Search Results (7,746)

Background/Objectives: Coupling mobile health (mHealth) technology with community-based nutrition programs may enhance diet quality in adolescents. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of integrating PortionSize Ed (PSEd), an image-assisted dietary assessment and education app, into the six-week Hawaiʻi Food and Lifeskills for Youth (HI-FLY) curriculum delivered via Supplemental Nutrition Assistance Program Education (SNAP-Ed). Methods: Adolescents (grades 6–8) from two classrooms were cluster-randomized into HI-FLY or HI-FLY + PSEd. Both groups received HI-FLY and completed Youth Questionnaires (YQ) and food records (written or app-based) at Weeks 0 and 7. Feasibility and acceptability were assessed via enrollment, attrition, and User Satisfaction Surveys (USS). Diet quality was measured using Healthy Eating Index-2020 (HEI-2020) scores and analyzed via mixed-effects models. Results: Of 50 students, 42 (84%) enrolled and attrition was minimal (2.4%). The sample was 49% female and 85% at least part Native Hawaiian or Pacific Islander (NHPI). PSEd was acceptable, with average USS scores above the scale midpoint. No significant HEI-2020 changes were observed, though YQ responses indicated improvements in sugary drink intake (p = 0.03) and use of nutrition labels in HI-FLY + PSEd (p = 0.0007). Conclusions: Integrating PSEd into SNAP-Ed was feasible, acceptable, and demonstrated potential healthy behavior change among predominantly NHPI youth in Hawaiʻi. Full article

Artificial intelligence (AI) is progressively being utilized in the healthcare sector to enhance efficiency, alleviate administrative burdens, and improve patient care outcomes. In the secondary healthcare sector, AI presents a range of opportunities as well as challenges. This study investigates the viewpoints of healthcare professionals regarding the adoption of AI in Greece, emphasizing the anticipated advantages and apprehensions associated with its integration. A cross-sectional descriptive study was carried out to collect responses from healthcare professionals at the General Hospital of “Evangelismos”, which is the largest hospital in Athens, Greece. A questionnaire was utilized and distributed over a period of four months, involving 513 registered healthcare professionals (comprising 136 physicians, 235 nursing staff, and 142 other healthcare personnel). Each participant had a minimum of one year of clinical experience and was selected using a convenience sampling method. The questionnaire comprised two parts: one focused on evaluating the AI knowledge and attitudes of healthcare professionals, and the other collected demographic data. The overall comprehension of knowledge pertaining to AI among healthcare professionals was evaluated as moderate, resulting in a mean score of 3.39. A distinction exists among different personnel categories, with physicians (M = 3.73) demonstrating a greater understanding of AI and a firm conviction that AI cannot supplant human positions. Conversely, nursing personnel appear to express apprehension regarding the implications of AI on the human experience, with a notable concern about potential replacement and job loss (M = 2.63), which was identified as the lowest-ranked issue. This latter concern is also echoed by other healthcare personnel (M = 2.90). Nevertheless, the majority of participants regard the prospective use of AI favorably, demonstrate confidence in its application, and contend that the benefits outweigh the possible risks. Sufficient training and ongoing updates would enhance employees’ comprehension of AI and their awareness of its potential benefits within the healthcare sector. Full article

