Search Results (77,580)

Background: Access to and use of health services represent crucial issues/challenges for older people experiencing frailty with functional limitations and chronic diseases, especially when they age in place alone. Both access to and use of health services are also characterised by gender differences. The present study analysed these factors in three Italian regions (Lombardy, North; Marche, Centre; and Calabria, South), where in 2019, the “Inclusive Ageing in Place” (IN-AGE) project was carried out, involving 120 senior people aged 65 years and of both genders. Methods: In this mixed-methods study, both qualitative (predominant section) and some quantitative data (e.g., socio-demographic aspects and functional limitations) were collected through semi-structured interviews. In addition to basic quantitative analyses, content analysis and the quantification of statements were performed to process the qualitative data. The results for both men and women are presented. Possible barriers to accessing health services were also considered. Results: Women reported more cases of chronic diseases than men, especially arthritis/osteoporosis, and a greater use of drugs than men. Both genders used services provided by the general practitioner (GP) and medical specialist (MS), the latter being mostly private. More women than men used rehabilitation, especially in the private sector, and reported the issue of cost for private healthcare and the travel distance to reach medical units as barriers to access. The long waiting lists/times were complained about by both males and females. Conclusions: This study, despite its simple/descriptive qualitative approach with a limited sample, could provide, however, some insights for policymakers and healthcare professionals to plan prevention policies and deliver appropriate and timely health services to older people experiencing frailty and ageing in place alone, devoting attention to gender-related issues in the design and provision of such services. Full article

Purpose: To describe the indication spectrum for high-dose 8 mg aflibercept for neovascular age-related macular degeneration (nAMD) in a real-world cohort in a tertiary referral center. Methods: The database of the University Eye Hospital Munich, Ludwig Maximilians-University was screened for eyes with nAMD treated with 8 mg aflibercept. Demographic data, multimodal imaging and treatment parameters were recorded. Reasons for treatment with 8 mg aflibercept were analyzed. Results: Thirty-four consecutive eyes of 31 patients (mean age 78.6 ± 8.9 years) were identified. There were 22 women (70.1%) and 9 men (29.9%). In all eyes (100%), 8 mg Aflibercept was applied as switching therapy. Prior to switching, the mean anti-vascular endothelial growth factor (VEGF) treatment duration for nAMD was 3.9 ± 2.9 years, pretreatment amounted to a mean of 34.5 ± 26.3 injections, equaling 9.2 ± 2.4 injections/year, and the mean visual acuity (VA) was 0.4 ± 0.4 logMAR. The last treatment before switching was 2 mg aflibercept in 76%, faricimab in 18%, ranibizumab in 3% and bevacizumab in 3% of cases. Reasons for switching included (A) recalcitrant nAMD with persistent fluid despite q4w dosing (17 eyes, 50%), (B) the wish for interval extension (15 eyes, 44%) and (C) macular hemorrhage (2 eyes, 6%). In group B, two-thirds of eyes (10/15, 66.7%) were maintained at ≤q6w prior to switching. Conclusions: In this study, high-dose 8 mg aflibercept was exclusively used as a switch therapy. Most eyes (76%) switched were from pretreatment with 2 mg aflibercept. The main reasons for switching were recalcitrant nAMD with persistent fluid despite q4w dosing (50%) or the wish for treatment extension beyond 6 weeks (32%). In the future, these data will aid in the design of prospective real-world studies comparing the efficacy of high-dose 8 mg aflibercept with older generation treatment options, especially 2 mg aflibercept. Full article

Objective: To evaluate the psychometric properties of the short version of the Token Test (SVTT) and the Rey–Osterrieth Complex Figure (ROCF) using an item response theory (IRT) framework and to establish normative data for Colombian children and adolescents based on ability scores. Methods: A total of 668 healthy participants aged 6–17 years took part in this study. Factorial structure was assessed through confirmatory factor analysis (CFA). Item parameters were estimated using a two-parameter logistic (2PL) model for the SVTT, which accounts for both item difficulty and discrimination in dichotomous responses, and a graded response model (GRM) for the ROCF, suitable for items scored on ordered categories reflecting increasing levels of performance accuracy and Differential Item Functioning (DIF) analysis was conducted to assess potential bias related to sex. Reliability was examined using the Test Information Function (TIF), internal consistency throughout Cronbach’s alpha, and the influence of sociodemographic variables was analyzed through regression models. Results: CFA confirmed unidimensionality for all measures. For most items, moderate-to-low ability was sufficient to achieve the highest scores in the ROCF, and low ability in the SVTT. DIF analysis indicated no meaningful sex-related bias in any of the subtests. Both tests showed excellent reliability and internal consistency. Copy scores were influenced by polynomial age and parents’ mean years of education (MPE), while both immediate recall in the ROCF and SVTT were affected by MPE and the interaction of logarithmic age. Conclusions: This study provides strong psychometric evidence and, together with the integration of digital tools for generating normative data, represents a meaningful advancement in neuropsychological assessment. Full article

