Search Results (5,133)

Background/Objectives: Progressive axial elongation is a key structural indicator of myopia progression. In school-based screening, repeated ocular biometry may not always be feasible; routinely collected visual-acuity information may support follow-up prioritization. This study examined the association between stable habitual spectacle-corrected distance visual-acuity profiles and annualized axial length growth. Methods: This retrospective real-world cohort study used the Chengdu school-based myopia screening database. Children aged 7.0–9.9 years with screening—defined as low-to-moderate myopia and three consecutive screening visits—were classified as adequately corrected (ACG), functionally under-corrected (UCG), or uncorrected myopia (UMG) according to stable spectacle-wearing and visual-acuity profiles. The primary outcome was annualized axial length growth from baseline to the second follow-up (ΔAL). The primary analysis used 1:1 propensity-score matching; robustness was assessed using interval-specific outcomes, alternative caliper widths, and full-cohort multivariable regression. Results: The final cohort included 4152 children: 391 ACG, 551 UCG, and 3210 UMG. Matching retained 313 ACG–UCG pairs and 387 UCG–UMG pairs. ΔAL was lower in the ACG than in the UCG groups (0.224 vs. 0.362 mm/year; mean difference, −0.139; 95% CI, −0.165 to −0.112; p < 0.001). No statistically significant ΔAL difference was detected between the UCG and UMG (p = 0.412). Sensitivity analyses yielded consistent findings. Conclusions: Stable habitual spectacle-corrected distance visual-acuity profiles were associated with annualized axial length growth. Achieved visual acuity under habitual spectacle-wearing conditions may provide information beyond spectacle-wearing status alone; however, these observational findings do not establish equivalence, predictive utility, or causality. Full article

The purpose of this study is to characterize, through an exploratory empirical diagnosis, the degree of development and preliminary association between circular economy capabilities and sustainability-oriented digital transformation capabilities in Chamber-affiliated SMEs in Lambayeque, Peru. Guided by three exploratory working hypotheses, the study expected intermediate levels of development, heterogeneous performance across dimensions, and a positive but non-confirmatory coupling between both capability families. A self-administered questionnaire with thirty Likert-type items measured four circular economy dimensions—circular design and eco-design, resource optimization, circular waste management, and circular business models—and four sustainability-oriented digital transformation dimensions—digital technology infrastructure, dynamic digital capabilities, sustainable digital strategy, and digital innovation culture. The initial database contained 111 complete Chamber-affiliated responses; however, seven large Chamber-affiliated firms were retained only as contextual comparators and were excluded from all statistical processing. Consequently, all descriptive, psychometric, and SEM results were calculated using the final analytical sample of 104 micro-, small-, and medium-sized enterprises. The findings show intermediate development in both constructs, higher perceived performance in digital innovation culture and resource optimization, and lower performance in digital technology infrastructure, reverse logistics, platforms enabling circularity, and monetization of circular models. The latent association between the two higher-order constructs was very high (β = 0.985, p < 0.001); however, because global fit indices were below conventional thresholds, this coefficient is interpreted as preliminary evidence of empirical overlap and capability co-occurrence rather than confirmatory evidence of a validated structural model or causal integration. Full article

The genus Nigrospora remains poorly understood as a plant pathogen. Until 2026, there were only 26 species recorded in MycoBank and 19 in GenBank. Diseases caused by Nigrospora were once considered uncommon, but in recent years there has been a sharp rise in first reports globally, especially in tropical and subtropical regions such as China, Malaysia, India, and the Americas, as well as in Europe. In November 2022, Oreopanax ecuadorensis, a plant endemic to Ecuador, exhibited symptoms of leaf blight and wilting in Quito Metropolitan Park-South, Ecuador. The causal agent was isolated on PDA; DNA was extracted, and PCR products of the ITS and EF regions were sequenced. DNA sequences from isolate CBC-FCA-001 were deposited in GenBank under accession numbers OR597663.1 (ITS region) and PP897887.1 (EF region). Morphological and molecular analyses identified the causal agent as Nigrospora oryzae. Koch’s postulates confirmed the isolate’s pathogenicity, with mycelium-inoculated, non-wounded plants exhibiting characteristic symptoms while control plants remained healthy. This marks the first report of N. oryzae affecting O. ecuadorensis. Symptoms were observed on multiple plants throughout the site, raising concerns about the vulnerability of endemic flora to emerging pathogens. The rise in Nigrospora-associated diseases, potentially driven by climate change and human activities, highlights the urgent need for research to mitigate their impacts on agriculture and biodiversity conservation. Full article

