Search Results (28,363)

Background: Co-prescribing opioids and gabapentinoids (GABA, gabapentin and pregabalin) is associated with increased risk of falls, fractures, opioid overdose and deaths. The Centers for Disease Control and Prevention (CDC) in 2016 and the Food and Drug Administration (FDA) in 2019 recommended caution in such co-prescribing. A key step in updating policy and revising prescribing guidelines aimed at reducing opioid and GABA co-use and its associated consequences is a thorough understanding of the prescriber and the patient factors associated with co-use. We thus examined national trends and patterns in opioid and GABA co-prescribing among Medicare beneficiaries from 2017 to 2022. Methods: We conducted a retrospective study of Medicare beneficiaries with ≥90 consecutive days of opioid use from 2017 to 2022. The study outcome was GABA use during the 90-day opioid use episode. A multivariable logistic regression model was constructed to examine the patient, prescriber and prescription factors associated with receiving a GABA prescription. Results: Our sample comprised 8035 opioid-only and 2818 opioid and GABA users. Non-cancer (e.g., back and neuropathic) pain was a more common diagnosis in the opioid and GABA cohorts than in the opioid-only cohorts. The opioid-GABA co-prescribing rate did not substantially change (2017: 24.5%, 2019: 28.2% and 2022: 25%). Co-prescribing rates were higher in non-white patients, those on Medicaid and Medicare, and those whose initial Medicare entitlement was not based on age. Tramadol and hydrocodone were the most prescribed opioids. Approximately 33% of opioid and GABA users started with an initial daily GABA dose of ≥1200 mg. In the 12-month lookback period, patients on opioids and GABA had nearly 17 clinic visits to approximately 8 different providers. Factors associated with co-prescribing were seeing pain physicians (odds ratio = 1.29, 95% confidence interval-[CI] = 1.11–1.50), having more healthcare encounters (6–11 visits, odds ratio-[OR] = 1.19, 95% CI = 1.02–1.39; 12–19, OR = 1.20, 95% CI = 1.00–1.43; 20+, OR = 1.27, 95% CI = 1.03–1.57) and seeing >10 providers (OR = 1.40, 95% CI = 1.12–1.73). Conclusions: One in four Medicare beneficiaries with long-term opioid use received opioid and GABA prescriptions. Our findings of association in co-prescribing with multiple visits to different clinics/prescribers can inform the development of public health policy and practice guidelines (e.g., prescription-drug monitoring program checks within electronic medical records, EMR alerts with opioid and GABA co-prescribing) to potentially reduce opioid and GABA prescriptions and associated adverse outcomes. Full article

The purpose of this study is to examine positive and negative emotions about climate change reported by youth living in northern California and explore how these emotions are linked to climate anxiety, activism, and other measures of well-being. We surveyed ethnically diverse first- and second-year students (N = 521, mean age = 19) at a Jesuit, urban university in California in Fall 2022. Survey measures assessed climate-related emotions, eco-anxiety, and eco-impairment, along with activism, optimism, and compassion. Bivariate and multivariate models examined positive and negative eco-emotions, controlling for race, gender, and income. Overall, climate anxiety was linked to greater activism and confidence that actions matter. However, experiencing positive climate-related emotions had a stronger relationship to activism and optimism for the present and future, compared to negative emotions which were linked to higher eco-anxiety and greater compassion for others. Climate education and communication should consider inducing and reinforcing positive emotions to encourage youth activism, especially since negative emotions in response to climate change are linked to worse mental health. More research on a range of climate emotions is needed, and future interventions should test how to induce hope without minimizing the seriousness of climate change to support confidence and youth action. Full article