Background: Thyrotoxicosis is a systemic condition with well-documented cardiovascular effects, but its role as a precipitant of acute coronary syndromes (ACS) is often overlooked. This review summarizes clinical cases and original studies from the last 20 years, describing ACS triggered by thyrotoxicosis. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, and Embase for reports published between 2004–2025. Only case reports and original articles were included. Data extracted included demographics, ECG findings, angiography results, thyroid function, etiology of hyperthyroidism, and outcomes. Results: A total of 35 cases were identified. The mean age was in the fourth decade of life, with a female predominance (57%, 20 out of 35). More than half of the patients presented with ST-segment elevation myocardial infarction (STEMI) or STEMI equivalents (21 out of 35; 60%). Electrocardiographic abnormalities most often involved anterior or inferior leads. Coronary angiography revealed normal vessels or diffuse vasospasm in 18 cases (51%), while thrombotic occlusion was observed in 4 cases (11%), spontaneous dissection in 2 cases (6%), and myocardial bridging in 3 cases (9%). The leading cause of thyrotoxicosis was Graves’ disease (≈65%), followed by painless thyroiditis, iatrogenic causes, and gestational hyperthyroidism. Thyroid storm was reported in approximately 20% of cases and was associated with malignant ventricular arrhythmias or sudden cardiac death. Conclusions: Thyrotoxicosis should be recognized as a rare but important trigger of ACS, especially in young patients without traditional risk factors. Pathophysiological mechanisms include coronary vasospasm, increased myocardial oxygen demand, and hypercoagulability. Early recognition may prevent unnecessary revascularization and optimize outcomes through integrated endocrine and cardiac management. Full article

Understanding the systemic synergy of peer effects on digital transformation is essential for overcoming development bottlenecks and stimulating digital vitality across industrial and regional ecosystems. Utilizing data from Chinese A-share listed companies on the Shanghai and Shenzhen stock exchanges from 2010 to 2024, this study empirically investigates the impact of peer effects on corporate digital transformation and its underlying influencing factors from a systems perspective. The findings reveal significant industry and regional peer effects in corporate digital transformation, indicating that firms’ decision-making is interdependent within broader ecosystems. A greater distance between a focal firm’s prior digital transformation level and that of its peers is associated with a higher level of enthusiasm for such transformation. Similarly, the more a focal firm’s prior performance falls below that of its peers, the stronger its impetus for digital transformation becomes. Furthermore, the influence of the transformation distance on digital transformation enthusiasm exhibits a non-linear threshold effect, which varies with the performance gap. Finally, further analysis indicates that peer effects exert a multiplier effect and that industry-level peer effects in digital transformation significantly enhance firm performance. These conclusions contribute to a deeper understanding of the systemic mechanisms and pathways of corporate digital transformation and offer both theoretical and empirical support for fostering resilient digital economic ecosystems across industries and regions. Full article

Background/Objectives: Sudden cardiac arrest (SCA) accounts for ~50% of cardiovascular mortality in the U.S. Cardiovascular complications are common in acute and post-acute COVID-19 infection. We aimed to examine nationwide trends in SCA-related hospitalizations in the United States before and during the COVID-19 outbreak. Methods: Using data from the National Inpatient Sample, we conducted a retrospective analysis of hospitalizations for SCA in the U.S. between 2016 and 2020. Sociodemographic and clinical characteristics and in-hospital mortality were compared between the pre-COVID (2016–2019) and COVID (2020) eras. Multivariable analysis was performed to identify factors associated with mortality. Results: Among a weighted total of 153,100 SCA hospitalizations between 2016 and 2020, the median age was 65 years, 62.7% were male, and 66.6% were white. There was a trend towards fewer hospitalizations in 2020 compared to prior years (n = 28,585 vs. n_average = 32,129, p = 0.07). In-hospital mortality remained unchanged between the pre-COVID and COVID eras (47.7% vs. 47.3%, p = 0.66). Increased mortality was associated with female sex (OR: 1.21; 95% CI: 1.15–1.28; p < 0.001), non-white race (OR: 1.24; 95% CI: 1.15–1.28; p < 0.001), history of renal failure (OR: 1.08; 95% CI: 1.02–1.15; p = 0.007), and diabetes (OR: 1.32; 95% CI: 1.25–1.39; p < 0.001). In 2020, 1.5% of the study population was diagnosed with COVID-19 infection, which was found to be independently associated with increased in-hospital mortality (OR: 1.57; 95% CI: 1.27–1.95; p < 0.001). Conclusions: In 2020, there was a trend towards a decrease in hospitalizations for SCA, while COVID-19 infection was independently associated with higher in-hospital mortality among patients admitted with SCA. Full article

