Search Results (172)

Probiotics, whether consisting of a single strain or multiple strains, are attracting growing interest in the management of type 2 diabetes mellitus (T2DM). However, their efficacy remains a matter of controversy and requires careful consideration. Accordingly, this meta-analysis aimed to compare the efficacy of single-strain to that of multi-strain probiotics supplementation on glycated haemoglobin (HbA1c) and fasting blood glucose (FBG) levels in adults with T2DM. Nineteen articles published between 2017 and 2024 obtained from 4 databases (Cochrane, Web of Science, Scopus, and PubMed) were included. These interventions, conducted in a total of 1159 participants, lasted from 6 to 24 weeks and were based on clearly identified probiotic formulations, with assessments of HbA1c and FBG. The results showed that, overall, probiotic supplementation had no significant effect on HbA1c (−0.24%; 95% CI [−0.76; 0.27]; p = 0.36), although a trend towards reduction was observed for single-strain formulations (−0.57%; p = 0.05). Regarding FBG, only the multi-strain group showed a significant reduction (−0.76; 95% CI [−1.18; −0.34]; p < 0.001), while the effect of the single-strain formulation was not significant. The comparison between the two formulations (Wald test) showed that there was no significant difference (p ≤ 0.05). However, high heterogeneity (I² > 75%) and variable strains/doses limit confidence in these findings. Full article

Background: Post-traumatic stress disorder (PTSD) is a severe psychiatric condition prevalent among combat veterans. Its diagnosis is challenging due to the heterogeneity of clinical presentations and the complex interplay of pathogenic factors. Objective: This study aimed to develop and validate a diagnostic algorithm for combat-related PTSD by integrating clinical data with a panel of biological markers associated with blood–brain barrier disruption (anti-GFAP and anti-NSE antibodies), HPA axis dysfunction (cortisol), and neuroinflammation (IL-6, IL-8). Methods: A total of 721 male participants were enrolled: 434 veterans with PTSD (F43.1), 147 combat veterans without PTSD, and 140 non-combat military controls. All participants underwent clinical and psychometric assessment (Likert scale, HADS). Serum levels of biomarkers were measured using ELISA. Statistical analysis included non-parametric tests, correlation analysis, and binary logistic regression with Wald’s method to build a predictive model. Results: The binary logistic regression model identified cortisol and IL-6 as the most significant predictors of PTSD. The final algorithm, based on a cortisol level below 199.8 nmol/L and an IL-6 level above 0.002438 pg/mL, correctly classified 78% of patients (AUC = 0.724, 95% CI [0.669, 0.779]). Furthermore, levels of IL-4, IL-8, and cortisol positively correlated with the severity of combat stress factors, independent of physical injuries. Conclusions: We developed a novel diagnostic algorithm for combat-related PTSD based on cortisol and IL-6 levels, demonstrating high accuracy. The correlation between neuroinflammatory markers and the severity of combat exposure suggests their role as primary indicators of stress response, highlighting their utility for early risk identification and targeted interventions. Full article

As human activities such as urbanization encroach on natural areas, some wildlife species adapt to these changes and learn ways to utilize newly available resources. We monitored the use patterns of the Eurasian otter in three urban ponds in southern Spain (Málaga province). We compared weekly otter visits and relative spraint abundance between the urban ponds and two control ponds located in natural areas, testing for differences in use patterns between them using Generalized Linear Mixed Models and the Wald–Wolfowitz run test. We also estimated prey survival rates through Kaplan–Meier estimator curves. We also assessed problems of coexistence with human interests. Relative spraint abundance was not affected by pond type (urban or natural). However, the number of otter visits was lower for urban ponds, and the pattern was not random but concentrated over a short time until prey depletion, suggesting consistent use of the urban feeding patches. Available food resources in urban settings can become a viable option for otters, which appear to explore urban habitats when it suits them. However, in the monitored urban ponds, otters competed with human interests and generated a conservation problem that almost led to lethal measures. Full article

