Search Results (1,831)

Smartphone-based portable slit lamp microscopes are increasingly used as low-cost tools for anterior segment imaging in teleophthalmology, yet the literature combines heterogeneous study designs, comparator standards, and deployment contexts. Because the evidence base spans engineering reports, basic science, clinical validation studies, implementation research, and case-based telemedicine, we structured a narrative review rather than a pooled meta-analysis. We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, Google Scholar, Cochrane Library, ScienceDirect, and DOAJ for literature available on or before 28 February 2026, supplemented by manual reference list screening and targeted retrieval of relevant technical standards. Peer-reviewed English original studies formed the core evidence base; contextual non-English and gray literature sources were retained only when explicitly labeled as non-core. To improve interpretability, the results were grouped by synthesis domain, clinical task, comparator standard, telemedicine scenario, and artificial intelligence (AI) dataset/validation characteristics. The highest-confidence evidence concerned nuclear cataract grading, tear film breakup time and corneal staining assessment, anterior chamber depth screening, tear meniscus height measurement, allergic conjunctival grading, and selected corneal disorders. Agreement with conventional slit lamp examination or anterior segment optical coherence tomography was generally moderate to high within task-specific comparisons, and telemedicine deployment was feasible for screening, follow-up, remote consultation, emergency triage, house visits, and outreach. However, illumination reporting remains inconsistent, explicit ISO-aligned dosimetry is sparse, and most AI studies remain retrospective, single-center, and device family-specific. Current evidence, therefore, supports smartphone-based portable slit lamp microscopes primarily as adjunctive teleophthalmology tools rather than replacements for comprehensive in-clinic microscopy. The synthesis clarifies where conclusions are supported by comparative validation data, where they remain exploratory, and which methodological gaps should be prioritized in future multicenter studies. Full article

RNA viruses exhibit high mutation rates, necessitating antivirals targeting conserved infection mechanisms. In this study, viral hemorrhagic septicemia virus (VHSV), a non-human pathogenic negative-sense RNA virus, was used as a surrogate model to enable high-throughput antiviral screening under reduced biosafety conditions. A recombinant VHSV expressing enhanced green fluorescent protein was used to screen 17,265 compounds, 2000 plant extracts, and 100 marine extracts. Among the candidates, the leaf extract of Phellodendron amurense Rupr. (PL extract) exhibited antiviral activity with low cytotoxicity (selectivity index ≈ 10). The extract reduced viral infectivity in a dose-dependent manner and showed cross-activity against snakehead rhabdovirus. Mechanistic analyses indicated that the PL extract acts primarily at early stages of infection. Virucidal assays demonstrated direct, time-dependent inactivation of viral particles, while pre-treatment reduced host cell susceptibility. Time-of-addition experiments confirmed that antiviral activity was restricted to early infection, suggesting interference with viral attachment or entry rather than intracellular replication. Fractionation revealed that activity was associated with the non-polar n-hexane fraction, implicating lipophilic compounds that may disrupt viral envelope integrity or membrane interactions. These findings suggest that P. amurense leaf extract is a promising candidate for broad-spectrum antivirals targeting conserved entry processes in enveloped RNA viruses. Full article

Firearm-related injuries are the leading cause of death for children, adolescents, and young adults in the United States, yet empirically evaluated court-based intervention models targeting firearm offenders remain rare in the peer-reviewed literature. This exploratory pilot study evaluates the implementation and pilot outcomes of the Violence Intervention Program (VIP), a court-based specialty docket designed to address gun violence through a trauma-informed, multidisciplinary model. This descriptive pilot evaluation utilized administrative court records, program data, and clinical service logs among 77 enrolled participants with felony-level, non-violent gun-related charges. Participants were entirely male, majority Black (87%), with a median age of 22 years, and primarily residents of high-poverty Cleveland, OH neighborhoods. Descriptive statistics and independent-samples t-tests were used to compare service utilization and drug screen outcomes between program participants who successfully completed and those who were unsuccessfully terminated from the program. Successful completion was contingent upon fulfillment of three program phase requirements, including consistent adherence to court-mandated supervision and active engagement in clinical and program services. Of 48 participants who exited the program during the pilot period, 34 successfully completed (67.3%). The one-year recidivism rate was 29.5%. Successful program completers received significantly higher monthly peer mentorship services than those who were unsuccessfully terminated, while counseling dosage and drug screen results did not significantly differ between groups. Findings suggest that multidisciplinary, trauma-informed, court-based models can safely intervene with justice-involved young adults and may serve as a replicable public health strategy for reducing gun violence. Full article