Objective: Perform endoscopic surgery for radiculopathy caused by compression fractures and evaluate the results. Methods: A total of 20 patients who underwent biportal endoscopic foraminotomy and unilateral screw fixation using a dynamic rod for radiculopathy secondary to osteoporotic compression fractures were included in this study. All surgeries were performed between July 2021 and January 2025. Patient demographic data, operated level, length of hospital stay, intraoperative blood loss, and operative time were reviewed. Radiological follow-up included assessment of segmental kyphosis, scoliosis, subsidence, and adjacent-level fractures. Complications and pain patterns—separately evaluated for back pain and radiculopathy—were assessed using the visual analog scale (VAS) preoperatively and during follow-up. Only single-level cases were included. Patients with infections, significant stenosis, instability, tumors, prior revision surgery, multilevel pathology, or ambiguous symptoms were excluded. Results: The mean age of the patients was 78.8 years (range, 69–89 years), reflecting an elderly cohort. The mean follow-up period was 13.0 ± 11.9 months (range, 1–41 months). The mean operative time was 164.8 ± 25.7 min, and the mean hospital stay was 10.2 ± 4.6 days (range, 4–25 days). The mean intraoperative blood loss was 126.5 ± 77.6 mL (range, 50–400 mL). One female patient developed postoperative pneumonia, which resolved after appropriate treatment; no other medical complications were observed. Radiculopathy improved significantly immediately after surgery and continued to improve during follow-up. Back pain also improved, but tended to persist to a mild degree. Radiologic evaluation revealed no significant changes in segmental lordosis, and there were no cases of subsidence, scoliosis, or symptomatic screw loosening during the available follow-up period. Conclusions: Biportal endoscopic foraminotomy with unilateral screw fixation may be an effective solution for radiculopathy caused by compression fractures. Full article

Background/Objectives: Evidence on spinal versus general anesthesia in unilateral total knee arthroplasty (TKA) may not extend to one-week-staged bilateral surgery, where older patients receive two anesthetics in a short interval and intra-operative spinal-to-general conversion is common but rarely reported transparently. We compared peri-operative acute kidney injury (AKI) and transfusion between strategies in this setting. Methods: We retrospectively analyzed 207 patients (414 surgeries) undergoing one-week-staged bilateral primary TKA at one center. Co-primary endpoints were creatinine-based AKI (patient level) and packed-red-blood-cell transfusion (surgery level). Because 42 general-anesthesia-classified surgeries had an attempted spinal injection, the primary analysis used the initial anesthetic plan (an intention-to-treat analogue), reclassifying these as spinal, with as-treated classification as a sensitivity analysis; AKI was modeled at the patient level (any general anesthesia versus spinal–spinal) and transfusion per surgery. Results: Median age was 75 years and 82.6% were female; AKI affected 74 of 207 patients (35.7%) and transfusion 185 of 414 surgeries (44.7%). The adjusted any-general-anesthesia versus spinal–spinal estimate was not statistically significant and opposite the spinal-protective hypothesis (adjusted odds ratio 0.49, 95% confidence interval 0.23–1.01, p = 0.054), and no pre-specified sensitivity scenario survived Benjamini–Hochberg correction. Transfusion did not differ between strategies; among secondary endpoints, length of stay, hemoglobin drop, peak C-reactive protein, and intra-operative hypotension likewise showed no significant difference after multiplicity correction. Conclusions: These hypothesis-generating findings do not support changing anesthetic practice; the choice should remain individualized. Approximately 12% of attempted spinal anesthetics converted intra-operatively to general anesthesia—a record-based observation, not a validated failure rate. Full article

