Search Results (56,132)

Despite extensive research on early childhood education (ECE) quality at the preschool level, toddler settings remain comparatively understudied, particularly in Chile and Latin America. Research suggests that quality ECE strengthens child development, while low-quality services can be harmful. ECE quality comprises structural features like ratios and classroom resources, and process features related to interactions within classrooms. This study examines how process and structural quality indicators are related in nurseries serving disadvantaged backgrounds. Data were collected from 51 Chilean urban classrooms serving children aged 12–24 months. Classrooms were evaluated using the Classroom Assessment Scoring System (CLASS) for toddlers, questionnaires, and checklists. Latent Profile Analysis identified process quality patterns, while multinomial regression examined associations with structural quality indicators. The results revealed low-to-moderate process quality across classrooms (M = 4.78 for Emotional and Behavioral Support; M = 2.35 for Engaged Support for Learning), with three distinct quality clusters emerging. Marginally significant differences were found between high- and low-performing clusters regarding classroom space (p = 0.06), number of toys (p = 0.08), and staff educational credentials (p = 0.01–0.07). No significant differences emerged for group sizes or adult-to-child ratios, which are heavily regulated in Chile. These findings underscore the need to strengthen quality assurance mechanisms ensuring all children access quality ECE. Full article

Hodgkin’s Lymphoma (HL) affects approximately 8500 individuals annually in the United States. The 5-year relative survival rate has improved to 88.5%, driven by transformative advances in immunotherapy and precision oncology. The integration of Brentuximab vedotin (BV) and immune checkpoint inhibitors (ICIs) has redefined treatment paradigms. The phase III SWOG S1826 trial established nivolumab plus doxorubicin, vinblastine, and dacarbazine (N + AVD) as an emerging new standard for advanced-stage HL, achieving a 2-year progression-free survival (PFS) of 92% compared to 83% for BV plus AVD (HR 0.48, 95% CI: 0.33–0.70), with superior safety, particularly in patients over 60. In relapsed/refractory HL, pembrolizumab outperforms BV, with a median PFS of 13.2 versus 8.3 months (HR 0.65, 95% CI: 0.48–0.88), as demonstrated in the KEYNOTE-204 trial. Emerging strategies, including novel ICI combinations, minimal residual disease (MRD) monitoring via circulating tumor DNA (ctDNA), and artificial intelligence (AI)-driven diagnostics, promise to further personalize therapy. This review synthesizes HL’s epidemiology, pathogenesis, diagnostic innovations, and therapeutic advances, highlighting the role of precision medicine in addressing unmet needs and disparities in HL care. Full article

Background/Objective: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting adverse effect of various chemotherapeutic agents. Previous work demonstrated that cannabis alleviates symptoms of oxaliplatin-induced CIPN. To evaluate the effects of cannabis components, cannabidiol (CBD) and tetrahydrocannabinol (THC), on CIPN-related symptoms. Methods: We reviewed a patient-reported outcomes dataset from “Tikun Olam,” a major medical cannabis provider. Of 1493 patients, 802 reported at least one CIPN symptom at baseline, including a burning sensation, cold sensation, paresthesia (prickling) and numbness, and 751 of them met the study inclusion criteria. Patients were categorized into THC-high/CBD-low and CBD-high/THC-low groups. Symptom changes after six months of cannabis use were analyzed using K-means clustering and logistic regression, incorporating interactions between baseline symptoms and THC and CBD doses. Linear regression assessed changes in activities of daily living (ADL) and quality of life (QOL). Results: Both groups reported symptom improvement. The THC-high group showed significantly greater improvement in burning sensation and cold sensation (p = 0.024 and p = 0.008). Improvements in ADL and QOL were also significantly higher in the THC group (p = 0.029 and p = 0.006). A significant interaction between THC and CBD was observed for symptom improvement (p < 0.0001). Conclusion: Cannabis effectively reduces CIPN symptoms and improves QOL and ADL. Higher THC doses were more effective than lower doses, with combined CBD and THC doses yielding greater symptom relief. Full article