Background/Objectives: A non-surgical orthodontic treatment strategy for transverse maxillary deficiencies, especially in late adolescents and young adults, is microscrew-assisted rapid palatal expansion (MARPE). The literature indicates several concerns regarding its long-term efficacy and potential complications. Recent studies have provided valuable insights into the MARPE technique, particularly focusing on its efficacy, potential complications, and treatment failures. The present scoping review aims to synthesize and critically appraise clinical evidence on MARPE in post-pubertal patients, with a specific focus on treatment outcomes, mechanisms of failure, and local and systemic adverse effects to inform risk–benefit assessment and clinical decision-making. Methods: A systematic search was conducted across four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to identify English-language clinical trials, observational studies, and systematic reviews published between January 2015 and December 2025. The search strategy employed controlled vocabulary (MeSH terms) and Boolean operators targeting MARPE, treatment failure, and adverse effects in patients aged ≥ 16 years. After title/abstract screening and full-text assessment using predetermined inclusion criteria, 15 studies (3 systematic reviews with meta-analysis, 2 umbrella reviews, 4 systematic/scoping reviews, 2 randomized controlled trials, and 4 observational studies) were selected for qualitative synthesis. Results: Fifteen studies were finally included, which demonstrated significant heterogeneity in methodological design, sample characteristics, outcome measurement protocols, and MARPE device specifications. Mean success rates of 92.5% for maxillary transverse expansion were reported, with mean expansion duration ranging between 20 and 126 days. Key adverse effects comprised dentoalveolar tipping (buccal inclination of maxillary molars and premolars), periodontal complications (buccal bone resorption of 0.6–0.9 mm, gingival recession, papilla recession in 18% of cases), root resorption, miniscrew loosening, midpalatine/circummaxillary sutures, and potential but minimally documented intracranial effects. Conclusions: MARPE appears to be a valid non-surgical option for selected post-pubertal patients, but its success depends on careful case selection and monitoring for dentoalveolar, periodontal, sutural, and rare intracranial adverse effects. Full article

Background/Objectives: Sleep disturbance is common among youth in the child welfare system, yet the role of placement instability and placement setting in shaping sleep outcomes remains understudied. This study examined the association between placement instability, time spent in different care settings, and sleep disturbance among children in foster care. Methods: We conducted a retrospective cohort study using longitudinal administrative child welfare data from a Midwestern U.S. state, including 20,888 youth aged 5–18 years who entered foster care between 2010 and 2020. Sleep disturbance was assessed using the Child and Adolescent Needs and Strengths (CANS) sleep item. Baseline was defined as the first CANS assessment within one month of entry into care, and follow-up as the assessment closest to discharge or the end of a three-year observation window, whichever occurred first. We estimated association using a time-lagged linear mixed-effects model predicting sleep disturbance after each placement episode, including placement instability: 1 (reference), 2, 3, or ≥4 placement(s), time since placement, time spent in care settings (kinship, foster home, treatment foster home, congregate care, institutional care), and baseline trait factor scores derived from non-sleep CANS items, while controlling for sleep at the time of placement and demographics. Results: At baseline, 2016 children had actionable sleep disturbance (CANS sleep = 2 or 3; 1701 moderate and 315 severe). By the end of follow-up, this increased to 2884 children (2372 moderate and 512 severe). In linear mixed-effects models, placement instability demonstrated a dose–response association with higher subsequent sleep disturbance relative to one placement (2 placements: β = 0.025; 3 placements: β = 0.045; ≥4 placements: β = 0.067; all p ≤ 0.02). Time spent in kinship care was associated with lower sleep disturbance (β = −0.049; p < 0.001), whereas time spent in treatment foster homes was associated with higher sleep disturbance (β = 0.035; p < 0.001). Trauma in the family, medical/developmental needs, and internalizing/sexual issues were positively associated with sleep disturbance. Time and instability interactions showed modest attenuations of instability-associated sleep disturbance over time for higher placement counts. Conclusions: Placement instability is associated with progressively worse sleep disturbance over time among youth in foster care, even after controlling for sleep status at placement and baseline functioning. Sleep disturbance may represent an actionable indicator for the child welfare system, highlighting opportunities for targeted screening and support during placement transitions. Full article