Background/Objectives: Prognostic assessment in endometrial cancer (EC) is based on clinical and pathological features such as histological type, FIGO stage, tumor grade, LVSI, P53 status, and hormone receptor expression. Recent molecular research has distinguished four EC subtypes, with MMR status (pMMR vs. dMMR) providing clinically relevant stratification due to its predictive value for immunotherapy. The present study aims to compare dMMR and pMMR tumors in terms of the prevalence of adverse histopathological prognostic factors. Methods: This retrospective study included 179 patients with endometrioid endometrial carcinoma (EEC) treated at the authors’ institution (1 January 2023–31 August 2025). Patients were classified by MMR status (pMMR vs. dMMR) based on immunohistochemistry, and clinicopathological variables, including FIGO stage, myometrial invasion depth, tumor grade, LVSI, ER/PR expression, and P53 status, were analyzed. Normality was assessed using the Shapiro–Wilk test. Categorical variables were tested with chi-square or Fisher’s exact tests, reporting odds ratios with 95% CI, while continuous variables were compared using the Mann–Whitney test and presented as median (IQR) with the Hodges–Lehmann difference and 95% CI. Multivariable logistic regression with Wald tests was performed. Results: dMMR tumors accounted for 29.05% of all cases. Patients in the dMMR group were significantly more likely to present with FIGO stage III/IV disease (p = 0.036) and to exhibit LVSI (p = 0.008). No differences were observed between the groups with respect to tumor grade, estrogen receptor positivity, progesterone receptor positivity, or the prevalence of deep myometrial invasion. The most frequent pattern of protein loss in the dMMR population was concurrent loss of MLH1 and PMS2. Conclusions: In the studied population, dMMR tumors more frequently exhibited adverse prognostic features of EC, such as advanced stage of disease and lymphovascular space invasion. This suggests the potential for effective immunotherapy in this patient group. Full article

Modeling loss data is a crucial aspect of actuarial science. In the insurance industry, small claims occur frequently, while large claims are rare. Traditional heavy-tail distributions, such as Weibull, Log-Normal, and Inverse Gaussian distributions, are not suitable for describing insurance data, which often exhibit skewness and fat tails. The literature has explored classical and Bayesian inference methods for the parameters of composite distributions, such as the Exponential–Pareto, Weibull–Pareto, and Inverse Gamma–Pareto distributions. These models effectively separate small to moderate losses from significant losses using a threshold parameter. This research aims to introduce a new composite distribution, the Gamma–Pareto distribution with two parameters, and employ a numerical computational approach to find the maximum likelihood estimates (MLEs) of its parameters. A novel computational approach for a nonlinear regression model where the loss variable is distributed as the Gamma–Pareto and depends on multiple covariates is proposed. The maximum likelihood (ML) and Approximate Bayesian Computation (ABC) methods are used to estimate the regression parameters. The Fisher information matrix, along with a multivariate normal distribution as the prior distribution, is utilized through the ABC method. Simulation studies indicate that the ABC method outperforms the ML method in terms of accuracy. Full article

Objective: This short-term prospective observational study aimed to evaluate the efficacy of vestibular rehabilitation therapy (VRT) in Patients Diagnosed with Persistent Postural-Perceptual Dizziness (PPPD). Methods: Given the exploratory design, the small sample (n = 25) and absence of a formal power calculation limit precision, findings should be interpreted as preliminary, and confirmatory trials are warranted. Patients were assessed before (T1), immediately after a five-week vestibular rehabilitation program (T2), and again three months later without continued therapy (T3). Clinical symptoms were assessed using the Dizziness Handicap Inventory (DHI). A Generalized Estimating Equations (GEE) model was used to analyze changes in dizziness-related physical, emotional, and functional impacts over time, accounting for sex and its interaction with time. Statistical significance was tested using the Wald test, with results reported as estimated means and standard errors (SEs), and a significance level set at p ≤ 0.05. Results: The mean age of participants was 44.48 ± 14.43 years, and the majority were women (84%). In the functional domain, the mean score difference was 6.69 points between T1 and T2 (p = 0.018), 7.11 points between T1 and T3 (p = 0.013), and 0.42 points between T2 and T3 (p > 0.05). In the emotional domain, the mean difference was 4.12 points between T1 and T2 (p = 0.008), 4.40 points between T1 and T3 (p = 0.005), and 0.29 points between T2 and T3 (p > 0.05). In the physical domain, the mean difference was 3.77 points between T1 and T2 (p = 0.024), 4.32 points between T1 and T3 (p = 0.009), and 0.55 points between T2 and T3 (p > 0.05). For the total score, the mean difference was 14.58 points between T1 and T2 (p = 0.005), 15.83 points between T1 and T3 (p = 0.003), and 1.25 points between T2 and T3 (p > 0.05). The moment variable had a statistically significant effect across all domains. Sex had a significant effect only in the emotional domain, with women consistently reporting higher scores than men. Conclusions: This study demonstrates that a five-week vestibular rehabilitation program significantly improves the physical, emotional, and functional impacts of dizziness in patients with PPPD, with these benefits largely sustained three months after the intervention. Emotional improvements were particularly notable among women, highlighting potential sex-related differences in response to treatment. These findings underscore the importance of addressing emotional health in PPPD management and support the long-term effectiveness of vestibular rehabilitation in improving patient outcomes. Full article