Background/Objectives: Myocardial blood flow (MBF) and myocardial flow reserve (MFR) are key measurements in myocardial perfusion imaging (MPI), with [¹⁵O]H₂O-PET considered the reference standard. To further establish clinical and research utility, we investigated intra-individual variability of MBF and MFR over time in patients with angina, but no obstructive coronary disease. Methods: In a routine clinical setting, we prospectively studied 21 patients, >50 years with normal left ventricular function and no known coronary stenosis, undergoing clinically indicated PET MPI. Scan and re-scan were conducted within 30 days. Analyses were conducted by general clinical staff and re-evaluated by an expert reader. Reproducibility was assessed using paired t-tests, Bland–Altman analysis, repeatability coefficient (RC), within-subject coefficient of variation (CV) and intraclass correlation coefficient (ICC). Results: Twenty-one patients (mean age 70 ± 8.2 years; 48% female) underwent repeated scans with a median interval of 21 days. Resting MBF was 0.91 ± 0.24 vs. 0.92 ± 0.22 mL/min/g (r = 0.87; RC 0.23 mL/min/g; CV 9%; ICC 0.87). Hyperaemic MBF averaged 3.06 ± 0.9 vs. 2.97 ± 0.78 mL/min/g (r = 0.83; RC 0.98 mL/min/g; CV 11.6%; ICC 0.81). MFR showed only moderate reproducibility (3.47 ± 1.23 vs. 3.23 ± 0.92; RC 1.90; CV 21%; ICC 0.60). Neither expert re-evaluation nor rate–pressure product correction of the resting MBF improved the reproducibility. Variability was largely unaffected by atrial fibrillation and diurnal variation. Conclusions: Resting and hyperaemic MBF are reproducible, whereas MFR shows moderate variability, which should be considered when interpreting changes in individual patients. Full article

Background/Objectives: Chronic pain is increasingly conceptualized as a systemic condition characterized by central sensitization, autonomic dysregulation, and persistent neuroimmune and neuroendocrine alterations. These systemic changes have been linked to microbial dysbiosis, most prominently within the gut microbiome. In contrast, the relevance of the urinary microbiome outside primary urological disease remains poorly understood, particularly in non-urological chronic pain conditions. The objective of this study was to determine whether patients with chronic low back pain exhibit differences in urinary microbial diversity, community composition, or taxon-specific abundance compared with pain-free controls. Methods: In this age- and sex-matched case–control study, midstream urine samples were collected from ten patients with chronic low back pain and ten pain-free controls and analyzed using 16S rRNA gene sequencing (V4 region). Sequence data were processed using nf-core/ampliseq and DADA2. Alpha diversity, beta diversity, and differential abundance were assessed using depth-adjusted models, compositional and phylogenetically informed distance metrics, and ANCOM-BC2, with multiple sensitivity analyses to account for the low-biomass nature of urinary microbiome data. Results: After accounting for sequencing depth, no significant differences in alpha diversity were observed between patients and controls for any metric. Beta diversity analyses revealed no significant differences in overall community composition between groups across all distance measures, and dispersion was comparable between groups. Differential abundance analysis did not identify any bacterial taxa that differed significantly between patients and controls after correction for multiple testing. Conclusions: In this cohort, chronic low back pain was not associated with detectable alterations in the urinary microbiome. These findings suggest that, unlike the gut microbiome, urinary microbial communities may be relatively stable in the context of non-urological chronic pain, highlighting the importance of phenotype specificity and multidimensional approaches in microbiome-based pain research. Full article