Background: Digital health (mHealth) interventions are increasingly integrated into maternity care to improve health literacy and reassure expectant mothers. However, the “double-edged sword” of continuous monitoring may be associated with heightened anxiety. This study aimed to describe mHealth usage patterns and investigate the association between technology engagement and mental health outcomes among pregnant women in Romania, where perinatal distress is a significant public health challenge. Methods: This observational, cross-sectional study included 100 pregnant and immediate postpartum women at a tertiary maternity unit in Romania. Participants were stratified into mHealth Users (n = 52) and Non-Users (n = 48). Validated instruments, including the PHQ-9, GAD-7, and EPDS, assessed depressive and anxiety symptoms. Predictors of adoption were identified using multivariable binary logistic regression. Results: mHealth users were predominantly from urban environments (80.8% vs. 54.2%, p = 0.004) and reported higher rates of daily physical activity (p < 0.001). Users experienced significantly higher median scores for depression (PHQ-9: 6 vs. 4, p = 0.047), generalized anxiety (GAD-7: 7 vs. 6, p = 0.015), and pregnancy-specific anxiety (35 vs. 29.5, p = 0.028) compared to non-users. In the multivariable model, high psychological distress (OR 0.08 for low-stress vs. high-stress, p = 0.009) and urban residency (p = 0.043) were independent predictors of mHealth adoption. Notably, 96.2% of users shared their digital data with healthcare providers. Conclusions: mHealth adoption in this population is characterized by a “paradox of monitoring,” where usage is strongly associated with pre-existing psychological vulnerability and associated with higher distress. While these tools serve as markers for mental health risk, the high rate of data sharing offers a clinical opportunity for a hybrid model of care. Obstetricians should view high digital engagement as a prompt for targeted mental health screening and proactively mediate patient-generated data to mitigate anxiety. Full article

Over the past decade, veterinary forensic toxicology has gained increasing relevance due to the recognition of animal poisoning as a criminal, environmental, and public health concern. This review provides an updated overview on current perspectives in veterinary forensic toxicology, focusing on common toxicological scenarios, analytical innovations, and interpretative challenges. Intentional poisoning of companion animals, wildlife intoxication, and environmental contamination are discussed within a One Health framework. Mass spectrometry-based techniques, including targeted gas chromatography–tandem mass spectrometry (GC-MS/MS), liquid chromatography–tandem mass spectrometry (LC–MS/MS) and high-resolution mass spectrometry (HRMS) for non-targeted screening, and emerging ambient mass spectrometry approaches are highlighted as pivotal tools in modern forensic investigations. Major limitations related to post-mortem changes, species-specific toxicokinetic, and the lack of harmonized interpretative criteria are critically examined. The review also identified future priorities such as methodological standardization, expansion of toxicokinetic databases across species, detection of emerging contaminants, and strengthened international cooperation. Overall, veterinary forensic toxicology is an emerging discipline at the intersection of animal welfare, environmental conservation, and public health providing essential evidence for legal, regulatory, and investigative purposes. Full article