Driving under the influence (DUI) has long been recognized as a major contributor to traffic accidents. However, the factors influencing the severity of crashes in DUI situations may vary significantly between genders due to physiological and psychological differences. This study analyzes DUI single-vehicle crash data from Texas to construct a random-parameter logit model that captures gender-specific differences in crash severity. A partially constrained method is employed to better identify these gender-specific factors, emphasizing the importance of separately assessing DUI behavior for males and females in traffic safety analysis. The results reveal notable gender differences in the severity of injuries from DUI crashes. A comprehensive evaluation was conducted from four perspectives: driver characteristics, vehicle features, roadway conditions, and environmental factors. Out-of-sample simulations provided additional insights, showing that even at lower blood alcohol concentration (BAC) levels, the probability of severe injury increases significantly. In conclusion, this study not only uncovers the gender-specific mechanisms behind DUI crash severity but also offers valuable empirical evidence for integrating gender considerations into future traffic safety policies and interventions. Full article

Schizophrenia is a complex disorder influenced by genetic, neurobiological, and environmental factors, with increasing evidence implicating immune dysregulation. This study examined potential molecular mimicry between autoantigens associated with schizophrenia and proteins from Toxoplasma gondii, a parasite previously linked to the disorder. Amino acid sequences of schizophrenia-related autoantigens were retrieved from databases (AAgAtlas, PubMed), and homologous sequences were searched within the T. gondii proteome. Sequence identity was evaluated, and conserved B-cell epitopes were predicted using three-dimensional structures from the Protein Data Bank or models generated in Swiss-Model, followed by epitope mapping with ElliPro. Five autoantigens—gamma-enolase (ENO2), thyroid peroxidase (TPO), glutamic acid decarboxylase 65 kDa isoform (GAD65), serine/threonine-protein kinase 2 (VRK2), and dihydropyrimidine dehydrogenase [NADP(+)] (DPYD)—showed similarities with T. gondii proteins. Among them, enolase exhibited the highest homology, with identities up to 65%. These findings provide preliminary evidence of shared antigenic features between the parasite and schizophrenia-related autoantigens. Such mimicry could contribute to disease mechanisms by triggering autoimmune responses in genetically susceptible individuals, supporting the hypothesis that T. gondii infection may influence schizophrenia pathogenesis. Nonetheless, the results are based exclusively on in silico analyses, and experimental validation will be required to confirm potential cross-reactivity. Full article

Despite existing biosecurity frameworks, there is limited empirical evidence on how US swine producers’ beliefs, behaviors, and risk perceptions influence enhanced biosecurity implementation. We conducted an online survey among US swine producers to understand their biosecurity beliefs, behaviors, and practices. We used descriptive, unsupervised machine learning, and Factor Analysis for Mixed Data (FAMD). Of fifty-four respondents, 48.1% reported implementing some biosecurity measures, and 72.2% valued having enhanced biosecurity protocols. Majority (53.7%) considered their veterinarian’s biosecurity opinion most important, and 37% were not concerned about African swine fever. Almost all (90.7%) felt confident they could contain an outbreak on their farms. However, none practiced enhanced biosecurity. The cluster analysis identified four distinct producer profiles (K = 4). Cluster A had young, inexperienced producers operating breeding facilities, with moderate biosecurity adoption. Cluster B included young, small-farm producers with variable biosecurity practices and low mortality rates. Cluster C comprised farms with moderate experience, higher mortality rates, and the lowest biosecurity adoption. Cluster D was composed of older, experienced, educated producers with the highest biosecurity standards and lowest mortality rates. FAMD revealed clustering along human capital and resource availability dimensions. Regular biosecurity assessments, tailored recommendations, and training would improve biosecurity in the swine industry. Full article