Background: Menopause represents a critical physiological transition associated with hormonal changes that influence both metabolic health and quality of life (QoL). Metabolic dysfunction-associated steatotic liver disease (MASLD), a common metabolic condition, is closely linked to menopause; however, its independent contribution to QoL impairment remains unclear. This study aimed to investigate the interplay between menopausal status, metabolic dysfunction, MASLD, and QoL in midlife women. Methods: A cross-sectional observational study was conducted including 80 women aged 45–55 years, comprising both premenopausal and menopausal participants. Clinical, anthropometric, biochemical, and imaging data were collected. MASLD was diagnosed using magnetic resonance imaging in the presence of metabolic dysfunction. Metabolic assessment included glucose, insulin, liver enzymes, C-reactive protein, and indices of insulin resistance (HOMA-IR) and sensitivity (QUICKI). QoL was evaluated using the Utian Quality of Life (UQOL) scale. Associations were examined using univariate and multivariable linear regression models. Results: MASLD prevalence was significantly higher in menopausal women compared with non-menopausal women (61.9% vs. 15.8%, p < 0.001). Metabolic parameters, particularly insulin resistance and body mass index, were strongly associated with MASLD. The mean total UQOL score indicated moderate QoL. In multivariable analysis, menopausal status was the only independent predictor of reduced total QoL (b = −4.93, p = 0.01) and occupational health domain (b = −4.60, p = 0.001). MASLD and metabolic parameters were not independently associated with overall QoL. Correlation analyses revealed modest associations between metabolic markers and specific QoL domains, particularly occupational and physical health. Conclusions: Menopause is the primary determinant of reduced QoL in midlife women, particularly affecting functional domains, while MASLD does not independently impact QoL despite its strong association with metabolic dysfunction. These findings suggest that menopausal status may play a more prominent role in quality-of-life outcomes than MASLD in women undergoing the menopausal transition. However, the cross-sectional design does not allow conclusions regarding causal or mechanistic relationships. Full article

Every year, respiratory syncytial virus (RSV) causes an estimated 33 million lower respiratory tract infections in children under five years of age, driving millions of hospitalizations worldwide and substantial mortality in developing countries. For 28 years, the monoclonal antibody (mAb) palivizumab has been the principal agent for RSV immunoprophylaxis, reducing hospitalization in defined high-risk groups through monthly intramuscular dosing. The recent approval of two second-generation long-acting mAbs, nirsevimab and clesrovimab, and maternal preF vaccine has fundamentally changed the RSV prevention landscape. In contrast to palivizumab, the long-acting mAbs offer single-dose seasonal protection across a broader infant population, enabling universal immunization programmes for the first time. In this review, we conjointly examine nirsevimab and clesrovimab across their mechanisms of action, pharmacokinetics, efficacy, safety and cost-effectiveness, using palivizumab as the reference standard. Cross-trial efficacy comparisons are complicated by differences in study populations and endpoint definitions; however, when these factors are considered, the available evidence suggests that all three agents offer broadly comparable protection against severe RSV disease. All three agents also demonstrate favourable and comparable tolerability profiles. Nirsevimab is now supported by a substantial body of real-world evidence confirming effectiveness in routine immunization programmes that closely align with registrational studies. Clesrovimab, as the newest agent, currently lacks real-world effectiveness, and both long-acting monoclonals require further confirmatory evidence in high-risk groups. Overall, existing data support that both monoclonals have equivalent efficacy and safety profiles as palivizumab, and choice should be based on cost-effectiveness and local availability, with consideration given to optimal integration of infant immunoprophylaxis alongside maternal RSV vaccination programmes. Full article

Background/Objectives: Type 2 diabetes (T2D) remission can be defined as a return to a HbA1c < 6.5% (<48 mmol/mol) sustained without ongoing treatment for at least 3 months. Prevalence estimates and factors associated remain unknown for LMIC and resource-limited settings. Methods: We conducted a retrospective observational analysis of electronic medical records from 8463 adults who received multidisciplinary care at Mexico’s primary care specialized units (UNEMES-EC) between 2015 and 2019 and who were referred for inadequate metabolic control. Remission was defined per 2021 ADA criteria as HbA1c <6.5% sustained for ≥3 months without glucose-lowering medications. After estimating the prevalence of T2D remission, logistic regression models were used to evaluate its sociodemographic and clinical predictors, with particular attention to weight change and baseline adiposity interactions. Results: RT2D prevalence was 0.87% (95% CI: 0.68–1.10) over a median 393-day follow-up. Weight loss ≥10% (adjusted OR 2.75; 95% CI: 1.21-6.27) and systolic blood pressure (tertile 3 vs tertile 1: OR 2.49; 95% CI: 1.17–5.26) were positively associated with RT2D, while elevated baseline HbA1c (tertile 3 vs. tertile 1: OR 0.09; 95% CI: 0.02–0.33), triglyceride levels (tertile 3 vs. tertile 1: OR 0.49; 95% CI: 0.24–0.98) and intensive pharmacotherapy were inversely associated with RT2D. No associations with HDL and total cholesterol were found. Age, sex, educational attainment, and income demonstrated no independent associations with remission. Among lifestyle-treated patients achieving ≥5% weight loss, remission prevalence reached approximately 11%. No significant interaction between baseline BMI and weight change was detected (p = 0.60). Conclusions: This first large-scale Mexican study establishes RT2D as an achievable endpoint in patients with poor baseline metabolic control. The findings suggest that remission could be achieved with equity-focused, weight-centered interventions even in resource-constrained health systems and populations. Full article

