Search Results (783)

Background: Diabetes-related foot diseases represent a global health problem because of the associated complications, the risk of amputation, and the economic burden on health systems. Negative pressure wound therapy (NPWT) is a technique that uses sub-atmospheric pressure to help promote wound healing by reducing the inflammatory exudate while keeping the wound moist, inhibiting bacterial growth, and promoting the formation of granulation tissue. Objective: This study aimed to assess the effectiveness of NPWT in preventing major amputation in diabetic patients with complicated foot or lower limb infections and to contextualize the results through a review of the existing literature. Materials and methods: We conducted a retrospective study at the First Surgical Department of “Dr. I. Cantacuzino” Clinical Hospital in Bucharest, Romania, over a 15-year period, including 30 consecutive adult patients with diabetes and soft tissue foot or lower limb infections treated with NPWT. Patients with non-diabetic ulcers, incomplete medical data, or aged under 18 were excluded. All patients underwent initial surgical debridement, minor amputation, or drainage procedures, followed by the application of NPWT using a standard protocol. Dressings were changed every 2–4 days for a total of 7–10 days. Antibiotic therapy was adapted according to the culture results. The primary outcome was limb preservation, defined as avoidance of major amputation. Secondary outcomes included in-hospital mortality and wound status at discharge. Results: NPWT was associated with a favorable outcome in 24 patients (80%), defined by wound granulation or healing without the need for major amputation. Five patients (16.6%) underwent major amputation because of failure of the primary lesion treatment, and one patient died. No statistically significant association was observed between the outcomes and standard classification scores (WIFI, IWGDF, and TPI). A comprehensive literature review helped to integrate these findings into the existing pool of knowledge. Conclusions: NPWT may support limb preservation in selected diabetic foot cases. While the retrospective design and the small sample size of the study limit generalizability, these results reinforce the need for further controlled studies to evaluate NPWT in real-life clinical settings. The correct use of NPWT combined with etiological treatment may offer a maximum chance to avoid major amputation in patients with diabetes-related foot diseases. Full article

Raman spectroscopy allows for analyzing local molecular matrix components while preserving spatial resolution in tissue samples. The aim of this study was to use Raman line scans to discriminate between healthy and diseased cartilage tissue based on the depth-dependent sulfated glycosaminoglycans (sGAG) and total GAGs distribution. Full-thickness articular cartilage tissue was harvested from human individuals at different maturation stages (skeletally immature, skeletally mature) and from patients with diagnosed osteoarthritis. Raman spectroscopic line scans (30 µm step size) were utilized to analyze the sub-zonal sGAG (1062 cm⁻¹) and total GAG (1370–1380 cm⁻¹) distribution relative to the organic matrix (CH₂ band 1430–1480 cm⁻¹). We found a linear trend of the sGAG/CH₂ ratio over the tissue depth in all samples (p < 0.0001). The total GAG/CH₂ ratio of the skeletally immature and mature cartilage showed a characteristic non-linear behavior over the tissue distance. The elderly osteoarthritic cartilage exhibited lower total GAG/CH₂ ratios compared to the ratios of the skeletally immature and mature samples, without a pronounced increase in the superficial area. Raman spectroscopic line scans are a fast and representative method allowing us to identify the local and tissue depth-dependent distribution of GAGs at higher specificity and resolution compared to histological staining. Full article

Work–family conflicts (WFCs) and family–work conflicts (FWCs) have been found to be important to worker morale and retention as well as family (as defined by the respondents) well-being, with particular importance within the military, as indicated by a number of studies in the United States, Canada, and European countries. However, few studies have focused on the impact of WFC and FWC for high ranking officers and their families. This study involved two samples of officers attending an advanced leadership course at Fort Leavenworth, Kansas, in 2007, featuring a total of 262 Army officers and another 45 officers from other services and countries. The sample of Army officers included 239 men (85.4% of whom were a parent) and 22 women (63.6% of whom were a parent; Fisher’s Exact Test, p < 0.02), with one missing case for sex. Of the men and women, respectively, most were married for the first time (190/11), with some never married (14/5), married but divorced (10/1), married/divorced/remarried (20/4), married/spouse died/remarried (1/0), married/divorced/remarried/divorced/remarried (4/0), and married/divorced/remarried/divorced/remarried (0/1). Measures for cohabitation or same-sex partnerships were not used. Two modified measures of WFC and FWC of four items each were tested and found to represent different factors and to have high internal consistency reliability. In general we found few sex differences, but female officers seemed to be more influenced by family–work conflict than male officers. One of our most substantial findings was that work–family conflict was more prevalent than family–work conflict within our sample. Also, we found that marital satisfaction tended to be higher than parental satisfaction and that officers usually found their own retention intentions to be higher than their perception of that of their spouses. Satisfaction with the military was consistently and strongly related to lower levels of work–family conflict while similar but weaker trends were found for family–work conflict. Most of our results were found to cross-validate with a subsample of non-Army officers in our sample. We found bias from marital social desirability to be lower for our marital process scale and for FWC than for marital satisfaction and WFC. In sum, our results confirm adverse effects of deployments and other stressors on military families and a continuing need for military support for families, even among higher ranking officer families. Full article

