Search Results (2,160)

Accurate detection of field insect pests remains a significant challenge for precision agriculture due to the elongated and variable morphology of the target organisms, their frequent resemblance to complex background textures, and the long-tail distribution of species in natural datasets. While deep convolutional neural networks (CNNs) have advanced the field, they are often constrained by a limited effective receptive field and the entanglement of semantic and spatial features, which can lead to elevated false-positive rates and missed detections for low-contrast or rare targets. This paper introduces a novel detection framework that integrates state space modeling with multi-stream feature disentanglement to address these limitations. First, a visual state space module is employed as the backbone feature extractor, enabling the establishment of a global receptive field with linear computational complexity and thereby improving the perception of long-range morphological structures. Second, a Topological Feature Disentanglement Pyramid Network is proposed. This architecture explicitly separates feature representations into semantic and spatial streams and recombines them through graph convolutional interactions, which serves to suppress background interference and enhance localization precision. A meta-auxiliary detection head, active only during training, is introduced to amplify supervision signals for hard, low-contrast samples via adversarial gradient modulation. Furthermore, an implicit neural radiance field augmentation pipeline is used to generate physically consistent synthetic views of underrepresented pest classes, mitigating the negative effects of long-tail data distributions. Experimental evaluations on the public BAU-Insectv2 benchmark demonstrate that the proposed method achieves a mean average precision (mAP@0.5) of 81.8%, representing a 4.4-percentage-point improvement over a comparable baseline, while maintaining a compact parameter count of 2.33 M and an inference speed of 178.6 FPS. The framework exhibits particular efficacy in detecting elongated, minute, and rare pests, suggesting a promising technical approach for real-time, field-based pest surveillance in precision agriculture. Full article

Hypobaric hypoxia poses a serious threat to growth and development and can induce pronounced inflammatory responses. These effects are closely associated with the gut microbiota. However, the underlying mechanisms, particularly the role of gut microbiota in regulating hepatic metabolism under chronic hypoxic conditions, remain poorly understood. In this study, SD rats were used as recipients and assigned to three groups: a hypobaric hypoxia group (H), an antibiotic-treated group (HA), and an antibiotic-treated group receiving fecal microbiota transplantation from plateau zokors (HAM). All rats were maintained in a hypobaric hypoxia chamber simulating an altitude of 6000 m for 30 days. Subsequently, growth performance, routine hematological parameters, and multi-omics profiles were evaluated. Compared with the H group, both the HAM and HA groups showed significantly increased average daily gain (ADG) (p < 0.05), while the ADG/ADFI ratio was significantly higher in the HAM group than in the H group (p < 0.05). Monocyte count (Mon#) and monocyte percentage (Mon%) were significantly higher in the HA group than in both the H and HAM groups (p < 0.05). Microbiota analysis revealed significant enrichment of Lachnospiraceae_NK4A136_group in the HAM group, whereas Desulfovibrio was significantly enriched in the HA group (p < 0.05). Fecal metabolomics showed that ursodeoxycholic acid (UDCA) was significantly increased in the HAM group (p < 0.05). In the liver metabolome, the anti-inflammatory lipid FAHFA 18:1/20:3 was significantly elevated in the HAM group, whereas pro-inflammatory factors, including uric acid and leukotriene D4, were significantly reduced (p < 0.05). Correlation analysis further demonstrated that the abundance of Lachnospiraceae was positively correlated with FAHFA 18:1/20:3 and negatively correlated with uric acid and creatinine (p < 0.05). Collectively, these findings indicate that the gut microbiota can modulate gut–liver metabolism, alleviate inflammatory responses, and enhance the adaptation of rats to hypoxic environments. This study provides valuable insights into potential strategies for promoting sustainable animal health and adaptation under hypoxic conditions. Full article

