Search Results (452)

This scoping review examined the current literature on routines and habits in individuals with attention deficit hyperactivity disorder (ADHD). To our knowledge, research in this area remains limited. Therefore, this review mapped which areas of daily routines are most affected in children and adults with ADHD and explored related assessments and interventions. A comprehensive search was conducted across four databases: PubMed, Scopus, CINAHL, and PsycINFO, using keywords including “attention deficit hyperactivity disorder,” “ADHD,” “routine,” “habit,” and “lifestyle.” The findings identified four main domains in which individuals with ADHD experience difficulties: sleep hygiene, feeding, physical activity, and sedentary behaviors, with sleep hygiene addressed in more than half of the included studies. Study habits were addressed in only one included study. Among the 31 included studies, six involved interventions. The review also found that no validated assessment was specifically designed to measure routines or habits in individuals with ADHD, and that broader measures of routines, habits, or lifestyle were often non-validated or developed for a single project. Overall, the existing studies were concentrated primarily in pediatric populations, with limited research involving adults. These findings highlight important gaps in the literature and underscore the need for more research on routines and habits in adults with ADHD. They also support the development of assessments and interventions that specifically address these areas. Full article

Background and Objectives: The SARS-CoV-2 pandemic disrupted oral and maxillofacial surgery (OMS) services worldwide because of the high aerosol-generating nature of head-and-neck procedures, restricted access to elective dental care, and systemic reallocation of hospital resources. Continuous longitudinal multi-year data covering both the pandemic and the post-pandemic phases from regional Romanian (and more broadly central and southeastern European) emergency centers remain scarce. We aimed to quantify the impact of the pandemic on OMS activity in a large Romanian regional referral center and to evaluate post-pandemic resilience. Materials and Methods: We conducted a retrospective single-center study of all inpatient admissions to the OMS Clinic of a tertiary emergency hospital in western Romania between 1 January 2018 and 31 December 2024. Three periods were pre-specified: pre-pandemic (2018–2019), pandemic (2020–2022) and post-pandemic (2023–2024). A Newey–West segmented interrupted-time-series (ITS) regression and a negative-binomial monthly count model with Fourier seasonality were fitted; length of hospital stay was further analyzed with a multivariable gamma-log generalized linear model adjusted for age, sex, county, primary ICD-10 chapter and total ICD-10 codes. Variables analyzed included case volume, demographics, primary and secondary ICD-10 diagnoses, length of hospital stay (LOS), case complexity (total ICD-10 codes per admission) and in-hospital mortality. Results: A total of 11,628 inpatient admissions corresponding to 8084 unique patients (56.5% male; mean age 52.2 ± 19.2 years) were analyzed. Compared with the pre-pandemic baseline (mean 2037 admissions/year), annual volume dropped by 45.1% in 2020, 44.0% in 2021 and 32.3% in 2022, with a nadir of −76% during the first state of emergency (April 2020; n = 34 admissions). Recovery was rapid; 2024 exceeded the pre-pandemic baseline by +10.1% on raw counts and by +16.2% on admissions per 100,000 catchment population using year-specific INS denominators. The segmented ITS regression confirmed an immediate level drop of −114.2 admissions/month in March 2020 (95% CI −133.1 to −95.3; p < 0.001) and a positive post-intervention slope of +2.06 admissions/month (95% CI 1.23–2.88; p < 0.001), with observed monthly volume returning to the counterfactual projection by October 2023. The case mix shifted significantly (χ² = 406.9, p < 0.0001); elective benign neoplasm admissions were reduced from 7.2% to 2.0%, while neoplasms of uncertain behavior nearly doubled from 15.7% to 27.5%. Case complexity increased during the pandemic (mean ICD codes 4.08 ± 2.42 vs. 3.44 ± 2.30; p < 0.001); after exclusion of administrative codes (whole Z chapter and U07.x), the difference attenuated to 3.34 vs. 3.17 codes (still p < 0.001 by Kruskal–Wallis), indicating that the largest portion of the unadjusted increase was driven by the new mandatory pre-admission SARS-CoV-2 screening code Z11.5 rather than true clinical complexity. Notably, the clinically interpretable proxy R63.3 (feeding difficulty) independently rose from 41.5% to 53.1%. The crude median LOS did not differ between the pre-pandemic and pandemic periods (3.07 vs. 3.06 d; p = 0.19) and dropped significantly post-pandemic (2.22 d; p < 0.001); however, after multivariable adjustment for case mix, age, sex, county and code count, the LOS was 15.7% shorter during the pandemic (adjusted ratio 0.84, 95% CI 0.82–0.87; p < 0.001) and 22.8% shorter post-pandemic (adjusted ratio 0.77, 95% CI 0.75–0.80; p < 0.001) relative to baseline. Conclusions: The pandemic caused a severe but transient contraction of OMS activity accompanied by increased case complexity and a marked shift away from elective surgery. Inpatient volume returned to and exceeded the pre-pandemic baseline by 2024. These results support the value of standing pandemic-preparedness protocols, sustained access to preventive dental care, and integrated tele-triage pathways for future public-health crises. Full article

