Search Results (5,764)

Background: An unfavorable course of SARS-CoV-2 infection can lead to significant morbidity and mortality. The study aimed to develop a simple, accessible, and reliable tool to anticipate the poor results among COVID-19 pneumonia patients. Methods: This retrospective cohort study involves 306 individuals with severe COVID-19 pneumonia enrolled between March 2021 and June 2021. Each patient had confirmed SARS-CoV-2 infection and required oxygen therapy. Differential blood count and serum CRP were taken on admission day. Medical data were collected from the hospital’s information system. Results: Of 306 patients (133 females, 173 males, aged 66.3 ± 15.2 years), 105 (34.3%) died. Counts of neutrophils, lymphocytes, and eosinophils differed significantly between survivors and deceased (p < 0.001; p = 0.002; p = 0.009, respectively) and had substantially differentiating properties in ROC analysis. Built with the counts of neutrophils, lymphocytes, and eosinophils, the White Blood Cell Score (WBCS) was developed. WBCS robustly predicted mortality (OR = 2.821; CI: 2.037–3.906; p < 0.001) in the investigated population. Cumulative risk of death according to WBCS (ranging from 0 to 3 points) was as follows: 0 points—10.9%, 1 point—23.5%, 2 points—33.1%, 3 points—34.1%. Conclusions: Based on differential blood count, the proposed WBCS is easy to use and can be helpful in predicting mortality among severe COVID-19 patients. Full article

Virtual tours are increasingly used in education, particularly when access to real environments is limited. This study examined how display mode and representation format affect subjective user experience in an educational virtual tour of a hospital operating room. A within-subject 2 × 2 design compared two representation formats (360° photographs vs. 3D models) and two display modes (desktop PC vs. immersive virtual reality using Meta Quest 2). Eighty-four university students completed the four visualization conditions and evaluated each experience using an adapted version of the QUXiVE questionnaire. Descriptive statistics and internal consistency indices were calculated, and each questionnaire dimension was analyzed using a two-way repeated-measures ANOVA with display mode and representation format as within-subject factors. A significant main effect of display mode was found for presence, engagement, immersion, flow, emotion, judgment, physical consequences, and perceived educational usefulness (all p < 0.001), but not for usability (p = 0.273). A significant main effect of representation format was observed for presence (p = 0.003), emotion (p = 0.018), and perceived educational usefulness (p = 0.015), whereas no significant interaction effects were found. These findings indicate that immersive VR had the strongest and most consistent effect on subjective user experience across both 360° and 3D virtual tours, although it was also associated with higher physical-consequence scores. By contrast, the effect of representation format was more limited. Overall, both approaches appear to be complementary educational resources, depending on pedagogical goals, available infrastructure, and desired levels of interactivity. Full article

Considering the UN’s Sustainable Development Goals to foster quality education, curricula should encompass inclusive, equitable and contextually meaningful education. Since the textbook is the main support for EFL teaching in Chile, this study examines the alignment between 1st to 4th-grade English language textbooks and the unofficial Chilean English school curriculum. The research questions are as follows: (1) What content do the 1st to 4th-grade English language textbooks build? (2) To what extent does the content align with the unofficial curriculum for the first cycle of primary education? This is relevant since Chile has not improved proficiency in English despite substantial public investment in textbooks. To answer these questions, pedagogic discourse analysis was conducted, framed methodologically and analytically within the register model of Systemic Functional Linguistics, focusing on the field. The corpus comprises the textbooks and the vocabulary to certify young learners’ proficiency (pre-A1 and A1), as defined by the Common European Framework of Reference for Languages. The analysis reveals content building consistency across the textbooks and curriculum alignment, which ensures equitable access to quality learning opportunities. Full article