Coccocypselum lanceolatum is a tropical, perennial, creeping, herbaceous C3 plant species that is found in deeply shaded humid forests. This species has potential for medicinal and culinary uses. Knowledge about this species and other herbaceous Rubiaceae is confined to phytocoenological and morpho-anatomical studies. Here, it was hypothesized that (1) leaf gas exchange dynamics over a one-year period in C. lanceolatum are related to light conditions, phenology and environmental seasonal changes; (2) photosynthetic performance is focused on enhanced carbon gains through a high leaf net assimilation rate (A_net) relative to light availability, a low dark respiration rate (R_d) and a light compensation point (LCP); and (3) these parameters will vary over leaf age. The photosynthetic photon flux density (PPFD), characterizing the growth and development of C. lanceolatum, was reduced to 4–11% of incoming light in the open area, while the red-to-far-red light ratio (R:FR) was reduced from 1.15 to mean diurnal values of 0.45–0.81, depending on forest canopy dynamics. Leaf gas exchange parameters [A_net, stomatal conductance (g_s), leaf transpiration (E), and intrinsic water use efficiency (iWUE)] were observed over a one-year period. A_net, g_s, and E were correlated with energy factors (PPFD and air temperature) during vegetative growth, while only iWUE showed a correlation with leaf gas exchange parameters during blooming and fruiting, indicating that seasonality and phenology were additional drivers of leaf gas exchange. As a deep-shade forest species, C. lanceolatum displayed low iWUE (3–21 μmol m⁻² s⁻¹) and was adapted to maximize carbon gain and prioritize high g_s rather than water economy. The extremely low LCP (4.2 μmol m⁻² s⁻¹), low R_d (0.2 to 0.43 μmol m⁻² s⁻¹), maximum net photosynthesis (A_max, 5 μmol m⁻² s⁻¹), and apparent quantum efficiency of CO₂ assimilation (Φ of 0.04 µmol µmol⁻¹) were adaptational traits of this species for low light. Finally, the A_net, g_s, E, iWUE, gross photosynthesis under light saturation, R_d, LCP, and light saturation point values were different when comparing young and adult leaves. The ecophysiological responses over a one-year period shown here could assist in the success of C. lanceolatum as a sustainable soil-cover plant in shaded areas. Full article