Background: Carbapenem-resistant K. pneumoniae (CRKP) represents a major challenge in hospitalized patients because of its association with healthcare exposure, restricted antimicrobial options, and adverse clinical outcomes. Microbiological isolation alone does not define invasive disease; therefore, clinical interpretation requires separation of colonization, localized infection, invasive infection, and carbapenem-resistant Enterobacterales (CRE)-associated sepsis. This study evaluated epidemiological features, resistance phenotypes, treatment adequacy, and clinical outcomes among hospitalized adults with K. pneumoniae isolates, using a clinical framework that distinguishes colonization from active infection and invasive disease. Methods: This single-center retrospective observational cohort study included 157 consecutive adults admitted between January and July 2025 to a tertiary-care hospital with at least one microbiologically confirmed K. pneumoniae isolate recovered from clinical specimens and/or CRE surveillance rectal swabs. Isolates were assigned hierarchically to four mutually exclusive phenotypic groups: carbapenem-susceptible K. pneumoniae (CSKP), extended-spectrum beta-lactamase (ESBL)-producing carbapenem-susceptible K. pneumoniae (ESBL), carbapenem-resistant non-carbapenemase-producing K. pneumoniae (CRKP), and carbapenemase-producing K. pneumoniae (CP-KP). A prespecified secondary analysis compared carbapenem-resistant isolates (CRKP + CP-KP) with non-carbapenem-resistant isolates (CSKP + ESBL). Clinical adjudication distinguished colonization-only cases, non-invasive infection, bloodstream infection, device-associated infection, and CRE-associated sepsis; ventilator-associated pneumonia (VAP) was considered when source data allowed reliable attribution. Sepsis was defined according to Sepsis-3 criteria; quick Sequential Organ Failure Assessment (qSOFA) was used only as a bedside screening tool. Statistical tests were selected according to variable type, distribution, and expected cell counts. Results: The cohort comprised 157 unique patients, with a median age of 71 years (interquartile range [IQR], 61–76). Current CRE colonization was documented in 79/154 patients with available colonization status (51.3%). Complete-case in-hospital mortality was higher in the carbapenem-resistant group (CRKP + CP-KP, n = 46) than in the non-carbapenem-resistant group (CSKP + ESBL, n = 111): 11/42 (26.2%) versus 5/108 (4.6%; Fisher exact odds ratio (OR) 7.31, 95% confidence interval (CI) 2.36–22.65; p < 0.001); overall complete-case mortality was 16/150 (10.7%). Multivariable logistic regression for carbapenem resistance (N = 150; five prespecified covariates; events per variable (EPV) = 9.0) identified age 65 years or older (adjusted odds ratio [aOR] 3.78, 95% CI 1.32–10.86), recent hospitalization within 30 days (aOR 2.56, 95% CI 1.16–5.63), and current colonization (aOR 2.96, 95% CI 1.24–7.05) as independent predictors. CRE-associated sepsis was excluded a priori because of definitional circularity with the case definition. Male sex showed a non-significant protective trend (aOR 0.50, 95% CI 0.22–1.12). CRE-associated sepsis showed a strong bivariate association with carbapenem resistance (OR 9.90, 95% CI 3.91–25.09; p < 0.001), and this association is reported descriptively because the variable was excluded from the multivariable model owing to definitional circularity. Model performance was acceptable, with area under the curve (AUC) 0.77, Hosmer–Lemeshow p = 0.95, and Nagelkerke R² = 0.25. Of 99 molecularly characterized isolates, OXA-48-like was detected in 78 (78.8%), NDM in 71 (71.7%), KPC in 6 (6.1%), and NDM + OXA-48-like dual production in 54 (54.5%); VIM and IMP were uniformly negative. Conclusions: In this high-risk hospital cohort, carbapenem resistance in K. pneumoniae was associated with advanced age, recent healthcare exposure, current CRE colonization, and a pronounced unadjusted mortality signal. Interpretation of sepsis and mortality requires explicit separation of colonization from active infection and invasive disease. These findings support intensified CRE surveillance, source-specific clinical interpretation, rapid resistance detection, and risk-adapted empirical antimicrobial strategies in high-risk hospital settings. Full article