Hypertension is a severe global public health issue. Food-derived angiotensin-converting enzyme (ACE)-inhibitory peptides have shown great potential as safe and effective alternatives to synthetic antihypertensive drugs. Camel milk is rich in bioactive peptides. This study aimed to screen for ACE-inhibitory peptides from hydrolyzed camel casein, explore their inhibitory mechanisms and endothelial protective effects in vitro, and reveal their potential antihypertensive pathways using network pharmacology. This study screened three peptides with angiotensin-converting enzyme (ACE) inhibitory activity from enzymatically hydrolyzed camel casein components: MVPFLQPK, VPFLQPKVM, and QKWKFL, with IC₅₀ values of 277.1, 396.9, and 486.9 μmol/L, respectively. Enzyme inhibition kinetics analysis indicated that MVPFLQPK exhibited a non-competitive inhibition pattern, VPFLQPKVM exhibited a mixed inhibition pattern, and QKWKFL exhibited a competitive inhibition pattern. Molecular docking revealed that all three peptides formed hydrogen bond interactions with ACE, and QKWKFL and VPFLQPKVM directly bound to the enzyme’s active site to inhibit substrate catalysis. Molecular dynamics simulation further confirmed the high stability of the three peptide–ACE complexes, with binding free energies from −34.24 to −51.19 kcal/mol. The primary contributing forces include hydrogen bonds, van der Waals interactions, electrostatic forces, and nonpolar solvation effects. Network pharmacology analysis suggested that these peptides may exert synergistic antihypertensive effects by regulating multiple blood pressure-related pathways, including the renin–angiotensin system, renin secretion, and calcium signaling pathways, by acting on key targets such as ACE, REN, SRC, and MMP9. Cell experiments demonstrated that all three peptides exhibited no cytotoxicity in the Ang II-induced HUVEC injury model, significantly promoted NO release, inhibited ET-1 secretion, and possessed endothelial protective potential. This study investigated the in vitro ACE-inhibitory mechanism of peptides derived from camel milk and their potential role in blood pressure regulation, providing experimental evidence for subsequent in vivo activity validation and the development of functional camel milk protein products. Full article

Emerging organic pollutants (EOPs) in aquatic environments have attracted increasing attention because many occur at trace levels, undergo transformation during environmental transport, and contribute to poorly resolved mixture risks. Traditional targeted analysis is inherently restricted to predefined compounds, whereas high-resolution mass spectrometry (HRMS)-based full-scan workflows provide broader opportunities for discovering known unknowns and previously unrecognized contaminants. This review critically synthesizes an omics-based analytical framework for aquatic environments, covering sample digitalization, instrumental analysis and acquisition modes, chemical fingerprint/non-target screening, suspect screening, effect-directed analysis, and confidence-based structural identification. Particular emphasis is placed on practical decision points and trade-offs, including dissolved versus particulate-associated analytes, LC-HRMS versus GC-HRMS coverage, hard versus soft ionization, DDA- versus DIA-type acquisition, database dependence, and the persistent difficulty of linking analytical features to toxicological relevance. The review also discusses emerging directions involving artificial intelligence, chemometrics, organometallic contaminants, and microplastic-associated chemicals. By clarifying conceptual boundaries and highlighting current limitations, this article aims to support the development of more critical, transparent, and risk-oriented workflows for the discovery and prioritization of emerging pollutants in aquatic environments. Full article

Helicobacter pylori is the leading cause of chronic gastrointestinal tract diseases, with a worldwide prevalence of around 50%. For identification in medical practice, non-invasive methods such as the immunochromatographic test for antigen in stool (SAT) and the urease breath test (UBT) are widely used. Recently, we developed a highly sensitive and specific nested PCR (NPCR) that involves two amplification reactions and uses primers designed to target the variable regions of the 16S rRNA gene to amplify a short 148 bp amplicon. The aim of this study was to compare two classical methods, SAT and UBT, with the 148 bp amplicon NPCR. We examined samples from 137 volunteers, and found 46 positives with NPCR using stool samples, 34 with UBT, and only 24 with SAT. H. pylori origin of the 148 bp amplicons was confirmed by sequencing. NPCR had the highest detection rate in this cohort, suggesting that a portion of the population may be misdiagnosed, particularly by SAT. Due to the cost and simple performance in practice, SAT is a method of choice for initial screening. However, in cases of negative results and persistent digestive problems, we recommend the more sensitive UBT. NPCR may be a useful complementary method, especially in discordant or clinically suspicious cases. Full article

