Search Results (2,481)

Background: Non-suicidal self-injury (NSSI) is defined as the intentional damage to one’s body tissue without suicidal intent and for reasons that are not socially sanctioned. While NSSI has been widely studied in the general population, its clinical correlates and management in autism spectrum disorder (ASD) remain less clearly characterized, and it is often conflated with self-injurious behavior (SIB) described within restricted and repetitive behaviors (RRBs). In individuals with ASD, NSSI may be associated with emotional, behavioral, cognitive, social, medical, and demographic factors, and it differs from SIB typically observed among individuals with severe intellectual disabilities. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies published between 2000 and 2025 that assessed NSSI in individuals with a formal ASD diagnosis were included. Etiological/clinical correlates, explanatory mechanisms, and management challenges were examined. Sixteen studies were selected from PubMed, Scopus, and Web of Science. Findings were synthesized using narrative and thematic approaches. Results: The prevalence of NSSI among individuals with ASD ranged from 24% to 50%. Associated factors included emotion dysregulation (including alexithymia and affective distress), behavioral dysregulation (e.g., impulsivity/hyperactivity and aggression), sensory processing difficulties, communication and social impairments, and medical comorbidities (i.e., gastrointestinal and sleep problems), with preliminary evidence also implicating perinatal factors. NSSI was linked to emotion regulation, sensation seeking, and social communication processes. Early intervention and parental involvement were identified as protective factors. Conclusions: NSSI in ASD is a complex, multifactorial phenomenon frequently linked to emotion-regulation needs. Affective imbalance represents a central—though not exclusive—pathway. The review supports standardized terminology, function-based assessment, and clearer differentiation from SIB/RRBs, with implications for individualized interventions and sustained monitoring in persistent or severe cases. Routine screening for medical and sensory contributors may further improve case management and reduce preventable clinical burden. Full article

In contemporary practice, dental implants are widely recognized as a reliable and effective solution for rehabilitating edentulous patients. Nevertheless, implant placement in the atrophied maxilla presents considerable challenges, with treatment planning influenced by various factors such as patient demographics, anatomical constraints, and economic considerations. Advances in imaging technology have positioned cone-beam computed tomography (CBCT) as the preferred modality for enhancing implant placement accuracy. By producing high-resolution three-dimensional radiographic images, CBCT facilitates precise assessment of maxillary anatomy at the proposed implant site—including bone height, width, length, and angulation—thereby optimizing surgical planning and improving the predictability and success rates of implant integration. Moreover, the timing of implant placement must account for the necessity of maxillary augmentation to ensure implant stability and reduce the risk of postoperative complications. This review discusses the clinical utility of CBCT as a diagnostic tool for preoperative assessment, focusing on the identification of critical anatomical landmarks and the determination of indications for bone augmentation, thereby highlighting its crucial role in enabling accurate treatment planning, minimizing surgical risks, and promoting the long-term survival of dental implants. Full article

Physiologically based pharmacokinetic (PBPK) models are widely used in the context of personalized medicine, as they allow for the evaluation of dosing schedules and routes of administration by predicting absorption, distribution, metabolism and excretion (ADME) of drugs in biological systems. Traditionally, PBPK models have been developed and applied at the population level, enabling the characterization of predefined cohorts, which remains limited in supporting true precision dosing. In this review, we explored the increasingly common shift from population-based to individual PBPK modelling, where individuals are modelled as virtual twins (VTs). Through the inclusion of additional patient-specific data, such as demographic, physiological, phenotypic and genotypic information, models can be personalized, moving beyond traditional one-size-fits-all strategies. Overall, incorporating individual patient data (e.g., septic, psychiatric, cardiac, or neonatal populations) improves model performance. Physiological parameters, particularly renal function, show strong potential given their role in drug elimination, while demographic variables enhance predictive accuracy in certain studies. In contrast, the benefits of including cytochrome P450 (CYP) phenotypic and genotypic data remain inconsistent. We further emphasize methodologies used to evaluate model performance, with a focus on clinical validation through comparisons between predicted and observed concentration-time profiles. Key challenges, including limited sample sizes and data availability, that may compromise predictive precision, are also discussed. Finally, we highlight the potential integration of PBPK-based VTs into broader digital twin frameworks as a promising path toward clinical translation, while acknowledging the critical barriers that must be addressed to enable routine clinical implementation. Full article