Systematic trend-following strategies applied to equity markets are widely studied, yet most reported performance statistics are non-reproducible in live trading. This paper makes three contributions. First, we introduce a formal taxonomy of look-ahead bias organised around point-in-time correctness: a strategy is point-in-time correct if, for every decision time t, its information set lies in the natural filtration ${\mathcal{F}}_t$. Three bias classes—universe-membership contamination, price-data forward leakage, and stop-exit sequencing violations—are characterised as filtration breaches. Second, we formalise the average true range (ATR) trailing stop as a stochastic recurrence and codify its monotonic non-decreasing ratcheting property (Lemma 1), providing a structural per-trade loss bound. Third, we exhibit a closed-form construction (Theorem 1) of two return sequences with identical Sharpe ratios but arbitrarily divergent maximum consecutive negative-year runs, establishing investor-experience metrics as independent optimisation objectives. We complement these contributions with an 18-year empirical study (2008–2025) on the NASDAQ-100 with reconstructed point-in-time index constituency (Class I compliant) and measured residual Class II exposure, applying combinatorially symmetric cross-validation (CSCV) to a 14-configuration ATR-multiplier grid. The grid exhibits a stop-multiplier-insensitive, CAGR-flat region across $k\in [3.5,7.0]$ (CAGR 10.28–10.39%, net of Dutch progressive tax) and a uniform maximum consecutive negative-year run of 1 across all 14 configurations. The correlation-matrix eigenvalue spectrum of the grid is dominated by a single mode (${\lambda }_1=13.91$ of 14), yielding an effective independent-test count of $M_{\mathrm{eff}}=1.09$. This near-degeneracy persists in a parallel grid with the regime classifier disabled, establishing the ATR multiplier as a structurally near-redundant parameter for this strategy class. The associated PBO value of $=0.9351$ co-occurs with this near-degeneracy under the CSCV maximum-selection rule. The plateau-level performance survives Bonferroni correction for both $M=14$ and $M_{\mathrm{eff}}$. The combined evidence supports a region-based interpretation of robust strategy parameters rather than single-point optimisation. Full article

Background: Type II workplace violence by patients, relatives, or visitors is an occupational health and patient-safety concern in primary care. Cranston Ridge Medical Clinic (CRMC), a single urban family medicine and walk-in primary care clinic in Calgary, Alberta, plans to implement a universal, risk-informed workplace-safety bundle that is based on observable behaviour, situational risk, and documented safety concerns rather than demographic profiling. Methods: This article describes a single-site internal quality improvement and workplace-safety evaluation protocol. The comparison is CRMC usual practice during the pre-implementation baseline period; there is no concurrent external control group. The planned evaluation will use aggregate, de-identified operational data from a 12-month pre-implementation baseline, a four-week implementation period, and 12 months of post-implementation monitoring. All clinic staff will receive workplace-safety training as part of routine implementation. No staff, patients, or visitors will be recruited as research participants, and the evaluation will not use individual-level staff survey, interview, or focus-group data. Patient/visitor information will be used only as aggregate operational monitoring data when needed to assess safety, access, patient flow, and complaints. Intervention and analysis: The bundle includes worksite analysis, staff training, a brief arrival safety screen, a response algorithm, standardized reporting, monthly safety huddles, and post-incident support. The primary metric will be the Type II workplace-violence incident rate per 1000 clinic visits. Planned analyses include run charts, pre–post rate ratios, and Poisson or negative binomial segmented regression if monthly counts are sufficient. Implementation learning will be summarized from routine training records, safety-huddle summaries, post-incident debrief themes, and other aggregate de-identified operational indicators. Expected contribution: The protocol contributes a transparent, equity-sensitive, and operationally feasible model for balancing staff safety with patient access in primary care. Full article

Urinary tract infections (UTIs), particularly catheter-associated UTIs (CAUTIs), represent a significant clinical problem due to the predominance of Gram-negative uropathogens, their ability to form biofilms, and the increasing prevalence of antimicrobial resistance, which together reduce the effectiveness of conventional antibiotic therapy. This study aimed to evaluate the antimicrobial activity of selected natural plant-derived compounds against clinical Gram-negative uropathogens isolated from CAUTIs. The antibacterial effects of gallic acid, quercetin-3-D-glucuronide, and apigenin were assessed against Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis, including both ciprofloxacin-susceptible and -resistant strains. Antimicrobial activity was determined using the broth microdilution method, followed by quantitative assessment of bacterial viability based on colony-forming unit (CFU) enumeration. Gallic acid exhibited the strongest concentration-dependent inhibitory activity, reducing bacterial viability by up to 2–3 log₁₀ CFU across all tested species. Quercetin-3-D-glucuronide demonstrated moderate antibacterial effects with a predominantly bacteriostatic profile, resulting in a partial but consistent reduction in CFU counts. In contrast, apigenin showed only weak effects on bacterial viability under the applied experimental conditions. None of the tested compounds achieved complete bacterial eradication. These findings indicate that gallic acid and quercetin-3-D-glucuronide possess inhibitory activity against Gram-negative uropathogens, including antibiotic-resistant strains, supporting their potential use as adjunctive agents targeting bacterial persistence in UTIs rather than as standalone antimicrobials. In the present study, the viability of planktonic bacterial cells was assessed; however, future studies should focus on evaluating the direct impact of the tested compounds on biofilm structure and biofilm formation dynamics. Full article

