Search Results (41,082)

Background: Early diagnosis of obesity in adolescents is crucial for the prevention of severe health consequences. Different criteria for the diagnosis of obesity may lead to variations in prevalence. We aimed to compare the three most widely used international definitions (by WHO, IOTF and CDC) for overweight/obesity in adolescents in Northwestern Greece. Methods: A total of 403 adolescents aged 10–17 years were included. Agreement metrics and assessment of marginal heterogeneity and asymmetry were used for the comparison of the definitions. Results: In the total population, high agreement was observed among all definitions (Krippendorff’s alpha: 0.931, 95% CI 0.913–0.949). However, there was significant marginal heterogeneity (p < 0.001) and asymmetry (p < 0.001) for each pairwise comparison. WHO definition consistently yielded higher prevalence of obesity (WHO: 23.1%, IOTF: 15.4%, CDC: 21.6%). There were no significant differences in agreement (p = 0.247 for the comparison) between males and females, with more prominent marginal heterogeneity and asymmetry in males. Agreement among definitions was numerically lower in young adolescents aged < 14 years versus older ones (alpha: 0.919 vs. 0.953, p = 0.082), and systematic bias (p < 0.001) and asymmetry (p < 0.001) were present only in young adolescents without any significant difference in older ones. Conclusions: Although agreement was very high among definitions, they are not interchangeable, yielding different prevalence rates, particularly in young adolescents. IOTF criteria resulted in a reduced diagnosis of obesity and could lead to undertreatment; in contrast, WHO and CDC criteria may lead to overdiagnosis in our population. Caution is required when interpreting international criteria for overweight/obesity in various populations. Full article

The Barker hypothesis links intrauterine conditions, mainly low birth weight, subject to poor nutrition with paradoxically improved standards of living and nutrition after World War II in Western countries, to adult disease, mainly coronary heart disease. The limitations of his hypothesis include the fact that it is based only on human epidemiological data and animal studies, and also that it is difficult to isolate the effect of the intrauterine environment from postnatal conditions, familial and genetic background. In the last 20 years, the introduction of ultrasound and Doppler techniques in the assessment of fetal and maternal vascularity added a major contribution to the evaluation of the intrauterine environment. Studies based on ultrasound and Doppler assist in differentiating between prematurity and fetal growth restriction (FGR), mainly in those with placental insufficiency, and postnatal morbidity and even mortality. In addition, the Pedersen hypothesis regarding fetuses with overgrowth, mainly with diabetic mothers, states that they are also prone to postnatal morbidity. However, most of the studies on the issue do not emphasize the effects of the intrauterine environment on fetal organs, such as the brain, heart, liver, kidneys and pancreas in FGR and fetal overgrowth, that may impose a different prognosis in later life. This narrative review aims to summarize current evidence from animal and human studies regarding the impact of intrauterine undernutrition and overnutrition on fetal organ development, and to evaluate how ultrasound and Doppler findings may contribute to understanding the link between the intrauterine environment and postnatal morbidity. Full article

