Search Results (7,968)

Background: Spinal cord injury (SCI) is associated with persistent motor impairment, neuropathic pain, and reduced quality of life. While spinal cord stimulation (SCS) is an established therapy for neuropathic pain, motor effects have largely been demonstrated in experimental settings with activity-based training protocols. Whether such effects can be achieved within routine clinical care remains unclear. Case Presentation: We report on motor effects after the clinical implementation of percutaneous SCS using a commercially available system in a patient with chronic, posttraumatic, incomplete thoracic SCI. Following a standard inpatient trial and implantation of two percutaneous leads for neuropathic pain, all subsequent management, programming, and rehabilitation were conducted in an outpatient setting. Task-specific stimulation programs were iteratively developed to support functional activities during routine rehabilitation. Lower-extremity muscle strength was assessed using standardized handheld dynamometry at baseline and at monthly intervals over six months under stimulation-ON and stimulation-OFF conditions. Results: Serial dynamometry showed early stimulation-associated increases in force generation, with higher values under stimulation-ON than stimulation-OFF conditions. Over time, absolute strength values under OFF conditions also increased across individual muscle measurements, while stimulation-associated ON–OFF differences became less pronounced during intermediate follow-up but remained evident at month six. These observations included both acute stimulation-associated differences in force generation and longitudinal improvements in OFF-state motor performance. Stimulation was well tolerated during daily use and successfully integrated into outpatient rehabilitation. Functional outcomes showed concordant improvements in ambulatory performance and patient-reported domains. No stimulation-related adverse effects were observed during follow-up. Conclusions: This case illustrates how clinically indicated percutaneous SCS can be combined with motor-oriented programming within routine outpatient rehabilitation. The observed stimulation-associated motor effects and longitudinal changes in stimulation-OFF strength are limited to this individual patient and cannot establish efficacy or causality. Prospective controlled studies are needed to determine the reproducibility and clinical relevance of these observations in chronic incomplete SCI. Full article

Tropical perennial systems in Southeast Asia, including oil palm, rubber, and cocoa, are established on highly weathered soils under monsoonal climates that differ fundamentally from temperate systems for which most soil health frameworks were developed. Growing certification, environmental, social, and governance (ESG) reporting, and regenerative agriculture requirements demand demonstrable soil health outcomes, yet the diagnostic infrastructure needed to generate and verify such outcomes remains limited. Existing approaches rely on episodic, indicator-based assessment that captures static conditions rather than functional state, applying benchmarks from dissimilar agroecological contexts with limited basis for resolving system readiness, biological constraint, or functional trajectory. This creates a persistent diagnostic gap between measurement and decision-making, disproportionately affecting smallholders required to meet compliance frameworks calibrated for fundamentally different systems. This critical review synthesizes literature on conventional soil testing, indicator-based frameworks, monitoring programs, and biological diagnostics to identify the structural origins of this gap. Soil health surveillance is identified as a review-derived diagnostic logic, i.e., longitudinal, function-oriented, and crop-calibrated, integrative across chemical, physical, and biological dimensions, and tiered from field-level screening to longitudinal datasets supporting monitoring, reporting, and verification (MRV) reporting. Empirical calibration, context-specific threshold development, and longitudinal validation at the individual system scale are identified as research priorities for operationalizing governance-ready soil health assessment in tropical perennial agriculture. Full article