This study was conducted to investigate the effects of puffed jujube powder (PJP) supplementation in the diet on the slaughter characteristics, growth performance, meat quality, and serum antioxidant capacity of Hainan Black (HB) goats. Twenty-four healthy male HB goats, three months old with an initial body weight of 15.12 ± 3.67 kg, were randomly divided into three groups: the 10% PJP group (basal diet plus 10% PJP); the 20% PJP group (basal diet plus 20% PJP); and the control group (basal diet only). After a 10-day adaptation period, a feeding trial was carried out for 90 days in an ad libitum diet environment. The results show that the final body weight of the 20% PJP group was markedly higher (p < 0.05) than that of the control group (22.58 ± 0.94 kg vs. 20.45 ± 1.01 kg). The average daily gain of the 20% PJP group was 83.44 ± 1.78 g/d, which was substantially greater (p < 0.05) than the 59.22 ± 2.13 g/d of the control group. The feed intake of the 20% PJP group was 713.10 ± 4.54 g/d, notably higher (p < 0.05) than the 498.20 ± 4.33 g/d of the control group. In terms of slaughter characteristics, the carcass weight of the 20% PJP group was 13.99 ± 1.22 kg, considerably heavier (p < 0.05) than the 11.79 ± 1.38 kg of the control group. The muscle weight of the 20% PJP group was 11.43 ± 1.42 kg, distinctly greater (p < 0.05) than the 9.59 ± 1.99 kg of the control group. The slaughter rate of the 20% PJP group was 42.41%, showing a notable increase (p < 0.05) compared with the 37.42% of the control group, and the net meat rate of the 20% PJP group was 34.65%, with a significant rise (p < 0.05) compared with the 30.43% of the control group. Regarding serum antioxidant capacity and meat quality, the activities of serum antioxidant enzymes, superoxide dismutase (SOD) and catalase (CAT), were conspicuously increased (p < 0.05) in the 20% PJP group. The meat shear force of the 20% PJP group was decreased by 12.9%, and the cooking loss was improved by 8.9% in comparison with the control group. In conclusion, the supplementation of 20% PJP in the diet was demonstrated to enhance the growth performance, improve the meat quality, and boost the antioxidant status of HB goats, thus presenting a feasible strategy for optimizing tropical goat production systems. Full article

Under the current context of the large-scale integration of wind and solar power, the coupling of hydropower with wind and solar energy brings significant impacts on grid stability. To fully leverage the regulatory capacity of hydropower, this paper develops a multi-objective optimization scheduling model for hydropower, wind, and solar that balances generation-side power generation benefit and grid-side peak-regulation requirements, with the latter quantified by the mean square error of the residual load. To efficiently solve this model, Latin hypercube initialization, hybrid distance framework, and adaptive mutation mechanism are introduced into the Strength Pareto Evolutionary Algorithm II (SPEAII), yielding an improved algorithm named LHS-Mutate Strength Pareto Evolutionary Algorithm II (LMSPEAII). Its efficiency is validated on benchmark test functions and a reservoir model. Typical extreme scenarios—months with strong wind and solar in the dry season and months with weak wind and solar in the flood season—are selected to derive scheduling strategies and to further verify the effectiveness of the proposed model and algorithm. Finally, K-medoids clustering is applied to the Pareto front solutions; from the perspective of representative solutions, this reveals the evolutionary trends of different objective trade-off schemes and overall distribution characteristics, providing deeper insight into the solution set’s distribution features. Full article

