Search Results (588)

Background: A short cervix in the second trimester significantly increases preterm birth risk, yet no reliable first-trimester prediction method exists. Current guidelines lack consensus on which women should undergo transvaginal ultrasound (TVUS) screening for cost-effective prevention. Therefore, it is vital to establish a highly accurate and economical method for use in the early stages of pregnancy to predict short cervix in mid-pregnancy. Methods: A total of 1480 pregnant women with singleton pregnancies and at least one risk factor for spontaneous preterm birth (<37 weeks) were recruited from January 2020 to December 2020 at the Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine. Cervical length was assessed at 20–24 weeks of gestation, with a short cervix defined as <25 mm. Feature selection employed tree models, regularization, and recursive feature elimination (RFE). Seven machine learning models (logistic regression, linear discriminant analysis, k-nearest neighbors, support vector machine, decision tree, random forest, XGBoost) were trained to predict mid-trimester short cervix. The XGBoost model—an ensemble method leveraging sequential decision trees—was analyzed using Shapley Additive Explanation (SHAP) values to assess feature importance, revealing consistent associations between clinical predictors and outcomes that align with known clinical patterns. Results: Among 1480 participants, 376 (25.4%) developed mid-trimester short cervix. The XGBoost-based prediction model demonstrated high predictive performance in the training set (Recall = 0.838, F1 score = 0.848), test set (Recall = 0.850, F1 score = 0.910), and an independent dataset collected in January 2025 (Recall = 0.708, F1 score = 0.791), with SHAP analysis revealing pre-pregnancy BMI as the strongest predictor, followed by second-trimester pregnancy loss history, peripheral blood leukocyte count (WBC), and positive vaginal microbiological culture results (≥10⁵ CFU/mL, measured between 11⁺⁰ and 13⁺⁶ weeks). Conclusions: The XGBoost model accurately predicts mid-trimester short cervix using first-trimester clinical data, providing a 6-week window for targeted interventions before the 20–24-week gestational assessment. This early prediction could help guide timely preventive measures, potentially reducing the risk of spontaneous preterm birth (sPTB). Full article

Introduction: Scrub typhus is a mite-borne infectious disease caused by “Orientia tsutsugamushi”, a bacterium that was formerly classified under the genus Rickettsia. It is transmitted to humans through the bites of infected chigger mites (larval trombiculid mites). However, clinical data on the cardiac manifestations of scrub typhus and their outcomes remain limited. Methods: This research was retrospectively conducted at a tertiary care hospital in South India. The study included all patients admitted from January 2016 to September 2021 who fulfilled the clinical criteria for a diagnosis of scrub typhus. Data were collected for 426 patients. Patients with previously diagnosed heart disease and mixed infections (leptospirosis, dengue fever, blood culture positivity, and COVID-19 positivity) were excluded. Comprehensive assessments of clinical presentation, electrocardiography (ECG), 2D echocardiography, and outcomes, including all-cause mortality and probable myocarditis, were performed. Multivariate regression analysis was performed to identify independent predictors of all-cause mortality and probable myocarditis. Results: Out of 426 patients, 200 (46.9%) were male and 226 (53.1%) were female. The mean age at presentation was 49.29 ± 14.43 years. A total of 108 (25.4%) patients had diabetes and 82 (19.25%) had hypertension. Sinus tachycardia (29.3%) was the most frequent ECG finding. Echocardiographic evidence of probable myocarditis was observed in 20 (4.7%) patients, while 6 (1.4%) patients had isolated RV dysfunction, 4 (0.9%) had biventricular dysfunction, 7 (1.6%) had significant pulmonary hypertension, and 40 (9.4%) had trivial pericardial effusion. A total of 78 (18.3%) patients had acute respiratory distress syndrome. All-cause mortality was observed in 12 (2.8%) patients. A total of 56 (13.1%) patients developed multiorgan dysfunction syndrome (MODS) during their hospitalization. A total of 78 (18.3%) patients were documented to have acute kidney injury (AKI), and 22 (5.2%) patients underwent hemodialysis. Multivariable binary logistic regression analysis revealed that probable myocarditis and MODS were independent predictors of mortality among patients with scrub typhus, and age, female gender, and LV systolic dysfunction were identified as predictors of overall complications, including mortality, probable myocarditis, congestive heart failure, MODS, AKI, and the need for hemodialysis. Conclusions: Probable myocarditis was the most frequent cardiac manifestation noted in patients with scrub typhus, and in addition to MODS, probable myocarditis was an independent predictor of mortality in this cohort. Thus, it is crucial to maintain clinical vigilance regarding the cardiac status of such patients. Full article

