Search Results (835)

Agriculture remains one of the most hazardous industries in the United States, yet nonfatal surveillance remains incomplete. Prior studies have shown that trauma registries can support agricultural injury surveillance, but many approaches rely on text review, state-specific indicators, or coding frameworks that are not easily transferable across systems. In this study, Florida Trauma Registry records from 2016 to 2021 were screened using a reproducible case definition based on International Classification of Diseases, Tenth Revision (ICD-10) external cause of injury codes, registry occupation and industry fields, and the work-related indicator. Agricultural injuries were summarized descriptively and mapped to Occupational Injury and Illness Classification System (OIICS) categories. Injury severity scores (ISS) were modeled using generalized additive models (GAMs). The case definition identified 963 agricultural injuries requiring trauma care, including 17 fatalities. Most injuries were minor, and the leading event categories were contact incidents, falls, slips, and trips, and transportation incidents. Body region was the strongest correlate of severity, with head and abdomen/pelvic contents injuries showing the highest adjusted ISS. These findings suggest that the National Trauma Data Standard (NTDS)-aligned trauma registry fields may support reproducible agricultural injury surveillance when narrative text is unavailable. Full article

This research focuses on the creation and implementation of a digital Decision Support System for building inspections at the Bureau of Fire Protection (BFP) in Romblon, Romblon. For a long period, the agency has relied on traditional, paper-heavy workflows, leading to operational bottlenecks that necessitate modernization. This project re-imagines BFP operations by introducing a web-based framework to handle building permit and certificate applications digitally. The paper outlines the technical parameters, data structures, and configurations used to capture inspection details essential for generating official reports and Fire Safety Inspection Certificates (FSICs). Key findings highlight the success of contactless licensing procedures and the automated generation of corrective actions based on the Revised Implementing Rules and Regulations of the Philippine Fire Code (RA 9514). Evaluation via the ISO 25010:2011 metric yielded a weighted mean of 4.41, signifying a “very satisfactory” performance level for the system within the Romblon BFP office. Full article

Background: Artificial intelligence (AI) is increasingly entering hospital practice through diagnostic, predictive, workflow, operational, and generative applications. Hospitals often govern these systems as procurement or information-technology projects rather than as clinical–organizational interventions requiring indication, evaluation, monitoring, accountability, and withdrawal. Objective: To refine the concept of an “AI Hospital Formulary” as an operational, proportional, and accountable framework for the safe, equitable, and sustainable adoption of hospital AI. Design and Methods: This is a perspective article using a structured, non-systematic narrative synthesis and conceptual framework development. Targeted literature and policy sources were identified through purposive searches and citation chaining through 20 July 2026. The synthesis compares the formulary with existing oversight approaches, maps its lifecycle gates to regulatory and risk management duties, and applies the framework to a worked example based on published evaluations of the Epic Sepsis Model. The EQUATOR reporting-guideline selection tool was consulted, and SANRA was used to strengthen the narrative synthesis component. Framework: The revised framework combines a hospital-wide AI register, a standardized formulary monograph, six lifecycle gates, proportional review pathways, governance-of-governance safeguards, cloud and data-sovereignty controls, continuous monitoring of technical and behavioral feedback loops, and explicit renewal or deprescribing criteria. The worked example shows how version-specific evidence can lead to local validation, controlled implementation, restriction, suspension, or renewal rather than automatic adoption. Conclusions: Hospitals should not merely purchase, install, and update AI systems. They should prescribe, monitor, audit, renew, restrict, and, when necessary, deprescribe them. The AI Hospital Formulary is proposed as a complementary institutional layer that converts external standards and existing governance approaches into documented portfolio decisions at the hospital level. Full article