Background: The acquisition of adaptive skills is critical for independence and participation in activities of daily living (ADL). While caregiver perceptions provide valuable insights, most studies on autistic participation have focused on older children and relied on one-time clinic-based assessments. As a result, little is known about how autistic toddlers function in their natural environments across time. Ecological momentary assessment (EMA) is a real-time, context-sensitive method in which parents can report behaviors at multiple time points in the child’s natural environment. This pilot study aimed to examine ADL independence in autistic toddlers compared to their typically developing (TD) peers, to assess the feasibility of using EMA in early childhood, and to compare EMA-based assessments with a one-time standardized report. Methods: 23 autistic toddlers and 28 TD toddlers (aged 18–40 months) participated in the study. Parents completed a one-time report on the self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure for Children (WeeFIM) and then rated their child’s independence on the WeeFIM twice a day for two weeks via their smartphones. Results: EMA was feasible with high response rates (ASD: 91.1%, TD: 88.55%). Autistic toddlers showed different participation profiles, with less independent performance in ADL compared to TD peers. In the autism group, the average EMA scores (M = 16.53, SD = 6.58) were significantly higher than the one-time WeeFIM scores (M = 13.74, SD = 5.23), t (22) = 3.23, p < 0.01, suggesting underreporting in single-time assessments. In contrast, no such difference was found in the TD group. Significant positive correlations were found between the EMA mean and the one-time WeeFIM scores in both groups (r > 0.80), indicating convergent validity. In the autism group only, greater variability in EMA was moderately associated with higher functional independence (r = 0.46, p < 0.01). Conclusions: These findings indicate that autistic toddlers demonstrated higher levels of participation in their natural environment than reflected by the one-time assessment, emphasizing the limitations of single-time-point evaluations. This underscores the importance of collecting data across multiple time points to accurately assess adaptive functioning and ADL participation. The EMA technique demonstrated in this study provides exploratory evidence of feasibility as an ecologically valid approach to assessing functional independence in autistic toddlers, offering a richer and more context-sensitive alternative to traditional one-time clinical assessments. Full article

Synthetic aperture radar (SAR) provides all-weather and all-day imaging capabilities and can penetrate clouds and fog, playing an important role in ship detection. However, small ships usually contain weak feature information in such images and are easily affected by noise, which makes detection challenging. In practical deployment, limited computing resources require lightweight models to improve real-time performance, yet achieving a lightweight design while maintaining high detection accuracy for small targets remains a key challenge in object detection. To address this issue, we propose a novel lightweight network for accurate small-ship recognition in SAR images, named S2M-Net. Specifically, the Space-to-Depth Convolution (SPD-Conv) module is introduced in the feature extraction stage to optimize convolutional structures, reducing computation and parameters while retaining rich feature information. The Mixed Local-Channel Attention (MLCA) module integrates local and channel attention mechanisms to enhance adaptation to complex backgrounds and improve small-target detection accuracy. The Multi-Scale Dilated Attention (MSDA) module employs multi-scale dilated convolutions to fuse features from different receptive fields, strengthening detection across ships of various sizes. The experimental results show that S2M-Net achieved mAP50 values of 0.989, 0.955, and 0.883 on the SSDD, HRSID, and SARDet-100k datasets, respectively. Compared with the baseline model, the F1 score increased by 1.13%, 2.71%, and 2.12%. Moreover, S2M-Net outperformed other state-of-the-art algorithms in FPS across all datasets, achieving a well-balanced trade-off between accuracy and efficiency. This work provides an effective solution for accurate ship detection in SAR images. Full article

Bullying is a global issue that is associated with negative life outcomes. Anti-bullying programs have been shown to be effective, but with heterogeneity across studies. Thus, we examined how sensory processing sensitivity (SPS)—a biologically based trait associated with Differential Susceptibility to environmental factors—moderates the effects of a school-based, anti-bullying program. Students (301 middle-school students, M age = 12 years) in the United States underwent a 4-week anti-bullying and competency-enhancing program. They also completed competency (e.g., social skills) and bullying prevention skills measures prior to (T1) and after the intervention (T2); and the Highly Sensitive Child Scale (measure of SPS). Results of multivariate analyses revealed that youth with higher SPS showed greater increases in decision-making, media resistance, social, and bullying prevention skills at T2. Consistent with theories of Differential Susceptibility and Environmental Sensitivity, results revealed that high SPS was associated with stronger responsivity to a psychoeducational intervention, as shown by increased cognitive, social, and behavioral domain scores. Findings from the present study underscore the moderating role of SPS on factors that impact human health and development. Full article