Background: Big data capability is a core strategic asset for enterprises, but existing studies on its relationship with enterprise value creation are fragmented, with inconsistent effect magnitudes and boundary conditions. This meta-analysis synthesized empirical evidence to clarify their overall relationship and the moderating roles of antecedent, mediating, and outcome variables. Methods: A systematic search (ending July 2025) across seven databases (CNKI, Web of Science, etc.) identified thirty-three empirical studies meeting criteria (clear sample size, correlation coefficients). Following PRISMA 2020 and OSF registration, two researchers extracted data independently. CMA 3.0 was used with a random effects model; effect sizes (Pearson’s r), heterogeneity (Q, I²), and publication bias (funnel plots, Egger’s test) were analyzed. Results: Involving 14,993 samples, big data capability showed a moderately significant positive correlation with enterprise outcomes (r = 0.486, 95% CI: 0.408–0.557, p < 0.001) with high heterogeneity (I² = 93.502). Subgroup analyses revealed: learning orientation (r = 0.883) as the strongest antecedent; organizational agility (r = 0.631) and innovation (r = 0.595) as significant mediators (resource integration not significant); enterprise innovation performance (r = 0.730) as the top outcome. No publication bias was found (Egger’s p = 0.284). Conclusions: Big data capability positively impacts enterprises, with learning orientation and innovation performance as key moderators. Enterprises should prioritize a learning culture and leverage organizational agility. Future research needs diverse samples and longitudinal designs to explore causality. Full article

Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies for improving care for older adults. This integrative review explores the evolution, clinical contributions, and implementation barriers of these models. Methods: A comprehensive literature search was performed using PubMed, CINAHL, Scopus, and Web of Science, targeting peer-reviewed studies, including qualitative and quantitative studies published between 2010 and 2025, that involved adults aged 60 years and older. Inclusion criteria emphasized humanized and community-based nursing interventions while excluding non-nursing and pediatric-focused studies. Quality appraisal was performed using CASP and JBI checklists, and data were thematically synthesized. Results: Evidence indicates that these care models significantly improve functional independence and psychosocial well-being and reduce hospital readmissions. For instance, community-based care in Taiwan improved activities of daily living in dementia patients by 15%, while U.S.-based programs reduced depressive symptoms by 30% among Latino older adults. Interdisciplinary, nurse-led interventions in South Korea and Puerto Rico showed a 22% reduction in readmissions and an 85% increase in care access. Despite these benefits, numerous barriers hinder widespread implementation, including workforce shortages, inadequate funding, fragmented healthcare systems, cultural resistance, digital literacy challenges, and policy constraints, particularly in low-resource settings such as the Philippines and Nepal. Conclusions: These findings underscore the transformative potential of humanized and community-based nursing while highlighting the need for targeted strategies such as task-shifting, inclusive technologies, and policy reform to advance equitable, sustainable geriatric care globally. Full article

This study aims to explore the values of character education in the Chinese animated film Three Monks. This film serves as a teaching tool, not only imparting animation principles to university students majoring in animation but also showcasing Chinese cultural philosophy and educational values in implicit, exaggerated, and humorous action design. We employed a descriptive qualitative method. A total of 73 college students majoring in animation watched the film without any prior explanation of animation principles and moral education and then listened to detailed explanations of the character education and animation principles integrated into the film. Through repeated viewing, analysis, and summarization of the storyline, character behaviors, and action design in Three Monks, the values of character education, such as religion, kindness, diligence, independence, responsibility, tolerance, self-reflection, unity and cooperation, and courage to innovate, were embodied. These values are manifested through the film’s storyline, conflicts, character actions, animated performances, and background music. We compared the students’ pre- and post-viewing attitudes based on their discussions, reflections, and course evaluations. The results revealed that conveying moral values through animated films internalized and transmitted character education among university students, shaping cultural identity and social norms. This approach enhanced students’ learning engagement and improved their learning efficiency. Full article