Onion peel extract (OPE) is rich in polyphenolic compounds with antimicrobial potential. Salmonella Enteritidis (SE) infection in young broiler chicks causes morbidity, reduced growth, and contributes to human gastroenteritis through contaminated poultry products. The spleen is a key secondary lymphoid organ coordinating systemic responses to pathogens in chicken. This study evaluated how dietary OPE influences spleen metabolic profiles during SE infection. Day-old Ross 708 male chicks (n = 128) were assigned to four treatments: CON, CON-SE, OPE (6 g/kg), and OPE-SE. Chicks in CON and OPE received sterile broth, whereas CON-SE and OPE-SE received 2.25 × 10⁸ CFU/mL SE at 2 d of age. At 5 and 12 dpi, spleens from six chicks per treatment were collected for untargeted HPLC-MS metabolomics. A total of 857 metabolites were identified and analyzed using MetaboAnalyst 6.0 (p < 0.05; fold change ≥ 2.0; VIP score > 1.0). In CON-SE chicks, energy generating metabolites (6-phosphogluconic acid, methylmalonic acid, propionic acid) increased, while 13,14-dihydro-15-keto-prostaglandin D2 and kynurenic acid decreased. Dietary OPE elevated several dipeptides (L-Val-Gly, L-Leu-Gly, Gly-Gly-Leu, L-Val-L-Met) and reduced ATP linked metabolites (3,6-di-O-methyl-beta-D-glucose and 3-O-beta-D-galactosyl-sn-glycerol). Enrichment analysis showed that SE infection altered valine, leucine, and isoleucine degradation and aromatic amino acid biosynthesis, whereas OPE enriched galactose and biotin metabolism in uninfected chicks, but enriched tryptophan, taurine and hypotaurine metabolism in SE-infected chicks. Overall, dietary OPE optimized response of metabolic pathways associated with immune activation, unlike corresponding pathways in CON-SE birds. Full article

Background: We previously reported that consuming a Mediterranean-style healthy dietary pattern (MED-HDP) with lower vs. higher glycemic index foods differentially changed indices of postprandial glucose control and daily glycemic variability but did not influence improvements in cardiovascular health indices. Methods: Fifty-two adults (31 females, 21 males; aged 49 ± 11 y, BMI 31 ± 3.1 kg/m², mean ± SD) with two or more features of metabolic syndrome participated for 12 weeks in the randomized, controlled trial with all foods provided. At dinner only, participants could select from protocol-approved foods, including unprocessed chicken breast, unprocessed lean beef, and unprocessed salmon and shrimp (seafood). Objective: Herein, we retrospectively assessed whether the frequency of consuming different sources of meat (i.e., the exposures) was associated with MED-HDP-induced changes in cardiovascular health indices (i.e., the outcomes). Results: Among all participants, consuming the MED-HDP foods (88% adherence) reduced fasting systolic (SBP) and diastolic (DBP) blood pressures and serum total cholesterol (TC), triglycerides (TGs), and HDL. More frequent consumption of chicken at dinner, in place of beef and seafood, was associated with greater reductions in SBP (p = 0.034 and p = 0.047 for replacing beef and seafood, respectively) and DBP (p = 0.021 and p = 0.043, respectively). Frequency of chicken, beef, and seafood intakes at dinner did not associate with the reductions in serum TC, TG, HDL, or LDL. Conclusions: These results support that adoption of a MED-HDP improved multiple cardiovascular risk factors among middle-aged and older adults at elevated cardiovascular risk. The observed modest associations between more frequent consumption of unprocessed chicken at dinner and greater blood pressure reductions, which do not mean that eating more chicken at dinner causes lower blood pressure, warrant independent replication. Full article