Objectives: To assess whether [^99mTc]Tc-UBI 29-41 SPECT/CT combined with a standardized target-to-liver ratio can reliably support clinical decision-making in patients with difficult-to-diagnose bacterial infections and to establish a reproducible diagnostic threshold applicable across four infectious scenarios. Methods: This prospective diagnostic accuracy study, conducted following STARD guidelines, included 156 consecutive patients (346 lesions) with clinical suspicion of infected arthroplasty, spondylodiscitis, osteomyelitis, or fever of unknown origin. Target-to-liver total count ratios were calculated from SPECT/CT images. Diagnostic performance was assessed using bootstrap-resampled ROC analysis, Fagan nomograms, and penalized logistic regression. Results: All four conditions showed good discriminatory capacity (AUC: 0.965–0.979). At a cutoff ratio ≥ 1.5, specificities exceeded 95% and negative predictive values were ≥97.8% across all subgroups. Post-test probability after a negative scan decreased to 2–3% in every condition, consistent with clinically meaningful rule-out capability across all four scenarios. Penalized logistic regression confirmed significant associations between elevated ratios and confirmed infection (OR: 22.02–245.53; all p ≤ 0.003). Conclusions: [^99mTc]Tc-UBI 29-41 SPECT/CT with target-to-liver ratio analysis provides clinically meaningful diagnostic support across four distinct infectious scenarios, with particular strength as a rule-out test. A threshold of ≥1.5 offers a standardized, potentially reproducible criterion that may guide clinical decisions and reduce reliance on invasive confirmatory procedures. Prospective multicentre validation is warranted to establish this bacteria-specific approach as a practical complement to existing diagnostic algorithms. Full article

Objective: Restless leg syndrome (RLS) has been associated with an increased risk of vascular disorders, which suggests that endothelial dysfunction plays an important role in the pathogenesis of RLS. In this study, we aimed to evaluate coronary endothelial dysfunction in RLS patients using coronary flow velocity reserve (CFVR) and compared it with healthy controls. Methodology: In this study, the participants were divided into two groups as group RLS (n = 42) and group HC (n = 41). The primary outcome was the CFVR compared between groups. The number of participants with a CFVR value below 2.0 was also evaluated. In addition, a correlation between the international restless legs scale (IRLS) and CFVR, white-blood-cell-count (WBC), and C-reactive protein (CRP) was analyzed. Secondary outcomes were the WBC, hemoglobin, CRP, blood glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and creatinine compared between the two groups. Results: In the group RLS, CFVR was measured lower than healthy controls (p < 0.001). When the groups were compared in terms of the number of participants with a CFVR less than 2.0, the difference between the groups was significant (p < 0.001, 0/41 in group HC and 14/42 in group RLS). Patients with RLS had higher WBC and CRP values. There was a negative correlation between CFVR and IRLS (p < 0.001). The relationship between WBC, CRP, and IRLS was not statistically significant (p = 0.691). Conclusions: In this exploratory study, RLS patients had lower CFVR compared with healthy controls and a negative correlation was observed between RLS severity and CFVR. These findings warrant confirmation in larger, prospectively designed studies with multivariable adjustment. Therefore, we think that it may be beneficial to follow-up patients with RLS in terms of coronary heart disease. Clinical trial number: not applicable. Full article

The integrated usage of metro and bus services plays a key role in long-distance trips in big cities. Revealing the nonlinear relationship between the intermodal transfer demand and the built environment is significant for building a sustainable public transport system. This paper proposes a stacking ensemble explainable machine learning framework, which uses meta-learner to learn the prediction results of diverse base learners to improve performance, to detect how the impact factors impact the intermodal demand, including metro-to-bus and bus-to-metro directions. In this framework, the ensemble model is the stacking model; the ridge regression model is the second model. The base learners contain tree-based models (e.g., Random Forest, XGBoost and CatBoost) and non-tree-based models (e.g., SVR and KNN). The framework is applied to the case study of Beijing, China, based on one weekday (13 May 2019) and one weekend day (18 May 2019) of smart card data covering the main urban districts within the Sixth Ring Road. The results indicate that the stacking ensemble learning model outperforms the base learning models. For the metro-to-bus direction, transfer time, bus station count, and degree centrality are the top three influential factors; for the bus-to-metro direction, transfer time, bus station count, and shopping POI count are the top three, with lower predictive performance due to greater variability in this direction. However, the interaction effect of transfer time and bus station count is negative. This study could provide new insights into public transport planning and management. Full article