Theories on the early steps of the HIV-1 life cycle have been radically revised over the past five years. The long-held assumption that the capsid fully disassembles in the cytoplasm has given way to a more nuanced view: Cytoplasmic disassembly does occur and, in several myeloid systems, is increasingly linked to cytosolic cDNA sensing and to abortive infection. However, a substantial fraction of intact or nearly intact capsid cores instead traverse the nuclear pore complex (NPC) and, upon interacting with the host factor CPSF6, induce liquid–liquid phase separation. This leads to the formation of biomolecular condensates, termed HIV-1 membraneless organelles (HIV-1-MLOs), which subsequently merge with nuclear speckles (NSs). In this Perspective we read these condensates along five interlocking axes. First, the virus drives the host phase separation of cleavage and polyadenylation specificity factor 6 (CPSF6), which quickly fuses with another MLO: the NS composed of the speckle scaffold factors, SON and SRRM2. Second, the resulting condensate behaves as a catalytic site that concentrates the reverse-transcription machinery and thereby promotes integration of the viral DNA into speckle-associated chromatin (SPADs). Third, the same compartment is the final layer of a stratified programme of innate immune evasion, shielding nascent double-stranded DNA from cGAS–STING after cytoplasmic restriction factors and sensors have been outmanoeuvred. Fourth, although demonstrated only in vitro, stable HIV-1-MLOs can maintain the viral RNA genome in the presence of a reverse-transcription inhibitor. Upon removal of the inhibitor, reverse transcription resumes, mirroring, to some extent, the situation in individuals undergoing interruption of antiretroviral therapy and suggesting that these structures may act as a pre-integration reservoir. Fifth, and still largely unexplored, the sanctuary has a pharmacological dimension: anatomical lymphoid compartments, and possibly the condensate itself through selective small-molecule partitioning, may limit antiretroviral drug access. We situate HIV-1-MLOs within the convergent condensate strategies of SARS-CoV-2 and other viruses, and we discuss the clinical, diagnostic, therapeutic, and vaccine implications, including capsid inhibitors as “block-and-expose” tools. Full article

A 56-year-old patient was initially diagnosed with aseptic loosening of a left acetabular prosthesis based on ⁶⁸Ga-FAPI. Half a year after revision, this patient developed right hip pain and a subsequent ⁶⁸Ga-FAPI was performed revealing increased tracer uptake in the right hip, leading to a diagnosis of synovitis-induced osteoarthritis. This case highlights the utility of ⁶⁸Ga-FAPI-PET/CT in visualizing synovial activity and underscores the potential role of synovitis in the pathogenesis of osteoarthritis. Full article

Background/Objectives: Asymmetric acetabular liners used in Total Hip Arthroplasty (THA) are clinically successful in reducing revision associated with dislocation. The performance of an asymmetric liner is dependent on its positioning, although few studies have directly investigated the effects of variables such as cup orientation or extended rim position on outcomes such as impingement. Therefore, the aim of this study was to compare the incidence of impingement in THA with a standard and lipped liner. Methods: A THA was virtually implanted into a previously developed geometric model. Acetabular cups were placed in a range of clinically relevant orientations, and the model was moved through seven joint motions associated with dislocation-prone Activities of Daily Living (ADLs). The occurrence of implant–implant, implant–bone, and bone–bone impingement was assessed for the standard and lipped constructs across a total of 6,237 unique combinations of cup orientation and lipped liner apex rotations. Results/Conclusions: The model predicted that with both standard and lipped constructs, there were no component placement positions which avoided impingement for all ADLs. The number of impingement incidents was minimised when components were positioned at the higher end of the manufacturer’s recommendations for cup inclination and anteversion. The use of a lipped liner increased the frequency of impingement events compared with the standard construct. However, for anterior impingement leading to posterior dislocation, this increase may be minimised by rotating the lip apex to a posterior-inferior position. Anterior lip apex placement tended to minimise the increase in the less critical posterior impingement. Full article

Background/Objectives: Children with congenital long QT syndrome (cLQTS) are at extremely high risk of torsades de pointes (TdP) and sudden cardiac death (SCD). Although the implantable cardioverter-defibrillator (ICD) is a cornerstone in SCD prevention, traditional transvenous ICDs are associated with venous access occupation, lead wear or fracture due to somatic growth, and difficulties with long-term lead revision or extraction. The extravascular ICD, which places the lead in the substernal extravascular space, has the potential to circumvent these lead-related complications. We report the experience of successful extravascular ICD implantation in a young child with drug-refractory cLQTS type 2 (cLQTS2). Methods: The clinical data of a 9-year-old boy with cLQTS2 were retrospectively analyzed. The patient carried a heterozygous KCNH2 variant (c.1810G>A, p.Gly604Ser) and had been on long-term oral propranolol and mexiletine. He presented with a cardiac arrest out of hospital during nocturnal sleep, was transferred to our hospital after successful cardiopulmonary resuscitation, and had TdP captured on ambulatory monitoring. Following multidisciplinary discussion, preoperative chest computed tomography (CT) assessment of the substernal anatomy, and informed consent, extravascular ICD implantation was performed on hospital day 11. The procedure involved the creation of a substernal tunnel via a subxiphoid incision, placement of the defibrillation lead in the anterior mediastinum with lead slack reserved for growth, and positioning of the pulse generator in a left axillary subcutaneous pocket. Intraoperative defibrillation testing succeeded with a single 30 J shock. Results: The postoperative recovery was uneventful without procedure-related complications. At the 2-month follow-up, device parameters were satisfactory and no inappropriate shocks had occurred. The corrected QT interval (QTc) decreased from 563 ms on admission to 522 ms. Ambulatory monitoring detected asymptomatic episodes of non-sustained ventricular tachycardia, but no ventricular fibrillation or syncope was observed. Venous access was fully preserved. Conclusions: In children with drug-refractory cLQTS2, the extravascular ICD provides defibrillation and antitachycardia pacing (ATP) while avoiding transvenous lead complications and preserving venous access. This case shows that with precise preoperative planning and lead redundancy, the device appears feasible and can be implanted without short-term complications in young children. Larger studies with longer follow-up are needed to evaluate long-term device performance. Full article