Background/Objectives: Ventricular septal defect (VSD) is the most common congenital heart disease in children and is often associated with growth impairment and malnutrition. Increased metabolic demand, feeding difficulties, and recurrent infections contribute to poor nutritional status. Insulin-like growth factor-1 (IGF-1), a key mediator of growth hormone activity, reflects nutritional and metabolic conditions. Previous studies have evaluated endocrine and growth abnormalities in heterogeneous congenital heart disease populations. However, data specifically examining the relationship between serum IGF-1 levels and nutritional status in isolated pediatric ventricular septal defect remain limited, particularly in Southeast Asian populations. Methods: The single centre observational case–control study was conducted at Dr. Soetomo Hospital, Surabaya, involving 110 children (55 VSD patients and 55 healthy controls). VSD diagnosis was confirmed by echocardiography. Nutritional status was assessed using WHO anthropometric criteria. Serum IGF-1 levels were measured using ELISA. Statistical analyses compared IGF-1 levels between groups and across nutritional categories. Results: Moderate and severe wasting were more common in the VSD group. Median IGF-1 levels were significantly lower in VSD patients compared to controls (5.18 vs. 21.4 ng/mL; p < 0.001). A positive association between IGF-1 levels and nutritional status was observed. Conclusions: Children with VSD have poorer nutritional status and significantly lower IGF-1 levels compared to healthy controls. This association may be explained by the dysregulation of the growth hormone–IGF-1 axis. IGF-1 may complement nutritional assessment for identifying and monitoring growth impairment and guiding early nutritional interventions in pediatric VSD. Full article

A comprehensive and systematic study was conducted to address a series of key technical challenges encountered in the grinding process at a copper mine. These issues included the complex mechanical properties of the feed ore, which led to low grinding efficiency, difficulty in achieving the required grinding fineness for flotation, uneven particle size distribution in the grinding products, and severe occurrences of overgrinding and undergrinding. Based on the semi-theoretical ball diameter formula, the optimal initial ball size distribution for the ball mill was precisely calculated as Φ70:Φ50:Φ40:Φ30 = 15:25:35:25. Through laboratory-scale grinding tests and Discrete Element Method (DEM) simulations, a systematic analysis of multiple indicators under three different ball loading schemes was performed, including the motion state of particles inside the mill, the collision behavior of the grinding media, and the energy distribution. This analysis confirmed the rationality and effectiveness of the literature scheme. Industrial trial results showed the following: the yield of the +0.20 mm fraction decreased by 4.15 percentage points, and the yield of the −0.010 mm fraction and its proportion relative to the −0.074 mm fraction decreased by 10.17 and 19.10 percentage points, respectively. Conversely, the yields of the intermediate separated fraction (−0.20 + 0.010 mm), the easily separated fraction (−0.074 + 0.018 mm) and the −0.074 mm qualified fraction increased by 14.32, 14.13, and 7.29 percentage points, respectively. The grinding technical efficiency improved by 19.55 percentage points. Furthermore, the specific steel ball consumption decreased by 46 g/t, a reduction of 5.07%. The copper concentrate recovery increased by 0.65 percentage points, resulting in an annual increase of 40.51 tons of copper metal, additional revenue of CNY 3.2483 million, and steel ball cost savings of CNY 603,500. Collectively, this optimization generated a total economic benefit of CNY 3.8518 million. By optimizing the ball size distribution, the particle size composition of the grinding products was significantly improved, the flotation indicators were enhanced, and the grinding media consumption cost was reduced, achieving quality improvement and efficiency increase in the mineral processing. This study provides a valuable reference for solving similar grinding problems. Full article

