Search Results (726)

Background: The ketogenic diet (KD) is one of the most widely followed dietary approaches worldwide, frequently promoted in popular media for weight loss and chronic disease management, although it also has established therapeutic applications in clinical medicine. However, our previous reviews have shown that existing clinical studies and meta-analyses on KD suffer from serious methodological limitations, raising concerns about their reliability. Considering this, the present study aimed to assess knowledge and opinions on KD among university students and academic staff. Methods: Cross-sectional, self-developed online questionnaire was distributed to 23,330 students and academic teachers at the University of Pécs, Hungary. Data was collected in October 2024. A total of 891 responses were included (710 students, 123 academic staff). Knowledge scores were calculated (maximum 17 points, including penalties for incorrect answers) and data were analyzed using descriptive statistics, ANOVA, chi-square tests, Pearson correlation, and logistic regression. Results: Only 7.3% of students and 13.5% of staff achieved ≥60% of the maximum knowledge score. Health-related faculties did not consistently outperform non–health-related ones; in fact, some non-health-related faculties achieved the highest mean scores. Completion of nutrition-related courses and reliance on PubMed were associated with higher knowledge, while current KD adherence among staff was negatively associated. Most participants (over 65%) were uncertain about the reliability of KD research. Conclusions: Knowledge of KD among both students and staff was limited, highlighting susceptibility to misinformation. Critical appraisal skills and reliable nutrition education are urgently needed at the population level to support disease prevention and to counterbalance misleading claims about KD. Full article

Recently, we observed that pars planitis (PP) patients present alterations in peripheral blood (PB) Th17/Treg associated with dysregulation in the Th1 response. Yet, little is known about the systemic distribution of myeloid cells, which drive the recruitment and differentiation of the adaptive effectors toward pathogenic inflammatory Th1 and Th17 as well as regulatory lymphocytes in PP. Although myeloid populations in patients with uveitis have previously been addressed, the data did not provide an exact description of PP patients. Using flow cytometry, we evaluated monocyte and IDO-expressing monocyte-like myeloid-derived suppressor cell (MDSC) subpopulations in PB samples from 15 patients with different courses of PP (cystoid macular edema and non-macular edema subgroups; CME and nCME, respectively) and 17 healthy controls (HCs) in relation to the Th1, Th17, and immunoregulatory subsets. We observed that only PP patients from the CME subgroup presented a significantly higher fraction of CD16⁺ IDO-expressing MDSCs and intermediate CD14^highCD16⁺ monocytes compared to the HCs; this corresponded with relative up-regulation of Th1 and Th17, and down-regulation of Treg. In addition, alongside the increased percentage of IDO-expressing CD16+ MDSCs, the MDSC compartment displayed an inappropriate level of IDO (more pronounced in the CD16⁻ subset) only in CME patients. At the same time, the fraction of CD16⁻ myeloid cells did not differ significantly among the patient cohorts and healthy participants. Our study is the first to evaluate subpopulations of circulating myeloid cells in PP patients and indicates that an increased fraction of CD16⁺ myeloid cells might reflect the immunological and clinical severity of PP. Full article

This qualitative study explores how graduate students in literacy education connect theoretical frameworks to classroom practices. Grounded in Deweyan pragmatist philosophy and Kucer’s multidimensional literacy theory, researchers analyzed course assignments from online graduate students using document review and content analysis. The methodology employed a collaborative codebook and Dedoose software (version 10.0.25), utilizing descriptive coding to identify literacy practices and deductive coding to examine theoretical alignments. The results show patterns in how graduate students link theory and practice, with varying frequencies of references to different frameworks. Three main themes emerged: students’ integration of multiple theoretical frameworks, their focus on tailoring instruction to students’ developmental needs, and their emphasis on relating literacy instruction to students’ cultural backgrounds and personal experiences. The findings highlight participants’ preference for theoretical diversity, indicating a nuanced understanding of how multiple perspectives can inform teaching practices. This integration reflects educators’ recognition that complex classroom environments require diverse theoretical foundations, emphasizing the value of developing a new survey tool that captures this complexity. These results contribute to our understanding of how literacy educators integrate theoretical knowledge with practical classroom applications in contemporary educational settings. Full article