In the original randomised Dietary Intervention to Stop Coronary Atherosclerosis (DISCO-CT) trial, a 12-month Dietary Approaches to Stop Hypertension (DASH) project led by dietitians improved cardiovascular and metabolic risk factors and reduced platelet chemokine levels in patients with coronary artery disease (CAD). It is unclear whether these benefits are sustained. Objective: To determine whether the metabolic, inflammatory, and clinical benefits achieved during the DISCO-CT trial are sustained six years after the structured intervention ended. Methods: Ninety-seven adults with non-obstructive CAD confirmed in coronary computed tomography angiography were randomly assigned to receive optimal medical therapy (control group, n = 41) or the same therapy combined with intensive DASH counselling (DASH group, n = 43). After 301 ± 22 weeks, 84 individuals (87%) who had given consent underwent reassessment of body composition, meal frequency assessment, and biochemical testing (lipids, hs-CRP, CXCL4, RANTES and homocysteine). Major adverse cardiovascular events (MACE) were assessed. Results: During the intervention, the DASH group lost an average of 3.6 ± 4.2 kg and reduced their total body fat by an average of 4.2 ± 4.8 kg, compared to an average loss of 1.1 ± 2.9 kg and a reduction in total body fat of 0.3 ± 4.1 kg in the control group (both p < 0.01). Six years later, most of the lost body weight and fat tissue had been regained, and there was a sharp increase in visceral fat area in both groups (p < 0.0001). CXCL4 decreased by 4.3 ± 3.0 ng/mL during the intervention and remained lower than baseline values; in contrast, in the control group, it initially increased and then decreased (p < 0.001 between groups). LDL cholesterol and hs-CRP levels returned to baseline in both groups but remained below baseline in the DASH group. There was one case of MACE in the DASH group, compared with four cases (including one fatal myocardial infarction) in the control group (p = 0.575). Overall adherence to the DASH project increased by 26 points during counselling and then decreased by only four points, remaining higher than in the control group. Conclusions: A one-year DASH project supported by a physician and dietitian resulted in long-term suppression of the proatherogenic chemokine CXCL4 and fewer MACE over six years, despite a decline in adherence and loss of most anthropometric and lipid benefits. It appears that sustained systemic reinforcement of behaviours is necessary to maintain the benefits of lifestyle intervention in CAD. Full article

This research compares speech discrimination abilities between 17 children who are hard-of-hearing (CHH) and 13 children with normal hearing (CNH), aged 9 to 36 months, using either a conditioned head turn (CHT) or condition play paradigm, for two phoneme pairs /ba-da/ and /sa-ʃa/. As CHH were tested in the aided and unaided conditions, CNH were also tested on each phoneme contrast twice to control for learning effects. When speech discrimination abilities were compared between CHH, with hearing aids (HAs), and CNH, there were no statistical differences observed in performance on stop consonant discrimination, but a significant statistical difference was observed for fricative discrimination performance. Among CHH, significant benefits were observed for /ba-da/ speech discrimination while wearing HAs, compared to the no HA condition. All CHH were early-identified, early amplified, and were enrolled in parent-centered early intervention services. Under these conditions, CHH demonstrated the ability to discriminate speech comparable to CNH. Additionally, repeated testing within 1-month did not result in a change in speech discrimination scores, indicating good test–retest reliability of speech discrimination scores. Finally, this research explored the question of infant/toddler listening fatigue in the behavioral speech discrimination task. The CHT paradigm included returning to a contrast (i.e., /a-i/) previously shown to be easier for both CHH and CNH to discriminate to examine if failure to discriminate /ba-da/ or /sa-ʃa/ was due to listening fatigue or off-task behavior. Full article

Sinus augmentation provides a well-established model for investigating the three-dimensional morphometry and macromolecular dynamics of bone regeneration, particularly when using biphasic calcium phosphate (BCP) graft substitutes. This case series included six biopsies from patients who underwent maxillary sinus augmentation using BCP granules composed of 30% hydroxyapatite (HA) and 70% β-tricalcium phosphate (β-TCP). Bone core biopsies were obtained at healing times of 6 months, 9 months, and 12 months. Histological evaluation yielded qualitative and quantitative insights into new bone distribution, while micro-computed tomography (micro-CT) and Raman microspectroscopy (RMS) were employed to assess the three-dimensional architecture and macromolecular composition of the regenerated bone. Micro-CT analysis revealed progressive maturation of the regenerated bone microstructure over time. At 6 months, the apical regenerated area exhibited a significantly higher mineralized volume fraction (58 ± 5%) compared to the basal native bone (44 ± 11%; p = 0.0170), as well as significantly reduced trabecular spacing (Tb.Sp: 187 ± 70 µm vs. 325 ± 96 µm; p = 0.0155) and degree of anisotropy (DA: 0.37 ± 0.05 vs. 0.73 ± 0.03; p < 0.0001). By 12 months, the mineralized volume fraction in the regenerated area (53 ± 5%) was statistically comparable to basal bone (44 ± 3%; p > 0.05), while Tb.Sp (211 ± 20 µm) and DA (0.23 ± 0.09) remained significantly lower (Tb.Sp: 395 ± 41 µm, p = 0.0041; DA: 0.46 ± 0.04, p = 0.0001), indicating continued structural remodelling and organization. Raman microspectroscopy further revealed dynamic macromolecular changes during healing. Characteristic β-TCP peaks (e.g., 1315, 1380, 1483 cm⁻¹) progressively diminished over time and were completely absent in the regenerated tissue at 12 months, contrasting with their partial presence at 6 months. Simultaneously, increased intensity of collagen-specific bands (e.g., Amide I at 1661 cm⁻¹, Amide III at 1250 cm⁻¹) and carbonate peaks (1065 cm⁻¹) reflected active matrix formation and mineralization. Overall, this case series provides qualitative and quantitative evidence that bone regeneration and integration of BCP granules in sinus augmentation continues beyond 6 months, with ongoing maturation observed up to 12 months post-grafting. Full article