Background/Objectives: Stroke is a major cause of disability worldwide, with ischemic stroke being the most common type. This study investigated face perception in patients with lacunar strokes, specifically examining the ability to distinguish and recognize familiar and unfamiliar faces. Methods: We tested 52 patients with lacunar stroke (mean age = 65.97 ± 9.96) and 28 age-matched healthy controls (HC) (mean age = 66.24 ± 10.15). The participants received three face perception tasks: Name that Celebrity, Identity Sorting Task, and Face & Object Solitaire, and were also given the MMSE and mRS clinical assessments. Results: For the Name that Celebrity task, the stroke group had a lower efficiency score than the control group (i.e., they needed 2–3 extra slides of cues to recognize famous persons). For the Face Identity Sorting task, both groups were more accurate when sorting familiar faces; however, the stroke group performed significantly worse than the healthy group when sorting unfamiliar faces. For the Face/Object Solitaire task, the control group performed better than the stroke group on the face solitaire, but there were no differences in the object solitaire condition. Conclusions: Our findings suggest that despite having a normal mean MMSE score (HC: 28.22, Stroke: 27.96), patients with lacunar stroke had difficulties recognizing famous faces and discriminating among unfamiliar faces. This may reveal an overlooked deficit in face perception, highlighting the importance of future interventions that specifically focus on face recognition skills to enhance patients’ daily social interactions and the overall effectiveness of post-stroke rehabilitation programs. Full article

Remote sensing provides a viable alternative for understanding landscape modifications attributed to beaver activity. The central objective of this study is to integrate multi-source remote sensing observations in tandem with a deep learning (DL) (convolutional neural net or transformer) model to automatically map beaver-influenced floodplain inundations (BIFI) over large geographical extents. We trained, validated, and tested eleven different model configurations in three architectures using five ResNet and five B-Finetuned encoders. The training dataset consisted of >25,000 manually annotated aerial image tiles of BIFIs in Connecticut. The YOLOv8 architecture outperformed competing configurations and achieved an F1 score of 80.59% and pixel-based map accuracy of 98.95%. SegFormer and U-Net++’s highest-performing models had F1 scores of 68.98% and 78.86%, respectively. The YOLOv8l-seg model was deployed at a statewide scale based on 1 m resolution multi-temporal aerial imagery acquired from 1990 to 2019 under leaf-on and leaf-off conditions. Our results suggest a variety of inferences when comparing leaf-on and leaf-off conditions of the same year. The model exhibits limitations in identifying BIFIs in panchromatic imagery in occluded environments. Study findings demonstrate the potential of harnessing historical and modern aerial image datasets with state-of-the-art DL models to increase our understanding of beaver activity across space and time. Full article

Background/Objectives: Childhood obesity rates in Jordan have reached alarming levels, with 28% of school-age children classified as overweight or obese. School-based gardening interventions show promise for promoting healthy eating behaviors, yet limited research exists in Middle Eastern contexts. This study evaluated the effectiveness of a five-month school-based vegetable gardening and nutrition education intervention on anthropometric measures, dietary intake, and knowledge, attitudes, and practices (KAP) regarding vegetable consumption among Jordanian primary school children. Methods: A quasi-experimental controlled trial was conducted with 216 students (ages 10–12 years) from two demographically matched schools in Amman, Jordan. The intervention group (n = 121) participated in weekly one-hour gardening sessions combined with nutrition education and vegetable tasting activities over five months, while the control group (n = 95) continued the standard curriculum. Outcomes measured at baseline and post-intervention included anthropometric assessments, dietary intake via 24 h recalls, and vegetable-related KAP using a validated questionnaire. Data were analyzed using paired t-tests and repeated measures ANCOVA. Results: The intervention group demonstrated significant improvements in body composition, including reductions in BMI (−1.57 kg/m²), weight (−1.88 kg), and BMI z-score (−0.37), while controls showed minimal increases. Vegetable intake showed significant time × group interaction (p-value = 0.003), with a non-significant increase in the intervention group (2.7 to 2.9 times/day) and a non-significant decrease in the controls (2.5 to 2.4 times/day). Dietary quality improved, including increased fiber intake (+2.36 g/day) and reduced saturated fat consumption (−9.24 g/day). Nutrition knowledge scores increased substantially in the intervention group (+22.31 points) compared to controls (+1.75 points; p-value ≤ 0.001). However, attitudes and practices toward vegetable consumption showed no significant changes. Conclusions: This intervention effectively improved body composition, dietary quality, and nutrition knowledge among Jordanian primary school children. These findings provide evidence for implementing culturally adapted school gardening programs as childhood obesity prevention interventions in Middle Eastern settings, though future programs should incorporate family engagement strategies to enhance behavioral sustainability. Full article