Background/Objectives: Cutaneous squamous cell carcinomas (cSCC) of the head and neck district are among the most common non melanocytic malignant skin carcinomas. The proposal to differentiate, within the N stage, parotid metastases from lateral cervical metastases, originates from the different prognostic value of the metastatic region involved. Methods: We retrospectively evaluated 61 patients, surgically treated for parotid metastases from cSCC between January 2002 and June 2023, in four Departments of Surgery, to assess the geographic distribution of parotid metastases and to describe their recurrence patterns, to evaluate the prognostic value of the number of affected lateral cervical lymph nodes (LN) and the number of positive intra-glandular lymph nodes (IGLN) and to identify the main prognostic histopathological factors. Results: Our results did not show significant differences between participating centers in the distribution of parotid metastases, nor in their recurrence rates. However, our results highlight how adjuvant radiotherapy is deeply associated with the Overall Survival (OS), improving survival rates in patients with advanced-stage neoplasms (Odds Ratio 5.0), although causality cannot be inferred because of the retrospective study design. Moreover, a statistically significant correlation was found between the major inflammatory biomarkers and the OS. The presence of IGLN was identified as one of the main factors associated with recurrence and poor prognosis in patients with cSCC and in particular, in patients with N3b nodal stage. Conclusions: our findings suggest that both LN and IGLN could be used to propose an additional staging stratification for the N parameter, thereby guiding the treatment strategy and postoperative follow-up for patients with parotid metastases from cSCC of the head and neck district. Full article

Diabetic retinopathy (DR) is a leading cause of vision loss, yet its systemic proteomic mediators remain largely elusive. This study aimed to identify causal plasma proteins, map their cell-type-specific localization in the retina, and experimentally validate their expression under disease-relevant stress. We conducted a proteome-wide association study (PWAS) integrating UK Biobank plasma pQTL data (N = 53,022) with DR GWAS summary statistics. Causal relationships were inferred utilizing summary-data-based Mendelian randomization (SMR) and Bayesian colocalization. Prioritized candidates were mapped to the Human and Mouse Retina Cell Atlases via single-nucleus RNA sequencing (snRNA-seq). Finally, to substantiate the computational findings, in vitro validation of COL4A1 was performed in ARPE-19 cells cultured under hyperglycemic conditions utilizing quantitative real-time PCR (qPCR) and transcriptomic dataset re-analysis. The PWAS identified 26 proteins significantly associated with DR. Subsequent causal inference prioritized 12 high-confidence candidates, including GSTT2B, COL4A1, PAM, and GALNT3. Notably, GSTT2B emerged as a Tier-1 protective causal protein (Z = −3.609; P_SMR = 1.22 × 10⁻⁴). snRNA-seq mapping revealed that GSTT2B is robustly expressed in Müller glia and the retinal pigment epithelium (RPE), whereas COL4A1 is prominently enriched in vascular compartments. These specific expression signatures exhibited partial conservation across species with notable cell-type specific variations. Crucially, in vitro validation confirmed that COL4A1 mRNA expression is significantly upregulated under high-glucose stress. Furthermore, druggability analysis highlighted actionable targets, identifying GSTT2B as a highly probable causal mediator and COL4A1 as a prioritized candidate for structural intervention. This study provides robust genetic, single-cell, and experimental evidence implicating specific plasma proteins in DR pathogenesis. The identification of GSTT2B-mediated protective pathways and the hyperglycemia-induced upregulation of COL4A1 offer a high-resolution molecular atlas to guide drug repositioning and precision therapeutic strategies. Full article