To address the issue of insufficient contrast in conventional X-ray absorption imaging for biological soft tissues and weakly absorbing materials, this paper proposes a beam tracking X-ray phase-contrast imaging system using a conventional X-ray source. A periodic pinhole array mask is placed between the X-ray source and the sample to spatially modulate the X-ray beam, dividing it into multiple independent sub-beams. Each sub-beam is deflected due to the modulation effect of the sample, resulting in slight positional shifts in the intensity patterns formed on the detector. The experiments employ an X-ray source with a 400 μm focal spot and use a two-dimensional step-scanning approach to acquire image sequences of various samples. The experimental results show that this method can extract the edge profile and structural changes in the samples to some extent, and it demonstrates good contrast and detail recovery under weak absorption conditions. These results suggest that this method has certain application potential in material inspection, non-destructive testing, and related fields. Full article

Traditional maritime target element resolution, relying on manual experience and uniform sampling, lacks accuracy and efficiency in non-uniform sampling, missing data, and noisy scenarios. While large language models (LLMs) offer a solution, their general knowledge gaps with maritime needs limit direct application. This paper proposes a fine-tuned LLM-based adaptive optimization method for non-uniform sampling maritime target element resolution, with three key novelties: first, selecting Doubao-Seed-1.6 as the base model and conducting targeted preprocessing on maritime multi-source data to address domain adaptation gaps; second, innovating a “Prefix tuning + LoRA” hybrid strategy (encoding maritime rules via Prefix tuning, freezing 95% of base parameters via LoRA to reduce trainable parameters to <0.5%) to balance cost and performance; third, building a non-uniform sampling-model collaboration mechanism, where the fine-tuned model dynamically adjusts the sampling density via semantic understanding to solve random sampling’s “structural information imbalance”. Experiments in close, away, and avoid scenarios (vs. five control models including original LLMs, rule-only/models, and ChatGPT-4.0) show that the proposed method achieves a comprehensive final score of 0.8133—37.1% higher than the sub-optimal data-only model (0.5933) and 87.7% higher than the original general model (0.4333). In high-risk avoid scenarios, its Top-1 Accuracy (0.7333) is 46.7% higher than the sub-optimal control, and Scene-Sensitive Recall (0.7333) is 2.2 times the original model; in close and away scenarios, its Top-1 Accuracy reaches 0.8667 and 0.9000, respectively. This method enhances resolution accuracy and adaptability, promoting LLM applications in navigation. Full article

Background: Blast-induced spinal cord injuries (bSCI) account for 75% of all combat-related spinal trauma and are associated with long-term functional impairments. However, limited studies have evaluated the neuropathological outcomes in the spinal cord following blast exposure. Objectives In this study, we aimed to determine the acute and sub-acute neuropathological changes in the spinal cord of ferrets after blast exposure. Methods: An advanced blast simulator was used to expose ferrets to tightly coupled repeated blasts. The Catwalk XT system was used to detect gait performances in ferrets at 24 h and 1 month post-blast exposure. After euthanasia, the cervical spinal cord samples were collected at 24 h or 1 month post-blast. A quantitative real-time polymerase chain reaction was performed to evaluate changes in the gene expression of multiple Toll-like Receptors (TLR), Cyclooxygenase (COX-1 and COX-2) enzymes and cytokines. Western blotting was performed to investigate markers of axonal injury (Phosphorylated-Tau, pTau; Phosphorylated Neurofilament Heavy Chain, pNFH; and Neurofilament Light Chain present in degenerating neurons, NFL-degen) and neuroinflammation (Glial Fibrillary Acidic Protein, GFAP; and Ionized Calcium Binding Adaptor Molecule, Iba-1). Results: Blast exposure significantly affected the gait performances in ferrets, especially at 24 h post-blast. Multiple TLRs, COX-2, Interleukin-1-beta (IL-1β), Interleukin-6 (IL-6), and Tumor Necrosis Factor-α (TNF-α) were significantly upregulated in the spinal cord at 24 h after blast exposure. Although only TLR3 was significantly upregulated at 1 month, non-significant increases in TLR1 and TLR2 were observed in the spinal cord at 1 month post-blast. Phosphorylation of Tau at serine (Ser396 and Ser404) and threonine (Thr205) increased in the spinal cord at 24 h and 1 month post-blast exposure. The increased expression of pNFH and NFL-degen proteins was evident at both time points. The expression of GFAP, but not Iba-1, significantly increased at 24 h and 1 month following blast exposure. Conclusions: Our results indicate that blast exposure causes acute and sub-acute neuroinflammation and associated axonal injury in the cervical spinal cord. These data further suggest that inhibition of TLRs and/or COX-2 enzyme might offer protection against blast-induced injuries to the spinal cord. Full article