Museums serve as essential cultural centers, yet their mostly visual exhibits restrict access for blind and partially sighted (BPS) individuals. While recent technological advances have started to bridge this gap, many accessibility solutions focus mainly on basic inclusion rather than promoting independent exploration. This research addresses this limitation by creating features that enable visitors’ independence through customizable interaction patterns and self-paced exploration. It improved upon existing interactive tangible user interfaces (ITUIs) by enhancing their audio content and adding more flexible user control options. A mixed-methods approach evaluated the ITUI’s usability, ability to be used independently, and user satisfaction. Quantitative data were gathered using ITUI-specific satisfaction, usability, comparison, and general preference scales, while insights were obtained through notes taken during a think-aloud protocol as participants interacted with the ITUIs, direct observation, and analysis of video recordings of the experiment. The results showed a strong preference for a Pushbutton-based ITUI, which scored highest in usability (M = 87.5), perceived independence (72%), and user control (76%). Participants stressed the importance of tactile interaction, clear feedback, and customizable audio features like volume and playback speed. These findings underscore the vital role of user control and precise feedback in designing accessible museum experiences. Full article

Salmonella serovar identification typically requires multiple enrichment steps using selective media, consuming considerable time and resources. This study presents a rapid, culture-independent method leveraging artificial intelligence (AI) to classify Salmonella serovars from rich hyperspectral microscopy data. Five serovars (Enteritidis, Infantis, Kentucky, Johannesburg, 4,[5],12:i:-) were analyzed from samples prepared using only sterilized de-ionized water. Hyperspectral data cubes were collected to generate single-cell spectra and RGB composite images representing the full microscopy field. Data analysis involved two parallel branches followed by multimodal fusion. The spectral branch compared manual feature selection with data-driven feature extraction via principal component analysis (PCA), followed by classification using conventional machine learning models (i.e., k-nearest neighbors, support vector machine, random forest, and multilayer perceptron). The image branch employed a convolutional neural network (CNN) to extract spatial features directly from images without predefined morphological descriptors. Using PCA-derived spectral features, the highest performing machine learning model achieved 81.1% accuracy, outperforming manual feature selection. CNN-based classification using image features alone yielded lower accuracy (57.3%) in this serovar-level discrimination. In contrast, a multimodal fusion model combining spectral and image features improved accuracy to 82.4% on the unseen test set while reducing overfitting on the train set. This study demonstrates that AI-enabled hyperspectral microscopy with multimodal fusion can streamline Salmonella serovar identification workflows. Full article

Background/Objectives: Romania remains a tuberculosis (TB) hotspot in the European Union, yet host-derived factors of poor outcomes are poorly characterised. We quantified circulating pro-inflammatory cytokines and examined their interplay with behavioural risk factors, the nutritional status, and the clinical course in adults hospitalised with pulmonary TB. We analysed 80 adults with microbiologically confirmed pulmonary TB and 40 respiratory symptom controls; four TB patients (5%) died during hospitalisation, all within 10 days of admission. Methods: A retrospective analytical case–control study was conducted at the Constanța regional TB referral centre (October 2020—October 2023). Patients with smear- or culture-confirmed TB were frequency-matched by sex, 10-year age band, and BMI class to culture-negative respiratory controls at a 2:1 ratio. The patients’ serum interferon-γ (IFN-γ), interleukin-1α (IL-1α), interleukin-1β (IL-1β), and tumour-necrosis-factor-α (TNF-α) were quantified within 24 h of admission; the neutrophil/lymphocyte ratio (NLR) was extracted from full blood counts. Independent predictors of in-hospital mortality were identified by multivariable logistic regression; factors associated with the length of stay (LOS) were modelled with quasi-Poisson regression. Results: The median TNF-α (24.1 pg mL⁻¹ vs. 16.2 pg mL⁻¹; p = 0.009) and IL-1β (5.34 pg mL⁻¹ vs. 3.67 pg mL⁻¹; p = 0.008) were significantly higher in the TB cases than in controls. TNF-α was strongly correlated with IL-1β (ρ = 0.80; p < 0.001), while NLR showed weak concordance with multiplex cytokine patterns. Among the patients with TB, four early deaths (5%) exhibited a tripling of TNF-α (71.4 pg mL⁻¹) and a doubling of NLR (7.8) compared with the survivors. Each 10 pg mL⁻¹ rise in TNF-α independently increased the odds of in-hospital death by 1.8-fold (95% CI 1.1–3.0; p = 0.02). The LOS (median 29 days) was unrelated to the smoking, alcohol, or comorbidity load, but varied across BMI strata: underweight, 27 days; normal weight, 30 days; overweight, 23 days (Kruskal–Wallis p = 0.03). In a multivariable analysis, under-nutrition (BMI < 18.5 kg m⁻²) prolonged the LOS by 19% (IRR 1.19; 95% CI 1.05–1.34; p = 0.004) independently of the disease severity. Conclusions: A hyper-TNF-α/IL-1β systemic signature correlates with early mortality in Romanian pulmonary TB, while under-nutrition is the dominant modifiable determinant of prolonged hospitalisation. Admission algorithms that pair rapid TNF-α testing with systematic nutritional assessment could enable targeted host-directed therapy trials and optimise bed utilisation in high-burden settings. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