Excessive macrophage activation is thought to be the primary cause of the cytokine storm that results in severe coronavirus disease 2019 (COVID-19) complications. The underlying mechanisms remain elusive, and more research is needed to find disease-critical genes and develop effective therapies. In this study, we used publicly accessible microarray datasets of cytokine storm in cultured human monocyte-derived macrophages challenged with cytokines, and employed bioinformatics, such as weighted gene co-expression network analysis (WGCNA) and differential expression analysis, to dissect gene expression profiles and identify putative disease-related molecules. Initially, three co-expression modules and related key genes were discovered, which highly correlated to macrophages challenged with cytokines. Then, a preliminary gene expression signature consisting of 203 upregulated and 24 downregulated genes was identified. Next, protein–protein interaction analysis and hub gene identification were used to identify 11 crucial hub genes, namely tripartite motif-containing 21 (TRIM21), interferon regulatory factor 1 (IRF1), guanylate binding protein 1 (GBP1), transporter associated with antigen processing 1 (TAP1), nuclear myosin I (NMI), interleukin 15 receptor subunit alpha (IL15RA), apolipoprotein L1 (APOL1), intercellular adhesion molecule 1 (ICAM-1), protein tyrosine phosphatase non-receptor type 1 (PTPN1), E74-like ETS transcription factor 4 (ELF4) and guanylate binding protein 2 (GBP2). Then, the LINCS L1000 characteristic direction signatures search engine (L1000CDS2) was employed for drug repurposing studies. Dasatinib was predicted to be the leading therapeutic compound to perturb the gene signature of cytokine storm in human macrophages. Connectivity Map results suggested that dasatinib may normalize ICAM-1 expression. In addition, the results of molecular docking studies and molecular dynamics simulation revealed that dasatinib may spontaneously interact with ICAM-1 via several key residues and form a relatively stable protein–ligand complex. Overall, this work, based on an analysis of co-expression correlation networks, gene expression signatures and pivotal genes in human macrophages challenged with cytokines, combined with drug repurposing studies, demonstrated that dasatinib may interact with ICAM-1 and could be a potential candidate for cytokine storm. However, due to the limitations of computational approaches, further experimental validation is necessary. Full article

Background: Among individuals with type 2 diabetes (T2D), lifestyle improvements can restore glycemic control, yet few studies have examined deprescribing in settings where it was necessitated by improvements in health. This study aimed to (1) identify instances of medication deprescribing among adults with T2D in a primary care setting where patients had access to lifestyle medicine (LM), (2) document lifestyle changes among deprescribed patients, (3) assess changes in body mass index (BMI), glucose, and hemoglobin A1c (HbA1c) following deprescribing, and (4) assess the safety of deprescribing in the context of LM-informed care by identifying adverse events. Methods: A retrospective review of electronic health records (EHR) was conducted among 650 adults with a diagnosis of T2D per ICD-10 code at two primary care practices. To be included in the study, individuals had to be seen at least two times during the study period, from 2014 to 2023. Using a previously developed deprescribing framework, records were reviewed to identify deprescribing events. Among patients who were identified as deprescribed, BMI, glucose, and HbA1c, were extracted from the EHR, and age-, sex-, and time-adjusted differences in least squares means were calculated. Mentions of lifestyle change in provider notes in the EHR were also extracted pre- vs. post-deprescribing. Results: Forty-one deprescribing events were confirmed, totaling 6.3% of the study population. The most common medication changes included metformin dose reduction 34%, metformin discontinuation 19.5%, and insulin dose reduction 19.5%. Among patients with follow-up data, mean BMI decreased by 2.25 kg/m², p = 0.0003. Mean decreases of 25% in glucose and 13% in HbA1c were also observed, p < 0.0003 and p < 0.0013, respectively. Lifestyle modifications were specifically cited in 51% of records among deprescribed patients, most frequently related to diet and exercise. No serious adverse events were identified in patients who were deprescribed. Conclusions: In a primary care setting where patients had access to lifestyle medicine, a subset of adults with T2D experienced meaningful health improvements and were able to reduce glucose-lowering medications without any serious adverse events noted in the EHR. Full article

Objectives: Strictures are a major complication of Crohn’s disease (CD) affecting up to 20% of patients at diagnosis. Endoscopic balloon dilation (EBD) is the first-line endoscopic approach; however, it entails complications and a need for reintervention. Endoscopic stricturotomy (ESt) and stricturoplasty (ESTx) are promising alternatives. This review aims to provide an up-to-date and comprehensive assessment of their efficacy and safety in CD-associated strictures. Methods: A literature search was performed until August 2025. Primary outcomes were clinical and technical success. Secondary outcomes included adverse events, additional endoscopic or surgical treatments, medication escalation, emergency department visits and hospitalization following intervention. A minimum of four studies were required for meta-analysis, and pooled estimates were calculated using random-effects meta-analysis. Study quality was assessed using CASP checklist. Results: Fifteen studies including 1050 IBD patients (470 CD) were included. Strictures were short (0.9–2.4 cm) and some had prior EBD (7.8–57.1%) or surgery (3.6–91%). Technical success of ESt ranged from 88% to 100% and clinical success from 50% to 96%. The bleeding rate was up to 11.8%, but perforation rate was mostly <2%. The need for additional intervention, endoscopic (18.2–66.6%) or surgical (0–18.2%), varied considerably. Additionally, ESTx’s technical success ranged from 91.7% to 100% whereas clinical success ranged from 71.4% to 91%, with bleeding ranging from 5.2% to 8.8% and perforation from 0% to 3.4%. Similarly, the need for additional endoscopic procedures (7.1–57.1%) and surgery (9.5–25%) varied considerably. Conclusions: ESt and ESTx are safe and effective for managing CD-related strictures, particularly when short, straight, accessible, fibrotic, anastomotic, or refractory to EBD. Full article