Background: Lipoprotein(a) [Lp(a)] is a genetically determined, pro-atherogenic lipoprotein enriched in oxidized phospholipids and increasingly recognized as a key potential contributor to residual cardiovascular and inflammatory risk. However, data on its distribution and cardiometabolic associations in Middle Eastern populations remain limited. This study aimed to evaluate the prevalence of elevated Lp(a) and its association with type 2 diabetes (T2D), systemic inflammation, and ethnic variation in a multiethnic cohort. Methods: In this cross-sectional study, data from 2083 adults aged ≥ 18 years residing in Kuwait were collected through the Kuwait Diabetes Epidemiology Program (KDEP) at Dasman Diabetes Institute between 2011 and 2014 using random sampling. Plasma Lp(a) concentrations, cardiometabolic parameters, and high-sensitivity C-reactive protein (CRP) were measured. Elevated Lp(a) was defined as ≥ 50 mg/dL according to established clinical guidelines. Associations of elevated Lp(a) with T2D and CRP were assessed using multivariable Poisson regression models to estimate adjusted prevalence ratios. Results: The overall prevalence of elevated Lp(a) was 41.2%, exceeding global estimates. Significant ethnic variation was observed, with Arabs exhibiting the highest prevalence. After adjustment for potential confounders, individuals with T2D had a higher prevalence of elevated Lp(a) (APR = 1.166) and diabetes status significantly modified the association between CRP and elevated Lp(a) interaction (APR = 1.015), thus supporting a link between Lp(a) and systemic inflammation. Conclusions: Elevated Lp(a) was highly prevalent in this multiethnic Middle Eastern population and was independently associated with T2D and systemic inflammation. These findings support the emerging concept that Lp(a) may function as a molecular-inflammatory mediator potentially contributing to residual cardiovascular risk and highlight the importance of incorporating Lp(a) assessment into cardiometabolic risk stratification, particularly in high-risk populations. Full article

Background/Objectives: Acomys cahirinus exhibits more favorable cardiac remodeling after ischemic injury than Mus musculus, yet the molecular organization of the intact myocardium remains poorly characterized. This study aimed to identify baseline interspecies differences in the adult left ventricle, with particular emphasis on ventricular cardiomyocyte transcriptional states. Methods: Intact left ventricles from adult male A. cahirinus and M. musculus were analyzed by single-nucleus RNA sequencing using three biological samples per species. Cross-species integration was followed by cell type annotation, pseudobulk differential expression analysis, Augur-based assessment of interspecies separability, coexpression module analysis, and focused reintegration analysis of ventricular cardiomyocytes. Cardiomyocyte profiles were further compared with published embryonic and early postnatal M. musculus heart datasets. Results: Both species contained comparable major myocardial cell populations, whereas marked interspecies transcriptional differences persisted within individual cell types. Ventricular cardiomyocytes exhibited the largest number of differentially expressed genes and were classified into three transcriptional states: contractile, matrix-associated, and alternative. Adult A. cahirinus cardiomyocytes retained a mature cardiomyocyte phenotype but showed greater enrichment of developmental, morphogenetic, and Hippo-associated gene programs than adult M. musculus cardiomyocytes. Their transcriptional profile did not correspond to embryonic or early postnatal mouse states. The integrated atlas further identified interspecies differences in fibroblast-associated and extracellular matrix-related programs. Conclusions: The intact myocardium of A. cahirinus exhibits cell type-specific transcriptional differences relative to M. musculus. Ventricular cardiomyocytes display a distinct mature transcriptional configuration rather than a direct immature state, which may contribute to the favorable response of A. cahirinus to myocardial injury. Full article