Background/Objectives: Prostate cancer (PCa) is diagnosed at an earlier median age, more advanced stage, and has worse clinical outcomes in African American (AA) men compared to European Americans (EA). Methods: To investigate the role of aberrant DNA methylation in tumor-adjacent stroma (TAS), methyl binding domain sequencing (MBD-seq) was performed on AA (n = 17) and EA (n = 15) PCa patients. This was independently confirmed using the long interspersed nuclear element-1 (LINE-1) assay. Pathway analysis was performed on statistically significantly differentially methylated genes for AA and EA TAS. DNA methylation profiles of primary cultured AA and EA carcinoma-associated fibroblasts (CAFs) were compared with AA and EA TAS. AA and EA CAFs were treated with demethylating agent 5-Azacytidine (5-AzaC). Results: AA TAS exhibited higher global DNA methylation than EA TAS (p-value < 0.001). Of the 3268 differentially methylated regions identified (DMRs, p-value < 0.05), 85% (2787 DMRs) showed increased DNA methylation in AA TAS, comprising 1648 genes, of which 1379 were protein-coding genes. Based on DNA methylation levels, two AA subgroups were identified. Notably, AA patients with higher DNA methylation were predominantly those with higher Gleason scores. Pathway analysis linked methylated genes in AA TAS to several key signaling pathways (p-value < 0.05), including immune response (e.g., IL-1, IL-15, IL-7, IL-8, IL-3, and chemokine), Wnt/β-catenin, androgen, PTEN, p53, TGF-β, and circadian clock regulation. A total of 168 concordantly methylated genes were identified, with 109 genes (65%) showing increased methylation in AA CAFs and TAS (p-value < 0.05). Treatment with 5-AzaC significantly reduced DNA methylation of concordant genes in AA CAFs (p-value < 0.001). Conclusions: These findings suggest a distinct stromal methylome in AA, providing a foundation for integrating demethylating agents into standard therapies. This approach targets the tumor microenvironment, potentially addressing PCa disparities in AA men. Full article

The Vâlcea Subcarpathians, known for their wealth of natural resources and their spa tradition, are distinguished by renowned spa resorts such as Băile Olănești, Călimănești, Ocnele Mari and Băile Govora. These destinations provide tourists with a variety of treatment, relaxation, and recreational options. This research aims to explore the factors influencing tourist behavior at spa resorts in the Vâlcea Subcarpathians, Romania. Specifically, the relationships between tourists’ residential environment and frequency of visits, the influence of participation in cultural activities on the average duration of trips, and the impact of information sources and vacation planning methods on why tourists choose to visit spa resorts in the Vâlcea Subcarpathians, Romania, will be examined. As part of this study, a questionnaire was developed to collect relevant data on the perceptions and behaviors of visitors to spa resorts in the Vâlcea Subcarpathians, Romania. To analyze the collected data and test the research hypotheses, the following statistical methods were used: Chi-Square Test, Independent Samples t-Test and Analysis of Variance (ANOVA). The results obtained from the statistical tests largely confirmed the proposed hypotheses. There is a significant relationship between the age range of tourists and the frequency of visits, suggesting that different age groups have distinct visiting behaviors. Also, the perception of service quality varies by the gender of tourists, indicating that men and women have different experiences and expectations. Full article