Background/Objectives: Acute otitis media (AOM) remains a leading cause of pediatric morbidity and a primary indication for antibiotic prescription worldwide. Given the potential for serious complications and the evolving landscape of antimicrobial resistance, up-to-date epidemiological data on causative bacteria are essential. This study aimed to assess the global prevalence of major bacterial pathogens in pediatric AOM and evaluate variations across geographic regions and temporal periods (pre-2000 vs. post-2000). Methods: A systematic search of PubMed, Embase, and Web of Science (1980–2025) was conducted to identify studies reporting middle ear fluid culture results in children (0–18 years) with AOM. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 45 studies encompassing 16,305 AOM episodes were included. Data were synthesized from North America, Europe, the Middle East, Asia, Oceania, and Africa. Pooled prevalence estimates and 95% confidence intervals (CIs) were calculated using a random-effects model, and heterogeneity was assessed via the I² statistic. Results: The overall pooled culture-positive rate was 66.6% (95% CI, 62.2–70.8%). Regional pooled estimates ranged from 56.1% in the Middle East (95% CI, 40.3–70.6%; underlying counts, 3776/10,652) to 77.5% in North America (95% CI, 68.2–84.7%; underlying counts, 1567/2125). Streptococcus pneumoniae was the most prevalent pathogen, with a pooled proportion of 29.0% (95% CI, 26.3–31.8%), followed by Haemophilus influenzae (22.3%; 95% CI, 19.3–25.6%) and Moraxella catarrhalis (4.6%; 95% CI, 3.4–6.1%). While S. pneumoniae remained the leading pathogen in most regions, H. influenzae showed marked geographic variability, peaking in the Middle East at 27.5% (95% CI, 17.0–41.2%; underlying counts, 2280/10,652) and reaching its lowest level in Asia at 13.5% (95% CI, 7.8–22.4%; underlying counts, 336/1854). The pooled culture-positive rate declined from 72.5% before 2000 (95% CI, 67.6–76.9%; underlying counts, 5769/8199) to 59.4% in 2000 and later (95% CI, 52.1–66.3%; underlying counts, 6661/15,707), although S. pneumoniae remained the predominant isolate in both periods. Conclusions: S. pneumoniae remains the primary bacterial driver of pediatric AOM globally. However, the observed geographic disparities and the temporal shift in pathogen prevalence following pneumococcal conjugate vaccine (PCV) introduction underscore the necessity for region-specific empirical antibiotic selection. These findings highlight the critical need for sustained microbiological surveillance to inform future vaccination and treatment strategies. Full article

Background: Acinetobacter baumannii is a non-fermenting Gram-negative bacillus responsible for severe nosocomial infections, particularly in intensive care units (ICUs). The increasing prevalence of multidrug-resistant (MDR) and carbapenem-resistant A. baumannii (CRAB) strains has become a significant challenge for infection control and antimicrobial therapy worldwide. Objectives: This study aimed to analyze the antimicrobial susceptibility patterns of clinical A. baumannii isolates recovered from a multi-profile hospital in years 2020–2024 in Lodz, Poland. Methods: Clinical isolates from various specimen types (blood, urine, wound swabs, biopsies, sputum, and bronchoalveolar lavage fluid) were obtained during routine microbiological diagnostics. Identification was performed using MALDI-TOF MS. Antimicrobial susceptibility testing (AST) was conducted using the automated VITEK^®2 system with EUCAST/CLSI interpretive criteria. Minimum inhibitory concentrations (MICs) for colistin were determined by broth microdilution. Carbapenemase production was assessed using the Carbapenem Inactivation Method (CIM) and immunochromatographic assays for OXA-23, OXA-40/58, and NDM detection. Results: A total of 244 A. baumannii isolates were recovered over the study period. Susceptibility to carbapenems (meropenem, imipenem) declined markedly, with resistance exceeding 90% by 2023–2024. Aminoglycosides exhibited variable activity, with gentamicin demonstrating the highest susceptibility rates (up to 88% in 2022). Resistance to ceftazidime and cefepime remained consistently high (>90% in 2023–2024). No fully susceptible isolates were identified for ciprofloxacin. Conclusions: The high prevalence of CRAB strains highlights the urgent need for effective infection control measures, optimized antimicrobial stewardship, and consideration of novel treatment options in the clinical setting. Full article

Neurodegenerative diseases (NDDs) in children represent a heterogeneous group of rare but collectively significant disorders characterized by progressive neurological decline, developmental regression, and substantial morbidity and mortality. Unlike adult-onset neurodegeneration, pediatric conditions are predominantly genetic and frequently arise from defects in fundamental cellular pathways, including lysosomal degradation, mitochondrial oxidative phosphorylation, peroxisomal lipid metabolism, and myelin maintenance. This comprehensive review synthesizes current knowledge regarding the epidemiology, molecular classification, pathophysiology, and emerging therapeutic strategies of major pediatric neurodegenerative disorders. Epidemiological data indicate a “rare-but-many” landscape, where individually uncommon diseases collectively impose a measurable population burden. Mechanistically, disease progression reflects converging processes such as toxic substrate accumulation, impaired autophagy–lysosome flux, mitochondrial bioenergetic failure, oxidative stress, neuroinflammation, and glial dysfunction. Representative groups discussed include lysosomal storage disorders, leukodystrophies, mitochondrial encephalopathies, peroxisomal disorders, and other monogenic neurodegenerative syndromes. Advances in next-generation sequencing, metabolic profiling, and neuroimaging have substantially improved diagnostic accuracy and enabled earlier detection, including through newborn screening programs. Therapeutic paradigms are shifting from primarily supportive care toward mechanism-based interventions, including enzyme replacement therapy, hematopoietic stem cell transplantation, substrate reduction strategies, and gene therapy approaches. Early molecular diagnosis is increasingly recognized as critical for optimizing outcomes, particularly in disorders amenable to presymptomatic intervention. Continued integration of genomic medicine, standardized epidemiologic surveillance, and translational research will be essential to refine disease classification, improve prognostication, and expand access to targeted therapies. Collectively, pediatric neurodegenerative diseases exemplify the intersection of developmental neurobiology and inherited metabolic dysfunction, underscoring the need for multidisciplinary, precision-based clinical strategies. Full article

