Search Results (3,730)

Religiously diverse societies are often portrayed as marked by tensions between exclusive worldviews and aspirations toward inclusive and cohesive social relations. These tensions are particularly salient in religious contexts, where deeply held convictions about truth and moral order may coexist uneasily with ideals of tolerance and mutual recognition. A central question emerging from this dilemma is how religious worldviews shape evaluations of religious others in increasingly diverse societies. Using cross-sectional survey data among religious Christians and Muslims in the Netherlands, we analyse associations between religious exclusivism, religious and national belonging, bonding and bridging social capital, and outgroup attitudes, combining bivariate correlations, multivariate regression, and regression-based serial mediation analyses. Results show that religious exclusivism is a robust independent predictor of colder outgroup evaluations. In contrast, religious belonging and both bonding and bridging social capital are associated with warmer outgroup evaluations: bonding shows the stronger association. Mediation analyses indicate that religious exclusivism is indirectly associated with warmer outgroup evaluations through religious belonging, whereas bonding social capital does not mediate exclusivism in the direction of outgroup negativity. The findings challenge the view of bonding as primarily closing and suggest that supportive in-group embeddedness can coincide with more positive evaluations of religious others. Full article

In Latin America, the double burden of malnutrition is the region’s single most important public health concern for the incoming decade. Latin America’s burden of disease has distinct features in comparison to high-income countries: nearly 20 percent of NCDs are diagnosed in people under 60 years of age in Latin America, whereas only about 13 percent of people under 60 years of age in North America and Europe are diagnosed with these diseases. We aimed to better understand decision-making processes, preferences, and norms around food choices to provide input for future programming and policy suggestions at national and regional levels. We included key informant interviews and focus group discussions with parents and adolescents from urban and rural communities in three regions in Colombia and in Mexico. Results showed that food choices considered to be affordable, acceptable, accessible, and aspirational are driven by environmental and social factors that influence individual cognitive decisions. Across the study groups, cognitive biases influenced food decision-making in relation to eating out, natural, homemade, and “moderation”. At the sociological level, conversations, and social influences at home and in communities were strong indicators of dietary practices, health beliefs, and body size attitudes. Full article

Background: Fine-needle aspiration thyroglobulin (FNA-Tg) is widely used to detect lymph node metastases in differentiated thyroid cancer (DTC), but optimal cut-off values remain controversial. Anti-thyroglobulin antibodies (anti-Tg), present in 25–40% of DTC patients, may interfere with FNA-Tg measurements. This study aimed to evaluate whether anti-Tg status necessitates different FNA-Tg diagnostic thresholds in the preoperative setting. Methods: We retrospectively analyzed 605 cervical lymph nodes from 393 preoperative DTC patients who underwent ultrasound-guided fine-needle aspiration (FNA) with concurrent FNA-Tg measurement (February 2019–April 2025). All lymph nodes had histopathological or cytological confirmation. Patients were stratified by anti-Tg status (>4.5 IU/mL). Receiver operating characteristic curve analysis determined optimal FNA-Tg cut-offs, and areas under the curve (AUCs) were compared using the DeLong test. Results: FNA-Tg demonstrated excellent overall diagnostic accuracy (AUC 0.963, 95% CI 0.946–0.980) with an optimal cut-off of 84.0 ng/mL (sensitivity 91.6%, specificity 95.3%). Anti-Tg-positive patients had significantly lower FNA-Tg levels in malignant lymph nodes compared to anti-Tg-negative patients (median 9872 vs. 22,327 ng/mL, p = 0.001). Subgroup analysis revealed superior performance in anti-Tg-negative patients (AUC 0.983, cut-off 84.4 ng/mL) compared to anti-Tg-positive patients (AUC 0.923, cut-off 65.7 ng/mL; p = 0.008). No significant correlation was observed between anti-Tg levels and FNA-Tg (ρ = −0.03, p = 0.501). Conclusions: Anti-Tg status influenced measured FNA-Tg levels and receiver operating characteristic (ROC) derived optimal thresholds in the preoperative setting. However, because malignant lymph nodes generally showed FNA-Tg values well above the benign range, the clinical impact of this difference appears limited in most clearly positive cases. These findings may still help refine interpretation in selected borderline cases. Full article