Background/Objectives: The aim of this systematic review was to compare the effectiveness of virtual reality (VR)-based training with conventional exercise programs in improving functional outcomes related to fall risk among older adults with various health conditions. Methods: The review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (registration number CRD42022345678). The databases Scopus, PubMed, Web of Science, and EBSCO were searched up to 31 March 2025. Randomized controlled trials (RCTs) were included if they involved participants aged ≥60 years, a VR intervention lasting ≥6 weeks, and a control group performing traditional exercises or receiving usual care. Methodological quality was assessed using the PEDro scale, and a narrative synthesis was performed across four outcome domains: balance, mobility, cognitive function, and fall risk. Results: Seven RCTs were included in the analysis (totaling 664 participants). VR training was found to be at least as effective as conventional exercise in improving balance (e.g., Berg Balance Scale) and mobility (e.g., Timed Up and Go), with some studies showing superior effects of VR. One RCT demonstrated that combining VR with balance exercises (MIX) yielded the greatest improvements in muscle strength and physical performance. Additionally, two studies reported cognitive benefits (e.g., MoCA) and a 42% reduction in fall incidence within six months following VR intervention. The methodological quality of the included studies was moderate to high (PEDro score 5–9/10). Conclusions: VR-based training represents a safe and engaging supplement to geriatric rehabilitation, effectively improving balance, mobility, and, in selected cases, cognitive function, while also reducing fall risk. Full article

Background/Objectives: Mumps remains a relevant vaccine-preventable disease globally, especially in settings where immunization coverage fluctuates or vaccine-induced immunity wanes. This study aimed to assess long-term trends in mumps incidence, vaccination coverage, clinical outcomes, and demographic characteristics in the Autonomous Province of Vojvodina (AP Vojvodina), Serbia, over a 47-year period. Methods: We conducted a retrospective observational study using surveillance data from the Institute of Public Health of Vojvodina. Analyses included annual mumps incidence rates (1978–2024), coverage with mumps-containing vaccines (MuCVs; 1986–2024), monthly case counts, and individual-level case data for the 1997–2024 period. Variables analyzed included age, month of notification, gender, vaccination status, presence of clinical complications, and the method used for case confirmation. Results: Following the introduction of MuCV in 1986, the mumps incidence markedly declined, with limited resurgences in 2000, 2009, and 2012. Between 1997 and 2024, a total of 1358 cases were reported, with 62.7% occurring in males. Over time, the age distribution shifted, with adolescents and young adults being increasingly affected during the later (2011–2024) observed period. In 2012, the highest age-specific incidence was observed among individuals aged 10–19 and 20–39 years (49.1 and 45.5 per 100,000, respectively). Vaccination coverage for both MuCV doses was suboptimal in several years. The proportion of unvaccinated cases decreased over time, while the proportion with unknown vaccination status increased. Mumps-related complications—such as orchitis, pancreatitis, and meningitis—were rare and predominantly affected unvaccinated individuals: 84.2% of orchitis, 40.0% of pancreatitis, and all meningitis cases. Only two pancreatitis cases (40.0%) were reported after one MMR dose, while fully vaccinated individuals (two doses) had one orchitis case (5.3%) and no other complications. Laboratory confirmation was applied more consistently from 2009 onward, with 49.6% of cases confirmed that year (58 out of 117), and, in several years after 2020, only laboratory-confirmed cases were reported, indicating improved diagnostic capacity. Conclusions: Despite substantial progress in controlling mumps, gaps in vaccine coverage, waning immunity, and incomplete vaccination records continue to pose a risk for mumps transmission. Strengthening routine immunization, ensuring high two-dose MuCV coverage, improving vaccination record keeping, and enhancing laboratory-based case confirmation are critical. Consideration should be given to booster doses in high-risk populations and to conducting a seroepidemiological study to estimate the susceptible population for mumps in AP Vojvodina. Full article