Periventricular nodular heterotopia (PVNH) is a genetically heterogeneous malformation of cortical development with variable neurological outcomes. Among recessive forms, ARFGEF2-related disorder is uniquely characterised by the association of diffuse PVNH and progressive microcephaly. We describe a two-year-old boy born to consanguineous parents who presented with severe developmental delay, hypotonia, progressive microcephaly, and infantile-onset epileptic spasms with developmental regression. Brain MRI showed extensive bilateral PVNH associated with callosal hypoplasia and ventriculomegaly. EEG revealed dysmature background activity with multifocal epileptiform discharges and runs of asynchronous fast activity during sleep. Genetic testing identified a novel homozygous nonsense variant in ARFGEF2. The clinical course was characterised by drug-resistant epilepsy and multisystemic involvement, including feeding difficulties and recurrent respiratory infections. To contextualise this case, we performed a comprehensive review of previously reported patients, further delineating the clinical, neuroradiological, and electroclinical spectrum of ARFGEF2-related disorder. This case highlights progressive microcephaly as a key distinguishing feature of ARFGEF2-related PVNH and underscores the importance of early genetic diagnosis to guide targeted surveillance for extra-CNS complications and multidisciplinary care. Full article

Background/Objectives: Congenital esophageal stenosis (CES) is a rare condition that may present with feeding difficulties in infancy, often becoming evident during weaning. We report a case of CES presenting with progressive dysphagia during the introduction of solid foods. Methods: Clinical evaluation, contrast esophagography, endoscopy, and magnetic resonance imaging were performed to characterize the stenosis and guide management. Results: Imaging revealed a fixed narrowing of the mid-distal esophagus with minimal passage of contrast and proximal dilatation. Endoscopy confirmed a non-traversable intrinsic stenosis with macroscopically normal mucosa. The patient underwent three endoscopic dilation sessions under general anesthesia using Savary-Gilliard bougies with progressive diameters (3–5 mm, 3–7 mm, and 7–11 mm). No major procedural complications occurred. At 2-month follow-up after the last dilation, feeding was appropriate for age, dysphagia had improved, and growth was regular. Conclusions: CES should be suspected in infants with feeding difficulties that worsen during weaning, particularly when symptoms are resistant to anti-reflux therapy. Endoscopic dilation can improve feeding tolerance, although repeated and staged sessions may be required. The role of adjunctive therapies such as topical budesonide remains uncertain. Full article

Many blockchain-based cyber threat intelligence (CTI) sharing systems emphasize immutability and auditability, but often treat CTI submissions as ordinary blockchain transactions without explicitly separating content validation from publication anchoring. This paper presents CTIB, a proof-of-concept hybrid Proof-of-Stake (PoS) and Proof-of-Work (PoW) framework for CTI publication. CTIB uses a sequential workflow in which a PoS committee first evaluates CTI submissions, and an accepted feed hash is then anchored through a PoW step to provide verifiable temporal binding. The prototype is evaluated in a controlled local Hardhat environment; therefore, the results should be interpreted as prototype-level feasibility evidence rather than production-scale deployment results. CTI content is represented using STIX 2.1, canonicalized, and hashed using SHA-256; only integrity-critical evidence is stored on-chain, while full CTI content remains off-chain. Experimental results demonstrate prototype-level feasibility, with measured throughput, latency, and success rate metrics under different PoW difficulty profiles. Across ten independent local runs, CTIB achieved an average throughput between 141.13 and 166.14 feeds/min, average p50 latency between 326.18 and 403.09 ms, and average p95 latency between 553.22 and 700.82 ms under the tested difficulty profiles. Security analysis uses analytical modeling, committee capture probability, and Monte Carlo simulation to evaluate majority-attack feasibility under stated assumptions. The results indicate that sequential compromise of both validation and anchoring layers increases the cost of coordinated manipulation. Full article