The Clinical Descriptions and Diagnostic Guidelines (CDDG) for Mental, Behavioral, and Neurodevelopmental Disorders (MBND) in the International Classification of Diseases 11th Revision (ICD-11) are a substantial improvement over their equivalent in the ICD-10. This study evaluates the usefulness of the synchronous and asynchronous modalities of an online training course on the ICD-11-CDDG-MBND to increase readiness to implement it in routine clinical practice among Spanish-speaking clinicians. A convenience sample of psychiatrists, psychologists, and general practitioners completed online evaluations of one of the two course modalities. Acquired knowledge was evaluated through a multiple-choice questionnaire. Readiness to implement the ICD-11-CDDG-MBND was evaluated before and after the course, using an instrument based on the transtheoretical model of stages of change: precontemplation, contemplation, preparation and action. A total of 310 clinicians completed either the asynchronous (n = 176) or synchronous course (n = 134). Prior to the course, most participants were at the precontemplation stage. By the end of the course, participants reported a moderate level of knowledge. The percentage of clinicians at the preparation and action stages was higher than before the courses, with no differences being observed between course modalities. Online training was associated with increased knowledge and motivation to implement the ICD-11-CDDG-MBND. Full article

Background/Objectives: Henoch–Schönlein purpura (HSP), or IgA vasculitis, is the most common small-vessel vasculitis in children, yet Indian cohort data remain limited. We aimed to describe the clinical profile, renal involvement, treatment patterns, relapse, and outcomes of pediatric HSP at a tertiary centre in South India. Methods: We conducted a retrospective review of children <18 years diagnosed with HSP (January 2013–October 2018) using EULAR/PRINTO/PRES criteria. Demographics, clinical features, laboratory parameters, treatments, and outcomes were abstracted from records and analyzed in SPSS (descriptive statistics; Chi-square/Fisher’s exact and t/non-parametric tests as appropriate). Subgroup comparisons included renal vs. non-renal disease and age <6 vs. ≥6 years. An exploratory analysis examined predictors of nephritis. Results: Of 43 children identified, 2 were excluded (misclassified as systemic lupus erythematosus); 41 were analyzed. Mean age was 8.5 years (range 3–17), male: female 1.4:1. A preceding febrile illness or upper respiratory tract infection was noted in 41.4% and 17%, respectively. Palpable purpura was universal; joint involvement 73.1%, abdominal pain 61.0%, vomiting 41.5%. Renal involvement 17% occurred only in children ≥6 years; exploratory testing supported a strong age-linked signal for nephritis. Laboratory abnormalities included anemia (48.7%), thrombocytosis (19.5%), and elevated ESR (51.2%). Skin biopsy (n = 29) showed IgA and complement deposition; renal biopsy (n = 2) showed ISKDC grades II–III. Treatments included NSAIDs 71.6%, corticosteroids 31.7%, and dapsone 24.4% (used for severe systemic/persistent cutaneous disease). Rash relapse 7.3% clustered with joint plus abdominal symptoms and was not observed among children with nephritis. At a mean 18.9-month follow-up, one child required long-term antihypertensives; no child progressed to end-stage renal disease. Conclusions: Pediatric HSP in this South-Indian cohort followed a largely self-limited course with favourable renal outcomes. Age ≥6 years flagged higher renal risk, supporting age-targeted urine and blood-pressure surveillance, while relapse appeared to follow a non-renal trajectory (joint/abdominal clustering). Steroid and dapsone use reflected clinical severity rather than relapse risk. Findings align with Indian series and suggest lower renal morbidity than some East-Asian reports, adding region-specific evidence to guide monitoring and counselling. Full article

Background: African American (AA)/Black and Latinx communities have limited access to evidence-based fall prevention programs such as Tai Chi Prime (TCP). Community-led interventions that incorporate peer support are cost-effective and sustainable. Using the Treatment Fidelity Framework (TFF) and a mixed-methods research approach, we evaluated the training and support given to trainees during the TCP leader training pathway process and their subsequent fidelity in delivering six culturally tailored community courses. Methods: Trainees completed feedback forms after each TCP leader training pathway course. Using a fidelity checklist, a TCP master trainer rated six community TCP classes led by race- and language-concordant leaders. Trainees were invited to participate in virtual one-on-one semi-structured interviews to share their perspectives on the appropriateness and relevance of the TCP leader training pathway and their experience leading community TCP classes. Quantitative data was analyzed using descriptive statistics on Microsoft Excel. Three study team members coded qualitative data using directed content analysis approach. Results: Twenty-five candidates enrolled in the TCP leader training. Forty-eight percent identified as AA/Black while 52% identified as Latinx. Eleven trainees (six AA/Black and five Latinx) completed the entire TCP leader training pathway to become certified TCP leaders. Trainees rated the training process as highly satisfactory and appropriate. Leaders from both communities received high fidelity scores for community course delivery. Conclusions: Findings contribute to the existing literature, particularly regarding how to effectively disseminate and evaluate a culturally tailored TCP leader training and certification process for culturally diverse communities while maintaining fidelity to the curriculum. Full article