The Local Climate Zone (LCZ) provides a systematic approach for analyzing the differences in urban thermal environment. However, given the scarcity of accessible multi-year LCZ maps, studying the long-term thermal differences among LCZs remains challenging. This study classified LCZs using multi-year remote sensing imagery of Xiamen and analyzed the thermal differences among them. The results indicate that (1) the land surface temperatures (LSTs) of LCZ(8) Large low-rise and LCZ(10) Heavy industry are the highest, while the LSTs of LCZ(A) Dense trees and LCZ(G) Water are the lowest. Among compact LCZs(1,2,3), the LST of LCZ(1) Compact high-rise is consistently lower than that of LCZ(2) Compact mid-rise and LCZ(3) Compact low-rise. (2) The thermal contribution indices of built-up LCZs are positive, whereas those of land-cover LCZs are negative. The thermal contribution indices of LCZ(2) Compact mid-rise, LCZ(3) Compact low-rise, and LCZ(10) Heavy industry show a continuous annual increase, while the thermal contribution indices of LCZ(9) Sparsely built, LCZ(A) Dense trees, and LCZ(G) Water show a consistent annual decrease. (3) In terms of the thermal environment regulation demand index, LCZ(1) Compact high-rise, LCZ(2) Compact mid-rise and LCZ(3) Compact low-rise have the highest thermal environment regulation demand. By integrating long-term LCZ mapping with LST, TCI, and TERDI, this study provides a multidimensional and planning-oriented framework for urban thermal environment assessment and targeted mitigation. Full article

The ADA 2026 Standards of Care in Diabetes introduces pivotal updates that refine diagnostic and therapeutic workflows. Expanding upon the 2025 guidelines, the 2026 edition broadens continuous-glucose-monitoring (CGM) eligibility to include all individuals on insulin or non-insulin therapies where CGM aids management. Significant new guidance addresses hyperglycemia management in oncology, identifying metformin as the preferred first-line intervention for drug-induced glycemic excursions. Additionally, type 1-diabetes (T1D) risk stratification is refined; a confirmed single IA-2 autoantibody now warrants monitoring levels similar to the Stage 2 disease. Furthermore, prerequisites for automated-insulin-delivery (AID) initiation have been removed to streamline technology access. For laboratory professionals, these revisions emphasize the critical role of advanced glycemic metrics and precise autoantibody profiling in complex clinical contexts. Full article

Background/Objectives: Vestibular disorders can have functional consequences for children, including balance and gross motor delays, academic difficulties and behavioral manifestations; however, they are frequently undiagnosed in children. The purposes of this study were to evaluate the feasibility and clinical utility of performing a non-instrumented dynamic visual acuity (DVA) test as a primary screening tool for children and to examine typical performance on this non-instrumented DVA test in a large sample of children ages 2 through 13 years. Methods: A clinical DVA test was administered to a convenience sample of 208 children aged 2–13 years. Static visual acuity was assessed using a standard Snellen or LEA eye chart, depending on the child’s ability to read letters. Dynamic visual acuity was then measured while the examiner manually rotated the child’s head at 2 Hz (240 bpm). DVA was calculated as the number of lines of visual acuity lost with head movement. Results: All children aged 4 years and older and 67% of 3-year-olds successfully completed DVA testing. Most 2-year-olds and 33% of 3-year-olds were unable to complete DVA testing. Although the number of visual acuity lines lost with rotational head oscillations at 2 Hz varied between age groups, Kruskal–Wallis test indicated no significant difference in DVA scores between age groups (K = 12.721, DF = 9, P = 0.176). Ninety percent of children who were able to perform DVA testing lost two or fewer lines of visual acuity with head rotations consistent with adult norms. Conclusions: This method of DVA testing is an easily accessible and promising clinically feasible screening tool for identifying children with vestibular dysfunction. The authors recommend widespread vestibular screening of children to facilitate rapid referral for diagnosis and treatment of children with vestibular dysfunction. Full article

