Search Results (64)

Platelet-rich gel (PRG) is a fibrin-based biobased biomaterial generated by activating platelet-rich plasma (PRP), yet its biological characterization has commonly relied on univariate measurements of isolated mediators. This study aimed to define the multivariate biological organization of PRG and related hemocomponents (PRP, chemically induced platelet lysate (CIPL), and plasma) in a canine model under single exposure to non-steroidal anti-inflammatory drugs (NSAIDs). In a randomized crossover design (n = 6 dogs), hemocomponents were produced at baseline (0 h) and 6 h after administration of carprofen or firocoxib. Platelet and white blood cell (WBC) counts, growth factors (platelet-derived growth factor-BB (PDGF-BB) and transforming growth factor beta-1 (TGF-β1)), and cytokines (tumor necrosis factor alpha (TNF-α), interleukin-1 beta, and interleukin-10) were integrated using linear mixed-effects modeling, principal component analysis (PCA), and hierarchical clustering. PRG was derived from a leukocyte-poor PRP precursor with moderate platelet enrichment (~1.6-fold vs. whole blood) and a marked WBC reduction (~8–9-fold). In mixed-effects modeling, hemocomponent type significantly influenced the PDGF-BB:TNF-α log-ratio, with PRG (estimate −1.12; 95% CI −1.34 to −0.90) and plasma (−2.06; 95% CI −2.28 to −1.84) lower than PRP, while CIPL did not differ. Time and NSAID effects were not supported. PCA identified two orthogonal axes explaining 61.3% of total variance (PC1 = 43.7%, PC2 = 18.6%), separating a platelet/trophic dimension (log(PDGF-BB), log(TGF-β1), platelet count, PDGF-BB:TNF-α log-ratio) from an inflammatory dimension (log(TNF-α), log(IL-1β)). Overall, hemocomponent composition emerged as the primary determinant of mediator organization, supporting the interpretation of PRG as a structured, biomaterial defined by coordinated mediator networks. Full article

In Canada and elsewhere, there is an ascendancy of a whole-of-society approach that centres shared responsibility for wildfire management. This article engages the debates on the rise of shared responsibility for wildfire management to argue that this context demands a renewed research focus on understanding how the public allocates responsibility for wildfire management. We illustrate this argument through a case study of public engagement with wildfire risk and shared responsibility in Whistler, British Columbia, western Canada. Our case study draws on evidence from a quantitative survey administered to 1311 participants in the spring and summer of 2024. The study reveals a near-universal concern about wildfires among the participants and a high level of risk perception. This is consistent with community climate and wildfire reports and plans. This level of concern is driving a high level of mitigation activity completion among participants, even though the level of preparedness is mixed. Our study found a marked pattern of responsibility allocation across the phases of wildfire management. Participants put the municipal government at the forefront of mitigation, preparedness, and response. The provincial government was ranked as most responsible for recovery. Homeowner responsibility declined as one moves from mitigation and preparedness through to response and recovery. Private actors, such as insurance, have greater responsibility in the recovery phase. Multivariate General Linear Models (GLMs) show that how respondents allocate responsibility for various aspects of wildfire management is influenced by home ownership, prior wildfire experience, perceived preparedness, and commitment to bearing the costs of FireSmart assessment. We conclude that a sustained research commitment is needed to further elucidate the dynamics of public expectations and attitudes in the context of shared responsibility for wildfire management. Full article

Background: Smoking remains a major global public health challenge. As smoking often begins in early adolescence, early preventive programs are essential, yet research focusing exclusively on elementary school students is limited. This study measured smoking prevalence, smoking-related knowledge and attitudes, and the impact of a school-based intervention on these outcomes among 12–13-year-old students in Larissa, Greece. Methods: A total of 769 students participated (response rate: 75%). Knowledge, attitudes, and smoking prevalence were assessed at baseline. The intervention group (n = 316) was exposed to audiovisual and printed materials, and both groups were followed up at three- and twelve months post-intervention. Multivariable linear mixed-effects models and generalized estimating equations were used to evaluate intervention effects. Results: Baseline characteristics were balanced between groups. A statistically significant stage × group interaction was observed, indicating improvements in smoking-related knowledge and attitudes (p < 0.001) and a reduced likelihood of smoking initiation (p = 0.011) in the intervention group. Conclusions: This school-based intervention demonstrated significant improvements in knowledge and attitudes toward smoking and reduced the likelihood of smoking initiation. These findings support integrating early prevention programs into school curricula as a potentially effective approach to improving smoking-related outcomes. Full article