Candida krusei empyema is a rare but serious manifestation of invasive candidiasis, characterized by intrinsic resistance to fluconazole, biofilm formation, and high mortality, with limited case-level data to inform management. This review aims to systematically identify and synthesize all reported English-language cases of Candida krusei empyema from January 2005 to June 2025 using PubMed, ScienceDirect, OVID MEDLINE, and Gale OneFile and perform descriptive analysis on them. Screening, data extraction, and eligibility assessment were performed, and those articles not clearly meeting eligibility criteria were reviewed by additional reviewers with consensus resolution. Seven publications (six individual cases and two cohorts) were included. We additionally describe the clinical course, management, and outcome of a 70-year-old bilateral lung transplant patient who developed persistent C. krusei empyema despite optimized antifungal therapy. Patients ranged from 11 to 74 years of age (median 62.5 years). Predisposing factors included esophageal perforation (n = 4), post-transplant hemorrhage (n = 1), community-acquired empyema (n = 1), and thoracic surgery (n = 1). Empiric fluconazole was switched to caspofungin (3/4), with others receiving amphotericin B, voriconazole, or combination therapy. Source control varied: chest tube drainage (n = 3), percutaneous catheter (n = 3), and surgical decortication (n = 2). Mortality was 14.3% (1/7). In the absence of clear guidelines and robust literature, the management approach remains heterogeneous. Optimal care requires early recognition, aggressive multimodal antifungal therapy, and effective source control tailored to patient risk. Standardized antifungal protocols and larger case series are needed to guide clinicians in managing this challenging infection. Full article

Analyzing student performance in Introductory Programming courses in Higher Education is critical for early intervention and improved learning outcomes. This study explores the potential of a cognitive test for student success in an Introductory Programming course by analyzing data from 180 students, including Freshmen and Repeating Students, using descriptive statistics, correlation analysis, Categorical Principal Component Analysis and Item Response Theory models analysis. Analysis of the cognitive test revealed that some reasoning questions presented a statistically significant correlation, albeit of weak magnitude, with the course grades, particularly for freshman students. The development of models for predicting student performance in Introductory Programming using cognitive tests is also being explored. This study found that reasoning skills, namely logical reasoning and sequence completion, were more predictive of success in programming than general ability. The study also showed that a Programming Cognitive Test can be a useful tool for identifying students at risk of failure, particularly for freshmen students. Full article

Artificial intelligence is rapidly reshaping skill expectations across media, marketing, and journalism, however, university curricula are not evolving at a comparable speed. To quantify the resulting curriculum–skill gap in communication-related programs, two synchronous corpora were assembled for the period July 2024–June 2025: 66 course descriptions from six leading UK universities and 107 graduate-to-mid-level job advertisements in communications, digital media, advertising, and public relations. Alignment around AI, datafication, and platform governance was assessed through a three-stage natural-language-processing workflow: a dual-tier AI-keyword index, comparative TF–IDF salience, and latent Dirichlet allocation topic modeling with bootstrap uncertainty. Curricula devoted 6.0% of their vocabulary to AI plus data/platform terms, whereas job ads allocated only 2.3% (χ² = 314.4, p < 0.001), indicating a conceptual-critical emphasis on ethics, power, and societal impact in the academy versus an operational focus on SEO, multichannel analytics, and campaign performance in recruitment discourse. Topic modeling corroborated this divergence: universities foregrounded themes labelled “Politics, Power & Governance”, while advertisers concentrated on “Campaign Execution & Performance”. Environmental and social externalities of AI—central to the Special Issue theme—were foregrounded in curricula but remained virtually absent from job advertisements. The findings are interpreted as an extension of technology-biased-skill-change theory to communication disciplines, and it is suggested that studio-based micro-credentials in automation workflows, dashboard visualization, and sustainable AI practice be embedded without relinquishing critical reflexivity, thereby narrowing the curriculum–skill gap and fostering environmentally, socially, and economically responsible media innovation. With respect to the novelty of this research, it constitutes the first large-scale, data-driven corpus analysis that empirically assessed the AI-related curriculum–skill gap in communication disciplines, thereby extending technology-biased-skill-change theory into this field. Full article