This article examines how anti-Zionist sentiment and antisemitism relate among self-identified American Christians, drawing on an original 2024 survey of roughly 2000 respondents. The survey included multiple antisemitic tropes and Israel-related statements measuring severe anti-Israel and anti-Zionist sentiment. Using generalized ordered logistic regression, we find a strong and escalating association between anti-Zionist sentiment and antisemitic trope endorsement across multiple levels of antisemitic intensity. Respondents who express stronger opposition to Israel are significantly more likely to affirm classical antisemitic stereotypes involving Jewish power, dual loyalty, or financial control. Supersessionist beliefs are likewise associated with greater antisemitic sentiment, with the relationship becoming especially pronounced at higher levels of antisemitism. In contrast, the traditional deicide belief does not emerge as a statistically significant correlate once broader theological and political attitudes are taken into account. Younger Christians, urban residents, and Southerners exhibit higher antisemitism, while education, age, and female gender are associated with lower levels. Taken together, the findings show that anti-Zionism and antisemitism are often empirically intertwined within contemporary American Christianity, particularly at more extreme levels. Because the data are cross-sectional, the results should be interpreted as associations rather than causal effects. Full article

Age-associated metabolic dysfunction is commonly defined by abnormalities in adiposity, glucose regulation, lipid metabolism, and blood pressure. Although clinically useful, these criteria do not fully capture the biological heterogeneity that explains why older adults with similar metabolic profiles may follow divergent trajectories toward type 2 diabetes, cardiovascular disease, metabolic dysfunction-associated steatotic liver disease, frailty or multimorbidity. This narrative Review summarizes clinical, translational, and mechanistic evidence on the biological processes that shape metabolic aging, with particular emphasis on inflammaging, immunosenescence, cellular senescence, oxidative stress, mitochondrial dysfunction, adipose tissue dysfunction, endothelial injury, and inflammation-related microRNAs. We first discuss how chronic low-grade inflammation and immune remodeling alter the interpretation of conventional metabolic syndrome components in older adults. We then review redox imbalance and mitochondrial stress as amplifiers of insulin resistance, lipid injury, vascular dysfunction, and tissue remodeling. The review also examines inflammation-related microRNAs, including circulating and extracellular-vesicle-associated miRNAs, as post-transcriptional regulators that may connect inflammatory, metabolic, and redox pathways. Finally, we discuss how conventional metabolic markers may be integrated with inflammatory mediators, oxidative-stress indicators, adipokines, endothelial and senescence-related markers, and miRNA profiles to improve biological interpretation of metabolic risk. Within this context, we present the Inflammaging–Redox–InflammamiR Axis as a conceptual framework for organizing these overlapping mechanisms rather than as an established diagnostic or causal model. The proposed biomarker tiers and candidate risk phenotypes are author-derived, hypothesis-generating constructs intended to guide future longitudinal and interventional research. Clinical translation will require standardized assays, longitudinal validation, external replication, and intervention studies. Full article