Background: Non-syndromic retinitis pigmentosa (RP) is characterized by rod–cone degeneration, resulting in night blindness, visual field constriction, and eventual blindness. Recessively inherited RP is predominantly exacerbated in consanguineous populations, such as Pakistan. This study aimed to perform the genetic analysis of sixteen non-syndromic RP segregating Pakistani families, and to summarize the mutation spectrum of non-syndromic RP in our population by reviewing related literature. Methods: We screened 16 non-syndromic RP families using targeted capture panel sequencing of 344 genes related to inherited retinal dystrophies. Variants were prioritized based on rarity (minor allele frequency (MAF) < 0.001 in the gnomAD South Asian subset), pathogenicity assessments using ACMG/AMP criteria, and REVEL scores (>0.5). Candidate variants were validated for familial segregation through Sanger sequencing. Results: We identified 15 distinct variants across 14 genes associated with non-syndromic retinitis pigmentosa, comprising 6 missense, 7 nonsense, 1 frameshift, and 2 splice-site variants, including 4 novel variants, i.e., p.(Val220Met) and p.(Pro1282SerfsTer2) in RP1, 1 each in PDE6B (c.2021+5G>A), and PRCD p.(Ser38Ter). Homozygosity predominated, underscoring the impact of consanguinity on the burden of autosomal recessive disease in the present cohort, while the CERKL disease-causing mutation, i.e., p.(Arg257Ter), recurred in two families. Conclusions: This study expands Pakistan’s non-syndromic RP mutational spectrum by identifying novel variants in RP1, PDE6B, and PRCD, alongside recurrent CERKL and RHO mutations of the local population. The literature review suggests that RP1, TULP1, and PDE6B are among the most mutated genes in our population, supporting the value of population-specific genetic panels to enhance diagnostics and carrier screening. Full article

Background: Body mass index (BMI) is widely used as a proxy of nutritional status and related lifestyle risk patterns in public health, yet it does not capture body composition–related heterogeneity in cardiometabolic risk. Evidence on whether a more detailed body composition assessment improves population-level screening efficiency remains inconsistent, particularly in Central European populations. Methods: We conducted a cross-sectional analysis of 868 Hungarian adults participating in a nationwide mobile screening program. Locally weighted regression identified sex-specific BMI inflection points for cardiometabolic risk. Stratified receiver operating characteristic (ROC) analyses compared BMI with bioelectrical impedance-derived parameters across five outcomes. Cost- and time-effectiveness of scalable screening strategies were modeled at the population level. Results: Cardiometabolic risk increased at BMI levels below current WHO thresholds (females: 21.8–22.3 kg/m²; males: 23.8–24.3 kg/m²). Overall, body composition parameters did not outperform BMI in the full population. Subgroup-specific differences were observed, particularly among men with BMI 24–36 kg/m² for atherosclerosis risk, suggesting limited and outcome-specific added value rather than broad superiority over BMI. Together, non-linear risk patterns, stratified performance, and population-level modeling converged on mid-range BMI intervals (females: 22–30 kg/m²; males: 24–30 kg/m²) as likely screening windows of phenotypic heterogeneity. Within these ranges, targeted InBody assessment may help refine risk assessment for selected individuals. A mixed screening strategy covering 52% of the population would cost 178.4% of BMI-only screening, while reducing throughput by 24.3%. Conclusions: Population-specific BMI thresholds may more accurately reflect early deviations in nutritional and cardiometabolic risk than current universal cutoffs. BMI remains a useful first-line marker, and body composition assessment may add complementary information in selected BMI ranges. Overall, these findings support a potentially useful, subgroup-specific screening approach, but the modeled cost and time trade-offs should be considered hypothesis-generating and require further validation. Full article

Background: To elucidate the evolution of metabolites and fungal communities during storage of fragrant japonica rice (Liaoxiangjing 1396), and to investigate the biosynthetic mechanisms of key compounds and their association with quality deterioration, this study examined rice samples stored under simulated conditions for 16 months. Method: Samples were collected at 4-month intervals (designated R20, R14, R13, R12, and R11). Metabolites were identified using GC-MS non-targeted metabolomics, while fungal community structure was analyzed through metagenomics. Core mechanisms were further elucidated via PLS-DA, KEGG pathway enrichment, and multiomics association analysis. Result: Results demonstrated that the fatty acid content of rice increased initially and then stabilized (from 12.24 mg/g in R20 to 17.63 mg/g in R12). A total of 263 metabolites were identified, with oxygenated organic compounds (38 species) and lipids/lepidid molecules (24 species) as the predominant categories. Twelve key differential metabolites were screened from the R20 and R12 groups, involving five major metabolic pathways, including amino acid metabolism and lipid metabolism. In the fungal community, Pseudomonas (60.2%) and Pantoea (38.19%) were dominant taxa, with a specific Pantoea species (Pantoea sp.) identified as a core potential biomarker. Multiomics association analysis revealed that Klebsiella dominated the ndhB energy metabolism pathway, while multiple bacteria cooperatively regulated the mcp chemotaxis pathway, interacting with monosaccharide and amino acid accumulation. Conclusions: This study reveals that the storage quality deterioration of fragrant japonica rice is driven by the “metabolite–microbe-pathway” chain regulation, and the dynamic changes in key metabolites and fungal communities can serve as quality early warning targets. Full article