Using She County, a national new-type urbanization comprehensive pilot area, as a case study, this research develops a multi-layered “static–dynamic–driver” analytical framework based on rural settlement data. By integrating GIS spatial overlay, landscape pattern indices, average nearest neighbor analysis, kernel density estimation, and cold–hotspot analysis, the study systematically characterizes the spatiotemporal evolution and driving mechanisms of rural settlements from 1980 to 2020. The results reveal that: (1) settlement evolution exhibits distinct phase-specific patterns, encompassing four primary types of transformation: localized expansion and consolidation, individual disappearance, rapid expansion, and the emergence of new settlements with peripheral extension; (2) landscape pattern and aggregation analyses indicate continuous growth in both total area and number of settlements, accompanied by increasing irregularity and fragmentation of patches; settlement size aggregation shows a fluctuating decline followed by recovery, overall spatial clustering intensity trends upward, and high-density kernel areas shift from the central–western to the northwestern region; (3) under multi-factor interactions, settlement layouts transitioned from an early “survival–location dependent” pattern dominated by natural constraints and transportation accessibility, to a mid-stage rapid aggregation driven by economic development and public service provision, ultimately evolving into a composite pattern balancing economic drivers and ecological constraints. The findings underscore the nonlinear superimposed effects of natural environment, economic development, transportation accessibility, public service availability, and ecological carrying capacity, providing a robust scientific basis for optimizing rural settlement spatial arrangements and informing rural development policy under the context of national new-type urbanization. Full article

Primary care clinics represent a promising, yet underutilized, setting for delivering health-focused prevention programming targeting adolescent substance use, sexual assault, and sexual risk behaviors; however, little is known about adolescents’ prior exposure to such messaging. Therefore, the present study examined adolescents’ prior prevention exposure, their perceptions of prevention content, and recommendations for future programs. Semi-structured qualitative interviews were conducted with 25 adolescents (ages 14–18; 56% female, 36% male, 8% gender fluid or Two-Spirit) recruited from primary care and community settings in the southeastern United States. Thematic analysis was used to examine youth exposure to and perspectives on prevention programming. Three core themes emerged: (1) prior exposure to prevention content across topics; (2) appraisal of strengths and limitations within previous programming; and (3) recommendations for what adolescents believe their same-aged peers should know. Participants reported a preference for technology-based programs, criticized interventions exclusively promoting abstinence and negative consequences, and emphasized needing additional information on sexual consent. Adolescents in primary care settings report inconsistent exposure to prior prevention, most centering abstinence and negative consequences, rather than inclusive harm-reduction approaches. Findings highlight a structural gap in exposure to comprehensive adolescent prevention programming and position pediatric primary care as a uniquely flexible and developmentally congruent setting for delivering integrated, harm-reduction-oriented prevention interventions. These findings also further support the development of scalable, technology-driven prevention tools that can be implemented within pediatric primary care settings to improve accessibility reach, engagement, and relevance. Full article

Industrial heritage in resource-depleted mining towns faces the dual challenge of physical decay and social severance. To achieve sustainable urban revitalization, adaptive reuse strategies must align with local collective memory and emerging experiential consumption trends. Adopting a Scene Theory perspective, this study constructs a multi-level analytical framework using Meitanba Town (Hunan, China) and its power plant as a case study. A mixed-methods approach was employed, combining semantic network analysis of 1582 online user comments with 61 offline questionnaires distributed to local residents to quantitatively diagnose current scene elements, functions, and features. The quantitative results reveal a significant imbalance: while “Functional Media” achieved the highest comprehensive score (10.0) due to strong historical recognition, “Diverse Groups” scored the lowest (3.4), indicating a lack of social inclusivity. Specifically, residents expressed the highest demand for sports facilities (31.2%) and cultural spaces (23.7%), identifying the main workshop (26.4%) and chimney as core carriers of industrial identity. Responding to these findings, the paper proposes three targeted strategies: (1) Activate: creating open-access recreation scenes to satisfy urgent sports demands; (2) Link: constructing immersive cultural scenes to narrate the “coal–electricity–life” history; and (3) Enhance: developing industry-powered commercial scenes to avoid homogenization. This study enriches the localized application of Scene Theory and provides a data-driven, context-adjustable analytical and strategic model that can inform the sustainable renewal of mining towns globally, with its specific implementation requiring adaptation to local social, economic, and cultural characteristics. Full article