The Solvency II regulatory framework (Directive 2009/138/EC) defines the Solvency Capital Requirement (Solvency Capital Requirement, SCR) using a value-at-risk (VaR) approach, with a confidence level of 99.5% and a one-year time horizon. This structure makes regulatory capital extremely sensitive to the characteristics of the right tail of the loss distribution and, consequently, to the effectiveness of risk transfer mechanisms. This study analyzes the impact of the five main types of reinsurance contracts quota share, surplus, quota–surplus, excess-of-loss (XoL), and stop-loss on the transformation of the net loss distribution and the resulting dynamics of the SCR. The empirical analysis is based on a computational experiment using real data from a ten-year insurance portfolio covering the period 2016–2025. The results show that the use of reinsurance leads to a reduction in the total capital requirement in the range of 18.4–23.4% on an annual basis, with the effect exhibiting an approximately linear relationship with the size of the cession quota. The stratified comparative analysis conducted identifies significant differences in the effectiveness of individual contract structures with regard to the reduction of tail risk. In particular, XoL contracts demonstrate the strongest effect on the extreme quantiles of the loss distribution, with a reduction reaching −52.5% at the 99.5% VaR level and −68.6% at the 99.9% VaR level. In contrast, quota-share contracts result in a practically proportional scaling of risk, characterized by a symmetric reduction of approximately −40% across all confidence levels. The results further show that multi-tiered reinsurance programs combining quota share, excess, catastrophe XoL, and stop-loss components provide the highest degree of capital relief, reaching 48.8%, which indicates the presence of significant nonlinear diversification and complementarity effects among the individual risk transfer mechanisms. A waterfall decomposition is applied to identify the main factors determining the difference between the standard formula and the internal model. The analysis finds that the dominant drivers of the observed capital relief are the effect of precise risk calibration (on average −8.3%) and the effect of diversification (−4.7%). These results underscore the importance of adequately modeling the interdependencies among risk modules and the limitations of standardized regulatory parameterizations. In addition, a “wrong-way risk” stress scenario is developed, involving the simultaneous occurrence of a catastrophic risk and the insolvency of two key reinsurers. Under this scenario, the effectiveness of risk transfer is reduced to −27.3%, and the solvency ratio falls below the minimum capital requirement (12.5%). This result empirically confirms the cautious regulatory stance of the European Insurance and Occupational Pensions Authority regarding the limited recognition of capital reliefs that do not demonstrate resilience under extreme stress conditions. This study provides a quantitatively grounded framework for optimizing reinsurance programs under the Solvency II regime. The main conclusion is that capital efficiency is not a function of a single “optimal” reinsurance contract, but rather results from the strategic combination of various reinsurance mechanisms capable of simultaneously reducing tail risk, improving diversification, and limiting vulnerability to systemic stress events. Full article

This paper presents the first comprehensive review of radon concentration measurements conducted in educational institutions in the Republic of Serbia. The analysis includes data from the national radon survey conducted in 2019, long-term measurements performed within the national radioactivity monitoring program during the period 2011–2024, a local investigation carried out in the city of Šabac, and other available studies conducted throughout Serbia using different measurement methods (CR-39 detectors, activated charcoal canisters, and continuous radon monitors). During the 2011–2024 period, a total of 303 measurements were performed in kindergartens, primary schools, secondary schools, and universities across seven Serbian cities, while 4133 CR-39 detectors were collected during the 2019 national survey. The survey achieved high coverage of primary schools (87%) and kindergartens (76%), whereas the coverage of secondary schools was only 20%. Measured radon concentrations ranged from minimum values of 5–30 Bq/m³, with average concentrations between 60 and 150 Bq/m³ in most buildings, to a maximum of 2970 Bq/m³ recorded in a primary school. A significant proportion of the indoor radon concentration measurements exceeded the WHO reference level of 100 Bq/m³ (approximately 40%), while a smaller proportion also exceeded the threshold of 300 Bq/m³. The observed spatial variability could be associated with differences in geological conditions, building type, construction materials, and ventilation characteristics. On average, the estimated contribution of indoor radon exposure during occupancy of schools and kindergartens was below 1 mSv/y for children and educational staff. The critical analysis highlights insufficient coverage of certain regions and types of educational institutions, methodological differences among individual studies, and the need for a more rational approach to radon measurement and risk management. The findings indicate the need to move from fragmented and repeated measurements toward an integrated, risk-oriented national strategy based on mass screening, active public involvement, and targeted long-term measurements. Short-term measurements could be used for the initial screening of a large number of buildings, while buildings with elevated radon concentrations would be prioritized for confirmatory long-term measurements and mitigation measures, with the potential use of simple and IoT-based devices for large-scale data collection. Such an approach could provide a practical basis for the further development and implementation of the National Radon Action Plan in Serbia, with the aim of reducing individual and collective risks associated with radon exposure. Full article