Buckwheat (Fagopyrum esculentum) is an important source of nutrition for humans, providing essential nutrients such as protein, fiber, vitamins, and minerals. Its cultivation is highly attractive to flower-visiting insects, which find abundant nectar and a moderate amount of pollen grains. This study aimed to characterize the taxonomic diversity and composition of flower-visiting insect communities in buckwheat crops across two sites in Chitwan district, Nepal and to assess whether temperature and relative humidity influence community structure. We further quantified the contribution of insect pollination to buckwheat yield by comparing pollinator-excluded plots (net-covered) with open-pollinated plots. In addition, we estimated the economic value of insect-mediated pollination and the nutritional contribution of buckwheat production on a per capita basis. Data were analyzed using non-metric multidimensional scaling, permutational multivariate analysis of variance, similarity percentage analysis, and (generalized) linear mixed-effects models. We found significant differences in flower-visiting insect community composition between the two study sites, independent of temperature and relative humidity, with twelve taxa contributing most to this dissimilarity. Open-pollinated plots exhibited higher buckwheat yields than pollinator-excluded plots, highlighting the importance of insect visitation for crop production. Despite the presence of managed Apis species, we recorded frequent visitation by flies and solitary bees, indicating that these taxa are likely important contributors to buckwheat pollination at local scales. Similarly, insect-mediated pollination significantly increased buckwheat production, and its absence would result in substantial economic losses of USD 2.6 million and reduced nutritional contributions, highlighting the vulnerability of buckwheat-based food security for the Nepalese communities due to pollinator decline. Full article

Background and Objectives: The volume–outcome relationship in congenital heart surgery (CHS) has been widely reported internationally, but systematic nationwide evidence from Korea remains limited. Given the concentration of high-volume centers in the Seoul Capital Area (SCA), we aimed to examine whether hospital surgical volume was associated with short-term mortality and to what extent regional disparities could be explained by differences in surgical volume. Materials and Methods: We conducted a nationwide retrospective cohort study of 31,150 patients who underwent CHS in 91 hospitals in Korea between 2002 and 2021 using National Health Insurance claims data. Hospitals were classified by location (SCA vs. non-SCA). Annual surgical volume was defined using two approaches, (i) above vs. below the overall mean annual volume (17.1 cases per hospital), and (ii) three categories (≤20, 21–40, and >40 cases/year). The primary outcome was 30-day mortality. Multivariable logistic regression adjusted for case mix, including J-STAT category, sex, hospital type, age, prematurity, and low birth weight. Hospital-level variation was further evaluated using generalized linear mixed models with random hospital intercepts, and intraclass correlation coefficients (ICCs) were estimated to quantify between-hospital variation and the explanatory contribution of surgical volume. Results: Overall 30-day mortality was 1.99%, with higher mortality observed in non-SCA hospitals compared with SCA hospitals (3.19% vs. 1.57%). After adjustment, lower annual surgical volume was strongly associated with higher 30-day mortality. Compared with hospitals performing >40 cases/year, the adjusted odds ratios were 4.13 (95% CI, 3.30–5.17) for hospitals performing 21–40 cases/year and 4.95 (95% CI, 3.98–5.95) for those performing ≤20 cases/year. In multilevel analyses, annual surgical volume accounted for 54% of the between-hospital variation in 30-day mortality. Adjustment for surgical volume substantially attenuated the regional disparity, with the odds ratio for non-SCA versus SCA hospitals decreasing from 2.12 (95% CI, 1.80–2.49) to 1.14 (95% CI, 0.95–1.37). Conclusions: A strong volume–outcome relationship exists in congenital heart surgery in Korea, with excess mortality concentrated in low-volume hospitals rather than regional location itself. Regional disparities in outcomes appear largely attributable to the uneven distribution of surgical volume. Strategies focused on service consolidation and strengthened referral to high-volume centers may be effective in reducing inter-hospital variation and improving national outcomes in pediatric cardiac surgery. Full article