Background: Rapid-eye-movement (REM) sleep disinhibition—shorter REM latency and a larger nightly REM fraction—is a well-described laboratory correlate of major depression. Whether the same pattern can be captured efficiently with consumer wearables in everyday settings remains unclear. We therefore quantified REM latency and proportion of REM sleep out of total sleep duration (labeled “REM sleep coefficient”) from Apple Watch recordings and examined their association with depressive symptoms. Methods: 191 adults wore an Apple Watch for 15 consecutive nights while a custom iOS app streamed raw accelerometry and heart-rate data. Sleep stages were scored with a neural-network model previously validated against polysomnography. REM latency and REM sleep coefficient were averaged per participant. Depressive severity was assessed twice with the Beck Depression Inventory and averaged. Descriptive statistics, normality tests, Spearman correlations, and ordinary-least-squares regressions were performed. Results: Mean ± SD values were BDI 13.52 ± 6.79, REM sleep coefficient 24.05 ± 6.52, and REM latency 103.63 ± 15.44 min. REM latency correlated negatively with BDI (Spearman ρ = −0.673, p < 0.001), whereas REM sleep coefficient correlated positively (ρ = 0.678, p < 0.001). Combined in a bivariate model, the two REM metrics explained 62% of variance in depressive severity. Conclusions: Wearable-derived REM latency and REM proportion jointly capture a large share of depressive-symptom variability, indicating their potential utility as accessible digital biomarkers. Larger longitudinal and interventional studies are needed to determine whether modifying REM architecture can alter the course of depression. Full article

Background: Alexander disease (AxD) is a rare severe leukodystrophy that has no cure to date. A pathogenic gain-of-function variant in the GFAP gene affects the astrocytes and subsequently the function of the white matter in the CNS. Methods: We retrospectively analyzed the most frequent symptoms of nine AxD cases, classified them according to published classifications, and described the need of care and support. Results: The description of the courses of disease of nine cases with AxD reflects the broad spectrum of different phenotypes of AxD, with often occurring apnoea. Data about care and support for AxD patients indicate a high and heterogeneous need of support. Treatment with steroids reduced symptoms in two patients. Some patients showed lasting improvement during their course of disease. Conclusions: The course of AxD is very heterogeneous. Thus, we extracted relevant key features to describe the severity of the disease, namely feeding problems, epilepsy, age-appropriate motor function, failure to thrive, age-appropriate language and apnoea. We recommend early evaluation for clinical care and support. For some AxD patients, treatment with steroids may alleviate symptoms. Further development of efficient treatments is necessary. Full article

Introduction: Pediatric lower-lip dog bite injuries are challenging due to contamination, tissue loss, and the need to maintain function, appearance, and psychological well-being. This single case describes immediate definitive closure using sharp debridement with adjunct polyhexanide (PHMB), a full-thickness skin graft (FTSG), and a polyurethane (PU) compression foam bolster. Methods: A 10-year-old boy with a severe contaminated lower-lip defect underwent debridement and 0.04% PHMB irrigation. An upper-arm FTSG was inset and compressed with a suture-anchored PU dressing. Topical PHMB gel was used perioperatively and for seven days after bolster removal. Oral antibiotics were given for five days. The patient was discharged eight days after the injury with detailed wound care instructions. Results: Immediate definitive closure was achieved with complete graft survival and no infection, necrosis, unplanned early dressing changes, or reoperations. At 12 months, oral competence, speech, lip mobility, and contour were preserved. However, mild residual esthetic differences remained (dyschromia, shallow border indentation, vellus hairs on the graft). Conclusion: In this single descriptive case, primary closure of a lower-lip injury with the combined intervention was associated with an uncomplicated functional course and manageable esthetic trade-offs at 12 months. These observations are descriptive; comparative studies with standardized functional, esthetic, and psychosocial measures are needed. Full article