The safe operation of low-altitude UAVs is crucial for the effective utilization of low-altitude airspace, necessitating the development of appropriate risk assessment methods to evaluate the associated operational risks. However, current research primarily focuses on two-dimensional risk assessments, with limited focus on assessing risks across different heights, thus constraining the ability to guide UAV operations within three-dimensional airspace. In this study, we propose a three-dimensional airspace risk assessment method that integrates multisource data to estimate risks at various altitudes. First, we assess ground impact risks by considering factors such as population density, obstacle environment, and socioeconomic characteristics. Next, we develop a network signal evaluation model to estimate signal loss at various altitudes. Finally, we apply machine learning methods to classify multiple features to determine airspace risks at varying altitudes, resulting in a comprehensive three-dimensional risk map. The results indicate that the majority of the urban area falls within the low-risk category, accounting for approximately 84–87% of the city. High-risk regions are concentrated in central urban areas, with their proportion increasing from 5.9% at 30 m to 9.1% at 300 m. Although the overall trend remains broadly consistent across altitudes, the local variations highlight the necessity of three-dimensional risk evaluation. This three-dimensional risk map can effectively guide safe UAV operations across different altitude layers and provide valuable decision support for flight route planning. Full article

Symptomatic uncomplicated diverticular disease (SUDD) is the primary clinical manifestation of diverticular disease (DD). Although gut microbiota (GM) perturbation and dietary habits are considered important factors in the development of the disease, there is currently a lack of data on the potential relationship between diet, GM profile and SUDD. An exploratory retrospective study was conducted in a SUDD cohort of 47 patients to investigate this relationship; a diverticulosis cohort of 19 patients served as the control group. Patients were stratified by their self-reported dietary habits, i.e., Mediterranean diet, predominantly plant-based diet or omnivorous diet. GM was profiled using 16S rRNA amplicon sequencing of fecal swabs. SUDD patients following a Mediterranean or predominantly plant-based diet showed higher alpha diversity and enrichment of known fibre degraders and short-chain fatty acid producers, such as members of the Lachnospiraceae, Ruminococcaceae, Oscillospiraceae and Prevotellaceae families. This suggests that their gut (and whole-body) health is less impaired. In contrast, those following an omnivorous diet showed an increased presence of pro-inflammatory taxa, including the mucus degrader R. torques, which suggests impaired gut barrier function and potential systemic implications. Similar associations between GM profile and dietary habits were found when considering SUDD patients with moderate abdominal pain severity (according to visual analogue scale, VAS) and those scored as DICA 1 according to the endoscopic severity of the disease. However, no such associations or trends were observed in SUDD patients scored as DICA 2, which suggests that diet may be unable to impact GM dysbiosis as SUDD severity increases. Despite the study’s limitations, primarily its retrospective design and related biases, our findings suggest that other GM modulation tools should be employed in more severe cases of SUDD to reverse dysbiosis while alleviating symptoms. Full article

Background: Metabolic syndrome (MetS) is a growing global health concern. Although sex, smoking, and physical activity are recognized risk factors, their combined effects remain insufficiently studied, particularly among Asian populations. This study aimed to examine the associations of sex, cumulative smoking exposure, and physical activity with MetS among current smokers in Taiwan. Methods: Data were drawn from 15,385 participants recruited between 2013 and 2017 from a health screening center. Demographic characteristics, smoking status, physical activity levels, and biochemical data were analyzed. Mann–Whitney U tests, chi-square tests, and multiple logistic regression were used to identify variables associated with MetS. Results: MetS prevalence differed significantly by sex, with rates of 13.6% in men and 5.1% in women. Women had a lower chance of developing MetS compared to men (OR = 0.607, 95% CI 0.488–0.754). Older age, higher body mass index, and greater cumulative smoking exposure (quantified using a composite ‘smoke area’ index derived from questionnaire data on smoking duration, frequency, and daily amount) were positively associated with MetS risk. Among smokers younger than 45 years, women also had significantly lower odds of MetS than men (OR = 0.590, 95% CI 0.451–0.771). Higher levels of physical activity were linked to reduced MetS risk in both sexes. Conclusions: Among current smokers, being female was inversely associated with the risk of MetS. Greater physical activity and lower smoking exposure were also associated with reduced risk. Future research should use longitudinal designs and comorbidities to clarify mechanisms and inform tailored prevention strategies. Full article