Introduction: Posterior cervical fusion is commonly performed for cervical spine instability and fractures. However, dural injury may result in cerebrospinal fluid leakage, pseudomeningocele, and, rarely, hydrocephalus. These complications may lead to substantial neurological deterioration and functional decline. We report a rare case of severe cognitive impairment and dysphagia caused by postoperative CSF leakage-associated hydrocephalus after C1–2 fusion and highlight the role of comprehensive rehabilitation in functional recovery. Case presentation: A 67-year-old woman sustained a type III odontoid fracture and was initially managed with halo-vest immobilization. Because of fracture nonunion, posterior C1–2 fusion was performed. One month after surgery, she developed progressive mental status deterioration, confusion, and severe functional impairment. Brain computed tomography revealed progressive hydrocephalus, and cervical spine magnetic resonance imaging demonstrated a large posterior fluid collection consistent with pseudomeningocele. Revision surgery and ventriculoperitoneal shunt placement were performed. However, the patient remained bedridden with persistent vomiting, severe cognitive impairment, dysphagia requiring nasogastric tube feeding, and generalized deconditioning. Three months after revision surgery, her neurological condition stabilized and rehabilitation was initiated. Intensive and individualized rehabilitation, including cognitive rehabilitation, swallowing therapy was implemented. After three months of rehabilitation, the patient demonstrated gradual improvement in cognitive function, swallowing function, and mobility, ultimately achieving independent standing and ambulation using a walker. Conclusions: Postoperative CSF leakage-associated hydrocephalus and pseudomeningocele may lead to severe cognitive, swallowing, and functional impairments beyond structural complications alone. Comprehensive, individualized rehabilitation should be considered an essential component of care to maximize neurological and functional recovery. Full article

Background/Objectives: Suboptimal dietary patterns are among the leading modifiable contributors to global morbidity and mortality, particularly in cardiovascular disease, type 2 diabetes mellitus (T2DM), obesity, metabolic syndrome, and hypertension. Digital nutrition platforms have emerged to improve adherence to evidence-based dietary strategies; however, many systems lack structured optimization, processing-aware nutrient profiling, and explainable artificial intelligence (AI) mechanisms. The integration of large language models (LLMs) into digital health introduces conversational personalization but also risks hallucination and unsafe outputs without constraint enforcement. This study aimed to describe the system development, architecture, database infrastructure, optimization algorithms, explainability enforcement, and digital health implications of NutriSteppe-AI, a chatbot-first LLM-driven system for personalized health menu generation constrained by deterministic nutrient logic and processing-aware scoring. Methods: NutriSteppe-AI integrates: (1) a multi-source structured nutrient database of 20,000 food products with up to 130 tracked nutrients; (2) energy requirement estimation using the revised Harris-Benedict equation; (3) linear programming-based multi-objective optimization; (4) a Healthy Food Index (HFI; 0.5–5.0 scale) incorporating NOVA processing classification penalties; (5) traffic-light nutrient gating; and (6) a constrained LLM orchestration layer governed by structured API contracts. Algorithmic validation was performed using 10,000 simulated user profiles spanning diverse age, anthropometric, activity, dietary exclusion, and budget parameters. Results: The system achieved 96.8% full constraint satisfaction with macronutrient mean absolute errors of 11.60% (energy), 18.86% (protein), 16.26% (fat), and 20.91% (carbohydrates). Incorporating NOVA processing penalties reduced ultra-processed food HFI scores by 0.73 points (p < 0.001). Median optimized menu HFI improved from 3.6 to 4.3. Median system latency was 1.8 s. Explainability validation confirmed 100% deterministic alignment with zero hallucinated numeric claims. Conclusions: NutriSteppe-AI demonstrates that LLM-driven nutrition chatbots can achieve deterministic, explainable, and clinically aligned performance when governed by structured optimization, processing-aware scoring, and explainability enforcement. This architecture provides scalable digital health infrastructure for cardiometabolic disease prevention in diverse populations. Full article