Background/Objectives: Disparities in multiple myeloma (MM) survival occur based on factors like genetics, age, race, income level, and access to healthcare. The impact of age at diagnosis on MM survival is not fully understood and continues to draw research attention. This study explores the link between age at diagnosis and survival outcomes using data from the University of Arkansas Medical Sciences Myeloma Center Database (MMDB). Methods: Kaplan–Meier curves and Cox models were used to analyze the data. The log-transformed age variable strongly predicted survival. Results: The analysis found survival curves showing that patients in lower age brackets tend to have better survival profiles. Thus, for example, those in the oldest category (>70) showed the steepest decline, while the youngest age category (under 40) had better survival. Spline functions identified a non-linear relationship between age and survival. The likelihood ratio test, Wald test, and log-rank score test confirmed that the overall model was statistically significant, indicating that the spline-based approach effectively captured the relationship between age and survival. Further analysis using a stratified Cox model by age group showed significant risk differences. Patients aged 50–59, 60–69, and over 70 all had higher risks of death compared to younger patients, with those over 70 having a 3.3 times greater risk. Conclusions: In conclusion, the study confirmed that age at diagnosis has a significant association with survival outcomes for MM patients. Full article

This paper investigates the symmetric and asymmetric effects of renewable and non-renewable energy on Greece’s economic growth within an extended Cobb–Douglas production function for 1990–2022. The study is motivated by the rising role of renewable energy and the need to determine whether the energy–growth nexus is linear or nonlinear, an issue of central importance for policy. The Brock–Dechert–Scheinkman (BDS) test confirms the nonlinearity of the variables, while Zivot–Andrews unit root tests with structural breaks capture crisis-related disruptions. The Wald test indicates that renewable energy has an asymmetric long-run relationship with growth, whereas non-renewables exert symmetric effects. To model these dynamics, the Nonlinear Autoregressive Distributed Lag (NARDL) framework is applied. Results show that in the long run, positive shocks to renewable energy enhance growth, while both positive and negative shocks to non-renewables have symmetric impacts. In the short run, only non-renewable energy shocks significantly affect growth. Asymmetric causality analysis reveals a bidirectional relationship between positive renewable shocks and growth, suggesting a virtuous cycle of renewable expansion and economic performance. The study contributes by providing the first systematic evidence for Greece on the nonlinear energy–growth nexus, advancing empirical modeling with NARDL and break-adjusted tests, and highlighting the heterogeneous growth effects of renewable versus non-renewable energy. Full article

Background: As the United States population becomes increasingly diverse, the representation of minorities in health professions is critical to addressing health disparities. Few investigations have been conducted among students enrolled in the first semester of the nursing program, a vulnerable and adjustment period for most nursing majors. Thus, this study examined the association between reading comprehension and science aptitude on student retention and standardized test scores. Method: A cross-sectional repeated measures study was conducted to investigate the outcomes from a compendium of programmatic interventions implemented among n = 80 nursing students enrolled in the first semester of a pre-licensure baccalaureate nursing program in one Hispanic-serving institution. These interventions included the Weaver™ reading online program, case studies, NCLEX-type practice tests, test-taking skills, and peer-mentoring. Data collection was conducted in Spring 2024. Multivariate statistical analysis was used to determine predictors associated with student retention and standardized test scores. An independent t-test was used to examine any significant difference in the reading comprehension level among the cohort’s participants. A qualitative investigation using thematic analysis was conducted to understand students’ experiences with the programmatic interventions. Results: Students’ baseline reding comprehension level was significantly associated with failure in the first semester of the nursing program (β = −0.815; SE = 0.349; Wald = 5.444; p < 0.05). End-of-term reading comprehension level was significantly associated with end-of-course HESI score in the Foundations in Nursing course (β = 26.768; SE = 10.049; Beta = 0.445; p < 0.05) while science GPA was significantly associated with end-of-course HESI score for Health Assessment (β = 3.022; SE = 1.315; Beta = 0.434; p < 0.05. Cohort retention was 75%. The independent t-test result indicated a significant difference in reading level was found between those who dropped out from the cohort (M = 4.23, SE = 0.173 and those who did not (M = 5.15, SE = 0.188), t (68) = −3.037, p < 0.01. A reading level of grade 10 and above was associated with student progression to the next semester (M = 10.16, SE = 0.375, t (70) = −0.560, p < 0.05. Although the participants found the reading comprehension modules tedious, test-taking strategies, applying the nursing process in case studies, and the expertise of a nurse educator, who understood the learning needs of first-semester students, were perceived as critical to academic success. Conclusions: Reading comprehension and science aptitude are essential to students’ early success in the nursing program. Addressing gaps in reading comprehension and science aptitude before admission to a nursing program would increase chances of success in the early stages of a nursing major. Full article