Background/Objectives: In a series of 33 patients with advanced penile squamous cell carcinoma (PSCC), we evaluated tissue factor (TF), TROP2, and nectin-4 protein expression as potential therapeutic targets. Expression levels of these proteins were also correlated to clinicopathological characteristics, including high-risk human papillomavirus (HPV), CDKN2A (p16) status, and aberrant p53 expression. Methods: A tissue microarray (TMA) was constructed with three cores per patient tumor (99 total cores). Anti-TF antibody staining was performed by immunohistochemistry, and H-scores for membrane and cytoplasm staining were assessed (range 0–300). The percentage of cores and patient tumors staining positive for TF (≥10% of tumor cells with at least 1+ intensity in cytoplasm and/or membrane) and H-scores were described and compared with HPV and p16 status. The association of TF expression with tumor grade, presence of metastatic disease, lymphovascular invasion (LVI), perineural invasion (PNI), aberrant p53 expression, recurrence-free survival (RFS), and cancer-specific survival (CSS) was assessed. Nectin-4 and TROP2 staining and their association with clinical/pathological data were determined in a similar manner. Results: TF staining was evident in 26 (81.3%) of the cohort and was more prominent in HPV-negative tumors in both the membrane (H-score 69.6 vs. 18.8; p = 0.003) and cytoplasm (H-score 59.2 vs. 17.7, p = 0.007). Cytoplasmic (H-score 61.7 vs. 11.7, p < 0.001) and membrane TF staining (H-score 71.7 vs. 15.0, p < 0.001) favored p16-negative tumors. The p53 status was more likely to be aberrant in the higher TF staining samples (cytoplasm H-score 61.7 vs. 18.3, p = 0.012; membrane H-score 67.5 vs. 20.3, p = 0.006). We observed an association with TROP2 staining and positive p16 status (membrane H-score 120.3 vs. 85, p = 0.052; cytoplasmic H-score 135 vs. 107.5, p = 0.041). We observed an association of TROP2 staining with positive LVI (membrane H-score 136.7 vs. 66.7, p = 0.014; cytoplasmic H-score 110 vs. 93.3, p = 0.04). We found no association between TF, TROP2, or nectin-4 staining with CSS or RFS; however, we suspect that this was due to our small sample size. Conclusions: Our results indicate that TF was expressed in the majority of advanced PSCC with enhanced expression among HPV-independent, p53-aberrant tumors and may represent a novel therapy target in advanced PSCC. Full article

Ricinus communis is a significant economic crop, where plant height and stress tolerance are critical factors influencing both yield and quality. The variation in plant height is influenced by both genetic and environmental factors, with environmental stresses such as salt, drought, and cold notably affecting plant growth phenotypes. In this study, we utilized transcriptome data from two varieties, DL01 and Hale, which differ in plant height, to systematically identify the RcMYB transcription factor family and screen 12 key RcMYBs associated with height variation. We also analyzed the expression patterns of these genes under various stress conditions, including salt, drought, cold, and heat. Notably, these 12 height/stress-related RcMYB genes such as RcMYB45 and RcMYB27 showed notable expression changes in response to different stress treatments, suggesting their pivotal roles in regulating both plant height and stress tolerance. Through protein–protein interaction (PPI) network analysis, we further discovered that these RcMYBs could interact with several regulatory factors. This study highlights the roles of RcMYB regulators in controlling plant height and stress adaptation in R. communis, providing potential target genes for molecular breeding and offering valuable insights into improving growth performance and stress tolerance. Full article

In recent years, ecosystems in Saudi Arabia have experienced severe degradation due to factors such as hyperaridity, overgrazing, climate change, urban expansion, and an increase in uncontrolled wildfires. Among these, wildfires have emerged as the second most significant threat to forests after urban expansion. This study aims to map wildfire susceptibility in southwestern Saudi Arabia by identifying key driving factors and evaluating the performance of several machine learning models under conditions of limited and imbalanced data. The models tested include Maxent, logistic regression, random forest, XGBoost, and support vector machine. In addition, an NDVI-based phenological approach was applied to assess seasonal vegetation dynamics and to compare its effectiveness with conventional machine learning-based susceptibility mapping. All methods generated effective wildfire risk maps, with Maxent achieving the highest predictive accuracy (AUC = 0.974). The results indicate that human activities and dense vegetation cover are the primary contributors to wildfire occurrence. This research provides valuable insights for wildfire risk assessment in data-scarce regions and supports proactive fire management strategies in non-traditional fire-prone environments. Full article