Edible composite coatings represent an alternative approach to reducing postharvest losses and extending the shelf life of perishable fruits. This study developed a nano-biopolymer coating by integrating pullulan (PUL), nano-silica (Nano-SiO₂), and tea polyphenols (TP) to retard deterioration in cherry tomatoes (Solanum lycopersicum var. cerasiforme). Optimized through response surface methodology (0.06% Nano-SiO₂, 0.1% TP, 1.8% PUL, 0.77% glycerol), the resulting Nano-SiO₂/PUL/TP composite film showed improved barrier properties (water vapor permeability, WVP: 0.2063 g·mm·m⁻²·h⁻¹·kPa⁻¹) and increased mechanical strength (tensile strength, TS: 2.62 MPa; elongation at break, EB: 67.67%), which may be attributed to a homogeneous microstructure stabilized via intermolecular hydrogen bonding. The composite coating exhibited significant (p < 0.05) antioxidant activity (59.04% DPPH·scavenging) compared to the PUL film (1.17%) and showed efficacy against S. aureus. When applied to cherry tomatoes stored at 4 °C for 15 days, the coating contributed to improved postharvest quality by reducing weight loss (−27.6%) and decay incidence (−32.3%), delaying firmness loss (2.40 vs. 0.54 N in uncoated group, CK), suppressing respiration rate (−38.8%), and enhancing the retention of total acidity (+9.7%), vitamin C (+49.6%), and total soluble solids (+48.6%) compared to the CK (p < 0.05). Principal component analysis supported sensory evaluation results, indicating the coating helped maintain sensory quality (scores > 6.0) and commercial value while extending shelf life from 9 to 15 days. These results suggest that the Nano-SiO₂/TP/PUL composite coating may serve as a preservative for extending the shelf-life of cherry tomatoes by effectively reducing decay and mitigating quality degradation. Full article

Aim: The rationale for combining various extracorporeal blood purification techniques to improve patient outcomes is currently being discussed extensively. The combined use of CytoSorb^®, with high capacity for cytokine removal, and Oxiris^®, which adsorbs endotoxins and smaller cytokines, may enhance the efficacy of blood purification in sepsis. Study Design: Retrospective analysis of efficacy and safety of simultaneous use of CytoSorb^® and Oxiris^® in 12 consecutive critically ill patients with COVID-19, who developed secondary bacterial sepsis and persistent hemodynamic instability. Results: Most of the patients (n = 8) treated with combination of the Oxiris^® and CytoSorb^® had a significant decrease in vasopressor requirement. Pre- and post-haemoadsorption data were analysed in 9 patients, who completed a 24 h course of treatment. A significant decrease in mean SOFA score (16.3 ± 1.7 to 15.0 ± 2.0 points), median vasopressor requirement (0.56 ± 0.29 to 0.11 ± 0.21 µg/kg/min), median procalcitonin levels (6.5 ± 27.0 to 1.6 ± 6.0 ng/mL), median IL-6 levels (584 ± 6279 to 107 ± 571 pg/mL), and mean leucocyte count (36.0 ± 20.6 to 20.9 ± 10.1 × 10³/mL) was observed. Furthermore, there was significant increase in PaO₂/FiO₂ ratio (108 ± 30 to 185 ± 55). We did not observe any device-associated adverse events or technical problems. A 27.5% drop in platelet count (269 ± 116 to 195 ± 82 × 10⁶/mL) and an 11.8% drop in haemoglobin level (10.7 ± 2.9 to 9.5 ± 2.0 g/dL) was noted. Conclusions: Our data suggests that combined use of Oxiris^® and CytoSorb^® for simultaneous cytokine and endotoxin removal in patients with underlying viral infection may be a promising therapeutic option. Our findings may serve as a guide for future research and provide directions for further development in this field. Full article