Background/Objectives: Intraoperative bleeding remains one of the major challenges in pediatric liver transplantation (PLT), contributing significantly to perioperative morbidity, transfusion-related complications, and prolonged recovery. Although viscoelastic testing has improved intraoperative hemostatic management, there are currently no validated preoperative tools capable of predicting bleeding risk in this vulnerable population. Methods: We conducted a prospective, single-center observational study including 43 consecutive pediatric patients who underwent orthotopic liver transplantation between May 2008 and August 2009. A comprehensive dataset encompassing demographic, clinical, biochemical, and surgical variables was collected. A multivariable linear regression model was developed to predict intraoperative blood loss (IBL). Variable selection was guided by Mallows’ Cp criterion to ensure optimal model fit and clinical interpretability. Model performance was assessed using adjusted R², diagnostic residual analysis, and internal validation to verify regression assumptions. Results: Six independent predictors of IBL were identified: presence of ascites, prior abdominal surgery, operative time, baseline fibrinogen concentration, platelet count, and recipient weight. The final model explained 35.2% of IBL variance (adjusted R² = 0.352; F = 7.68; p < 0.001). Model diagnostics confirmed linearity, normal distribution of residuals, and homoscedasticity, supporting its robustness and reliability. Conclusions: This multivariable model provides an interpretable, clinically applicable framework for individualized preoperative estimation of blood loss in PLT. It may assist in planning perioperative patient blood management strategies and serve as a foundation for future decision-support systems. Limitations include the single-center design and modest sample size; however, internal validation supported the stability and reliability of the model. Full article

Introduction: Cutibacterium acnes, a component of normal skin flora and a common commensal Gram-positive bacterium, presents a diagnostic challenge for arthroplasty surgeons. While Cutibacterium acnes (C. acnes) as a source of infection has been well characterized in shoulder surgery, its presentation and clinical significance in total hip (THA) and total knee arthroplasty (TKA) remain less understood. Methods: A retrospective chart review identified patients with C. acnes culture positivity following THA or TKA. Demographics, laboratory values, and microbiologic data were collected. Statistical comparisons were performed using t-tests and chi-squared analysis. One-year outcomes were evaluated using the Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT) criteria among patients undergoing further surgical intervention. Results: Twenty-nine patients with C. acnes-positive cultures were identified (21 THA, 8 TKA); 15 (52%) were polymicrobial. Ten THA patients (47.6%) and seven TKA patients (87.5%) met MSIS criteria for infection at the time of presentation. Mean time to culture positivity was similar between THA (6.8 days) and TKA (7.4 days; p = 0.57). Sonicated cultures were positive in 24% of THA and 12.5% of TKA cases. Mean ESR was 36.4 mm/h for THA and 51.5 mm/h for TKA (p = 0.21); mean C-reactive protein (CRP) was 35.2 and 36.8 mg/dL, respectively (p = 0.95). Mean synovial cell counts were 27,055 for THA and 22,194 for TKA, with polymorphonuclear cells (PMN) percentages of 68% and 73.9% (p = 0.72, 0.70). Monomicrobial infections demonstrated a mean cell count of 24,143 with 58.9% PMNs, compared to 25,903 and 78.8% in polymicrobial cases. At one year, 72% of patients undergoing subsequent surgery achieved successful outcomes. Higher ASA classification was the only significant predictor of failure (mean 3.0 vs. 2.75). Conclusions: C. acnes-associated THA and TKA infections often present with delayed culture growth, mild inflammatory markers, and frequent polymicrobial involvement. At one-year, patients with available follow-up who undergo surgical management experience favorable outcomes, with 72% achieving MSIS ORT success. Full article

The emerging concept of circular parks positions protected areas as active generators of shared value, as they integrate biodiversity conservation with natural resource optimization, local economies, and social cohesion. This perspective challenges traditional passive management by applying circular economy principles to parks as dynamic territorial organisms embedded within a regional socio-ecological metabolism. The research explores and tests circular park approaches starting from forest-related resource flows in areas where ecological richness coexists with socio-economic fragility. Focusing on the case study of the Madonie Regional Park (Sicily, Italy), the research investigates alternative pathways for the reuse of retrievable biomass by relating material flows to local social, economic, and cultural activities potentially involved in circular processes. This study supports the design of recycling, repurpose, and re-vision strategies to transform residual biomass into regenerative local value and strengthen the territorial resilience in inner areas characterized by demographic fragility despite being endowed with significant environmental and cultural capital. Through a design-oriented approach, the research experiments with alternative circular strategies in a case study, proposing a shift from extractive and mono-output models towards multi-output approaches and from an energy-centered towards a community-centered model. This perspective emerges not only as a cultural challenge but also as an opportunity to build an operational and replicable planning practice within the Italian and European park system, contributing to the debate on the ecological transition of fragile territories. Full article