Agentic artificial intelligence (AI) systems—software that plans, acts, and decides without step-by-step human approval—are already deployed in finance, healthcare, recruitment, and public services. They differ from earlier AI in one critical way. They do not produce outputs for a human to accept or reject. They take actions. Those actions may be irreversible. They may affect people who never used the system. Existing governance frameworks were not designed for this. Current alignment approaches—including reinforcement learning from human feedback, constitutional AI, and preference aggregation—assume that a well-aligned system satisfies what users ask for. This paper argues that the assumption fails in agentic contexts. What people ask for is not what they value. Preferences are volatile and user-centric. Values are stable, culturally grounded, and other-regarding. This paper proposes the Human Values Alignment Framework for Agentic AI (HVAF-A), grounded in Schwartz’s cross-culturally validated Basic Human Values theory. The framework connects value inputs, three alignment mechanisms (elicitation, arbitration, and propagation), and governance outcomes at individual, organizational, and societal levels. The paper positions the HVAF-A against the main international policy instruments—the EU AI Act, the NIST AI Risk Management Framework, ISO/IEC 42001, and the OECD and UNESCO principles—and specifies an empirical program of constructs, measures, validity tests, and study designs. An illustrative case study of an agentic hiring system shows how the framework would operate. This is a purely conceptual study. No study was conducted and no instrument was administered to validate the model. A dedicated section states the framework’s boundary conditions. Empirical validation is set out as future research. Full article

The increasing penetration of photovoltaic (PV) generation in industrial parks creates challenges associated with renewable-energy accommodation due to temporal mismatches between PV output and electricity demand. Electric vehicle (EV) fleets with coordinated charging and discharging capabilities provide potential flexibility for mitigating PV curtailment and improving local energy utilization. This paper proposes a hierarchical multiobjective rolling-horizon vehicle-to-grid (V2G) control framework for EV fleets in industrial parks. First, an individual EV model is developed by considering charging/discharging modes, travel requirements, V2G willingness, and acceptable departure state-of-charge (SOC) shortfall. Based on the uncontrolled-charging baseline, pointwise fleet flexibility limits are evaluated by considering SOC constraints and departure-energy recoverability. Second, a lexicographic three-level mixed-integer linear programming (MILP) model is established to prioritize PV accommodation, followed by purchased-energy cost and user-related operating costs. The proposed optimization is implemented through a causal rolling-horizon strategy, where updated measurements and forecast information are used to revise future schedules without accessing future realized PV outputs. Case studies on a representative industrial-park system show that the causal rolling-horizon strategy increases PV utilization from 90.50% to 93.89% and reduces total operating cost by approximately 13.0% compared with the static day-ahead schedule under the tested PV deviation scenario. Furthermore, 20 paired trials with a fixed fleet composition and regenerated EV-state and PV-error realizations show consistent system-level gains, accompanied by higher user compensation and battery use. The multi-scenario comparison further shows that the proposed hierarchical rolling-horizon V2G configuration achieves 99.26% PV utilization and lower total operating cost than uncontrolled charging and unidirectional smart-charging (V1G) operation. The results indicate that the proposed framework can effectively coordinate EV-fleet flexibility and hierarchical objectives for PV accommodation in industrial parks. Full article

Mangroves support a diverse insect fauna that plays essential roles in ecosystem functioning; however, the diversity of bark and ambrosia beetles (Curculionidae: Scolytinae) in the mangroves of the Mexican Pacific remains poorly understood. This study aimed to characterize the diversity and community structure of Scolytinae associated with two mangrove ecosystems in the state of Colima, western Mexico: Palo Verde Estuary and Juluapan Lagoon. Beetles were sampled using ethanol-baited traps (70% ethanol). A total of 1869 individuals belonging to 19 species and 10 genera were collected. Hypothenemus was the most species-rich genus, whereas Xyleborus volvulus was the dominant species. Five species are reported for the first time in Colima: Ambrosiodmus obliquus, Corthylus comatus, Premnobius cavipennis, Hypothenemus dolosus, and Hypothenemus indigens. Palo Verde Estuary showed higher beetle abundance, whereas Juluapan Lagoon exhibited greater species diversity and community evenness. Although the community shared several genera with mangrove ecosystems from other regions of Mexico and Brazil, it differed in species composition and dominance patterns. This study provides the first baseline on the Scolytinae fauna associated with the mangroves of Colima and establishes a reference for future ecological monitoring and phytosanitary surveillance programs. Full article

Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy characterized by chronic anemia, recurrent pain episodes, and multi-organ complications, which collectively impact patients’ quality of life and functional capacity. Exercise and physical activity are recognized as essential components of general health and well-being; however, their role in individuals with SCD remains underexplored due to concerns regarding safety, tolerance, and the potential to precipitate vaso-occlusive crises. This study aimed to assess the patterns and frequency of exercise and physical activity among patients with sickle cell disease using a validated questionnaire. Methods: We conducted a cross-sectional study on patients diagnosed with sickle cell disease at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. After obtaining ethical approval, we contacted the patients by phone or met them in person and administered the Global Physical Activity Questionnaire (GPAQ). Data on age, gender, comorbid conditions, disease-related variables, and weekly physical activity were collected. Total physical activity was expressed in metabolic equivalent of task (MET)-minutes per week, and participants achieving ≥600 MET-minutes per week were classified as meeting the World Health Organization (WHO) recommendation. Results: Of the 97 patients, males represented 52.6% of the participants, with a median age of 33 years. Overall, 70.1% of the patients were on hydroxyurea, and 14.4% had undergone splenectomy. More than half of the patients (56.7%) reported difficulties with exercise. According to the findings, 39% of the patients were getting enough physical activity each week, as recommended by the WHO. Male patients were significantly more likely to meet the WHO physical activity recommendation (p = 0.003), whereas no statistically significant associations were observed for age, nationality, body mass index, hemoglobin level, hydroxyurea use, splenectomy, hospital admissions, transfusion history, comorbidities, or exercise-related symptoms (all p > 0.05). Conclusions: Our data suggest that a significant proportion of patients with SCD did not achieve the WHO-recommended physical activity level, with adherence observed in only about forty percent of participants, and that adherence was more common in male patients (adjusted odds ratio 3.30, 95% CI 1.36–8.52, after multivariable adjustment for age, body mass index, hemoglobin, and transfusion status). This association was concentrated in occupational rather than recreational activity and was not explained by the clinical variables measured. Because no comparison group was studied, the extent to which this shortfall is attributable to SCD itself, rather than to the population-level inactivity already documented in Saudi Arabia, cannot be determined from these data. These findings identify a potential area for targeted intervention, particularly among women, and underscore the need for further research into disease-specific and sociocultural barriers before tailored programs can be developed. Further larger, controlled, multi-center studies are necessary to clarify the specific contribution of SCD to inactivity and to guide individualized physical activity promotion in this population. Full article

This pilot study examined a cascading coaching model to train graduate student clinicians and caregivers to use adapted Naturalistic Developmental Behavioral Intervention (NDBI) techniques with autistic preschoolers who use echolalia. Adaptations were designed to incorporate children’s echolalic speech within intervention activities and support changes in spoken language. Strategies emphasized responding to, expanding upon, and creating opportunities around children’s verbal productions during play. Two clinician–caregiver–child triads participated. Effects were evaluated using multiple-probe designs across adult participants and intervention contexts. Across four weeks, adults increased their use of targeted NDBI skills, including elicitation techniques (e.g., creating opportunities, wait time, prompting) and response techniques (responsive actions and language models), with moderate to very large effects. Child participants also demonstrated increases in targeted spoken-language communication responses across intervention contexts, with the strongest effects observed during student clinician-led interactions and more variable outcomes during caregiver-led interactions. Visual analysis indicated functional relations for most adult and child outcomes, although individual differences and variability were observed across participants. Findings provide preliminary evidence regarding the feasibility of incorporating echolalia-responsive adaptations within NDBI-based coaching programs for autistic children who use echolalia and their caregivers. Full article