Background: Thyroid cancer (TC) represents the most common endocrine malignancy worldwide, with incidence increasing rapidly across diverse geographic regions. However, population-based evidence from North Africa remains limited, and comprehensive longitudinal analyses examining sex-specific incidence patterns, histological subtypes, and trends in tumor extension are lacking in Tunisia. Aim: This study aimed to (i) quantify TC incidence trends by sex and age group, (ii) characterize histological subtype-specific temporal patterns and tumor extension at diagnosis in northern Tunisia between 2000 and 2018, and (iii) to address projections in incidence by sex until 2040. Methods: A retrospective, population-based registry study was conducted using data from the Northern Tunisia Cancer Registry (NTCR), covering 11 governorates with a population of 5,233,700 in 2018. All primary invasive TC cases diagnosed between 2000 and 2018 were included (n = 3639). Age-standardized incidence rates (ASIRs) were calculated using the WHO standard population. Temporal trends were assessed using Joinpoint regression to estimate average annual percentage change (AAPC) with 95% confidence intervals. Projections of TC incidence to 2040 were generated using Bayesian autoregressive age–period–cohort models. Results: TC incidence increased significantly between 2000 and 2018, with overall ASIR rising from 2.8 to 5.0 per 100,000 person-years (AAPC = 3.8%, p < 0.001). In males, ASIR increased from 0.9 to 2.4 (AAPC = 3.0%, p < 0.001), while in females it rose from 3.7 to 7.8 (AAPC = 4.3%, 95% CI: 3.0–5.7; p < 0.001). The increase was predominantly driven by papillary thyroid carcinoma (PTC) (AAPC = 6.4% in males; 5.8% in females; both p < 0.001), whereas follicular thyroid carcinoma (FTC) remained stable. Notably, the proportion of metastatic cases decreased significantly in females (AAPC = −7.2%, p = 0.033), and the proportion of regionally advanced disease decreased in males (AAPC = −5.0%, p = 0.034). Conclusions: This population-based study demonstrates a sustained rise in TC incidence in northern Tunisia, disproportionately affecting women and largely driven by papillary histology. The concurrent increase in TC incidence alongside a reduction in regional and metastatic extension at diagnosis occurred. These findings have important implications for cancer prevention and control, highlighting the need for risk-adapted screening strategies and rationalized diagnostic practices. Full article

Peste des petits ruminants (PPR) is an infectious disease with high morbidity and mortality rates, and four distinct lineages have been discovered in different regions globally. In this study, a quadruplex RT-qPCR method capable of differentiating all four lineages of PPRV was established. By screening specific conserved regions across all viral genomes, we designed primers, as well as four TaqMan probes capable of distinguishing all lineages. The established method underwent validation of its relevant characteristics. The sensitivity of the detection method was determined by testing plasmid serial dilutions ranging from 10⁸ to 10⁰ copies/μL; results showed that the method could detect as few as 10 copies per microliter of PPRV. No cross-reactivity was observed among the four probes or with other common pathogens of goats and sheep. The coefficient of variation (CV) values for inter-assay and intra-assay repeatability of each probe were both below 2% (intra-assay: 0.11% to 0.98%; inter-assay: 0.18% to 1.95%), demonstrating excellent repeatability. Testing of 62 clinical samples also confirmed that the method could effectively detect and differentiate clinical samples of different PPR lineages. This method, for the first time, enabled the differentiation of all PPRV lineages in a single reaction, improving the detection efficiency of the PPR virus and providing robust technical support for the global PPR eradication program. Full article