Background and Objectives: Patients with a prior history of coronary artery bypass grafting (CABG) who present with non-ST-segment elevation myocardial infarction (NSTEMI) represent a complex, high-risk subgroup due to advanced comorbidity burden and challenging coronary anatomy. Whether an invasive strategy offers meaningful benefit over conservative management in this population remains unclear. Therefore, this study aimed to compare long-term outcomes of percutaneous coronary intervention (PCI) versus medical therapy in NSTEMI patients with previous CABG and to identify independent predictors of major adverse cardiovascular events (MACE) and all-cause mortality. Materials and Methods: This retrospective cohort study included 286 NSTEMI patients with prior CABG (PCI: 112; medical therapy: 174). Baseline demographic, clinical, laboratory, and angiographic characteristics were assessed. The primary endpoint was MACE, while the secondary endpoint was all-cause mortality. Kaplan–Meier analysis evaluated survival differences, and multivariable Cox regression identified independent predictors. Results: During follow-up, MACE rates were comparable between PCI and medical therapy (14.3% vs. 18.9%; p = 0.305). All-cause mortality was likewise similar (9.8% vs. 10.3%; p = 0.541). Kaplan–Meier analysis showed no survival benefit with PCI (log-rank p = 0.334). Hypoalbuminemia independently predicted both MACE and mortality, while CKD and HF were major determinants of long-term mortality. Conclusions: In NSTEMI patients with prior CABG, no long-term superiority of PCI over medical therapy was observed with respect to MACE or mortality. Prognosis appears more closely linked to hypoalbuminemia, CKD, and HF than to the chosen management strategy. These findings underscore the importance of individualized and risk-adapted clinical decision-making in this complex population. Full article

Background/Objectives: Challenging behaviour post-stroke can complicate care and disrupt rehabilitation, yet its presentation and management are underreported. This study explored how such behaviours were documented in clinical records and managed in stroke settings, and how care delivery and discharge outcomes were documented in this context. Methods: A retrospective chart review was conducted across two NHS stroke units, covering all admissions between March and April 2022. Patient records were reviewed to capture demographic, clinical, and behavioural information, together with details relating to management and discharge. Challenging behaviour was identified retrospectively from clinical documentation during routine care. Descriptive statistics were used to summarise the data. Results: Forty-eight stroke admissions were examined, with challenging behaviour documented in thirteen patients (27%). Eleven had ischaemic stroke, with moderate severity common (n = 6), while inattention/neglect (n = 5) and infection (n = 4) were also documented. Behaviours were commonly recorded as confusion or agitation, and predominantly by nursing staff. Challenges to care delivery were documented in six of these patients, and additional professional input was provided for seven. Discharge delays were documented in patients with challenging behaviour, and the median length of stay was notably longer for this group (19 days compared with 7). Documentation of cognitive or delirium screening was uncommon. Conclusions: Challenging behaviour was documented in over a quarter of acute stroke admissions and was documented alongside greater care complexity and longer hospital stays. These preliminary descriptive findings from a small sample indicate a need for further exploration to better characterise challenging behaviour following stroke and its implications for care. Full article

Until recently, the Karpathos water frog (Pelophylax cerigensis) was considered endemic to Karpathos Island (Greece) and has recently been reclassified by the IUCN as Endangered (EN), having been previously assessed as Critically Endangered (CR). The species faces severe threats primarily associated with the scarcity of freshwater bodies in the southern Aegean Sea. Over the past decade, demographic assessments have revealed a marked population decline, driven by the intensifying effects of climate change, including reduced rainfall, and increasing summer temperatures. In addition, the few natural ponds that persist during the dry summer months are often shared with the Levantine freshwater crab (Potamon potamios), resulting in increased frog mortality due to predation. Despite these challenges, recent developments provide cautious optimism. These include the construction of a dam in southern Karpathos and the taxonomic reassessment of the water frog population on the neighboring island of Rhodes as conspecific with P. cerigensis. In response to the species’ precarious status, the Hellenic Herpetological Society designed and implemented a National Action Plan aimed at the protection and conservation of the Karpathos water frog. The Action Plan includes a series of targeted mitigation measures, such as the construction of artificial ponds to retain water during the summer, as well as a hydrological study addressing the seasonal drying of the ecologically important Eleimonitria spring. A key component of the Action Plan involves education and outreach initiatives targeting primary school students, local residents, and visitors, highlighting the frog’s ecological importance and conservation needs. Informational brochures will be distributed across the island to raise awareness of the species’ conservation status and the importance of safeguarding its habitat. The implementation of this Action Plan aims to secure the long-term survival of the Karpathos water frog and to strengthen integrated conservation efforts across its extremely limited range. Full article