Background: Intraoperative hypotension (IOH) is the leading modifiable contributor to postoperative acute kidney injury (AKI), yet most evidence is associational and the heterogeneity of its effect is unknown. We estimated the causal effect of IOH burden on AKI and tested whether the most susceptible patients can be identified preoperatively. Methods: In a retrospective cohort of 2726 general-anesthesia cases from VitalDB, the exposure was the time-integrated mean arterial pressure (MAP) <65 mmHg burden (≥30, ≥60 and ≥120 mmHg·min) and the outcome was KDIGO-defined AKI within 7 days. The primary estimator was pre-treatment-adjusted augmented inverse-probability weighting (AIPW; doubly robust) with bootstrap 95% confidence intervals (CIs). Sensitivity analyses comprised a controlled-direct-effect model, negative control outcomes, E-values and vasopressor-stratified estimates. Effect heterogeneity was estimated with a causal forest; preoperative gradient-boosted models and decision-curve analysis assessed personalization and clinical utility. Results: AKI occurred in 205 (7.52%) cases. At 60 mmHg·min the AIPW risk difference was +3.00 percentage points (pp; 95% CI +0.84 to +5.26), with a monotonic dose–response (+2.78 to +7.62 pp across thresholds) and E-values rising from 2.08 to 3.44. The effect was concentrated in patients with elevated preoperative creatinine (conditional effect +9.86 pp, more than twice the cohort average). This susceptibility was recoverable from routine preoperative variables alone, with intraoperative waveform features conferring no measurable improvement (ΔAUROC −0.001). For predicting AKI itself, a parsimonious 4-feature preoperative score matched a 27-feature model (AUROC 0.775 vs. 0.768) and provided positive net benefit. Conclusions: Intraoperative hypotension burden shows a dose-dependent association with postoperative AKI that is consistent with a causal effect, concentrated in patients with reduced baseline renal reserve who are identifiable from routine preoperative data without intraoperative waveform infrastructure. Full article

Mental health during childhood is a major public health concern, and physical activity has been proposed as a modifiable behaviour associated with psychological well-being and emotional health. This study examined the associations between physical activity and mental health indicators, including psychological well-being, anxiety symptoms, and everyday stress, in primary school children. A cross-sectional study was conducted with 207 children from two schools in Jaén (Spain). Physical activity, psychological well-being, anxiety, and stress were assessed using validated questionnaires. Pearson correlations and multiple linear regression analyses adjusted for age, sex, and socioeconomic status were performed. Physical activity was positively associated with all dimensions of psychological well-being and with total psychological well-being (r = 0.182, p = 0.009). Significant inverse correlations were observed between physical activity and all anxiety dimensions, as well as total anxiety (r = −0.145, p = 0.037), although the association with total anxiety was not significant after adjustment (β = −0.149, p = 0.112). Physical activity was also negatively associated with all stress dimensions and remained significantly associated with lower total stress after adjustment (β = −0.253, p = 0.007). These findings indicate that higher levels of physical activity are associated with greater psychological well-being and lower everyday stress in primary school children. However, given the cross-sectional design, these associations should not be interpreted as causal relationships. Longitudinal studies are needed to clarify the directionality of these associations. Full article

This study aimed to investigate the therapeutic effects of camel milk (CM) on chronic fatigue syndrome (CFS) and elucidate the mechanisms underlying the microbiota–gut–brain axis. Using a murine model of CFS induced by chronic restraint and forced swimming stress, we administered lyophilized CM (1500 mg/kg/day, equivalent to approximately 121.5 mg/kg/day in humans based on body surface area conversion using the standard allometric scaling formula) orally. CM supplementation was significantly associated with ameliorated fatigue-like behaviors, as evidenced by prolonged swimming endurance and reduced immobility time. Metagenomic analysis revealed that CM was associated with reshaping of the small intestinal microbiota, including enrichment of beneficial Lactococcus lactis and suppression of pathobionts (H. hepaticus and H. typhlonius). These microbial shifts correlated with increased luminal lactic acid, improved intestinal barrier integrity (increased villus height, reduced crypt depth), and attenuated local inflammation (reduced TNF-α and IL-6, elevated IL-10). Consequently, CM was associated with reduced bacterial translocation and systemic inflammation, and normalization of hypothalamic–pituitary–adrenal (HPA) axis hyperactivity. We conclude that CM is associated with prevention of CFS-like symptoms through modulation of the gut ecosystem and strengthening of the intestinal barrier, potentially breaking the vicious cycle of gut inflammation and HPA axis dysfunction, although causality remains to be established through fecal microbiota transplantation or similar mechanistic studies. Full article