We study Portugal’s household electricity retail market after legal liberalisation, quantifying market concentration (Herfindahl–Hirschman Index (HHI) and the four-firm concentration ratio (CR4)), consumer switching, and asymmetric wholesale-to-retail price pass-through. Using monthly data for January 2014–December 2019 (primary sample) and robustness checks for 2008–2022, we compute concentration indices from ERSE supplier shares, analyse switching dynamics, and estimate nonlinear autoregressive distributed lag (NARDL) models that decompose wholesale price changes into positive and negative components. The retail market remains highly concentrated during the primary window (HHI ≈ 6300–6800 using shares expressed as percentages on a 10,000 scale); switching rose after deregulation but stabilised at moderate monthly rates; and long-run pass-through is estimated at β⁺ ≈ 0.55–0.61 for wholesale increases and β⁻ ≈ 0.49 for decreases (Wald tests reject symmetry at conventional levels). Results are robust to alternative concentration metrics, exclusion of 2022, and varied lag orders. Policy implications emphasise tariff simplification, active consumer-activation measures, and regular monitoring of concentration and pass-through metrics. Full article

This study systematically evaluates the spatial effects and driving mechanisms of Passenger Throughput (PT) within the Multi-airport System (MAS) of the Yangtze River Delta (YRD) region in China, using data from 22 cities between 2011 and 2019. Initially, the Air Passenger Location Entropy (APLE) index is introduced to quantify the spatial agglomeration within the MAS. Subsequently, both global and local Moran’s I indices are employed to assess the spatial autocorrelation of PT. Finally, Lagrange Multiplier (LM) tests, Wald test and Likelihood Ratio (LR) tests are utilized to select the appropriate spatial econometric model under different spatial weight matrices. Key findings include: (1) Air transport activity within the MAS exhibits a dynamic trend toward intensified spatial agglomeration and enhanced regional equilibrium; (2) APLE with higher value primarily concentrated in the southeastern coastal cities; (3) APLE has a significant positive impact on PT, with a 1% increase in APLE, leading to an average increase of 0.429% in PT; and (4) in cities with a well-developed air transport system, PT is predominantly influenced by APLE (0.915), whereas in cities with less robust air transport infrastructure, PT is more strongly influenced by tertiary industry value added (0.839) and GDP (0.442). These findings underscore the pivotal role of spatial dynamics in shaping PT and emphasize the necessity of spatially informed policy interventions to foster balanced regional development, strengthen system resilience, and advance the sustainable evolution of the MAS. Full article

Background/Objectives: People are better at recognizing the faces of racial in-group members than out-group members. This own-race bias relies on pattern recognition and memory processes, which rely on hemispheric specialization. We hypothesized that handedness, a proxy for hemispheric specialization, would moderate own-race bias. Specifically, consistently handed individuals perform better on tasks that require the hemispheres to work independently, while inconsistently handed individuals perform better on tasks that require integration. This led to the hypothesis that inconsistently handed individuals would show less own-race bias, driven by an increase in accuracy. Methods: 281 participants completed the study in exchange for course credit. Of those, the sample was isolated to Caucasian (174) and African American individuals (41). Participants were shown two target faces (one Caucasian and one African American), given several distractor tasks, and then asked to identify the target faces during two sequential line-ups, each terminating when participants made an identification judgment. Results: Continuous handedness score and the match between participant race and target face race were entered into a binary logistic regression predicting correct/incorrect identifications. The overall model was statistically significant, Χ² (3, N = 430) = 11.036, p = 0.012, Nagelkerke R² = 0.038, culminating in 76% correct classifications. Analyses of the parameter estimates showed that the racial match, b = 0.53, SE = 0.23, Wald Χ² (1) = 5.217, p = 0.022, OR = 1.703 and the interaction between handedness and the racial match, b = 0.51, SE = 0.23, Wald test = 4.813, p = 0.028, OR = 1.671 significantly contributed to the model. The model indicated that the probability of identification was similar for own- or cross-race targets amongst inconsistently handed individuals. Consistently handed individuals, by contrast, showed an increase in accuracy for the own-race target and a decrease in accuracy for cross-race targets. Conclusions: Results partially supported the hypotheses. Inconsistently handed individuals did show less own-race bias. This finding, however, seemed to be driven by differences in accuracy amongst consistently handed individuals rather than a hypothesized increase in accuracy amongst inconsistently handed individuals. Underlying hemispheric specialization, as measured by proxy with handedness, may impact the own-race bias in facial recognition. Future research is required to investigate the mechanisms, however, as the directional differences were different than hypothesized. Full article