Speech-driven 3D cartoon facial animation remains underexplored due to the difficulty of handling heterogeneous geometries with exaggerated proportions, limited generalization to diverse unseen subjects, and the scarcity of datasets. To address these challenges, we propose Let Toon Talk, a two-stage cascaded framework that effectively mitigates these bottlenecks in both modeling and driving. It enables one-shot, speech-synchronized 3D animation from a single unseen humanoid cartoon image, driven by arbitrary audio. Specifically, for avatar modeling, we propose a parametric adaptation mechanism to capture diverse heterogeneous facial topologies, which subsequently guides a feed-forward reconstruction module to create high-quality 3D Gaussian Splatting (3DGS) avatars. Building upon this, for speech driving, we introduce an Identity-Adaptive Flow Matching network. This generative module effectively maps audio to precise facial dynamics, achieving identity-adaptive motion synthesis for diverse humanoid cartoon characters without per-subject pretraining. Furthermore, we construct a hybrid cartoon talking-face dataset with a systematic curation strategy to bridge the data gap. Extensive experiments demonstrate that our framework produces high-quality, temporally coherent animations, exhibiting effective generalization on unseen structurally humanoid cartoon characters. Full article

A homemade NiCr/NiSi thin-film thermocouple integrated with a PCBN turning tool was developed for real-time temperature monitoring during dry turning of AISI 1045 steel. The study addresses a practical limitation of existing cutting-temperature methods, namely the difficulty of combining local in situ sensing near the cutting edge with a transient thermal analysis framework that can interpret the measured signal under repeatable cutting conditions. The sensor was fabricated on an Al₂O₃ substrate by magnetron sputtering, protected by a SiO₂ layer, and tested at cutting speeds corresponding to spindle speeds of 1000, 1500 and 2000 rpm, with a cutting depth of 0.5 mm, a feed rate of 0.1 mm/rev and cutting times of 30–90 s. A three-dimensional transient heat-conduction model and inverse heat-flux reconstruction were then used to interpret the temperature history. The maximum measured temperature increased from 342 °C to 488 °C, and VB increased from 0.082 mm to 0.295 mm, showing a strong temperature–wear association within the investigated parameter window. Full article

This study reports a previously unreported heterozygous MYCN missense variant, c.454G>A (p.Ala152Thr), identified in a child and two affected relatives, with clinical findings consistent with Feingold syndrome type 1, an autosomal dominant developmental disorder most commonly caused by loss-of-function variants in MYCN. The proband presented with a cleft palate, craniofacial dysmorphism, feeding difficulties, hypotonia, and characteristic digital anomalies. Similar features were observed in the father and sibling. Clinical exome sequencing revealed the novel MYCN variant, which was confirmed by Sanger sequencing and demonstrated co-segregation with the phenotype. Although most pathogenic MYCN variants leading to FS1 truncate the protein, this missense change lies within the N-terminal transactivation domain, a region involved in transcriptional regulation and protein stability. The physicochemical alteration introduced at residue Ala152 may plausibly affect MYCN function, consistent with haploinsufficiency as the established disease mechanism. According to the 2024 ACGS Best Practice Guidelines, the variant was classified as a variant of uncertain significance leaning toward pathogenicity. This report expands the mutational spectrum of MYCN, supports the potential clinical relevance of N-terminal missense variation in MYCN, and highlights intrafamilial phenotypic variability in FS1. Full article