Food festivals have become important instruments of regional tourism development, destination branding, agricultural promotion, and cultural policy. Yet the authenticity of food festivals is often evaluated through visitor perception or promotional discourse, leaving limited room for scalable assessment across large festival systems. This study develops a Location Quotient (LQ)-based framework for measuring agricultural embeddedness as a supply-side structural condition that can support objective material authenticity claims. Using a dataset of 277 South Korean regional food festivals, the study examines how featured food materials are connected to regional agricultural specialization and how this structural connection compares with budget scale, infrastructure, and material-duplication factors in explaining administrative visitor attendance and portfolio-level governance patterns. The results show that agricultural embeddedness is unevenly distributed across the national festival portfolio. Festival budget is the strongest predictor of log-transformed visitor attendance, whereas agricultural embeddedness is not significantly associated with visitor attendance after budget and infrastructure controls are included. Material-level duplication is useful as a portfolio diagnostic for identifying crowded food categories where place-product credibility may become strategically important. Scenario-based portfolio comparisons provide planning benchmarks suggesting that targeted restructuring and reallocation would be associated with higher average agricultural embeddedness under specified portfolio assumptions, although these scenarios should not be interpreted as causal forecasts. The study contributes to food tourism, event governance, and destination branding research by offering a reproducible way to assess the material grounding of food festival authenticity claims and by shifting policy discussion from festival proliferation toward portfolio quality. Full article

The manufacturing sector’s significant contribution to global carbon emissions necessitates effective decarbonization. This study evaluates the causal effect of exposure to China’s “Made in China 2025” (MIC) initiative, an industrial policy promoting intelligent manufacturing, on firms’ estimated carbon emissions by exploiting the policy as a quasi-natural experiment. Employing a Difference-in-Differences (DID) model on a panel of Chinese A-share manufacturing firms from 2011 to 2022, we find that exposure to the MIC policy is associated with an approximately 0.5% reduction in firms’ estimated carbon emissions. Although the reduction appears modest at the firm level, its aggregate effect may be substantial given the large scale of China’s manufacturing sector. Various robustness checks confirm the validity and persistence of this effect. Crucially, the environmental benefits are heterogeneous, showing stronger effects in competitive, technology-intensive, and labor-intensive sectors compared to capital-intensive ones. Mechanism analysis reveals that exposure to the MIC policy promotes substantive green innovation, accelerates digital transition through process optimization, and significantly enhances energy efficiency, thereby contributing to lower estimated firm-level carbon emissions. These findings underscore the potential role of intelligent-manufacturing-oriented industrial policies in reconciling industrial growth with climate mitigation and provide micro-level evidence on the environmental effects of policy-induced intelligent manufacturing transformation, extending a literature that has largely focused on economic outcomes. The results also suggest that policymakers should further promote intelligent manufacturing and design sector-specific green technology support policies, particularly for capital-intensive sectors where carbon-reduction effects appear relatively weaker, to maximize carbon reduction benefits. Full article

Background: Skin aging is influenced by intrinsic and extrinsic factors that alter skin texture and microrelief. Non-invasive imaging techniques enable objective longitudinal assessment of these characteristics. This study aimed to instrumentally and subjectively evaluate skin surface changes during a standardized 90-day dermocosmetic regimen containing multiple active ingredients. Methods: This prospective, single-arm observational study included 47 women aged 30–60 years with visible signs of facial skin aging. Participants applied a standardized anti-age serum and cream regimen twice daily for 90 days. Skin surface morphology was assessed at baseline and after 30, 60, and 90 days using Visioscan^® VC 20plus imaging with SELS^® software. Subjective outcomes were evaluated using a structured product questionnaire and the validated Skindex-16 instrument. Results: Significant temporal changes were observed across objective skin surface parameters. From baseline to day 90, mean skin roughness decreased from 4.99 ± 2.29 to 1.66 ± 0.67, while the wrinkle-related parameter decreased from 191.08 ± 87.26 to 74.27 ± 15.25. Reductions were also observed in scaliness, contrast, entropy, variance, and anisotropy, whereas smoothness, homogeneity, and energy increased over time. Skindex-16 scores decreased across Symptoms, Emotions, and Functioning domains, indicating lower participant-reported dermatology-related burden. The regimen was well tolerated, with no serious adverse events reported. Conclusions: In this exploratory single-arm observational study, the standardized dermocosmetic regimen was associated with measurable longitudinal changes in Visioscan-derived skin surface parameters and patient-reported outcomes over 90 days. Because the study included no control group, the findings cannot establish causality or isolate the contribution of individual regimen components. Full article