Immigrants from Latin America’s Indigenous and rural communities in New York City are likely to break the cycle of poverty by improving language proficiency, acculturation, and education. Their well-being has received poor attention in the economic literature, and little is known about the needs, financial welfare, health status, or education among Indigenous-origin migrants from Latin American households. This study used primary data from a non-probabilistic sample of 121 self-identified Indigenous migrants living in New York City (NYC), a demographic cohort presenting challenges in terms of research access. National-level data usually aggregates all Spanish-speaking individuals as Hispanics and fails to acknowledge the presence of these pre-Hispanic groups. Integrating low-skilled Latin American Indigenous migrants into labor markets remains a challenge. We examined the link between the household income of Indigenous migrants from Latin America in NYC and education, acculturation, and discrimination. Using a logistic regression, we substantiated that education retains its prominence as the primary determinant of income for Indigenous migrants, but perceptions of discrimination based on skin color undermined this progress. This study highlights the need for interventions to promote language proficiency, acculturation, and education among Indigenous immigrant communities and implement culturally tailored policies to encourage the upward mobility of this population. Full article

Background/Objectives: Multimodal large language models (MLLMs) offer potential for automated fracture detection, yet their diagnostic stability under repeated inference remains underexplored. This study evaluates the diagnostic accuracy, stability, and intra-model consistency of four MLLMs in detecting hand fractures on plain radiographs. Methods: In total, images of hand radiographs of 65 adult patients with confirmed hand fractures (30 phalangeal, 30 metacarpal, 5 scaphoid) were evaluated by four models: GPT-5 Pro, Gemini 2.5 Pro, Claude Sonnet 4.5, and Mistral Medium 3.1. Each image was independently analyzed five times per model using identical zero-shot prompts (1300 total inferences). Diagnostic accuracy, inter-run reliability (Fleiss’ κ), case-level agreement profiles, subgroup performance, and exploratory demographic inference (age, sex) were assessed. Results: GPT-5 Pro achieved the highest accuracy (64.3%) and consistency (κ = 0.71), followed by Gemini 2.5 Pro (56.9%, κ = 0.57). Mistral Medium 3.1 exhibited high agreement (κ = 0.88) despite low accuracy (38.5%), indicating systematic error (“confident hallucination”). Claude Sonnet 4.5 showed low accuracy (33.8%) and consistency (κ = 0.33), reflecting instability. While phalangeal fractures were reliably detected by top models, scaphoid fractures remained challenging. Demographic analysis revealed poor capabilities, with age estimation errors exceeding 12 years and sex prediction accuracy near random chance. Conclusions: Diagnostic accuracy and consistency are distinct performance dimensions; high intra-model agreement does not imply correctness. While GPT-5 Pro demonstrated the most favorable balance of accuracy and stability, other models exhibited critical failure modes ranging from systematic bias to random instability. At present, MLLMs should be regarded as experimental diagnostic reasoning systems rather than reliable standalone tools for clinical fracture detection. Full article

Background: Primary school teachers are experiencing unprecedented occupational stress due to technological demands, varied student needs, and the enduring psychological effects of the COVID-19 pandemic. Although burnout research is extensive globally, evidence regarding Greek primary educators remains scarce, particularly in post-pandemic contexts where Mediterranean cultural values, economic constraints, and centralized governance may yield unique patterns. Methods: This cross-sectional study examined professional burnout among 102 primary school teachers in Achaia prefecture, Greece, during autumn 2022. The Greek-validated Maslach Burnout Inventory-Educators Survey assessed emotional exhaustion, depersonalization, and personal accomplishment. The psychological impact of COVID-19 was evaluated alongside demographic and occupational factors. Analyses included descriptive statistics, nonparametric tests, correlation analyses, hierarchical clustering, and multiple regression models. Results: The sample exhibited mixed burnout profiles, with 42.2% indicating low emotional exhaustion (while 35.3% showed high levels) and 67.6% showing minimal depersonalization. Bivariate analysis revealed that the psychological burden of COVID-19 was significantly correlated with depersonalization (r = 0.339, p < 0.001) but not with emotional exhaustion (r = 0.078, ns) or personal achievement. However, multivariate regression controlling for demographic factors revealed a suppression effect: pandemic burden emerged as the strongest predictor of emotional exhaustion (β = 0.52, p < 0.001), while its association with depersonalization became non-significant. Cluster analysis identified four distinct profiles: Emotionally Strained (49.0%), Resilient (32.4%), Detached (15.7%), and At-Risk (2.9%). Gender significantly predicted emotional exhaustion (model R² = 0.136), while rural location and years of service predicted depersonalization (model R² = 0.225). Conclusions: Greek primary school teachers demonstrated remarkable resilience after the pandemic, maintaining professional effectiveness despite emotional challenges. The suppression effect observed for COVID-19 burden—significantly associated with depersonalization bivariately but with emotional exhaustion multivariately—highlights the importance of examining both direct and demographically mediated stress pathways. The dimensional independence observed, particularly personal achievement's resilience to external stressors, contests unified burnout models and indicates that targeted interventions addressing specific burnout dimensions may be more effective than holistic approaches. Full article