Obesity is a global epidemic, posing intricate health dilemmas with wide-reaching ramifications. Despite its rising prevalence, obesity often receives inadequate attention in medical training, which is hypothesized to influence obesity management. The study aimed to evaluate medical students’ readiness in addressing obesity, which is especially relevant in a country with significant high obesity rates. A cross-sectional pilot study was carried out by disseminating a mixed-methods anonymous questionnaire among pre-clinical and clinical students studying at the University of Malta. Quantitative data was analyzed through descriptive and inferential statistical analysis, while qualitative responses were subject to thematic assessment. One hundred and eighty-nine students were recruited, and the majority expressed dissatisfaction with curricular education on obesity, especially clinical students who reported a perceived lack of essential theoretical and practical skills (82.65%, 95% CI [73.69–89.56]). Less pre-clinical students perceived receiving sufficient education on obesity and obesity management students (33.3% and 43.33%, respectively) compared to their clinical counterparts (67.68% and 53.54% respectively), which highlights a potential curriculum gap. Qualitative analysis revealed discontent with teaching methods and demonstrated the need for a more holistic approach to obesity education. This study highlights an urgent need to integrate holistic and comprehensive obesity education within the medical education curriculum that addresses both theoretical understanding and practical skills. Full article

Background: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) are characterized by neuropsychiatric symptoms linked to immune dysregulation. Emerging evidence highlights the role of host–microbiome interactions in modulating neuro-immune functions via gut–brain axis signaling; however, its contribution to PANDAS pathophysiology remains poorly understood. Methods: We conducted microbiome analysis from samples collected across multiple sites of PANDAS patients including nasal, throat and stool. We performed an integrated multi-omics analysis of stool samples from pediatric PANDAS cases and healthy controls, including discordant twin pairs. Microbial composition and function were assessed using 16S rRNA gene sequencing, shotgun metagenomics, while untargeted metabolomic profiling was performed using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS). Results: PANDAS cases exhibited reduced alpha diversity and significantly altered beta diversity compared to controls, indicating shifts in gut microbial composition. Shotgun metagenomic analysis revealed differential enrichment of functional pathways, including diminished quorum sensing, altered gamma-aminobutyric acid (GABA) biosynthesis, and microbial degradation processes. Multiple gut–brain modules (GBMs) and gut metabolic modules (GMMs) associated with neurotransmission, transport activities and metabolism were significantly perturbed in PANDAS. Metabolomic profiling showed reduced functional diversity and distinct clustering of metabolic profiles, with differential abundance of amino acids, bile acids, and neuroactive compounds. Integrative analysis further identified disrupted microbe–metabolite networks allied to gut–brain signaling. Conclusions: Our findings reveal significant functional shifts in gut microbiota composition, functional capacity and metabolite profile in PANDAS, suggesting dysregulation of the gut–brain axis signaling. This study provides a foundation for development of microbiome-based biomarkers and therapeutic strategies for pediatric neuropsychiatric disorders. Full article

(1) Background: Regular school attendance is foundational to students’ academic achievement, social-emotional development, and long-term career success. Yet chronic absenteeism continues to affect a substantial proportion of PreK-12 students in the United States, underscoring the urgent need for evidence-based interventions. (2) Methods: This meta-analysis synthesized findings from 13 randomized controlled trials and quasi-experimental studies published between January 2020 and March 2025 and identified through six digital databases. All included studies evaluated interventions that reported school absenteeism as an outcome. Effect sizes were calculated using Hedges’ g and estimated with a random-effects model. To explain variability in effects, meta-regression analyses examined 10 moderators across the following four domains, guided by the ecological systems theory: study-level features (methodological rigor), individual-level characteristics, intervention-level characteristics, and contextual-level characteristics. (3) Results: The overall effect size was 0.091 (95% CI: 0.012–0.170), indicating a small but statistically significant reduction in absenteeism favoring intervention groups. Substantial heterogeneity was observed (I² = 73%). Study setting emerged as the only significant moderator, with stronger effects in single-school implementations. Although other moderators were not statistically significant, variation in effect magnitudes suggests meaningful contextual and implementation differences. (4) Conclusions: These interventions produce modest but statistically reliable reductions in absenteeism, with implementation context significantly influencing effectiveness. Full article