Background: Functional gastrointestinal disorders (FGIDs) are highly prevalent among infants. Exclusive breastfeeding has been consistently associated with better gastrointestinal health. However, current evidence regarding the associations between early feeding practices and infant gastrointestinal development remains limited. Objectives: To examine the associations between early feeding practices at 1 month of age and gastrointestinal symptoms and overall gastrointestinal burden in infants during the first 12 months of life. Methods: In this multicenter prospective cohort study, 669 healthy mother–infant pairs were finally included. According to feeding practices at 1 month of age, infants were categorized into three groups: exclusive direct breastfeeding (EDB, n = 236, 35.28%), bottle-fed expressed breastmilk (EBB, n = 150, 22.42%), and mixed feeding (MF, n = 283, 42.30%). Gastrointestinal (GI) symptoms were assessed using the Infant Gastrointestinal Symptom Questionnaire (IGSQ) and symptom items from the PedsQL™ Infant Scales. Generalized estimating equations (GEEs) were used to assess the associations. Results: Infants in the EDB group had the lowest incidence of GI symptoms and lower IGSQ scores throughout the follow-up period. Compared with EDB, the MF group showed higher IGSQ scores (β = 0.95, p = 0.002) and higher odds of constipation (OR = 1.64, p < 0.001), vomiting (OR = 1.70, p < 0.001), and swallowing difficulty (OR = 1.79, p = 0.002); these associations remained robust across multiple sensitivity analyses. The EBB group showed higher odds of certain symptoms in the main analysis, but sensitivity analyses (e.g., time-varying exposure) indicated that these associations were not robust, except for bloating (OR = 1.31, p = 0.042). Conclusions: The EDB is the optimal strategy for infant gastrointestinal health and should be prioritized. The MF is robustly associated with increased odds of constipation, vomiting, swallowing difficulty, and overall gastrointestinal burden. The EBB may slightly increase the odds of bloating, which can be mitigated by paced feeding and adequate burping. Full article

Background/Objectives: Survival after pediatric intensive care unit (PICU) admission has improved, yet many children experience post-intensive care syndrome in pediatrics (PICS-p), including persistent feeding difficulties that impair growth and quality of life. An intensive feeding program (IFP), also known as intensive interdisciplinary behavioral treatment (IIBT), reduces tube dependence and improves oral intake; however, outcomes in PICU survivors remain understudied. This study aimed to evaluate feeding outcomes in children with prior PICU admission who completed IIBT. Methods: This study was a retrospective case series of children (0–18 years) admitted to the HDVCH, Corewell Health, Grand Rapids, Michigan, who subsequently completed IIBT (from 2007 to 2024). Variables included demographics, PICU course (admission indication, complications, length of stay, ventilation, and nutrition status) and IIBT outcomes (feeding modality, oral skills, and malnutrition status). Feeding outcomes were compared pre- and post-IIBT. Results: Sixteen patients were included (62.5% female; mean age 1.44 ± 1.21 years). Primary PICU admission causes were post-operative recovery (68.8%) and acute respiratory failure (25%). PICU complications included acute respiratory failure (43.8%) and the need for respiratory support beyond baseline (62.5%). At PICU discharge, 75% remained tube-fed and 18.8% were malnourished. The mean time from PICU discharge to IIBT initiation was 641 ± 385 days. At IIBT baseline, 75% were tube-fed and all were non-self-feeders. Following IIBT completion (mean length of stay 4.8 ± 0.9 weeks), 58% of tube-fed patients achieved tube removal eligibility; 44% transitioned to partial or full self-feeding; problematic mealtime behaviors decreased (45.7% → 9.9%); oral acceptance improved (62% → 95%); and mouth clearance improved (59% → 96%). Malnutrition prevalence decreased (20% → 12%). Conclusions: Children with prior PICU admission demonstrated substantial feeding and behavioral improvement during IIBT participation, with over half achieving tube-weaning eligibility. The time from referral to program start reflects barriers that delay intervention. Full article