The existing literature estimating the additional costs of living faced by people with disabilities is still scarce, despite its relatively long existence. At the moment, existing studies have focused mainly on EU, Anglo-Saxon countries, Malaysia, the Philippines, Ghana, Vietnam, Cambodia, one state in India, sub-Saharan Africa, and China. This limited geographical coverage provides certain estimates for a large fraction of the OECD countries, along with non-representative samples from most other countries, leaving behind more than 75% of the countries worldwide. The main disadvantage of the scarcity of studies relates to the difficulty in estimation and the unavailability of data on disability and related costs. This study surveys the literature on the additional costs of living for people with disabilities. It summarizes the models of disability, the categorization of different costs, the cost assessment methods, and the reasons for difficulty in measuring/estimating costs. We present all studies in the literature received estimating the additional costs of living for people with disabilities, along with the methods used and the geographical areas investigated. The main conclusions drawn from the present survey point to significant additional costs of living for people with disabilities, depending on the type and intensity of disability, which in all cases are not less than 20% of household income, and increase significantly depending on the specifics. Full article

High-resolution (HR) medical images provide clearer anatomical details and facilitate early disease diagnosis, yet acquiring HR scans is often limited by imaging conditions, device capabilities, and patient factors. We propose a transform domain deep multiscale feature fusion generative adversarial network (MSFF-GAN) for medical image super-resolution (SR). Considering the advantages of generative adversarial networks (GANs) and convolutional neural networks (CNNs), MSFF-GAN integrates a deep multi-scale convolution network into the GAN generator, which is composed primarily of a series of cascaded multi-scale feature extraction blocks in a coarse-to-fine manner to restore the medical images. Two tailored blocks are designed: a multiscale information distillation (MSID) block that adaptively captures long- and short-path features across scales, and a granular multiscale (GMS) block that expands receptive fields at fine granularity to strengthen multiscale feature extraction with reduced computational cost. Unlike conventional methods that predict HR images directly in the spatial domain, which often yield excessively smoothed outputs with missing textures, we formulate SR as the prediction of coefficients in the non-subsampled shearlet transform (NSST) domain. This transform domain modeling enables better preservation of global anatomical structure and local texture details. The predicted coefficients are inverted to reconstruct HR images, and the transform domain subbands are also fed to the discriminator to enhance its discrimination ability and improve perceptual fidelity. Extensive experiments on medical image datasets demonstrate that MSFF-GAN outperforms state-of-the-art approaches in structural similarity index (SSIM) and peak signal-to-noise ratio (PSNR), while more effectively preserving global anatomy and fine textures. These results validate the effectiveness of combining multiscale feature fusion with transform domain prediction for high-quality medical image super-resolution. Full article

Background/Objectives: Outpatient operative hysteroscopy is a cornerstone in the management of intrauterine pathologies within reproductive medicine. However, procedural pain and anxiety remain key barriers leading to failed procedures and referrals for surgery under general anesthesia. This study aimed to assess whether a comfort-enhanced procedural environment could reduce perceived pain and increase procedural success rates. Methods: Analysis of 970 consecutive patients who underwent outpatient operative hysteroscopy at the Hysteroscopy Unit of “Degli Infermi” Hospital (Biella, Italy): 470 in 2023 under standard conditions, 500 in 2024 with an enhanced setting. Surgical technique, analgesic/sedation policies and operators were unchanged. The primary outcome was referral to the OR for completion of the procedure. Secondary outcomes included patient-reported pain assessed by Visual Analog Scale (VAS) in a consecutive subsample. Differences between years were evaluated with appropriate parametric/non-parametric tests. Results: Implementation of the enhanced environment was associated with a lower OR referral rate in 2023 versus 2024. Post hoc power for this comparison was approximately 60%. Mean VAS scores also decreased in 2024, with post hoc power >99%. No adverse events were recorded. Conclusions: Environmental and interpersonal modifications were associated with meaningful decline in reported pain and OR referrals. Prospective studies incorporating systematic case-mix and validated anxiety measures are warranted to confirm these results. Full article