This study examines the transformation of the Balaton region in Hungary from a traditional tourist destination into an international retirement migration destination for older adults from Western Europe. Migration theories and models are applied to illustrate the relationships between migration and development and to explore how tourism, lifestyle aspirations, and socio-economic factors influence the settlement decisions of older migrants. Empirical findings suggest that prior tourism experience can mitigate the uncertainty associated with migration and foster belonging. However, many retirees move to Hungary with limited knowledge of the country, relying on social networks and real estate agents for information. These retired migrants also utilize local services and infrastructure, including healthcare and community spaces, which shape their daily lives and help them integrate into the community. The migration of older adults stimulates the development of peripheral rural areas through real estate purchases, renovations, and small-scale entrepreneurial activities, particularly in the accommodation sector. This challenges the traditional perception of older-age migrants as inactive. Full article

Background: The characterization of thyroid lesions is essential in clinical practice. Recent advances in imaging modalities, including nuclear imaging (NM), color Doppler ultrasonography, and sonography, have markedly improved the diagnostic accuracy for thyroid nodules. Objective: To assess thyroid diseases using Doppler ultrasound, nuclear scintigraphy, and sonography. Results: In this cross-sectional single-center study, 144 patients were examined to determine their thyroid structure and function using a multimodal imaging approach. Fine-needle aspiration cytology (FNAC) indicated that most thyroid nodules were benign (62.5%), with 37.5% being malignant. Doppler vascularity demonstrated a sensitivity of 70.4% and a specificity of 40% (AUC = 0.514) for malignancy detection, while scintigraphy uptake in hypofunctioning nodules (nodules with decreased radionuclide uptake) showed a sensitivity of 37% and a specificity of 54.4% (AUC = 0.388). Thyroxine hormone levels showed a sensitivity of 57.4% and a specificity of 45.6% (AUC = 0.503) for detecting malignant thyroid nodules. In multivariate logistic regression, increased Doppler vascularity remained an independent predictor of malignancy (OR = 2.39; 95% CI: 1.15–4.96; p = 0.019), whereas decreased scintigraphic uptake showed a borderline effect (OR = 1.82; p = 0.069); high T4 level and increased uptake were not significant predictors. The combined Doppler ultrasound, scintigraphy, and thyroxine level model yielded an AUC of 0.72 (95% CI: 0.63–0.81), markedly higher than any single parameter. At the optimal Youden threshold (0.43), the model achieved 79.6% sensitivity, 68.2% specificity, and 72.4% accuracy, highlighting the superior diagnostic performance of the integrated approach for pre-FNAC stratification of thyroid malignancies. There was a strong, significant linear association between thyroxine levels and thyroid scintigraphy uptake (p-value < 0.001). Most patients with normal thyroxine levels exhibited decreased uptake (66.1%), whereas a minority (6.5%) demonstrated elevated uptake levels. This study found a strong correlation between mixed-echogenicity nodules and thyroid scintigraphy uptake (p-value = 0.019). Mixed-echogenicity nodules were most often associated with reduced uptake (57.8%), and hypoechoic nodules often had normal uptake (57.1%). Conclusions: The complementary integration of color Doppler vascularity, Tc-99m thyroid scintigraphy, and serum thyroxine levels yields superior Doppler–scintigraphy uptake correlation, increases the overall diagnostic accuracy, and offers a practical, non-invasive algorithm for differentiating benign from malignant thyroid nodules prior to FNAC or surgery. Full article

This narrative review evaluates the current role of interventional radiology in the diagnosis and treatment of parathyroid disorders. In patients with biochemically confirmed hyperparathyroidism but inconclusive or discordant preoperative localization imaging, image-guided interventions can help establish a diagnosis that can alter management. This review outlines the current diagnostic and therapeutic modalities for the study of parathyroid pathology from the interventional radiologist’s perspective, highlighting novel techniques and their growing clinical adoption. The combination of ultrasound-guided fine-needle aspiration biopsy and measurement of parathyroid hormone (PTH) in the needle washout fluid can improve diagnostic specificity by providing biochemical evidence of parathyroid tissue. This is particularly useful for lesions that are difficult to differentiate from thyroid nodules or cervical lymph nodes based solely on imaging characteristics. Despite this, no widely accepted cut-off washout PTH level has yet been established. Due to the differences in assay techniques and laboratory procedures, results should be interpreted in conjunction with clinical findings and concomitant biochemical parameters. Ultrasound-guided thermal ablation techniques, especially radiofrequency and microwave ablation, have recently been reported as minimally invasive alternatives or adjuvants to surgery in appropriately selected patients. Evidence supporting parathyroid embolization is limited, but it may be considered a potential salvage option for persistent or recurrent disease. Given that most of the current evidence is derived from retrospective case series, multicenter prospective studies for technical standardization and long-term outcomes evaluation are clearly needed. Full article