Background: The nationally advertised mass media campaign Act-FAST UK, delivered in multiple waves since its launch in 2009, has increased public awareness of stroke symptoms. However, many stroke patients still delay in calling for help and reach the hospital too late to receive emergency treatments. The reasons for this cognitive dissonance between recognition of symptoms and urgent seeking of emergency medical services (EMS) are unclear. Aims: This study aimed to quantify cognitive, psychological, and knowledge-based barriers to help-seeking in patients with acute stroke or transient ischaemic attack (TIA), as well as in intervening witnesses, and to examine their association with the use of EMS as the initial point of contact. Methods: We interviewed patients admitted to a hyperacute stroke unit with a stroke or transient ischaemic attack (TIA) from 2013 to 2016. People who contacted emergency services on the patient’s behalf (intervening witnesses (IWs)) were also interviewed when available. Reasons given for delays in calling for help were related to correct symptom recognition, and whether/at what time, emergency services were contacted after symptoms onset. Results: A total of 602 patients (429 with stroke, 173 with TIA) along with 128 witnesses who intervened in calling for help in those cases (IWs) were interviewed. In the subset of patients with both measures available, there was a strong positive correlation between NIHSS score and number of FAST symptoms (Spearman’s rho = 0.645, p < 0.001), providing supportive evidence for the use of FAST symptom count as a proxy measure of stroke severity. A total of 469 (77.9%) of the patients were aware of a media education campaign about stroke, but only 145 (24.1%) had attributed their own symptoms to stroke at onset. However, correct self-diagnosis of stroke was not associated with direct calls to the EMS (OR 1.43, 95% CI 0.84–2.45). Cognitive, psychological or emotional barriers to help-seeking, as reported by prior published studies, were reported by 463 (81.2%) of the patients we interviewed but in only 63 (53.3%) of the IWs (p < 0.001). Amongst the patient cohort, “not thinking symptoms were serious” (275, 45.7%) and “waiting to see if symptoms would go away” (285, 47.3%) were most strongly negatively associated with EMS use (OR 0.52, 95% CI 0.32–0.84 and OR 0.34, 95% CI 0.21–0.55, respectively). Only 55 (9.1%) of the patients interviewed had been aware of any time-critical stroke treatment prior to their stroke. Eighteen stroke patients (4.2%) reached hospital in time to receive thrombolysis, but an additional 170 (39%) could have been considered for this treatment (i.e., had no apparent other contraindications from a notes review) had they arrived within 4 h of symptom onset. Conclusions: Future public education campaigns may be more effective if they specifically address factors associated with delays in calling for help after stroke symptoms and emphasise the existence of emergency treatments, which are also time-critical. More effective public education may have the potential to increase the proportion of patients arriving in time to benefit from such treatments. Full article

Urban vitality research treats food-and-beverage venues as aggregate point-of-interest counts and existing morphometric classification frameworks operate at the building, block or neighbourhood scale, leaving the commercial ground-floor interface without a programme-specific typology. This study develops GATE (Ground-floor Architectural Typology at the street Edge), a 22-variable morphological framework operating at the venue–street–interface scale, and applies it to 85 interfaces across eleven commercial arteries in the core of a mid-sized Turkish city. Ward hierarchical clustering yields a single dendrogram read at macro (k = 3) and micro (k = 7) resolutions, validated through Kruskal–Wallis tests that separate 17 and 19 of the 22 variables, respectively. Three macro types emerge: narrow-fronted apartment-ground-floor venues, detached garden-plot pavilion venues and vertically organised transparent-fronted venues. Space Syntax Integration, Choice and Shannon diversity produce no significant relationship with pedestrian density in the aggregate. Type stratification points to a resolution-dependent moderator effect: the apartment-ground-floor type shows negative Integration and positive Choice coupling, while the transparent vertical type shows positive Integration coupling, producing a directional pattern consistent with Simpson’s paradox. GATE provides one of the first programme-specific venue-level morphological frameworks and establishes an explicit quantitative mapping of the Panerai–Castex analytical typology with future multi-city applications to test its generalisability. Full article