This study evaluated the effects of different storage conditions, varying in light exposure, relative humidity (RH), and packaging materials, on the physicochemical stability of Lobosphaera sp. biomass, the retention of bioactive compounds, and the bioactivity of its extracts. Under light and 75% RH, the biomass absorbed moisture over time, reaching 0.779 ± 0.003 g/g dry weight (DW) after three months. This was accompanied by a decline in luminosity, chroma, and hue values. In contrast, samples stored under other conditions showed minimal changes, indicating that high humidity, combined with light exposure, compromises biomass stability. Packaging in metalized polyethylene terephthalate (PETmet/PE) effectively preserved the water content, color, and carotenoid levels during a two-month storage period. Bioactive compounds extracted via hydroethanolic ultrasound-assisted extraction yielded 15.48 ± 1.35% DW. Total phenolic content (TPC) of the extracts declined over time in both PETmet/PE and low-density polyethylene (LDPE) packaging, though the decrease was less pronounced in PETmet/PE. Antioxidant activity, assessed via the ABTS assay, remained stable, regardless of storage duration or packaging. Antimicrobial activity of the extract decreased over time but remained more effective against Gram-positive bacteria (Staphylococcus aureus, Bacillus cereus, and Listeria monocytogenes), with PETmet/PE packaging better preserving antimicrobial efficacy than LDPE. These findings underscore the importance of optimized storage conditions and packaging for maintaining the quality and bioactivity of Lobosphaera sp. biomass and its extracts. Full article

Background/Objectives: The TOPAZ-1 phase III trial reported a survival benefit of using durvalumab, an anti-programmed death ligand 1 (anti-PD-L1) antibody, in combination with gemcitabine and cisplatin (GCD) treatment in patients with advanced biliary tract cancer. This retrospective study investigated the efficacy and safety of GCD treatment for advanced biliary tract cancer in real-world conditions. Methods: The study subjects were 52 patients with biliary tract cancer who received GCD therapy between January 2023 and May 2024. The observation parameters included the modified Glasgow Prognostic Score (mGPS), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), tumor markers (CEA, CA19-9), overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events. Results: The cohort included 36 men and 16 women, with a median age of 73.0 years. There were 36 cases of cholangiocarcinoma (distal: 10, perihilar: 19, intrahepatic: 7), 13 cases of gallbladder cancer, and 3 cases of ampullary carcinoma. The stages were locally advanced in 30 cases and metastatic in 22 cases. Biliary drainage was performed in 30 cases. There were 38 cases receiving first-line therapy and 14 cases receiving second-line or later treatments. The median values at the start of GCD therapy were ALB 3.7 g/dL, CRP 0.39 mg/dL, NLR 2.4, PLR 162.5, CEA 4.8 ng/mL, and CA19-9 255.9 U/mL. The mGPS distribution was 0:23 cases, 1:18 cases, and 2:11 cases. The treatment outcomes were ORR 25.0% (CR 2 cases, PR 11 cases), DCR 78.8% (SD 28 cases, PD 10 cases, NE 1 case), median PFS 8.6 months, and median OS 13.9 months. The PLR was suggested to be useful for predicting PFS. A decrease in CEA at six weeks after the start of treatment was a significant predictor of PFS and OS. Gallbladder cancer had a significantly poorer prognosis compared to other cancers. The immune-related adverse events included hypothyroidism in two cases, cholangitis in one case, and colitis in one case. Conclusions: The ORR, DCR, and PFS were comparable to those in the TOPAZ-1 trial. Although limited by its retrospective design and small sample size, this study suggests that GCD therapy is an effective treatment regimen for unresectable biliary tract cancer in real-world clinical practice. Full article