Background: Proton pump inhibitors (PPIs) have been associated with lung dysbiosis and increased respiratory risk. Micro-aspiration is a proposed mechanism, but reliable biomarkers remain elusive. This study evaluates the potential of fluorescein as a biomarker of micro-aspiration and PPI-associated pulmonary risk. Methods: We conducted a retrospective analysis of 137 bronchial washing fluid samples from patients with pulmonary conditions to assess microbial colonization in relation to PPI use. Bacterial burden was determined by culture and PCR and categorized as 0, 1 or ≥2 pathogens. Micro-aspiration was evaluated by quantifying fluorescein-laden macrophages in bronchoalveolar lavage following oral fluorescein administration. Associations between PPI use, fluorescein levels and pathogen burden were analyzed using adjusted ordinal regression models. Results: PPI use was associated with higher odds of increased pathogen burden, though not statistically significant (OR = 1.40, 95% CI: 0.71–2.75, p = 0.33). Fluorescein-laden macrophages were higher in PPI users (41.5 versus 31.2 ng/mL), but showed no meaningful correlation with pathogen load (p = 0.09). Corticosteroid therapy was significantly associated with Gram stain results (OR = 2.37, 95% CI: 1.12–5.15, p = 0.03). Conclusions: These findings suggest a potential link between PPI use and airway colonization. Fluorescein shows promise as a biomarker for micro-aspiration, but its clinical utility requires further validation. Full article

Despite strong evidence that gender-diverse leadership improves organizational innovation and performance, women remain underrepresented in leadership pipelines worldwide, particularly in Asia. While prior research largely examines the outcomes of gender diversity at the firm level, far less is known about the psychological and social factors that shape women’s leadership aspirations in the first place. Addressing this gap, this study applies Social Cognitive Career Theory (SCCT) to explain how contextual support and developmental experiences influence women’s leadership aspirations in a collectivist business environment. Using survey data from 400 adult women in Indonesia and structural equation modelling, the study examines how parental involvement shapes personal mastery, how personal mastery strengthens leadership self-efficacy, and how self-efficacy, role models, and perceived leadership traits jointly predict leadership aspiration. The findings show that parental involvement indirectly contributes to leadership aspiration through personal mastery and self-efficacy, while role models and leadership traits also play significant roles. Among all predictors, self-efficacy emerges as the strongest driver of women’s leadership aspiration. This study makes three contributions. First, it extends SCCT beyond traditional STEM career research into the domain of leadership aspiration. Second, it provides rare empirical evidence from a collectivist Asian context, highlighting the role of family and social environment in shaping women’s leadership pathways. Third, it shifts the focus of gender diversity research from representation outcomes to the formation of the female leadership pipeline, offering actionable insight for educators, families, and organizations seeking to foster future women leaders. Full article

Adventitial cystic disease (ACD) is a rare vascular condition, representing approximately 0.1% of all vascular diseases, with about 325 cases reported in the literature since its first description in 1947, including 72 venous cases. This study aims to highlight the diagnostic and therapeutic challenges of venous ACD, which is frequently misdiagnosed as deep vein thrombosis (DVT), femoral varices, aneurysms, venous tumors, or lymphadenopathy due to its rarity. Clinical, imaging, and treatment data from reported cases of venous adventitial cystic disease (VACD) were reviewed. The disease most commonly involved the common femoral vein (56%) and external iliac vein (24%), with less frequent involvement of the saphenous and popliteal veins (7%). Symptoms commonly mimic deep vein thrombosis (DVT), with unilateral swelling resulting from progressive cyst enlargement and subsequent venous luminal stenosis. Doppler ultrasound typically shows a hypoechoic lesion in the venous wall with preserved flow and normal D-dimer levels, while CT angiography and MRI confirm an adventitial cyst occupying ≥ 90% of the lumen without thrombus. Surgical intervention, particularly transadventitial cyst evacuation with excision, is the preferred method of treatment due to lower recurrence rates (7–20%) as compared to cyst aspiration and drainage with higher recurrence (83.3%). These findings highlight the need for heightened clinical suspicion and advanced imaging to optimize the diagnosis and management of venous ACD and reduce misdiagnosis and recurrence. Further studies are needed to optimize diagnostic protocols and treatment strategies, but the limited number of cases hampers meaningful scientific research. Full article