Background/Objective: To evaluate the association between optical coherence tomography angiography (OCTA)-derived choriocapillaris flow (CCflow), retinal vascular fractal dimension (FD), and drusen burden in eyes with dry age-related macular degeneration (AMD). Methods: This retrospective study included 113 eyes from 73 patients with dry AMD. Eyes were classified into large and small drusen groups based on median drusen area. OCTA-derived CCflow and FD indices of the superficial and deep capillary plexuses were analyzed. Patient-level clustered analyses were performed using linear mixed-effects and generalized estimating equation models to account for inter-eye correlation. Results: Eyes with large drusen showed significantly lower CCflow compared with those with small drusen (p < 0.001), whereas FDsup did not differ between groups, and FDdeep demonstrated only a near-significant trend toward higher values. CCflow was moderately and negatively correlated with drusen area (ρ = −0.452, p < 0.001), whereas FDdeep showed no significant correlation in unadjusted analyses (ρ = 0.137, p = 0.148). In patient-level age-adjusted multivariable models accounting for inter-eye dependency, CCflow remained independently associated with drusen burden, while FDdeep demonstrated an independent association only after adjustment for age. Conclusions: Reduced CCflow is independently associated with increased drusen burden in dry AMD. FD metrics provide complementary descriptive information regarding microvascular remodeling but do not function as independent biomarkers. CCflow may serve as a robust quantitative indicator of early choroidal compromise in dry AMD. Full article

Mobile games have become one of the fastest-growing segments of the digital economy, and in-app advertisements represent a major source of revenue while shaping consumer attention and memory processes. This study examined the relationship between visual attention and brand recall of in-app advertisements in a mobile sports game using mobile eye-tracking technology. A total of 79 participants (47 male, 32 female; Mage = 25.8) actively played a mobile sports game for ten minutes while their eye movements were recorded with Tobii Pro Glasses 2. Areas of interest (AOIs) were defined for embedded advertisements, and fixation-related measures were analyzed. Brand recall was assessed through unaided, verbal-aided, and visual-aided measures, followed by demographic comparisons based on gender, mobile sports game experience and interest in tennis. Results from Generalized Linear Mixed Models (GLMMs) revealed that brand placement was the strongest predictor of recall (p < 0.001), overriding raw fixation duration. Specifically, brands integrated into task-relevant zones (e.g., the central net area) achieved significantly higher recall odds compared to peripheral ads, regardless of marginal variations in dwell time. While eye movement metrics varied by gender and interest, the multivariate model confirmed that in active gameplay, task-integration drives memory encoding more effectively than passive visual salience. These findings suggest that active gameplay imposes unique cognitive demands, altering how attention and memory interact. The study contributes both theoretically by extending advertising research into ecologically valid gaming contexts and practically by informing strategies for optimizing mobile in-app advertising. Full article