Background: Chimeric antigen receptor (CAR) T-cell therapy has revolutionized treatment of relapsed/refractory large B-cell lymphoma (LBCL), but its administration is often complicated by cytokine release syndrome (CRS). Interleukin-6 (IL-6) is widely used to monitor CRS, though its clinical value diminishes after tocilizumab administration. We aimed to evaluate serum amyloid A (SAA), a dynamic acute-phase reactant, as a treatment-independent biomarker of inflammation and toxicity in CAR-T recipients. Methods: This retrospective study included 43 adults with LBCL treated with axicabtagene ciloleucel. SAA and other inflammatory markers were assessed from lymphodepletion through day +11 post-infusion. CRS and ICANS were graded per ASTCT criteria. Statistical analyses included Mann–Whitney U tests, Spearman’s correlation, and ROC curve analysis to evaluate predictive performance. Results: SAA levels peaked at day +4 and normalized by day +11, displaying wave-like kinetics. Levels were significantly higher in patients with any-grade CRS at early timepoints but showed no association with ICANS. SAA correlated strongly with CRP, suPAR, sST2, fibrinogen, ferritin, procalcitonin, and IL-6. Compared to IL-6, SAA was more predictive of CRS at day +2 and +4, and unaffected by tocilizumab. Baseline SAA also correlated with the mEASIX score, suggesting linkage to endothelial stress. Non-responders at 3-month PET had higher baseline SAA than responders (196.0 vs. 17.7 mg/L, p = 0.036), with ROC analysis yielding an AUC of 0.74 and an optimal threshold of 79.8 mg/L. Conclusions: SAA is a robust and dynamic marker of systemic inflammation, with potential utility in both toxicity monitoring and response prediction in the CAR-T setting. Its independence from IL-6 modulation positions it as a promising biomarker for future integration into clinical algorithms. Full article

Background: Adolescents with obesity participate in self-directed weight loss attempts, and these may be associated with disordered eating. This study aimed to understand prior engagement with a dietitian and previous dieting practices of adolescents presenting for obesity treatment. Additionally, we aimed to understand the association between prior dieting and eating disorder risk, binge eating, weight bias internalisation and body image. Methods: This cross-sectional study included 141 adolescents (median [IQR] age: 14.8 [13.8–15.7] years) with BMI 35.28 (31.99–38.57) kg/m² and ≥1 related complication presenting for a prescriptive dietary intervention. Adolescents were asked whether they had previously seen a dietitian (yes/no) and/or previously trialled any other diets for weight management. Associations between reported diets and the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale, the Weight Bias Internalisation scale and Body Appreciation Scale scores were assessed using multiple one-way ANOVAs. Results: A total of 68 (48.2%) adolescents had previously seen a dietitian and 106 (75.2%) had trialled at least one diet. Most adolescents had used one diet type (n = 74; 52.5%), and 29 (20.6%) had used two or three different diets. Most adolescents reported following a healthy eating pattern (n = 76; 53.9%), with 11 trying a low-carbohydrate diet (7.8%) or a specific eating plan, e.g., low sugar, vegetarian (n = 11; 7.8%). There were no associations between dieting attempts and scores of measures of disordered eating, weight bias or body appreciation. Conclusions: Many adolescents presenting for obesity treatment will have trialled diets, with or without the support of a dietitian. Clinicians providing nutrition education and prescribing dietary interventions should be aware of this and the potential influence on adolescent perceptions of dieting practices. Full article