The Southeast Asian deletion (--^SEA), the most prevalent α⁰-thalassemia mutation in Southeast Asia, is a major target of regional thalassemia prevention programs. Coinheritance of α⁰-thalassemia with other hemoglobinopathies, particularly hemoglobin E (Hb E), complicates routine hematological screening and requires reliable molecular confirmation. This study developed and validated a duplex nanoplate digital polymerase chain reaction (dPCR) assay for simultaneous identification of the wild-type α-globin and --^SEA deletion alleles in a single reaction. The assay was established on the QIAcuity nanoplate platform and evaluated using 171 blinded leftover DNA specimens from individuals with Hb E. Diagnostic performance was compared with conventional gap-PCR. Distinct fluorescence amplitude patterns enabled discrimination among normal, heterozygous, and homozygous --^SEA genotypes in a single closed tube. Among the 171 specimens, 70 were identified as --^SEA carriers and 101 as non-carriers, showing 100% concordance with gap-PCR. All subjects with Hb E + A₂ levels ≥ 25% were negative for the --^SEA deletion, whereas 56.0% of those with levels < 25% carried the deletion. In the representative prenatal case, duplex dPCR accurately identified parental carrier status and a homozygous --^SEA fetus. This assay provides an accurate and practical molecular confirmatory assay for thalassemia screening and prenatal diagnosis in Southeast Asia. Full article

With the increasing power of institutional investors, in order to compete for more investment agency business, the competition among institutional investors has become increasingly fierce. This paper studies a non-zero-sum game between two competing institutional investors who adopt mean–variance preferences and account for model uncertainty in order to derive robust optimal portfolios. The ambiguity-averse institutional investors can invest in a financial market with one risk-free bond and one individual stock. The objective of each institutional investor is to maximize the mean–variance utility of his terminal wealth relative to that of his competitor under the worst-case scenario of the alternative measures. By means of stochastic dynamic programming, we obtain closed-form expressions for the robust Nash equilibrium strategies and prove a verification theorem. Numerical simulations are finally presented to examine how model parameters influence the equilibrium strategies and to extract associated economic interpretations. Full article

Background/Objectives: Nurses may support offense-related self-reflection through practices that extend beyond formal group programs and dedicated offense-focused interviews; however, the scope of such support remains unclear. In this study, we described the range of nursing practices that nurses in Japanese forensic psychiatric inpatient settings perceived as supporting offense-related self-reflection beyond these formal interventions. Methods: A qualitative descriptive study was conducted using individual semi-structured interviews with 13 nurses from six hospitals between May and November 2025. Japanese-language transcripts were analyzed using inductive qualitative content analysis. Meaning units were coded and iteratively organized into subcategories and categories. Credibility and dependability were strengthened through co-researcher review, reflexive discussion, audit trail, and peer debriefing. Results: Five categories and 15 subcategories were identified: (1) examining offenses, victim impact, and responsibility; (2) clinical and relational readiness for self-reflection; (3) applying reflective insights to recidivism-prevention actions; (4) extending reflective learning into post-discharge life planning; and (5) integrating offense-related understanding into inpatient–community care planning. Conclusions: The categories describe functions that participants attributed to nursing practices surrounding formal interventions; therefore, they should not be interpreted as validated components of self-reflection or as evidence of effectiveness. The findings provide an initial, context-specific framework to guide nursing assessment, care planning, education, and further conceptual and empirical research that includes patients and community providers. Full article

Background/Objectives: The brachial plexus is a complex network of nerves responsible for the sensory and motor functions of the upper limbs. While extensively studied, the typical configuration taught only sometimes matches what is found in individuals, as numerous variations have been documented. These variations can have significant clinical and surgical implications. This study explored the prevalence and types of brachial plexus variations in donor bodies from the Midwestern United States. Methods: Using bodies donated through the Gift of Body Donation program at A.T. Still University’s Kirksville College of Osteopathic Medicine, the brachial plexuses of 32 donors were analyzed. Results: Among the 64 plexuses examined, 33 (52%) had a typical M-shaped median nerve formation without additional variations, 18 (28%) had a typical M-shaped formation with additional variations, 6 (9%) had an abnormal M without other variations, and 7 (11%) had an abnormal M with other variations. Thus, 31 plexuses (48%) showed atypical branching patterns. The most common variations were extra communicating branches, observed in 17 (55%) of the 31 variant plexuses. These branches were most often found between the medial and lateral cords (13/17, 76%) and between the musculocutaneous and median nerves (4/17, 24%). Other, less common variations included variant nerves, small branches, and rejoining nerves. Conclusions: This study highlights the significant prevalence of variations in the brachial plexus, which may impact clinical and surgical practices. Further research is needed to fully understand the implications of these variations, especially in procedures like nerve blocks and reconstructive surgeries. Full article