Background/Objectives: Vertebral discitis osteomyelitis (VDO) is a serious infection involving the vertebral bodies and intervertebral discs, often requiring biopsy for pathogen identification. However, biopsy yields are variable, and guidance on patient selection remains limited. This study aimed to assess how biopsy culture results influence clinical management and to develop imaging-based scoring systems to predict biopsy outcomes. Methods: In this retrospective study, 70 patients who underwent image-guided vertebral biopsy for suspected VDO between 2013 and 2022 were reviewed. Pre-biopsy MRI and CT findings were scored using novel, simplified criteria. MRI was graded based on soft tissue involvement, while CT evaluated the presence or absence of a vacuum phenomenon. Culture results were correlated with imaging scores and subsequent changes in antibiotic management. Statistical analysis included logistic regression, ROC analysis, and interobserver agreement using Cohen’s Kappa. Results: Of the 70 patients, 27 (38.6%) had positive cultures, and 20 (28.5%) experienced changes in management. Among the 48 patients with both MRI and CT imaging, MRI scores indicating soft tissue involvement and absence of the vacuum sign on CT were independent predictors of positive culture (p = 0.022 and p = 0.047, respectively). The combined predictive model showed an AUC of 0.76. Interobserver agreement was excellent (κ = 0.90 for MRI, κ = 0.95 for CT). Conclusions: MRI and CT features can be used to predict biopsy yield and guide clinical decisions in suspected VDO. These scoring systems may help clinicians identify patients most likely to benefit from biopsy, potentially improving outcomes and minimizing unnecessary procedures. Full article

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12–17 years old) in the United States. Methods: Data from the 2018–2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75–0.84), while Hispanic (OR = 1.13, 95%CI: 1.08–1.18), Asian (OR = 1.56, 95%CI: 1.3–1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04–2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77–0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4–6 months and 7–12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population. Full article

Clinically significant antimicrobial-resistant bacteria and resistance genes are increasingly being reported in wildlife. In this study, 127 splenic samples from red foxes (Vulpes vulpes) from northern and central Italy were analysed for the presence of resistance genes against antimicrobials such as tetracycline, sulphonamide, β-lactam, and colistin, which were previously extensively used in human and veterinary management of bacterial diseases. One or more antimicrobial resistance genes were detected in 78 (61%) of 127 splenic samples. Polymerase chain reaction positivity was revealed for 13 genes—tet(A), tet(B), tet(K), tet(L), tet(M), tet(O), tetA(P), tet(Q), tet(S), tet(X), sul1, sul2, and bla_TEM-1—out of the 21 tested genes. Our results, corroborated by reports in the literature, confirm the potential role of the red fox as a sentinel for antimicrobial-resistant bacteria in contaminated environments and suggest that detecting resistance genes in biological samples by a culture-independent method might be an effective tool for the epidemiological study of antimicrobial resistance in wildlife. Full article

Objectives: The aim of this study was to validate the Polish version of the Somatosensory Amplification Scale (SSAS-PL) and examine its psychometric properties in clinical and non-clinical samples. Methods: The study included 1128 participants (711 healthy adults, 194 cardiac patients, 223 psychiatric patients). The analyses were categorized into exploratory and confirmatory phases. Exploratory analyses were conducted on a randomly selected sample that comprised 60% of the study participants (training sample) to estimate the reliability (Cronbach’s alpha) and factorial validity (EFA with varimax rotation). Confirmatory analyses were performed on an independent (test) sample that represented 40% of the total sample size to facilitate the cross-validation of the factor structure (CFA) and to assess the convergent and discriminant validities (using the HTMT method) in relation to health anxiety (SHAI) and psychopathological symptoms (KOFF-58). Additionally, measurement invariance was examined with respect to gender (female vs. male) and health status (healthy vs. clinical). Results: The SSAS-PL demonstrated good internal consistency (α = 0.75–0.78) after removing item 1. A one-factor structure showed the best fit and theoretical interpretability. The measurement invariance was supported across clinical groups. The SSAS-PL showed convergent validity with the measures of somatic symptoms, anxiety, and health anxiety. It demonstrated discriminant validity from other psychopathology measures. Conclusions: The SSAS-PL was a reliable and valid measure of somatosensory amplification in the Polish population. Its unidimensional structure aligned with most cross-cultural adaptations. The scale may be useful for assessing somatosensory amplification in both research and clinical settings in Poland. Further research on its utility in specific clinical populations is warranted. Full article