. Conclusions: Children and adolescents from vulnerable groups in Seville experience a high prevalence of dental caries and substantial unmet treatment needs. Findings highlight marked oral health disparities linked to socioeconomic status, emphasizing the urgent need for early preventive programs, culturally adapted oral health education, and equitable access to dental care. Full article

The development of epidermis plays a central role in driving the morphogenesis of the Caenorhabditis elegans embryo. However, current research on epidermal morphogenesis focuses disproportionately on overt phenotypic abnormalities, potentially overlooking the crucial role of developmental timing. In this study, we developed a modular two-step deep learning-based image analysis pipeline. First, we used ResU-Net to extract completely developed embryos and suppress noise; second, ResNet was used to predict the corresponding embryonic stage. The predicted probabilities and their corresponding embryonic time points were subsequently utilized to construct a developmental timeline. Combining this pipeline with differential interference contrast time-lapse microscopy, we dynamically tracked the timeline of epidermal morphogenesis in RNAi-treated embryos (ajm-1, tes-1, leo-1) and mutant embryos (clk-1). By statistically comparing the duration of each embryonic stage, our approach enabled the detection of stage-specific developmental timing without relying on overt phenotypic abnormalities or fluorescent markers, successfully recapitulating and extending the known roles of these genes from a temporal perspective. Our work underscores the importance of incorporating developmental timing into morphogenetic analysis, offering a novel framework for revealing subtle developmental processes, deepening the understanding of morphogenetic dynamics, and bridging the methodological gap in C. elegans embryology. Full article

This study examines the exposure of the U.S. insurance sector to climate-related risks using a two-step approach combining factor modeling and Extreme Value Theory. The analysis first constructs a climate risk factor from transition-sensitive sectors and estimates its impact on the SPDR S&P Insurance ETF using a standard factor model. The resulting residual, termed Insurance Climate Risk, isolates climate-driven excess returns by controlling for market-wide effects. To assess the sector’s sensitivity to extreme events, the study applies both the Peaks Over Threshold method using the Generalized Pareto Distribution and the Block Maxima Method using the Generalized Extreme Value distribution. The findings reveal statistically significant climate sensitivity, especially in daily and weekly data, and confirm the presence of heavy tails in the loss distribution. VaR and CVaR estimates indicate heightened risk over longer horizons and under block maxima modeling. Notably, peak over threshold daily returns yield a 95% VaR of 1.33% and CVaR of 2.28%, while block maxima CVaR exceeds 5%. These results show the importance of incorporating tail-risk-aware metrics in insurance risk management and highlight the growing influence of climate-related financial shocks. Full article

Introduction: Trace metals can negatively impact biological functions and brain development. Cognitive and neurobehavioral disorders in children are poorly documented in Haut-Katanga Province, an area with significant and multiple exposures to trace metals that can lead to the exacerbation of cognitive and behavioral disorders. Objective: This study aimed to characterize the behavior of schoolchildren linked to their cognitive performance in urban and rural environments. Methods: A cross-sectional pilot study was conducted on 52 schoolchildren aged 6 to 11 (22 from rural areas presumed less exposed to metals and 30 from Lubumbashi, DRC). This study employed NEPSY-II tests, the Strengths and Difficulties Questionnaire (SDQ-Tutor), ENA 2020 software and trace metal spectrometry assays. Statistical tests were carried out with SPSS-20 and Stata-18. Results: Our findings revealed a correlation between children’s malnutrition and low mother’s education. The “total difficulties score” was more prevalent in rural areas (73%) compared to urban settings (37%) p < 0.05), in contrast to the “negative impact of difficulties” (59% versus 57%, p > 0.05). Urban children demonstrated superior cognitive performance, particularly in “facial affect recognition” (8 versus 4, p = 0.013) and “inhibitory control” (6.5 versus 3, p = 0.032). As-U(urine), Cd-B(blood), Hg-B, Mo-U, Ni-U, Pb-U, Pb-B and Sb-U were elevated compared to references. In general, urban areas had higher metal levels than rural areas. Blood and urine metals showed a complex and significant relationship with behavioral difficulties or cognitive performance. Conclusions: The observed behavioral issues, cognitive performance deficits and their association with nutritional deficiencies and trace metal exposure suggest a multifactorial neurodevelopmental origin. These findings highlight the need for further research in the region. Full article