Background: Triple-negative breast cancer (TNBC) is a biologically heterogeneous disease. Clinically accessible biomarkers remain limited. Objective: To evaluate androgen receptor (AR) expression and immune response—stromal tumor-infiltrating lymphocytes (sTILs), CD4⁺, CD8⁺, CD4/CD8 ratio—to explore their clinicopathological associations and relationships with 3-year overall survival (OS) in TNBC. Methods: We retrospectively analyzed data from 86 treatment-naïve women with TNBC who were treated between 2012 and 2019 at a single academic center. AR and CD4/CD8 were assessed immunohistochemically; sTILs were scored on H&E following The International TIL Working Group recommendations. Survival analyses focused on 3-year OS, with follow-up truncated at 36 months and multivariable Cox regression restricted to non-metastatic disease (stage I–III). Results: High AR expression (≥10%) occurred in 23% of tumors and was associated with lower CD8⁺ infiltration and lower tumor grade. Across adjusted models, we did not demonstrate statistically significant and independent associations between AR or immune markers and 3-year OS; however, inference is limited by the low number of events (10 deaths). Conclusions: AR status was associated with the immune response, particularly with reduced CD8⁺ infiltration in AR-high tumors, supporting the concept of biologically distinct AR–immune phenotypes. The absence of statistically significant survival associations in adjusted analyses should be interpreted cautiously given the limited event counts, and larger prospective cohorts are needed to validate prognostic and potential therapeutic implications. Full article

The gut microbiota of fish plays a crucial role in nutrition, metabolism and immune regulation, and is highly sensitive to environmental stressors such as pesticide exposure. This study investigated the effects of emamectin benzoate (EMB) exposure on Asian stinging catfish (Heteropneustes fossilis) gut microbiota using an integrated culture-dependent and culture-independent approach to assess functional and taxonomic dysbiosis. Gut smear samples from control and EMB-treated fish at two sublethal concentrations (0.5 µg/L and 5 µg/L) were analyzed for major functional bacterial groups, including heterotrophic, lipid-hydrolysing, starch-hydrolysing, spore-forming, and Gram-negative bacteria and Pseudomonas spp., using standard plate count techniques. In parallel, microbial community composition and diversity were examined through 16S rRNA (V3–V4 region) gene amplicon sequencing followed by bioinformatic analysis. Culture-based results showed a significant decline in total heterotrophic bacteria and key functional groups in EMB-treated fish, indicating suppression of microbial metabolic activity and functional imbalance. Lipid-hydrolysing and starch-hydrolysing bacteria showed pronounced sensitivity to pesticide exposure, while spore-forming bacteria exhibited a marked reduction, suggesting compromised microbial resilience. Although Gram-negative bacteria declined overall, Pseudomonas spp. displayed a non-linear response, with an initial decrease, followed by partial recovery under higher exposure. Culture-independent analysis demonstrated reduced alpha diversity, altered community structure, and taxonomic shifts in EMB-treated fish. Pseudomonadota exhibited a distinct pattern characterized by decline at 0.5 µg/L and partial recovery at 5 µg/L, reflecting adaptive tolerance rather than restoration of microbial homeostasis. Overall, the combined evidence indicates pronounced EMB-induced gut dysbiosis at both functional and compositional levels. This study highlights the fish gut microbiome as a sensitive biomarker of stress and underscores the ecological risks associated with EMB in aquatic environments. Full article

Richard J. Arneson’s theory of welfare underwent a significant transformation from subjectivism to objectivism. Three difficulties—adaptive preferences, false beliefs, and non-prudential desires—demonstrate that a welfare theory grounded in subjective attitudes is untenable in principle, driving Arneson toward an objective list theory. Through his rejection of the endorsement constraint, he established a purely objectivist position: subjective attitudes are “neither necessary nor sufficient” for well-being. This position generates significant justificatory pressure toward hard paternalism. Arneson confronted this consequence by arguing that hard paternalism is defensible in principle, while contending that paternalistic intervention must remain restrained in practice on grounds of the intrinsic value of autonomy, the limitations of state capacity, and the costs of stigmatization. However, the reasons Arneson offers for restraint cannot be adequately supported by the objective list alone; they face explanatory pressure at the level of political application. Conditional objectivism can better fill this explanatory gap: for an item on the objective list to count as contributing to a particular individual’s well-being, a negative condition must be satisfied—namely, that the individual would not rationally reject the item under conditions of reflective deliberation. Full article