Social security systems constitute a structurally significant component of public finance in developing economies and often generate persistent fiscal pressures through budgetary transfers. Demographic transformation, widespread informality in labor markets, and weaknesses in contribution-based financing increase the dependence of social security systems on public resources. The objective of this study is to examine whether budget transfers to the social security system affect fiscal sustainability in Turkey by analyzing their relationship with the budget deficit and the public sector borrowing requirement. The analysis employs annual data for Turkey covering the period of 1984–2024. A comprehensive time-series econometric framework is adopted, incorporating conventional and structural-break unit root tests, the ARDL bounds testing approach with error correction modeling, and the Toda–Yamamoto causality method. The empirical findings provide evidence of a stable long-run relationship among the variables. The results indicate that social security budget transfers exert a statistically significant and persistent effect on the public sector borrowing requirement, while no direct long-run effect on the headline budget deficit is detected. Causality results further confirm that fiscal pressures associated with social security financing materialize primarily through borrowing dynamics rather than short-term budgetary imbalances. By explicitly modelling social security budget transfers as an independent fiscal channel over a long historical horizon, this study contributes to the literature by offering new empirical insights into the fiscal sustainability implications of social security financing in Turkey. The findings also provide policy-relevant evidence for developing economies facing similar institutional, demographic, and fiscal challenges. Full article

Sustainable development is a central objective of contemporary spatial planning; however, empirical evidence on how sustainability principles are implemented through municipal planning instruments remains limited. This study examines how sustainable development is embedded in Municipal Spatial Plans (MSPs) and reflected in spatial development practice in four Slovenian municipalities—Gornja Radgona, Hrastnik, Kostanjevica na Krki, and Lenart. A qualitative, indicator-based comparative framework was applied, structured around five thematic areas, twelve sub-themes, and thirty-one indicators. The analysis triangulated statutory planning documents, ten-year official statistical data, and five-year municipal investment reports, deliberately avoiding composite indices to prevent false precision in cross-municipal comparison. The results show that all MSPs formally incorporate sustainability as a guiding principle; however, significant differences emerge in how concretely these principles are translated into spatial provisions, investments, and observed development trends. Lenart demonstrates the strongest alignment between planning objectives and implementation, while Hrastnik and Gornja Radgona exhibit persistent gaps related to demographic decline and mobility patterns. Kostanjevica na Krki illustrates a protection-oriented sustainability approach shaped by flood risk and constraints relating to cultural heritage. The study concludes that MSPs primarily function as strategic and coordinating instruments, while effective implementation of sustainable development depends on complementary governance arrangements, investment alignment, and monitoring mechanisms beyond statutory spatial planning. The findings provide transferable insights for municipalities facing similar sustainability challenges. Full article

Road transport across Asia is undergoing rapid motorisation and exemplifies growing road safety challenges, with rising accident rates closely linked to driver behaviour. Recent reports indicate that Vietnamese drivers often perceive risk as manageable and enforcement as inconsistent, contributing to habitual violations such as speeding, signal ignoring, and risky manoeuvres, particularly when traffic is light. Evidence shows that riders, especially young adults, feel confident controlling their vehicles and frequently disregard safety warnings. This study investigates traffic safety awareness among motorcyclists and car drivers in Hanoi, based on a questionnaire survey of 393 respondents. Principal Component Analysis (PCA) was used to group 11 attitudinal statements into key components influencing road safety perceptions, identifying five: non-compliance with traffic regulations (Component 1), aggressive driving behaviour (Component 2), traffic signal issues (Component 3), road quality and infrastructure (Component 4), and preventive measures (Component 5). Multiple Correspondence Analysis (MCA) and two-step cluster analysis (TCA) were then applied to determine user clusters by socio-demographic characteristics, producing three groups: young adults in employment riding motorcycles (Cluster 1), young adults in education riding motorcycles (Cluster 2), and mature adults in employment driving cars (Cluster 3). Finally, Multinomial Logistic Regression (MLR) was applied to assess variations in road safety perceptions across the different groups (clusters). Mature adults driving cars (Cluster 3) identified the first four components as significant, with Components 1 and 2 showing negative associations and Components 3 and 4 positive associations. Full article