Reperfusion therapy uses thrombolysis and clot removal to restore blood flow in the brain after stroke; however, three months after reperfusion therapy, roughly 46% of stroke patients become independent again. MiRNAs (micro RNA) regulate cerebral ischemia/reperfusion injury, and their transfer between cells via exosomes may differentially affect recipient cells. We examined serum exosomal miRNA levels, stroke treatments, and functional outcomes in stroke patients, and we explored the potential role of estimated differentially expressed miRNA (DEmiRNA) target genes in the brain’s reaction to reperfusion after ischemia. The patients in the study received aspirin or reperfusion therapy with either intravenous thrombolysis (rt-PA), mechanical thrombectomy (MT), or a combination of both (rt-PA/MT). Serum samples were collected from stroke patients on days 1 and 10 post-stroke. Serum exosomes’ miRNA was analyzed using qRT-PCR. We identified DEmiRNAs, estimated their targets, and performed enrichment analysis. Functional outcomes were assessed using the modified Rankin Scale (mRS) on days 10 and 90 post-stroke. Among studied treatments, only rt-PA/MT lowered DEmiRNA by day 10 vs. other groups. Specifically, patients with unfavorable mRS score exhibited decreased levels of miR-17, miR-20, miR-186 and miR-222 after combined stroke therapy. Functional analysis identified target genes and pathways associated with cytoskeleton remodeling, cell death, autophagy, inflammation, and dementia. In conclusion, unfavorable stroke outcomes following poor rt-PA/MT response could result from lower miRNA expression levels, thus activating cell death and neurodegenerative processes in brain. Full article

Objective: Vitamin D deficiency (VDD) is common in pregnancy and may affect lipid metabolism. The underlying mechanisms are multifactorial, but most evidence so far comes from non-pregnant populations. This study aims to identify metabolites and metabolic patterns associated with VDD in early pregnancy and to evaluate their relationships with maternal lipid profiles. Methods: A nested case–control research was carried out in the Zhoushan Pregnant Women Cohort (ZPWC). Cases were defined as women with VDD (25(OH)D < 20 ng/mL), and controls (≥20 ng/mL) were matched 1:1 using propensity scores based on age, pre-pregnancy BMI, gestational week, and calendar year at blood sampling. The untargeted metabolomics of first-trimester maternal plasma were measured. Metabolic profiles were analyzed using partial least squares-discriminant analysis (PLS-DA). Principal component analysis (PCA) was applied to visualize group separation, and metabolite set enrichment analysis (MSEA) was performed to reveal biologically relevant metabolic patterns. Associations between VDD-related metabolite components in early pregnancy and lipid levels in mid-pregnancy were assessed using linear regression models. Results: 44 cases and 44 controls were selected for the study. There were 60 metabolites identified as being connected to VDD. Among these, 26 metabolites, primarily glycerophospholipids and fatty acyls, exhibited decreased levels in the VDD group. In contrast, 34 metabolites showed increased levels, mainly comprising benzene derivatives, carboxylic acids, and organooxygen compounds. PCA based on these metabolites explained 52.8% of the total variance (R²X = 0.528) across the first six principal components (PC1: 16.4%, PC2: 10.6%, PC3: 9.2%, PC4: 6.3%, PC5: 5.7%, PC6: 4.6%). PC2, dominated by lineolic acids and derivatives, was negatively associated with total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) (all p < 0.01). PC3, dominated by glycerophosphocholines, was negatively associated with TC, TG, and high-density lipoprotein cholesterol (HDL-C) (all p < 0.05). MSEA revealed significant enrichment of the pantothenate and CoA biosynthesis pathway after multiple testing correction (FDR < 0.05). Conclusions: This study reveals distinct metabolic alterations linked to VDD and suggests potential mechanisms underlying its association with maternal lipid metabolism in early pregnancy. Full article

This study examines whether audit quality enhances the value relevance of earnings and book value of equity in explaining market prices of common shares in Thailand’s emerging market. Using data from 401 non-financial firms listed on the Stock Exchange of Thailand between 2021 and 2023, we analyze 1203 firm-year observations collected from Bloomberg and company annual reports. Multiple regression results show that earnings per share (EPS), book value per share (BVPS), and audit quality measures are significantly associated with share prices. Audit quality is proxied by audit firm size, audit fees, and financial statement irregularities (Beneish M-score). Big 4 auditors increase the relevance of book value, while higher audit fees strengthen the earnings–price relationship. Conversely, firms with higher M-scores, signaling potential earnings manipulation, display weakened associations between accounting metrics and share value. These findings highlight audit quality’s role in reducing information asymmetry, reinforcing investor trust, and supporting market efficiency in a post-crisis environment. By integrating audit quality into the Ohlson valuation framework, this study contributes to the literature on audit assurance and capital market behavior in emerging economies, offering insights for investors, regulators, and managers regarding the credibility of financial reporting. Full article