Background: Despite significant advances in diagnosis and treatment, gastric cancer remains a major global malignancy. This study aimed to evaluate the impact of Surveillance, Epidemiology, and End Result (SEER) stages on all-cause and cause-specific mortality in gastric cancer. Methods: This nationwide population-based cohort study analyzed data from the Cancer Public Library Database (CPLD). Patients aged ≥ 30 years diagnosed with gastric cancer between 2012 and 2019 were followed up until 31 December 2020. Cox proportional hazards models and Fine–Gray models were used to compare the risk of all-cause and cause-specific mortality based on SEER stages. The Kaplan–Meier method and cumulative incidence functions were applied to analyze cumulative incidences of all-cause and cause-specific mortality. Statistical significance was assessed using the log-rank test and Gray’s test. Additionally, a subgroup analysis was performed. Results: Among 218,491 individuals, 59,952 died during a median follow-up of 3.62 years. Compared with the localized stage, the risk of all-cause mortality was 4.31 and 24.73 times higher in patients with the regional and distant stages, respectively, after adjusting for sex, age, income, residential area, and comorbidities. The regional stage was associated with an 8.70-, 6.08-, 1.28-, and 1.43-fold higher risk of stomach cancer death, cancer death, cardiovascular death, and respiratory death, respectively. The distant stage was associated with 51.67-, 35.97-, 1.74, and 1.54-fold higher risk of stomach cancer death, cancer death, cardiovascular death, and respiratory death, respectively. Conclusions: Higher SEER stage in gastric cancer is associated with an increased risk of all-cause mortality, gastric cancer-specific mortality, overall cancer mortality, cardiovascular disease-related mortality, and respiratory disease-related mortality. Notably, cardiopulmonary mortality increased with advancing SEER stage, particularly among younger patients, underscoring the need for vigilant monitoring. Full article

Introduction. Bronchiolitis is the leading cause of Pediatric Intensive Care Unit (PICU) admission for lower respiratory tract infection in infants. Although survival has improved, concerns remain regarding potential long-term functional impairments, including alterations in psychomotor development, learning, and behavior. This study aimed to describe the epidemiological and clinical characteristics of children admitted to the PICU for bronchiolitis and to evaluate their functional outcomes at 12-month follow-up. Methods. A retrospective descriptive cohort study was conducted, including all patients admitted to the PICU for bronchiolitis during the 2021–2022 period. Epidemiological, clinical, microbiological, and laboratory data were collected. Functional health status was assessed using the Pediatric Overall Performance Category (POPC), Pediatric Cerebral Performance Category (PCPC), and Functional Status Scale (FSS) at PICU discharge and 12 months. Changes in functional status were categorized as improved, stable, or worsened. Exploratory unadjusted analyses were performed to describe differences between outcome groups. Results. A total of 164 patients were included (43.9% female), with a median age of 51 days (IQR 26.25–118.5). Respiratory syncytial virus was identified in 79.7% of cases. Invasive mechanical ventilation was required in 31.1% of patients, and 45.7% developed complications during PICU admission. Mortality was 0.6%. At 12 months, functional deterioration was observed in 14.6% of patients according to POPC, 16.5% according to PCPC, and 3.6% according to FSS. Higher proportions of functional deterioration were observed among patients with underlying medical conditions, those requiring invasive mechanical ventilation, those with complications, and those with longer PICU and hospital stays, particularly in the PCPC scale. Conclusions. Most children admitted to the PICU for bronchiolitis showed stable or improved functional status at 12 months. However, a subset experienced functional deterioration, more frequently observed in patients with greater clinical severity and complexity during admission. These results support the need for further studies to better characterize long-term outcomes and to identify children who may benefit from closer follow-up. Full article