Background: Nasopharyngeal carcinoma (NPC), particularly the non-keratinizing subtype (NK-NPC), is prevalent in Southeast Asia and often presents diagnostic challenges due to overlapping histological features with benign nasopharyngeal lesions. While Epstein–Barr virus (EBV) serology supports diagnosis in many cases, its limitations in sensitivity and specificity necessitate additional tissue-based markers. Objective: To assess the immunohistochemical expression of cytokeratins CK8/18 and CK19 in NPC compared to benign nasal tissue and evaluate their potential as adjunct immunohistochemical markers. Methods: This retrospective study evaluated the immunohistochemical expression of cytokeratins CK8/18 and CK19 in 24 NK-NPC and 22 benign nasopharyngeal tissue samples collected between April 2021 and April 2024 at Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia. Staining intensity and distribution were scored semi-quantitatively, and statistical analysis was performed using SPSS v29.0 (p < 0.05). Results: CK19 was expressed in all NK-NPC cases, with strong positivity in 79.2%, while CK8/18 was positive in 92%, primarily with weak to moderate staining. Only one benign case (inverted papilloma) showed focal positivity. The differences in expression between malignant and benign tissues were statistically significant (p < 0.001). Sub-analysis of EBER-positive cases (n = 15) confirmed consistently strong CK19 expression. Conclusions: Based on this small retrospective cohort, CK8/18 and particularly CK19 demonstrate expression patterns that may support their use as adjunct immunohistochemical markers in the histopathological assessment of NK-NPC, especially in morphologically ambiguous cases. Further validation in larger studies is needed before these markers can be considered for routine diagnostic application. Full article

Background/Objectives: An ASD diagnosis from EEG is challenging due to non-stationary, low-SNR signals and small cohorts. We propose a compact, interpretable pipeline that pairs a shift-invariant Stationary Wavelet Transform (SWT) with Fisher’s Linear Discriminant (FLDA) as a supervised projection method, delivering band-level insight and subject-wise evaluation suitable for resource-constrained clinics. Methods: EEG from the KAU dataset (eight ASD, eight controls; 256 Hz) was decomposed with SWT (db4). We retained levels 3, 4, and 6 (γ/β/θ) as features. FLDA learned a low-dimensional discriminant subspace, followed by a linear decision rule. Evaluation was conducted using a subject-wise 70/30 split (no subject overlap) with accuracy, precision, recall, F1, and confusion matrices. Results: The β band (Level 4) achieved the best performance (accuracy/precision/recall/F1 = 0.95), followed by γ (0.92) and θ (0.85). Despite partial overlap in FLDA scores, the projection maximized between-class separation relative to within-class variance, yielding robust linear decisions. Conclusions: Unlike earlier FLDA-only pipelines and wavelet–entropy–ANN approaches, our study (1) employs SWT (undecimated, shift-invariant) rather than DWT to stabilize sub-band features on short resting segments, (2) uses FLDA as a supervised projection to mitigate small-sample covariance pathologies before classification, (3) provides band-specific discriminative insight (β > γ/θ) under a subject-wise protocol, and (4) targets low-compute deployment. These choices yield a reproducible baseline with competitive accuracy and clear clinical interpretability. Future work will benchmark kernel/regularized discriminants and lightweight deep models as cohort size and compute permit. Full article

Background: Sexually expansive (sexual identities beyond traditional monosexual categories) Latina/e/x women navigate intersecting systems of oppression shaped by cultural expectations, gender norms, and heterosexism. Despite their resilience, they remain underrepresented in minority stress research. This study examines how individual (sexual and ethnic identity centrality), relational (social support from family, partners, and friends), and communal (community connectedness) protective factors relate to internalized heterosexism and improved or diminished mental health factors (life satisfaction and psychological distress). Methods: Grounded in an intersectional ecological systems and minority stress framework, this study uses secondary data from the Generations Study, a national longitudinal investigation of sexually expansive adults in the U.S. from 2016 to 2019. A subsample of sexually expansive Latina/e/x women (n = 120) was analyzed using one-way ANOVA, multiple regression, and moderation analyses. Results: Sexual and ethnic identity centrality was independently associated with lower internalized heterosexism. Family, friend, and significant other social support were significantly associated with improved and diminished mental health factors, as was community connectedness with sexual identity centrality. ANOVAs and moderation results were non-significant. Conclusions: These findings highlight the protective impact of identity affirmation and social support on mental health, offering valuable insights for clinicians, researchers, and community leaders supporting a strong yet underrepresented group. Full article