This study presents an algorithm for non-invasive blood pressure (BP) estimation in neonates using photoplethysmography (PPG), suitable for resource-constrained neonatal telecare platforms. Using the Windkessel model, the algorithm processes PPG signals from a MAX 30102 sensor, (Analog Devices (formerly Maxim Integrated), based in San Jose, CA, USA) filtering motion noise and extracting cardiac cycle time and systolic time (ST). These parameters inform a derived blood flow signal, the input for the Windkessel model. Calibration utilizes average parameters based on the newborn’s post-conceptional age, weight, and gestational age. Performance was validated against readings from a standard non-invasive BP cuff at SES Hospital Universitario de Caldas. Two parameter estimation methods were evaluated. The first yielded root mean square errors (RMSEs) of 24.14 mmHg for systolic and 19.13 mmHg for diastolic BP. The second method significantly improved accuracy, achieving RMSEs of 2.31 mmHg and 5.13 mmHg, respectively. The successful adaptation of the Windkessel model to single PPG signals allows for BP calculation alongside other physiological variables within the telecare program. A device analysis was conducted to determine the appropriate device based on computational capacity, availability of programming tools, and ease of integration within an Internet of Things environment. This study paves the way for future research that focuses on parameter variations due to cardiovascular changes in newborns during their first month of life. Full article

Background/Objectives: Family caregivers of individuals with schizophrenia often face considerable psychological and physical strain due to the complexity of caregiving. Although psychoeducation has demonstrated benefits in alleviating this burden, its provision via telenursing remains underexplored in Saudi Arabia. This study evaluated the effect of a psychoeducational program delivered via telenursing on reducing caregiver burden. Methods: A quasi-experimental design was used with 60 caregivers from a tertiary mental health hospital in northern Saudi Arabia, who were divided equally into intervention and control groups. The intervention group participated in a structured four-week psychoeducational program via Zoom, while the control group received routine care. Caregiver burden was assessed using the Family Burden Interview Schedule (FBIS), a validated tool designed to measure the objective and subjective burden experienced by family members caring for individuals with mental illness. The FBIS was administered before and three months after the intervention. The statistical analysis included independent and paired t-tests and ANOVA. Results: The pre-intervention scores showed no significant differences, confirming baseline equivalence. The post-intervention scores showed a significant reduction in burden among the intervention group (p < 0.001), while no meaningful change occurred in the control group. Additionally, a lower burden was associated with higher education, sufficient income (i.e., the caregiver’s perception of being able to meet essential household expenses without financial strain), strong family support, and absence of caregiver illness. Conclusions: These findings suggest that psychoeducation through telenursing is an effective strategy for reducing caregiver burden and improving support accessibility, particularly for those in remote areas. Full article

Precise recognition of individual ovine specimens plays a pivotal role in implementing smart agricultural platforms and optimizing herd management systems. With the development of deep learning technology, sheep face recognition provides an efficient and contactless solution for individual sheep identification. However, with the growth of sheep, their facial features keep changing, which poses challenges for existing sheep face recognition models to maintain accuracy across the dynamic changes in facial features over time, making it difficult to meet practical needs. To address this limitation, we propose the lifelong biometric learning of the sheep face network (LBL-SheepNet), a feature decoupling network designed for continuous adaptation to ovine facial changes, and constructed a dataset of 31,200 images from 55 sheep tracked monthly from 1 to 12 months of age. The LBL-SheepNet model addresses dynamic variations in facial features during sheep growth through a multi-module architectural framework. Firstly, a Squeeze-and-Excitation (SE) module enhances discriminative feature representation through adaptive channel-wise recalibration. Then, a nonlinear feature decoupling module employs a hybrid channel-batch attention mechanism to separate age-related features from identity-specific characteristics. Finally, a correlation analysis module utilizes adversarial learning to suppress age-biased feature interference, ensuring focus on age-invariant identifiers. Experimental results demonstrate that LBL-SheepNet achieves 95.5% identification accuracy and 95.3% average precision on the sheep face dataset. This study introduces a lifelong biometric learning (LBL) mechanism to mitigate recognition accuracy degradation caused by dynamic facial feature variations in growing sheep. By designing a feature decoupling network integrated with adversarial age-invariant learning, the proposed method addresses the performance limitations of existing models in long-term individual identification. Full article