Background/Objectives: Respiratory syncytial virus (RSV) causes a significant hospitalization burden in infants. The objective of this study was to evaluate the cost-effectiveness of introducing clesrovimab, a recently approved long-acting monoclonal antibody, in all US infants born during or entering their first RSV season. Methods: A decision analytical model simulated the clinical and economic impact of clesrovimab in a yearly birth cohort, compared with three alternative interventions: nirsevimab, palivizumab, and the RSVpreF maternal vaccine. Model inputs were obtained from the published literature. Efficacy estimates for clesrovimab were derived from post hoc analyses of randomized control trial data, which were conducted to align endpoints from different studies (nirsevimab and RSVpreF). Medically attended lower respiratory infection (MALRI), quality-adjusted life years (QALYs, 3% discounting), and costs (in 2024 USD) were evaluated from a societal perspective. Both deterministic and probabilistic sensitivity analyses were performed. Results: Clesrovimab resulted in fewer (38,252) RSV-related MALRI outcomes and was cost-saving compared to nirsevimab, with significant reductions in total costs (USD 98 million saved). When compared with palivizumab, clesrovimab and nirsevimab were estimated to cost USD 38,655 and USD 79,912 per QALY, respectively. Results were sensitive to changes in intervention costs, efficacy, and QALY loss due to RSV infection. Conclusions: Clesrovimab may significantly reduce the burden of RSV among US infants in their first RSV season and may save costs compared to nirsevimab. Full article

Background/Objectives: An imbalance in oxidative stress (OS) has been implicated in the pathogenesis of Inflammatory Bowel Disease (IBD). We compared OS status in IBD children and adults versus healthy controls by exploring variables impacting the OS disruption in IBD. Methods: Total antioxidant capacity (ferric-reducing ability of plasma (FRAP)), reactive species (ROS), oxidative products (advanced oxidation protein products (AOPPs) and thiobarbituric acid reactive substances (TBARSs)), and antioxidant defenses (glutathione, GSH and intracellular activity of the main antioxidant enzymes) were evaluated. Correlations between OS markers, clinical features, disease characteristics, and inflammatory indices were explored. Results: Eighty-two IBD patients (67.5% in clinical remission) and 73 healthy subjects were enrolled. IBD children showed significant FRAP reduction compared to controls and IBD adults (p < 0.0001), increased AOPPs and reduced GSH compared to controls (p < 0.0001 and p = 0.0011, respectively), higher total GSH (p = 0.020), and lower TBARSs (p = 0.023) compared to IBD adults. In the pediatric group, FRAP was significantly reduced in those with IBD and increased in older subjects and males, while AOPP levels were positively affected by increasing age. In the total IBD cohort, higher FRAP was associated with male gender, increasing age, overweight, and mesalazine therapy. The diagnosis of Ulcerative Colitis was associated with lower FRAP and AOPP levels compared to Crohn’s disease. Increased fecal calprotectin significantly decreased the total antioxidant capacity. Conclusions: The antioxidant system shows significant differences in IBD compared to controls, particularly in the pediatric group. The observed pediatric–adult pattern may suggest age-related differences in oxidative balance, but these findings should be interpreted with caution, given the modest sample size. Clinical Trial Registration Number: NCT04513015. Full article

Background/Objectives: There is growing interest among researchers in improved biological risk factor indices or combinations of indices, which have emerged as a major focus in evaluating the risk of cardiovascular disease (CVD). This study aimed to identify latent profiles based on the clustering of biological factors and to explore associations between lifestyle factors and CVD outcomes across the identified latent profiles. Methods: This epidemiological health survey was performed during 2023–2024. A random sample of Kaunas inhabitants aged 25–69 years, stratified by sex and age, was randomly selected from the Lithuanian population register. The 3426 individuals were screened. Latent profile analysis was performed using Latent Gold 6.1 and IBM SPSS Statistics 30. Multinomial logistic regression and multivariable binary logistic regression were used to evaluate the associations between biological risk factor profiles, lifestyle factors, and CVD outcome. Results: Three biological risk factor profiles were identified: low-risk profile (42.6%) was considered the healthiest, having the lowest levels of body mass index (BMI), fasting glucose, systolic blood pressure (SBP), and the highest level of high-density lipoprotein (HDL) cholesterol. Medium-risk profile (50.4%), having intermediate indicators of those factors. The high-risk profile (7.0%) was characterized by the lowest HDL cholesterol and the highest values of triglycerides, fasting glucose, SBP, and BMI. Conclusions: Compared to the low-risk profile, medium- and high-risk biological profiles were independently associated with higher odds of CVD, according to sociodemographic and lifestyle factors. The study suggests that integrating multiple biological risk factors rather than a single risk factor in clinical practice may enhance diagnostic accuracy. Full article