Over 30,000 hip hemiarthroplasty (HA) operations are performed every year across England and Wales to treat fractured necks of the femur. HA reduces surgical and recovery time with lower complication rates; however, it may cause acetabular deterioration, which can lead to revision surgery and possible conversion to total hip arthroplasty (THA). This study assessed hip hemiarthroplasty under gait-representative loading in an anatomical hip simulator. Paired natural acetabula were tested against a CoCr femoral head with radial clearance (RC) of −0.75 mm (head larger than natural) and positive RCs of <0.6 mm (small), 2 mm–4 mm (large), and >4 mm (extra-large). Cartilage surface deterioration was quantified via photogrammetry. Cartilage surface changes were observed in all hemiarthroplasty groups, while no changes were observed in the control group. No statistically significant between-groups in the affected area were detected (Kruskal–Wallis, p > 0.29). The negative RC group showed statistically significant progressive worsening over time (Friedman: (χ²(2) = 8.00, p = 0.018). Groups differed in damage onset, location, intensity, and presence of delamination. Samples with negative RC (oversized head) produce earlier and progressive cartilage changes. The results highlight the importance of carefully measuring the native head diameter and choosing a femoral head size when performing HA. Full article

Background/Objectives: Spinal cord injury (SCI) frequently leads to impaired respiratory function and increased pneumonia risk due to reduced respiratory muscle strength, altered thoracic compliance, autonomic dysregulation, and diaphragm displacement. This guideline aims to ensure appropriate, high-quality, and quality-assured care for individuals requiring respiratory support. Methods: This work represents a consensus-based S2k guideline developed by the “BeAtmung” working group of the German-speaking Medical Society for Paraplegiology (DMGP), in collaboration with experts from Germany and Switzerland, and endorsed by eight professional societies. Development followed the German Association of the Scientific Medical Societies (AWMF) guidance manual. Topics were defined in editorial meetings, supported by targeted literature searches and existing guidelines. Drafts were revised regularly with written feedback and final approval was granted after a consensus conference on 18 January 2022. Results: The guideline includes 11 specific recommendations addressing ventilation, monitoring, care structures, and discharge planning. Recommendations were graded using a three-level scheme (“need,” “should,” and “can be considered”) and consensus strength was classified as strong (>95%), consensus (>75–95%), majority (>50–75%), or no consensus (<50%). These recommendations support clinical decision-making and promote standardised, high-quality respiratory care for people with SCI. Conclusions: This guideline provides consensus-based recommendations for the comprehensive respiratory management of individuals with acute and chronic SCI, integrating diagnostic, therapeutic, and long-term care strategies to support high-quality, coordinated care across settings and healthcare systems. Full article

The security of new energy vehicle (NEV) industry chains has become a strategic issue for industrial competitiveness, the energy transition, and economic security. This study examines how digital economy capabilities jointly support NEV industry chain security across 30 provincial-level administrative regions in China. Drawing on Organizational Information Processing Theory and Dynamic Capability Theory, we conceptualize artificial intelligence capability (AIC), big data analytics capability (BDA), cloud computing infrastructure (CCI), and blockchain application level (BCL) as complementary information-processing and reconfiguration capabilities. We combine Necessary Condition Analysis (NCA), fuzzy-set Qualitative Comparative Analysis (fsQCA), and Random Forest/SHAP analysis. The revised results show that AIC is a practically necessary condition for supply chain resilience, BDA is a necessary condition for achieving a high cybersecurity level, and BCL is a dimension-specific necessary condition for data security. Four sufficient configurational paths—technology-driven, data-driven, infrastructure-driven, and security-synergistic—lead to high comprehensive NEV industry chain security. Robustness checks using alternative calibration anchors and consistency thresholds show that the core configurations are stable. A revised machine learning specification using only digital economy predictors confirms the high relative importance of AIC. It also shows that the marginal contribution of AIC tends to flatten beyond the upper-middle range. The findings provide a configurational and regionally differentiated perspective on digital economy empowerment while avoiding overgeneralization beyond the Chinese provincial context. Full article