Over recent decades, planners in the U.S. have increasingly adopted mixed-use projects to reduce automobile dependency and strengthen local community identity, although results remain inconsistent across cities. Urban health and fitness outcomes are shaped by complex interactions between the built environment, socioeconomic factors, and demographic characteristics. This study introduces a Health and Fitness Index (HFI) for 28,758 U.S. ZIP codes, derived from normalized measures of walkability, healthcare facility density, and carbon emissions, to assess spatial disparities in health-supportive environments. Using four modeling approaches—lasso regression, multiple linear regression, decision trees, and k-nearest neighbor classifiers—we evaluated the predictive importance of 15 urban and socioeconomic variables. Multiple linear regression produced the strongest generalization performance (R² = 0.60, RMSE = 0.04). Key positive predictors included occupied housing units, business density, land-use mix, household income, and racial diversity, while income inequality and population density were negatively associated with health outcomes. This study evaluates five statistical formulations (Metropolis Hybrid Models) that incorporate different combinations of walkability, land-use mix, environmental variables, and socioeconomic indicators to test whether relationships between urban form and socioeconomic conditions remain consistent under different variable combinations. In cross-sectional multivariate regression, although mixed-use development in high-density areas is strongly associated with healthcare facilities, these areas tend to serve younger and more racially diverse populations. Decision tree feature importance rankings and clustering profiles highlight structural inequalities across regions, suggesting that enhancing business diversity, land-use integration, and income equity could significantly improve health-supportive urban design. This research provides a data-driven framework for urban planners to identify underserved neighborhoods and develop targeted interventions that promote walkability, accessibility to health infrastructure, and sustainability. It contributes to the growing literature on urban health analytics, integrating machine learning, spatial clustering, and multidimensional urban indicators to advance equitable and resilient city planning. Full article

Background: Telepsychiatry expanded rapidly during the COVID-19 pandemic, yet patient experience data from mixed urban and rural areas in Saudi Arabia remain scarce. Objective: We aimed to quantify the perception of telepsychiatry among adults with major depressive disorder [MDD] in Madinah City, the KSA, and to identify associated demographic and clinical factors. Methods: A cross-sectional survey was conducted at Madinah Mental Health Hospital between December 2024 and March 2025. Eligible participants were Arabic-speaking adults [≥18 years] with a clinician-confirmed diagnosis of major depressive disorder [MDD] according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], following a scheduled video- or audio-based telepsychiatry consultation. Perception of telepsychiatry was assessed using the validated 10-item Arabic version of the Telehealth Satisfaction Scale [TeSS], which evaluates audiovisual quality, communication, and support. Variables associated with perception at p < 0.20 in the bivariable analyses were entered into a multiple linear regression model to identify independent predictors. Results: Of the 218 eligible patients, 207 participated [response rate = 95%], with similarly high participation rates being reported in comparable telepsychiatry surveys [e.g., 90–91%]. The majority were male [59%], with a mean [SD] age of 38.4 [11.2] years. The mean satisfaction score was 32.3 ± 6.3, and 36% of participants were classified as highly satisfied. In the multivariable analysis, higher satisfaction was independently associated with male gender [B = 3.0, 95% CI: 1.3–4.7], intermediate versus elementary education [B = 4.3, 95% CI: 1.1–7.6], and the presence of a chronic illness [B = 2.1, 95% CI: 0.3–3.8]. Conclusions: Telepsychiatry is generally well-accepted among adults with depression in Madinah. However, women and individuals with lower educational attainment report lower satisfaction. Targeted interventions such as improving privacy, offering digital literacy support, and tailoring communication may help improve the telepsychiatry experience for underserved groups. Full article

Background: The global prevalence of pediatric hypertension is on the rise. Adolescence is a period of high prevalence of childhood hypertension. Obesity and insulin resistance (IR) are important risk factors in the development of hypertension, but their interaction and combined effects on adolescent hypertension remain unclear. Methods: This cross-sectional study utilized data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers (2016–2017). A total of 7031 adolescents aged 12–17 years from five provinces were included. The triglyceride-glucose index (TyG) was used as an indicator of IR. Multivariable logistic regression and generalized linear mixed-effect models were used to assess the interaction and joint effects of IR and obesity (measured by body mass index [BMI] and waist circumference [WC]) on hypertension. Relative excess risk due to interaction (RERI), proportion attributable to interaction (AP), and synergy index (SI) were calculated to evaluate additive interactive effects. Mediation analysis explored the potential mediating role of the TyG in the association between obesity and hypertension. Results: IR and obesity were positively associated with adolescent hypertension (p < 0.001). Interaction analyses revealed a robust synergistic interaction between obesity and IR on hypertension, with the AP being approximately 40% (p < 0.001). TyG significantly mediated the association between obesity and adolescent hypertension (6.30% for high BMI and 8.54% for high WC, both p < 0.001). Conclusions: This study suggests that obesity and IR could synergistically contribute to the prevalence of hypertension in adolescents. For the primary prevention and management of hypertension in adolescents, strategies targeting both factors should be considered. Full article