Pesticide manufacturing industry wastewater is a complex mixture of potentially harmful components. If not properly treated, discharged effluents may pose serious risks to environment and organisms. In this study, influent and effluent wastewater samples from a pesticide factory were comprehensively non-screened by liquid chromatography high-resolution mass spectrometry, coupled with zebrafish embryo toxicity testing to assess whole effluent toxicity. A total of eight chemical groups were identified, including pesticides, antibiotics, nitrogen compounds, ketones, esters, amines and derivatives, other drugs, and other organic compounds. While wastewater treatment processes reduced most of the analyzed groups of compounds, compounds (e.g., 2-aminophenol, N-Nitrosodipropylamine, and carbamazepine) increased during the treatments. The influent samples were more toxic to zebrafish than the effluent samples in terms of lethality, teratogenic effects, developmental impacts, locomotor behavior, and neurotoxicity. The results showed that locomotor behavior was the most sensitive phenotypic toxicity endpoint, with significantly higher sensitivity than traditional acute lethal or teratogenic endpoints. Through a multi-dimensional assessment approach combining chemical screening, literature-based, risk ranking, and targeted quantification, we identified three predominant pesticide residues in the wastewater samples (both influents and effluents): hexaconazole, fenobucarb and isoprocarb. All three compounds exhibited additive or synergistic toxicity in zebrafish embryos. Exposure to ≥0.08% influent or ≥2% effluent increased inflammation (interleukin-1 beta, IL-1β), oxidative stress (copper/zinc superoxide dismutase, Cu/Zn-Sod), apoptosis (tumor protein p53, p53), and significantly impaired neurodevelopment in zebrafish larvae by altering the expression of sonic hedgehog a (shha), synapsin IIa (syn2a), and glial fibrillary acidic protein (gfap). This study suggests the necessity of incorporating non-apical endpoint (locomotor behavior) into whole effluent toxicity test, as this approach is essential for reducing the environmental risks posed by pesticide factory wastewater. Full article

Microgreens are increasingly promoted as sustainable, nutrient-dense foods, yet their content of potentially harmful specialized metabolites remains poorly explored. Here, we developed and applied a reversed-phase liquid chromatography–electrospray ionization high-resolution mass spectrometry (RPLC-ESI-HRMS) method for the detection of cyanogenic glycosides (CNGs) in edible microgreens. Method optimization, performed using dhurrin and lotaustralin as model standards, showed that positive ion detection of sodium adducts provided the most informative and selective HRMS/MS response, with diagnostic fragmentation patterns suitable for CNG recognition in complex matrices. Quantitative validation for lotaustralin showed excellent linearity (R² = 0.998), low detection/quantification limits (LOD 0.16 mg/L; LOQ 0.53 mg/L), good extraction recovery, and a negligible matrix effect. Application of the method revealed a clear species-dependent profile. No detectable CNGs were found in broccoli raab and kale microgreens, supporting their safety as ready-to-eat products in this respect. In contrast, flax microgreens contained four CNGs: linamarin, lotaustralin, linustatin, and neolinustatin. Monoglycosylated species predominated, with lotaustralin quantified at 5.5 ± 0.6 mg/g dry weight and linamarin estimated at even higher levels. Diglycosylated CNGs were present at much lower concentrations and displayed multiple chromatographic peaks, consistent with the occurrence of structurally related isomeric forms. These quantitative results are specific to the flax microgreen samples analyzed here, obtained by pooling the lyophilized material obtained from several plants; thus, they do not account for biological variability among individual plants. Based on the measured CNG levels, flax microgreens showed a non-negligible cyanogenic potential. Assuming 1, 10 and 25% conversion to hydrogen cyanide, the estimated release would be, respectively, about 3, 33 and 81 mg HCN/kg of fresh flax microgreens, values lower than the current EU limit (150 mg HCN/kg of edible product) for flaxseed intended for direct consumption but comparable to values reported for other foods. These findings highlight the need to complement the nutritional evaluation of novel microgreens with targeted toxicological screening. Full article