Objective: The AXS Vecta 46 intermediate catheter (Stryker) features a large inner diameter, enabling effective aspiration, combined with a small outer diameter and soft distal-tip flexibility, which allows for safe tracking through more tortuous and smaller arterial segments to target medium vessel occlusions non-traumatically. The efficacy of the Vecta 46 in the spectrum of large and medium vessel occlusions has not been well elucidated in the literature. Methods: This retrospective cohort study included patients who underwent MT for acute ischemic stroke at our institution between July 2022 and June 2024. The outcomes of patients treated with Vecta 46 were compared to those of all other catheters used at the institution. Results: The distribution of aspiration and stent retriever attempts in Vecta 46 procedures versus non-Vecta 46 procedures was significantly different (p = 0.00325). Aspiration was attempted 1.66 ± 0.936 times in the Vecta 46 group and 1.12 ± 0.650 times in the non-Vecta 46 group (p = 0.00135). More mechanical thrombectomies with the Vecta 46 included aspiration of a secondary thrombus (p = 0.0314), despite no difference in the distribution of the primary or secondary occlusion location. There were no statistically significant differences in recanalization success (p = 0.800), recanalization time (p = 0.245), procedure duration (p = 0.580), discharge modified Rankin Score (p = 0.875), or intracranial hemorrhage rate (p = 0.720) between non-Vecta 46 and Vecta 46 procedures. Conclusions: Vecta 46 has similar safety and functional outcomes compared to other endovascular treatment options despite procedural differences. Full article

Background: Low-dose CT scanning is a key tool in lung cancer screening, enabling the detection of clinically significant abnormalities in asymptomatic individuals and often prompting further diagnostic evaluation. Case Presentation: We describe the case of an 80-year-old man with a heavy smoking history who was found to have a new right middle lobe collapse on screening CT. Subsequent positron emission tomography-computed tomography (PET/CT) imaging demonstrated mild fluorodeoxyglucose (FDG) uptake (SUVmax 2.7), raising concern for a low-grade endobronchial malignancy versus mucoid impaction. Flexible fiberoptic bronchoscopy revealed a large exophytic endobronchial mass occluding the airway. Histopathologic examination of the biopsy sample unexpectedly revealed vegetable material, consistent with chronic foreign-body aspiration. Discussion: Unrecognized aspiration events are relatively common in elderly adults and can mimic malignancy on imaging. This case highlights an important diagnostic pitfall: inflammatory endobronchial processes, including foreign-body granulomas, can demonstrate FDG uptake and mimic malignancy. Conclusion: Clinicians should maintain a broad differential diagnosis when evaluating PET-avid endobronchial lesions, especially in elderly patients. Full article

Background: Endosonography (i.e., endoscopic ultrasound with bronchoscope fine-needle aspiration, EUS-B-FNA and endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA) is a widely used technique in the diagnosis and staging of non-small cell lung cancer. Limited data are available in diagnosing small cell lung cancer (SCLC), and no studies have specifically investigated the diagnostic accuracy of EUS-B-FNA in these patients. The study aims at evaluating the sensitivity and safety of endosonography in the diagnosis of SCLC. Methods: A prospective, single-center, observational study was conducted in Italy. All patients diagnosed with SCLC who underwent EUS-B-FNA and/or EBUS-TBNA were enrolled. The sensitivity of EUS-B-FNA and EBUS-TBNA were assessed using pathological confirmation as the gold standard. Results: A total of 72 patients (38 (53%) males) with confirmed SCLC were included in the study. EUS-B-FNA was performed in 31 (43%) patients and EBUS-TBNA in 44 (61.1%) patients; both procedures were performed in three (4.2%). The overall sensitivity of endosonography was 97.2%. The sensitivity of EUS-B-FNA and EBUS-TBNA was 96.8% and 90.9%, respectively. No differences were observed in the sensitivity of both techniques when sampling lymph nodes vs. pulmonary parenchymal lesions (p = 0.99). The overall complication rate was 5.6%. No major complications were reported. Conclusions: Endosonography is a highly accurate and safe technique in diagnosing SCLC. EUS-B-FNA alone demonstrates excellent sensitivity, supporting its extensive role as a valuable diagnostic tool. The combined use of both techniques may further optimize diagnostic yield in the diagnosis of SCLC. Full article