Background/Objectives: Multi-cancer detection (MCD) tests have emerged as a promising tool to redefine the landscape of early cancer detection. Implementation of this novel technology will likely fall to primary care clinicians (PCC). The purpose of this study is to characterize and explore differences in PCCs perceptions and preferences towards MCD testing. Methods: Between March and May of 2023, this cross-sectional survey was administered to 281 PCCs, including physicians and advanced care providers practicing within an integrated healthcare system spanning five states. The survey collected data on self-reported characteristics, perceptions of MCD testing, and preferences for learning about MCD testing. Analysis was limited to those with no prior experience with MCD testing (N = 181, response rate 22.8%). Descriptive statistics summarized key variables and chi-square tests assessed differences in perceptions and preferences by key characteristics. Results: Most PCCs were interested in MCD testing (66.3%), but limited knowledge/awareness of MCD testing and confidence to manage patients with a positive test were observed, along with concerns around cost (76.7%) and misuse/poor implementation. The primary preferences for learning about MCD testing were online courses or classroom instruction (64.5%). Significant differences in perceptions and preferences for learning were observed by location, degree, and years in practice. Conclusions: PCCs in our study held positive views towards MCD testing, but gaps and variation in knowledge and confidence towards MCD testing and concerns around the cost and misuse/poor implementation were observed. While efforts to train and educate all PCCs on MCD testing is a critical first step, more research is needed to understand how best to support implementation tailored to individual and system-level needs and characteristics. Full article

Personal identity is a multidimensional, universal, and ever-developing construct that forms primarily during youth. One domain of identity—gender—manifests quite clearly in terms of developmental course and psychosocial components in the lives of transgender individuals. Members of this population often initiate various social and medical transitions to rework their gendered characteristics to align more authentically with their internal selves. Consequently, healthcare and social service professionals express growing interest in facilitating and fostering the psychological health of transgender youth. Rather than focus on adversity (e.g., depression, suicidality, mental illness), the current study addresses this concern by describing positive components of the gender identity of 120 transmasculine youth participants. To this end, we operationalized gender identity health through three overarching constructs: developmental process, psychological functioning, and the positive outcomes of being a transgender person. Further, we investigate how these components interrelate, plus compare responses by age and gender identity cohorts. For age, we compared adolescent responses to the identity measures to those of transgender emerging adults (n = 166; 20–29 years) and adults (n = 53; 30–39 years). For gender, we partitioned the adolescent participants into binary (n = 91) versus non-binary (n = 29) identities. The descriptive results demonstrated that identity is reasonably developed, functional, and positive in this adolescent sample. Moreover, the three hypothetical components of transgender identity demonstrated modest overlap with each other. The youth did not differ in identity development, functionality, or positivity compared to older cohorts. Binary transmen scored slightly higher on gender authenticity and commitment than their non-binary transmasculine counterparts, but the two gender groups were the same on the other identity components. We discuss some practical implications of these findings as focus areas for healthcare providers and support systems to continue to foster healthy identity development. Full article

Generational approaches to climate engagement among older adults remain limited. This study examines the evolution of eco-anxiety, environmental activism, and pro-environmental behavior from a life course perspective, focusing on older adults in Spain. A nationwide CATI survey of 3000 residents aged 18 and older was conducted, employing validated multidimensional scales for eco-anxiety, environmental activism, and pro-environmental behavior, each rescaled to a 0–10 range. Data were analyzed using descriptive statistics, analyses of variance, and hierarchical regression models to estimate linear and quadratic age effects beyond sex, education, and subjective social class. Results show that (1) eco-anxiety follows an inverted-U pattern, peaking at ages 45–49 and declining significantly after 60; (2) environmental activism remains high until the late sixties, while everyday pro-environmental behaviors sharply decline after retirement; and (3) eco-anxiety and environmental action in older adults are partially decoupled, reflecting the role of supportive personal and contextual factors beyond emotional concern. The findings challenge prevailing stereotypes of passive older adults by demonstrating that older age can constitute a significant period of climate engagement. Despite a slight decline in climate concern following retirement, the willingness to take action remains notably resilient. Older adults maintain consistent involvement in environmental volunteering and activism, often motivated by a desire to leave a lasting legacy and shaped by personal experiences of past crises and collective struggles. However, pro-environmental behaviors show a marked decrease in older adults, not due to diminished interest but likely as a result of structural constraints such as declining health, limited income, and inadequate housing conditions. This study suggests that, in the context of liquid modernity marked by rapid change and uncertainty, older adults may serve as societal anchors—preserving narratives, emotional bonds, and civic networks. Through policies that address structural barriers, this anchor role can be supported, empowering older adults to improve their well-being and strengthening community resilience in the face of climate change. Full article