Background/Objectives: Cognitive impairment in older adults has emerged as a growing public health concern, particularly in relation to COVID-19 infection and its associated neuropsychiatric symptoms. The identification of modifiable risk factors may contribute to the development of targeted preventive strategies. This study aimed to assess predictors of cognitive impairment in older adults with and without recent SARS-CoV-2 infection. Methods: A prospective cohort study was conducted from June 2023 to March 2024 at a tertiary hospital in western Mexico. Adults aged 65 years or older with confirmed SARS-CoV-2 infection within the previous six months, along with uninfected controls, were enrolled. Cognitive function (Mini-Mental State Examination), depression (PHQ-9), anxiety (Geriatric Anxiety Inventory), insomnia (Insomnia Severity Index), functional status (Katz Index and Lawton–Brody Scale), and laboratory markers were evaluated at baseline, three months, and six months. The primary outcome was cognitive impairment at six months. Independent predictors were identified using a multivariable generalized linear mixed-effects model. Results: Among the 111 participants, 20 (18.8%) developed cognitive impairment within six months. Low serum magnesium (adjusted risk ratio [aRR] 2.73; 95% CI 1.04–7.17; p = 0.041) and depression (aRR 5.57; 95% CI 1.88–16.48; p = 0.002) were independently associated with a higher risk. A significant synergistic among COVID-19, depression, and hypomagnesemia was observed (RR 44.30; 95% CI 9.52–206.21; p < 0.001), corresponding to the group with simultaneous presence of all three factors compared to the group with none. Conclusions: Depression and hypomagnesemia appear to be independent predictors of cognitive impairment in older adults with recent COVID-19 infection. These findings suggest potential targets for prevention and support the implementation of routine neuropsychiatric and biochemical assessments in this population. Full article

Background/Objectives: Despite medical advances, stigma remains a major challenge for people living with HIV (PLWH). This study examined clinical, sociodemographic, and psychological predictors of HIV-related stigma, and explored whether affective temperament moderates the impact of depression on stigma. Methods: This cross-sectional observational study included 97 PLWH attending a tertiary infectious disease unit in Rome, Italy. Participants completed a battery of validated psychometric instruments assessing depressive symptoms, anxiety, manic symptoms, mixed affective states, general psychopathology, impulsivity, and affective temperament. HIV-related stigma was evaluated using the Berger HIV Stigma Scale, which measures personalized stigma, disclosure concerns, negative self-image, and concerns with public attitudes. Descriptive statistics were used to characterize the sample. Univariate linear regressions were conducted to explore associations between clinical, psychometric, and sociodemographic variables and each stigma subdimension, as well as the total stigma score. Variables significant at p < 0.05 were included in five multivariate linear regression models. Moderation analyses were subsequently performed to assess whether affective temperaments moderated the relationship between significant psychopathological predictors and stigma. Bonferroni correction was applied where appropriate. Results: Higher depressive symptom scores are significantly associated with greater internalized stigma (B = 0.902, p = 0.006) and total stigma (B = 2.603, p = 0.008). Furthermore, moderation analyses showed that anxious temperament significantly intensified the relationship between depressive symptoms and both negative self-image (interaction term B = 0.125, p = 0.001) and total stigma (B = 0.336, p = 0.002). Conclusions: Depressive symptoms and anxious temperament are associated with HIV-related stigma. Integrating psychological screening and targeted interventions for mood and temperament vulnerabilities may help reduce stigma burden in PLWH and improve psychosocial outcomes. Full article