Culturally unsafe mental health services contribute to persistent inequities for Aboriginal and Torres Strait Islander peoples, yet existing cultural safety frameworks lack clear, prioritised, community-endorsed implementation guidance. This study aimed to establish Aboriginal consensus on cultural safety principles, implementation priorities and practical actions for culturally safe mental health services. A three-round modified Delphi study was conducted with 37 Aboriginal participants from Western Australia with expertise in mental health, social and emotional wellbeing and lived experience. In Round 1, participants completed an online survey rating the importance of cultural safety principles and identifying those requiring urgent action. In Rounds 2 and 3, facilitated yarning sessions reviewed findings, refined principles, grouped them into implementation domains, and identified priority actions. Aboriginal Participatory Action Research ensured Aboriginal leadership and governance throughout. All principles achieved strong consensus for importance. The most urgent priorities were trustworthiness, Aboriginal governance, trauma-informed care, addressing racism and strengthening the Aboriginal workforce. Participants organised the refined principles into six implementation domains, with Leadership and Governance identified as foundational to reform. Trustworthiness was reframed as an aspirational outcome requiring structural change. This study provides a community-endorsed, prioritised framework for translating cultural safety principles into mental health service practice and policy. Full article

Type 2 diabetes mellitus (T2DM) affects approximately 10–25% of patients undergoing orthopedic procedures and is associated with impaired tissue healing, increased complication rates, and reduced responsiveness to orthobiologic therapies, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cell (MSC) preparations. The underlying mechanisms include advanced glycation end-product accumulation, NF-κB-driven chronic inflammation, Nrf2 pathway impairment, mitochondrial dysfunction, and epigenetic diabetic memory, collectively compromising both orthobiologic product quality and the tissue microenvironment. Emerging, predominantly mechanistic evidence suggests that targeted nutritional interventions, including bioactive compounds targeting mitochondrial biogenesis pathways, anti-inflammatory dietary patterns, and specific micronutrients, may modulate these pathological processes and potentially improve orthobiologic outcomes. This narrative review synthesizes evidence from diabetic pathophysiology, orthobiologic outcomes research, and nutritional science to propose a conceptual clinical framework for regenerative medicine optimization in T2DM patients. Critical knowledge gaps are identified, and a research agenda is proposed. The proposed framework, based primarily on mechanistic and preclinical evidence, should be interpreted as a foundation for research prioritization and hypothesis generation rather than as a clinical protocol. Rigorous randomized trials directly evaluating nutritional optimization in orthobiologic therapy for diabetic patients are required before evidence-based recommendations can be established. Full article

Background and Clinical Significance: Nonbacterial thrombotic endocarditis (NBTE) is a sterile fibrin-platelet valvular condition associated with malignancy and hypercoagulable states. It produces friable vegetations prone to systemic embolization, often presenting as multifocal ischemic stroke. While modestly linked to advanced adenocarcinomas, its association with melanoma is exceedingly rare; Case Presentation: We present a 43-year-old man with recently diagnosed metastatic melanoma who presented with fever, confusion and abdominal pain. Brain magnetic resonance imaging (MRI) revealed multifocal bilateral acute infarcts. Additional imaging demonstrated splenic and bilateral renal infarcts. Transesophageal echocardiography (TEE) revealed an 8 mm × 7 mm multilobar lesion on the posterior mitral valve leaflet. Blood cultures remained persistently negative; autoimmune and infectious workup were unrevealing, and positron emission tomography-computed tomography (PET-CT) showed no cardiac hypermetabolism. Despite empiric antibiotics for suspected infective endocarditis (IE), progressive embolic infarcts occurred. After exclusion of infection, NBTE was considered, and therapeutic enoxaparin was initiated, resulting in clinical stabilization without hemorrhagic conversion; Conclusions: Distinguishing NBTE from IE remains challenging due to overlapping and nonspecific imaging findings. TEE is the preferred diagnostic modality because of its high sensitivity for detecting small valvular vegetations. Adjunctive imaging modalities such as brain MRI and PET-CT may support the diagnosis by demonstrating embolic patterns or excluding metabolically active infectious vegetations. Management primarily relies on systemic anticoagulation, while percutaneous vegetation aspiration may represent a potential diagnostic and therapeutic strategy. Clinicians should maintain high suspicion of this condition in patients with advanced melanoma and other malignancies presenting with multifocal embolic phenomena and negative cultures to enable timely anticoagulation. Full article