Background/Objectives: Sapropterin dihydrochloride is an established treatment option for individuals with phenylketonuria (PKU) who demonstrate responsiveness, but uncertainty persists regarding dosing frequency, timing relative to meals, the influence of dietary composition, and efficacy of different formulations. Despite widespread use in the UK, real-world administration behaviours have not previously been characterised. This study aimed to characterise sapropterin administration behaviours among people with PKU in the UK. Methods: A 31-item questionnaire was developed and disseminated via the National Society for Phenylketonuria website and social media channels. The survey captured demographic information, dosing schedules, formulation use, administration techniques, co-ingestion with food, and changes in natural protein tolerance following initiation of generic sapropterin. Results: 124 current sapropterin users completed the survey. Most respondents were caregivers of children or adolescents (68.5% aged 0–18 years). Once-daily dosing was most common (66.1%, n = 82), typically administered at breakfast, followed by twice-daily (32.3%, n = 40) and three-times-daily (1.6%, n = 2). Tablets were the predominant formulation (92.7%, n = 115); 50.4% (n = 58/115) swallowed tablets whole, while the remaining (49.6%, n = 57/115) crushed or dissolved them in water or juice. Nine respondents (7.3%, n = 9/124) used powder sachets. Most participants (75%, n = 93/124) took sapropterin with food, with both low-fat (36.6%, n = 34/93) and high-fat (26.9%, n = 24/93) meals reported. Over a third of participants (33.9%, n = 42/124) tolerated a natural protein intake >30 g/day when this was measured, and a further 15.3% (n = 19) were able to maintain a fully unrestricted protein intake without protein substitute supplementation. The magnitude of protein intake improvement was significantly greater among adults (p < 0.001), those with higher baseline natural protein intake (≥30 exchanges/day) (p < 0.001), and individuals who swallowed sapropterin tablets whole (p = 0.038). Although 71.8% (n = 89/124) were pleased with their increased natural protein allowance, many expressed a desire for further improvement. Conclusions: Substantial heterogeneity in dosing schedules, formulation handling, and co-ingestion practices highlights the absence of standardised guidance. These findings emphasise the need for clearer clinical recommendations to optimise treatment effectiveness and support consistent, equitable care. Full article

In this study, the microstructural changes and coarsening behavior of Ag₃Sn in Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge (mass%) during high-temperature aging were investigated. Additionally, low-cycle fatigue tests were conducted to compare the fatigue behavior of Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge with that of Sn-3.0Ag-0.5Cu. At room temperature, SbSn phases are dispersed in the β-Sn matrix. As the temperature rises, Sb atoms dissolve in the β-Sn phase; thus, the SbSn phases disappear, and some of the atoms aggregate. The activation energy was 45 kJ/mol for the coarsening of Ag₃Sn in Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge due to aging. Ag₃Sn coarsening was estimated to be controlled by the lattice diffusion of Ag atoms in the β-Sn phase. Furthermore, it was confirmed that the solid solution of Sb atoms in the β-Sn phase reduces the solubility limit of Ag atoms in the β-Sn phase, which delays the coarsening of Ag₃Sn. Regarding fatigue properties, while both alloys exhibited comparable low-cycle fatigue behavior at room temperature, the fatigue ductility exponent’s increase was confirmed to be suppressed for the Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge alloy at 175 °C. This trend suggests that the delayed coarsening of Ag₃Sn maintains the cyclic strain-hardening exponent, thereby influencing high-temperature fatigue behavior. Full article

Background: HIV/AIDS remains a major global public health challenge, with persistent regional disparities in burden and progress toward the UNAIDS 95–95–95 targets. This study assessed temporal trends in the HIV/AIDS burden in Kazakhstan, compared them with Central Asia and global patterns, and projected trends through 2030. Methods: We conducted a population-level analysis using Global Burden of Disease 2023 data, examining age-standardized rates (per 100,000) of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) from 2010 to 2023. Trends were quantified using percent change and average annual percentage change, with projections based on log-linear models. Results: Between 2010 and 2023, prevalence in Kazakhstan increased by 332.1% and incidence by 111.0%, contrasting with the decline in global incidence (−24.7%). Mortality decreased (−32.7%), along with DALYs (−28.8%) and YLLs (−37.1%), while YLDs increased by 135.5%, indicating a shift toward a chronic disease burden. In 2023, Kazakhstan had a lower overall burden than global estimates but showed steeper increases in incidence and prevalence. Age-specific analyses indicated the largest increases among adults aged 30–69 years. Under current trend assumptions, projections suggest continued growth in prevalence and incidence, with modest mortality declines through 2030, though these trajectories do not account for future changes in prevention coverage, treatment access, or policy. Conclusions: Kazakhstan is undergoing a transition toward a chronic HIV epidemic, underscoring the need to strengthen prevention, expand PrEP and testing coverage, and address structural barriers to achieve epidemic control. Full article