This work presents the design of a control algorithm based on an augmented incremental state-space model, emphasizing its compatibility with Takagi–Sugeno (T–S) fuzzy models for nonlinear systems. The methodology integrates key components such as incremental modeling, fuzzy system identification, discrete Linear Quadratic Regulator (LQR) design, and state observer implementation. To optimize controller performance, the Extremum Seeking Control (ESC) technique is employed for the automatic tuning of LQR gains, minimizing a predefined cost function. The control strategy is formulated within a generalized framework that evolves from conventional discrete fuzzy models to a higher-order incremental-N state-space representation. The simulation results on a nonlinear multivariable thermal mixing tank system validate the effectiveness of the proposed approach under reference tracking and various disturbance scenarios, including ramp, parabolic, and higher-order polynomial signals. The main contribution of this work is that the proposed scheme achieves zero steady-state error for reference inputs and disturbances up to order N−1 by employing the incremental-N formulation. Furthermore, the system exhibits robustness against input and load disturbances, as well as measurement noise. Remarkably, the ESC algorithm maintains its effectiveness even when noise is present in the system output. Additionally, the proposed incremental-N model is applicable to fast dynamic systems, provided that the system dynamics are accurately identified and the model is discretized using a suitable sampling rate. This makes the approach particularly relevant for control applications in electrical systems, where handling high-order reference signals and disturbances is critical. The incremental formulation, thus, offers a practical and effective framework for achieving high-performance control in both slow and fast nonlinear multivariable processes. Full article

Considering that effective selection strategies are essential for the development of new ornamental pepper cultivars, the objective of this work was to select superior partially endogamic lines (PEL) of pepper in a F_2:3 generation, using the combination of the genealogical method with mixed linear models. The experiment consisted of four cycles: parents and generations F₁, F₂ and F_2:3. Qualitative (QLD) and quantitative (QTD) descriptors were evaluated. QLD were analyzed through descriptive statistics, and QTD were analyzed through estimates of genetic parameters and prediction of genetic values by REML/BLUP. Multivariate analysis was performed to group and select individuals based on QLD and QTD simultaneously. The descriptors number of flowers per axil, flower position, mature fruit color, fruit position, fruit brightness, and capsaicin in the placenta presented no variation within the F_2:3 population. The selection accuracy varied from high to very high, denoting a high experimental precision. Higher additive genetic action was detected for descriptors, considering the individual heritability in the strict sense and the additive heritability within the progeny. Forty-eight PELs were selected quantitatively and, considering QLD and QTD descriptors simultaneously, the number of individuals was reduced from 48 to 30 PELs. The combined strategies used enabled to establish the best strategy for an efficient selection of superior PEL of ornamental pepper. Full article

Introduction: In Haemophilia B, guideline-level factor IX (FIX) prophylaxis is recommended, but real-world dosing and adherence vary. Aim: To assess treatment patterns, adherence, FIX dosing, and their associations with bleeding events in Korean patients. Methods: We conducted a retrospective chart review and one-time survey of 130 Korean patients with haemophilia B treated with FIX for ≥12 months at 12 centers (June 2022–May 2023). A total of forty-seven patients (36.2%) received prophylaxis (≥90 IU/kg/week for ≥45 weeks); the remainder were managed non-prophylactically. Annualized bleeding events (ABEs) were analyzed using negative binomial regression, and monthly bleeds with a generalized linear mixed model. Covariates with p < 0.10 and clinical relevance were included in multivariable models. Results: The prophylaxis group showed significantly fewer ABEs (incidence rate ratio [IRR]: 0.383, p = 0.011). Each 100 IU/kg monthly dose increment reduced bleed risk (IRR: 0.692, p < 0.001). Adherence showed no independent association with bleeding in adjusted models. Conclusions: Bleed prevention in haemophilia B is driven more by delivered FIX exposure than by regimen label. Study-defined sustained prophylaxis remains underused and under-dosed. Individualized dosing and continuous adherence monitoring are essential to close this treatment gap and improve outcomes. Full article