Background and Objectives: The SARS-CoV-2 pandemic disrupted oral and maxillofacial surgery (OMS) services worldwide because of the high aerosol-generating nature of head-and-neck procedures, restricted access to elective dental care, and systemic reallocation of hospital resources. Continuous longitudinal multi-year data covering both the pandemic and the post-pandemic phases from regional Romanian (and more broadly central and southeastern European) emergency centers remain scarce. We aimed to quantify the impact of the pandemic on OMS activity in a large Romanian regional referral center and to evaluate post-pandemic resilience. Materials and Methods: We conducted a retrospective single-center study of all inpatient admissions to the OMS Clinic of a tertiary emergency hospital in western Romania between 1 January 2018 and 31 December 2024. Three periods were pre-specified: pre-pandemic (2018–2019), pandemic (2020–2022) and post-pandemic (2023–2024). A Newey–West segmented interrupted-time-series (ITS) regression and a negative-binomial monthly count model with Fourier seasonality were fitted; length of hospital stay was further analyzed with a multivariable gamma-log generalized linear model adjusted for age, sex, county, primary ICD-10 chapter and total ICD-10 codes. Variables analyzed included case volume, demographics, primary and secondary ICD-10 diagnoses, length of hospital stay (LOS), case complexity (total ICD-10 codes per admission) and in-hospital mortality. Results: A total of 11,628 inpatient admissions corresponding to 8084 unique patients (56.5% male; mean age 52.2 ± 19.2 years) were analyzed. Compared with the pre-pandemic baseline (mean 2037 admissions/year), annual volume dropped by 45.1% in 2020, 44.0% in 2021 and 32.3% in 2022, with a nadir of −76% during the first state of emergency (April 2020; n = 34 admissions). Recovery was rapid; 2024 exceeded the pre-pandemic baseline by +10.1% on raw counts and by +16.2% on admissions per 100,000 catchment population using year-specific INS denominators. The segmented ITS regression confirmed an immediate level drop of −114.2 admissions/month in March 2020 (95% CI −133.1 to −95.3; p < 0.001) and a positive post-intervention slope of +2.06 admissions/month (95% CI 1.23–2.88; p < 0.001), with observed monthly volume returning to the counterfactual projection by October 2023. The case mix shifted significantly (χ² = 406.9, p < 0.0001); elective benign neoplasm admissions were reduced from 7.2% to 2.0%, while neoplasms of uncertain behavior nearly doubled from 15.7% to 27.5%. Case complexity increased during the pandemic (mean ICD codes 4.08 ± 2.42 vs. 3.44 ± 2.30; p < 0.001); after exclusion of administrative codes (whole Z chapter and U07.x), the difference attenuated to 3.34 vs. 3.17 codes (still p < 0.001 by Kruskal–Wallis), indicating that the largest portion of the unadjusted increase was driven by the new mandatory pre-admission SARS-CoV-2 screening code Z11.5 rather than true clinical complexity. Notably, the clinically interpretable proxy R63.3 (feeding difficulty) independently rose from 41.5% to 53.1%. The crude median LOS did not differ between the pre-pandemic and pandemic periods (3.07 vs. 3.06 d; p = 0.19) and dropped significantly post-pandemic (2.22 d; p < 0.001); however, after multivariable adjustment for case mix, age, sex, county and code count, the LOS was 15.7% shorter during the pandemic (adjusted ratio 0.84, 95% CI 0.82–0.87; p < 0.001) and 22.8% shorter post-pandemic (adjusted ratio 0.77, 95% CI 0.75–0.80; p < 0.001) relative to baseline. Conclusions: The pandemic caused a severe but transient contraction of OMS activity accompanied by increased case complexity and a marked shift away from elective surgery. Inpatient volume returned to and exceeded the pre-pandemic baseline by 2024. These results support the value of standing pandemic-preparedness protocols, sustained access to preventive dental care, and integrated tele-triage pathways for future public-health crises. Full article