Crossover trials are specifically designed to evaluate treatment effects within individual participants through within-subject comparisons. In a standard AB/BA crossover trial, participants are randomly allocated to one of two treatment sequences: either the AB sequence (where patients receive treatment A first and then cross over to treatment B after a washout period) or the BA sequence (where patients receive B first and then cross over to A after a washout period). Asymptotic and approximate unconditional test procedures, based on two Wald-type statistics, the likelihood ratio statistic, and the score test statistic for the odds ratio (OR), are developed to evaluate the equality of treatment effects in this trial design. Additionally, confidence intervals for OR are constructed, accompanied by an approximate sample size calculation methodology to control the interval width at a pre-specified precision. Empirical analyses demonstrate that asymptotic test procedures exhibit robust performance in moderate to large sample sizes, though they occasionally yield unsatisfactory type I error rates when the sample size is small. In such cases, approximate unconditional test procedures emerge as a rigorous alternative. All proposed confidence intervals achieve satisfactory coverage probabilities, and the approximate sample size estimation method demonstrates high accuracy, as evidenced by empirical coverage probabilities aligning closely with pre-specified confidence levels under estimated sample sizes. To validate practical utility, two real examples are used to illustrate the proposed methodologies. Full article

Paired data often arise in medical studies, with a correlation between responses of paired organs or parts. Under an intra-correlated model, this paper proposes a generalized linear model to investigate probable confounding factors of the individual response rates in paired data. The main link functions include logistic, log–log, complementary log–log, probit, and double exponential. The estimators of model parameters are calculated through the Newton–Raphson, quadratic lower bound, and Fisher bounded algorithms. Then, three tests (i.e., likelihood ratio test, Wald-type test, and score test) are constructed to analyze whether covariates significantly affect the response rate. Finally, the proposed methods are illustrated by numerical simulation and visual impairment data from Iran. Full article

Background: Urethral stricture disease involves fibrotic scarring that narrows the urethral lumen and can occur at any site. Sonourethrography (SUG) is increasingly used because it depicts both luminal anatomy and periurethral fibrosis, yet little is known about patient or lesion features that influence its diagnostic performance. Methods: We conducted a prospective single-center study of 170 men who underwent SUG before anterior urethroplasty between May 2016 and May 2021. Anthropometric data, comorbidities, and detailed ultrasonographic measurements were recorded and compared with intra-operative findings, which served as the reference standard. Accuracy was analyzed with Wald chi-square testing and Spearman correlation. Results: SUG length estimates matched intra-operative measurements in 139/170 strictures (81.8%). Length accuracy was higher in patients ≥ 60 years (89.2% vs. 77.0%, p = 0.03) and in those with type 2 diabetes (92.3% vs. 80.9%, p = 0.02) in conditions associated with pronounced spongiofibrosis that enhances echo contrast. Among stricture-specific factors, proximal location (63.6% vs. 84.5%, p = 0.01) and complete luminal occlusion (68.8% vs. 84.8%, p = 0.02) reduced precision, largely because deeper anatomy and absent saline flow hinder acoustic delineation. The Chiou ultrasonographic grade was the strongest determinant of performance; higher grades yielded clearer margins and better length estimation (p < 0.001). Conclusions: SUG is a reliable bedside technique for assessing anterior urethral strictures, but its accuracy varies with age, diabetes status, stricture site, degree of occlusion, and fibrosis grade. Recognizing these determinants allows clinicians to judge when SUG alone is sufficient and when complementary imaging or heightened caution is warranted. The findings support tailored imaging protocols and underscore the need for multi-center studies that include operators with diverse experience to confirm generalisability. Full article