This work proposes a fiber-tethered UAV-enabled adaptive aerial passive optical network (AA-PON) framework for rapid extension of optical access and backhaul in hard-to-reach or temporarily disrupted environments. The proposed architecture supports two distinct operating modes: (i) an aerial base station (ABS) mode for wide-area service extension and (ii) a ground-to-air-to-ground (G2A2G) mode for targeted high-speed optical bridging to ground terminal units. Unlike conventional UAV relay approaches, the proposed framework is developed as a network-level optical access/backhaul architecture based on tether-assisted aerial nodes and reconfigurable optical topology formation. In the ABS mode, representative Bus, Ring, and Star topologies are analyzed to evaluate serviceability, outage, deployment latency, and scalability as the number of UAV nodes increases. In the G2A2G mode, a stochastic-geometry-based analysis is used to characterize blockage-limited optical serviceability and infrastructure-density trade-offs. To complement the analytical study, a 2 Gb/s proof-of-concept FSO link between two fiber-tethered UAVs is demonstrated as an initial feasibility validation of the end-to-end optical link. The results show that the proposed AA-PON provides a flexible aerial optical networking framework that combines reconfigurable topology support with localized high-capacity optical access extension. Full article

Background/Objectives: Fentanyl test strips (FTS) are a harm reduction tool used to detect fentanyl in illicit substances. However, little is known regarding Americans’ beliefs regarding FTS. Therefore, the purpose of this study was to assess the U.S. general public’s FTS knowledge and perceptions. Methods: This study utilized a cross-sectional design. Adults ≥18 residing in the U.S. were recruited to participate in an anonymous online survey via Amazon Mechanical Turk (MTurk). Participants received $5 upon survey completion. The survey instrument was informed by the Health Belief Model, and primary outcome measures included: (1) FTS knowledge (13-items); (2) perceived susceptibility to fentanyl exposure (8-items); (3) perceived severity of fentanyl exposure (10-items); (4) perceived FTS benefits (9-items); (5) perceived barriers to FTS access (13-items); (6) comfort using and accessing FTS (15-items); (7) confidence using and accessing FTS (11-items); and (8) FTS utilization intentions (6-items). Outcomes were measured via 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Data were analyzed using descriptive statistics and Mann–Whitney U tests to compare differences in scale scores across participant sociodemographics. Predictors of FTS utilization intentions were assessed via multiple linear regression, controlling for participant age, race, sex, geographic setting (rural/urban), and recreational drug use history (yes/no) (α = 0.05). Results: Of n = 206 respondents, the majority were male (55.8%) and White (83.0%) with a mean age of 46.4. Approximately 81% resided in urban areas and 58.5% reported a history of recreational drug use. Participants who identified as Black, Asian, Indigenous, Pacific Islander, or Multiracial reported significantly higher mean (SD) perceived susceptibility compared to White participants (2.06 [0.54] vs. 1.91 [0.58]; p = 0.034). Participants residing in urban areas reported significantly higher comfort using and accessing FTS (3.61 [0.86]) than those in rural areas (3.29 [0.92]; p = 0.048), and younger individuals (≤44.5 years) were more confident in their ability to access FTS (3.75 [0.73]) compared to their older counterparts (3.60 [0.64]; p = 0.048). Perceived susceptibility (β = 0.442; p < 0.001), benefits (β = 0.250; p = 0.020), and comfort (β = 0.453; p < 0.001) were positive predictors of FTS utilization intention (R² = 0.417). Conclusions: Perceptions regarding FTS varied across race, geographic setting, and age. Perceived susceptibility, perceived benefits, and comfort positively predicted the U.S. general public’s FTS utilization intentions. Future interventions may leverage these influential factors to enhance FTS uptake. Full article

People with special needs often face barriers to participating in adapted outdoor leisure physical activities. A participatory action research project involving a nonprofit organization, a citizen with motor disabilities, and researchers aimed to co-develop a digital platform connecting people with special needs interested in outdoor leisure physical activities with trained volunteers. The adopted co-design methodology followed four stages: (1) Exploration (identifying users’ needs and preferences), (2) Co-design (defining key information and platform features), (3) Validation (prioritizing features), and (4) Development (implementing and testing the platform). This article focuses on stages 2, 3, and 4. During stage 2, key information and features were identified to support matching people with special needs and volunteers and informing users about adapted outdoor leisure physical activities. In stage 3, these elements were prioritized using eight key considerations, including technological (e.g., ease of use), environmental (e.g., avoiding redundancy with existing initiatives), organizational (e.g., availability of human resources), and financial factors (e.g., grant planning). Stage 4 resulted in the launch of Tandem Actif, followed by user testing to document user experience and guide improvements. This article details the application of co-design within a participatory action research project aimed at promoting safe, ethical, and accessible participation in outdoor leisure physical activities for people with special needs. Full article