Background: In older adults, multimorbidity and polypharmacy complicate medication regimens and often lead to poor adherence. Mobile health (mHealth) has been suggested as a solution to enhance medication adherence in chronic conditions. Despite the increase in smartphone usage among people aged 65 and over, there is still a lack of evidence of mHealth in this age group. Objectives: To evaluate the impact of mHealth interventions on medication adherence in older adults (≥65 years) with chronic diseases, compared with standard care or other interventions. Methods: The review was conducted in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews. Randomized controlled trials published from 2000 onwards were considered with no linguistic or geographical restrictions. The databases searched included PubMed, Scopus, Cochrane Library, and CINAHL. Methodological quality was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. Results: 551 records were initially identified, from which 8 randomized controlled trials published between 2014 and 2025 were included. Six of eight studies showed that medication adherence in mHealth groups was significantly higher than in controls. However, one study found benefits only in specific drug classes rather than a general improvement. Conclusions: The results of this review suggest that mHealth has the potential to improve medication adherence among older adults with chronic diseases, especially when interventions go beyond simple reminders and incorporate educational and relational components. Nevertheless, higher quality studies with larger samples and longer follow-up are needed to clarify mHealth’s role in the care of this population. Full article

Background: Developmental dysplasia of the hip (DDH) is one of the leading causes of secondary hip osteoarthritis and frequently results in severe anatomical alterations that make total hip arthroplasty (THA) technically demanding. Restoration of hip biomechanics, limb length, and joint stability remains challenging, particularly in patients with moderate-to-severe dysplasia. Objective: To evaluate the clinical and radiographic outcomes of cementless total hip arthroplasty combined with soft-tissue balancing, with or without acetabular reconstruction using autologous femoral head graft, in patients affected by osteoarthritis secondary to DDH. Methods: A retrospective single-center case series was conducted on eight female patients (mean age 53.9 ± 14.6 years; range 33–80 years) who underwent primary cementless THA for DDH-related osteoarthritis between 2019 and 2025. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Radiographic evaluation included implant positioning, osteolysis, heterotopic ossification, bone graft incorporation, and leg-length discrepancy. Data normality was assessed using the Shapiro–Wilk test. Preoperative and postoperative outcomes were compared using paired Student’s t-test and confirmed with the Wilcoxon signed-rank test. Implant survival and revision-free status were recorded throughout the follow-up period. Results: At a minimum follow-up of 12 months (range 12 months–6 years), significant improvements were observed in all clinical outcome measures. Mean HHS increased from 49.3 ± 2.5 preoperatively to 90.4 ± 2.7 postoperatively (p < 0.001), while mean WOMAC decreased from 53.5 ± 5.6 to 7.4 ± 3.3 (p < 0.001). Mean SF-36 improved from 47.2 ± 3.8 to 89.9 ± 3.2 (p < 0.001). Wilcoxon analysis confirmed the statistical significance of these findings (all p = 0.0078). Radiographic assessment demonstrated satisfactory implant positioning and stable fixation in all patients, with no evidence of osteolysis or implant loosening. Minor complications included one intraoperative periprosthetic femoral fracture treated successfully with cerclage wiring, two cases of Brooker grade I–II heterotopic ossification, and one case of minimal graft resorption without clinical consequences. No revision procedures were recorded during follow-up, and implant survival was 100%. Conclusions: Cementless THA combined with selective soft-tissue balancing provides excellent clinical, functional, and radiographic outcomes in patients with osteoarthritis secondary to DDH. This approach significantly improves hip function and quality of life while ensuring stable implant fixation, low complication rates, and excellent mid-term implant survival. Full article

Background: Radiculopathy originating from a previously fused lumbar segment is a clinically relevant but often underrecognized problem. Progressive foraminal stenosis may develop due to postoperative structural changes, leading to mechanical irritation of the exiting nerve root. Transforaminal endoscopic lumbar foraminotomy (TELF) is a minimally invasive option, but its role in this setting is not well defined. Methods: In this retrospective cohort study, we included 36 consecutive patients who underwent TELF for symptomatic foraminal stenosis at a previously fused segment between 2020 and 2023. Clinical outcomes were assessed using the visual analog scale (VAS) for leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria, with follow-up of up to 2 years. Radiographic and intraoperative findings were reviewed to explore the underlying mechanisms. Results: The mean VAS score improved significantly from 8.36 preoperatively to 2.00 at 2 years, and the mean ODI decreased from 70.9% to 16.8%. According to the modified MacNab criteria, 86.1% of the patients achieved excellent or good outcomes. Intraoperative findings revealed fibrotic or hypertrophic foraminal stenosis in 86.1% patients (n = 31), whereas 13.9% of patients (n = 5) showed pedicle screw-related nerve root irritation. Five patients experienced transient postoperative dysesthesia, and no postoperative instability was observed. Conclusions: Radiculopathy at the fused segment is primarily caused by progressive mechanical foraminal compromise after fusion. TELF provides effective symptom relief through direct decompression and may serve as a less invasive alternative to revision fusion in selected patients. Full article