Screening for diabetes-specific distress should be considered a standard component of diabetes management. This study aimed to evaluate the psychometric properties of the Serbian adaptation of the Problem Areas in Diabetes—Teen Version (PAID-T). Methods: A multicentre, validation, cross-sectional study was conducted with 374 adolescents (aged 13–18 years) diagnosed with type 1 diabetes (T1D), all of whom completed the Serbian version of the PAID-T. The psychometric evaluation included assessments of construct validity through exploratory (EFA, first subsample, n = 140) and confirmatory (CFA, second subsample, n = 234) factor analyses, as well as examinations of concurrent and convergent validity. Reliability was evaluated using measures of internal consistency and test–retest stability (n = 289). Results: Factor analyses indicated some multidimensionality; however, the high correlations between factors in the three-factor model and the optimal fit of the hierarchical three-factor model with a single second-order factor supported the interpretation that the PAID-T measures a unified construct, with satisfactory fit indices (CFI = 0.95; TLI = 0.93; RMSEA = 0.08; SRMR = 0.05). Concurrent validity testing demonstrated gender-based differences in adolescents’ perceptions of the emotional burden of diabetes (W = 19.718, p = 0.03, small effect size = 0.11). Convergent validity analyses showed that adolescents who were non-adherent to treatment (W = 11.390, p = 0.01, small effect size = 0.13) or experienced difficulties managing diabetes at school (W = 16.333, p < 0.001, small effect size = 0.16) reported significantly higher levels of diabetes-specific distress. A significant negative correlation was also observed between PAID-T scores and perceived social support (ρ = −0.24, p < 0.001). Importantly, Serbian adolescents with T1D reported mean PAID-T scores close to the cutoff point of 44, indicating clinically relevant levels of distress. The Serbian version demonstrated strong internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.93) and excellent test–retest reliability (ICC = 0.99, 95% CI), confirming stability over time. Conclusions: The Serbian adaptation of the PAID-T demonstrated strong validity and reliability, supporting its use as a robust tool for assessing self-reported diabetes-specific distress in adolescents. Notably, the mean PAID-T scores in Serbian adolescents with T1D were close to the established cutoff point of 44, underscoring the clinical relevance of routine screening in this population. The early identification of diabetes distress can enable nurses and other members of the multidisciplinary healthcare team to deliver tailored interventions, ultimately improving psychological well-being and health outcomes. Full article

Despite its wide acceptance, one of the most critical limitations of Terahertz wave technology is its high sensitivity to moisture. This limitation can, in turn, be exploited for use in moisture detection applications. This work presents a quantitative, non-invasive characterization of moisture content in standard gypsum drywall using Terahertz Time-Domain Spectroscopy (THz-TDS). With an increase in the moisture content of the drywall sample, experimental results indicated an increase in the dielectric properties such as the refractive index, permittivity, absorption coefficient, extinction coefficient, and dissipation factor. The demonstrated sensitivity to moisture establishes THz-TDS as a powerful tool for structural monitoring, hidden defect detection, and electromagnetic modeling of real-world building environments. Beyond material diagnostics, these findings have broader implications for THz indoor propagation studies, especially for emerging sub-THz and low THz communication technologies in 5G/6G and THz imaging of objects hidden behind the wall. Full article

The study investigates the interplay among second language (L2) learners’ willingness to communicate (WTC), L2 self-confidence (L2SC), and academic self-concept (ASC) within a cohort of Vietnamese university students studying in the United Kingdom. Employing an explanatory sequential mixed-methods design, self-reported quantitative data were collected via validated survey instruments (n = 32 students), followed by semi-structured interviews with a purposive subsample (n = 5 students) to contextualise the findings. Results revealed that participants exhibited moderate levels of WTC and L2 self-confidence, alongside emerging academic self-concept. Significant positive correlations were observed between WTC and L2 self-confidence and between L2 self-confidence and academic self-concept; a weak, non-significant association was found between WTC and academic self-concept. Qualitative data corroborated these patterns, highlighting how learners’ communicative confidence was shaped by supportive environments and evolving self-perceptions. While self-comparisons and cultural expectations occasionally influenced students’ academic self-concept, most participants reported resilience and a commitment to communication development. The study contributes to the literature by integrating psychological and contextual variables influencing WTC, offering pedagogical implications for enhancing communicative competence among international English as a second language learners. Full article