Background: Glutaric acidemia type 1 (GA1) is an autosomal recessive neurometabolic disorder caused by pathogenic variants in glutaryl-CoA dehydrogenase (GCDH), with variable clinical severity despite early biochemical detectability. Population-specific mutational spectra and genotype–phenotype correlations remain insufficiently defined in infantile-onset disease. Therefore, this study aimed to define the GCDH variant spectrum in GA1 patients with mild hepatopathy and assess genotype–phenotype correlations. Methods: We performed integrated clinical, biochemical, and molecular characterization of 15 unrelated patients with infantile-onset GA1. Whole-exome sequencing (WES) was performed for all participants, and the resulting data were compared with the reference sequence of the GCDH gene. Results: All patients presented within the first 6 months of life with macrocephaly, seizures, dystonia, and feeding difficulties. Neurological impairment and mild hepatopathy were variably observed, and one patient developed an acute encephalopathic crisis. Six homozygous GCDH variants were identified, predominantly missense. A common variant, c.541G>C (p.Glu181Gln), accounted for 73.3% of cases and defined a consistent phenotype of early macrocephaly and movement disorder with frequent mild hepatic involvement, suggesting regional enrichment and raising the possibility of a founder effect that warrants confirmation in future haplotype studies. A truncating variant, c.382C>T (p.Arg128Ter), was associated with severe early encephalopathy. Exon 6 represented a mutational hotspot. Biochemically, all patients showed elevated urinary glutaric and 3-hydroxyglutaric acids, increased glutarylcarnitine, and low-to-normal free carnitine, with higher metabolite levels in clinically more severe cases. All variants were pathogenic or likely pathogenic and extremely rare in population databases. Conclusions: This cohort reveals a striking predominance of the GCDH c.541G>C variant and establishes a clear biochemical signature with genotype-associated clinical patterns in infantile-onset GA1. These findings support a population-specific mutational spectrum, refine genotype–phenotype correlations, and underscore the importance of early molecular diagnosis to guide targeted neurological and hepatic monitoring as well as regional screening strategies. Full article

Addressing the persistent challenges of low resource utilization efficiency and the difficulty in quantifying hidden costs within the beef cattle sector, this study proposes an integrated diagnostic methodology that couples Material Flow Cost Accounting (MFCA) with Value Stream Mapping (VSM). Using a cohort of 1623 beef cattle finished in 2024 at the case study farm in Heilongjiang Province, China, the full life-cycle accounting reveals that hidden costs constitute 6.43% of total inputs. Attribution analysis further pinpoints two critical nodes: feed loss and bedding consumption, which account for 33.14% and 35.77% of negative product costs, respectively. Based on these diagnostics, two optimization strategies were devised: refined feed supply chain management and a recycled bedding system centered on the aerobic fermentation of cattle manure. Empirical estimates indicate that upgrading hardware facilities could reduce the feed loss rate to under 2%, yielding annual savings of ¥485,200. Furthermore, the bedding recycling system not only achieves zero waste discharge but also generates an average annual displacement income of ¥3.504 million, with an investment payback period of just 0.54 years. These findings demonstrate the efficacy of the coupled MFCA-VSM model in identifying environmental costs and unlocking economic potential, thereby providing an actionable pathway for the livestock industry’s transition toward more intensive and circular practices. Full article

Groundwater quantification is essential for sustainable water resources management, yet it is often hampered by limited data availability and difficulties in measuring spring discharges. This study investigates three carbonate aquifers in Central Italy’s Abruzzo region: the Genzana–Greco, Morrone, and Marsicano mountains. The aim is to resolve uncertainties in spring attribution, and groundwater flow patterns using isotopic analyses combined with field surveys. The Genzana–Greco aquifer was examined to clarify the sources of the Acquachiara spring and the previously unreported Germina spring, assessing whether recharge occurs locally or from the carbonate massif. In this case, the results indicate that the Germina, together with a similar known spring of Capolaia, share a common recharge sector, while the Acquachiara spring is mainly fed by higher-elevation carbonate areas, excluding significant contributions from local alluvial deposits. In the Morrone mountain aquifer, discharge gains along the Pescara River through the Gole di Popoli were quantified, and spring isotopic compositions were compared to the main basal spring Giardino to better define groundwater contributions. In this case study, the stable isotopes and tritium data confirm recharge from the central–southern massif and support the identification of basal springs and Pescara River gains as primary discharge points, with minimal influence from surface water. For the Marsicano mountain aquifer, the role of Lake Scanno in feeding the Villalago springs was investigated through isotopic analysis of inflows, downstream springs, and basal aquifer discharge points to constrain the hydrogeological water budget. The results highlight Lake Scanno’s role in the recharge of Villalago springs and delineate the Cavuto group as a major discharge system receiving inputs from central and northern sectors of the massif. Overall, the integration of isotopic tracers with hydrological measurements allowed a more precise characterization of aquifer recharge areas, Mean Residence Times, and groundwater flow paths, improving the understanding of regional water resources in a complex carbonate setting. Full article