Introduction: In critical environments, patient discharge decisions present significant challenges, particularly regarding the prevention of readmissions. However, traditional AI systems focus on correlations rather than causation, resulting in issues related to explainability and generalization. This study conducts a comparative evaluation between standard predictive and causal-fused models to assess their ability to mitigate clinical confounding on predicting readmissions. Methodology: Utilizing the MIMIC-IV dataset, we predicted 30-day ICU readmissions through a comparative analysis of associative models (XGBoost, LSTM) and their causal-fused equivalents. The Fast Causal Inference (FCI) algorithm mapped latent confounding via a Partial Ancestral Graph (PAG), while counterfactuals were computed using Causal Forests to estimate the Average Treatment Effect (ATE), which was integrated into the predictive models. Performance was evaluated via AUROC, AUPRC, calibration metrics, precision, recall, and F1-score while feature extraction was used to monitor feature realignment. Results: The causal-fused LSTM model maintained a stable AUROC (0.7342 to 0.7357), while the XGBoost AUROC improved (0.6517 to 0.6909). Feature importance extraction revealed a structural realignment; whereas standard models relied heavily on non-actionable frailty proxies such as polypharmacy, causal integration elevated the individualized causal effect of length of stay as a primary predictive driver. The estimated ATE for length of stay was calculated at −0.038. Conclusions: The comparison showed that transitioning to causal-fused AI mathematically resolves a clinical Simpson’s Paradox, while also realigning the features based on causal mechanisms without sacrificing predictability. By making this shift, we can mitigate reliance on administrative noise and promote de-confounded interventions rather than passive correlations. Full article

Background/Objectives: Asthma-coded hospital admissions in very young children represent a clinically relevant but diagnostically complex marker of severe wheezing/asthma-like morbidity. Methods: We conducted a nationwide ecological municipality-year study of children aged 0–3 years in Spain during 2020–2022 using hospital discharge records from the Spanish Minimum Basic Data Set (MBDS/RAE-CMBD). Exposure and outcome were analyzed at the municipality-year level: the exposure metric was the contemporaneous annual mean municipality-level concentration of PM_2.5, PM₁₀, NO₂, SO₂, O₃, and CO, and the outcome was the annual number of asthma-coded admissions, with the population aged 0–3 years as offset. Results: The regression panel comprised 20,746 municipality-year observations, 7251 municipalities, and 3231 admissions; 93.7% of municipality-years had zero admissions. In unipollutant Poisson models adjusted for calendar year, rural–urban status, temperature, and relative humidity, incidence rate ratios per interquartile-range increase were 1.54 (95% CI 1.28–1.85) for PM_2.5 and 1.89 (95% CI 1.59–2.26) for PM₁₀. Negative-binomial and province-fixed-effect sensitivity models attenuated but did not remove the particulate-matter signal. The multipollutant model was unstable because of strong collinearity between particulate fractions and was interpreted only as an exploratory sensitivity analysis. Conclusions: These findings should be interpreted as ecological, population-level associations between annual ambient particulate pollution and pediatric respiratory hospital burden, not as individual-level causal risk estimates. Full article