Search Results (14,186)

Background/Objectives: Patient-level factors strongly influence antimicrobial resistance (AMR) through the pressure applied to healthcare professionals to prescribe antibiotics even for self-limiting viral infections, enhanced by knowledge and attitude concerns. This includes Africa, with high levels of AMR. However, validated measurement tools for African primary healthcare (PHC) are scarce. This study evaluated the reliability, structural validity, and interpretability of the Community Antimicrobial Use Scale (CAMUS) in South Africa. Methods: A cross-sectional survey was conducted with 1283 adults across 25 diverse public PHC facilities across two provinces. The 30-item theory-based tool underwent exploratory and confirmatory factor analysis (EFA/CFA), reliability, and validity testing. Results: EFA identified a coherent five-factor structure: (F1) Understanding antibiotics; (F2) Social and behavioural norms; (F3) Non-prescribed use; (F4) Understanding of AMR; and (F5) Attitudes. Internal consistency was strongest for knowledge and misuse domains (alpha approximation 0.80). Test–retest reliability was good-to-excellent (ICC: 0.72–0.89). CFA confirmed acceptable composite reliability (CR ≥ 0.63). Although average variance extracted (AVE) was low for broader behavioural constructs, indicating conceptual breadth, it was high for AMR knowledge (0.737). Construct validity was supported by positive correlations with health literacy (r = 0.48) and appropriate use intentions (r = 0.42). Measurement error metrics (SEM = 1.59; SDC = 4.40) indicated good precision for group-level comparisons. Conclusions: CAMUS demonstrated a theoretically grounded structure with robust performance in knowledge and misuse domains. While social and attitudinal domains require refinement, we believe the tool is psychometrically suitable for group-level antimicrobial use surveillance and programme evaluation in South African PHC settings and wider to help with targeting future educational programmes among patients. Full article

In recent years, human activities have impacted surface water and groundwater and their interactions with natural water bodies. Lake Cuitzeo is one of Mexico’s most important water bodies but has significantly reduced its flooded area in recent years. Previous studies did not explicitly evaluate the combined effects of hydrological variables on lake dynamics, limiting the understanding of how basin-scale processes influence lake-level. The objective of this study is to evaluate the change in spatio-temporal patterns of hydrological variables under climatic and anthropogenic stress in the Lake Cuitzeo endorheic basin. The proposed methodology uses the SWAT model to analyze at the basin scale, land use and land cover changes, and trends in precipitation and their effect on hydrological processes. Consequently, groundwater flow interactions were assessed for the first time for the Cuitzeo Lake Basin using an automatically coupled SWAT-MODFLOW (v3, 2019), despite limited observational data. A statistically significant change in mean precipitation was detected beginning in 2015, with a decrease of 10.22% compared to the 1973–2014 mean. Land use and land cover changes between 1997 and 2013 resulted in a 26.20% increase in surface runoff. In contrast, estimated evapotranspiration decreased by 1.77%, potentially associated with the reduction in forest cover. As a combined effect of decreased precipitation and land use and land cover change, groundwater percolation declined by 6.34%. Overall, the combined effects of climatic variables and anthropogenic activities have altered lake–aquifer interaction. Full article

Background/Objectives: Von Hippel–Lindau (VHL) disease is a rare autosomal dominant hereditary disorder. Central nervous system hemangioblastomas are one of the most common tumor types associated with VHL disease. Although these tumors are histologically benign, delayed diagnosis and treatment may result in severe neurological dysfunction, permanent disability, and even death. However, little is known about the experiences of patients with VHL disease. The aim of this study was to gain a better understanding of the illness experiences and psychological responses of patients with VHL disease accompanied by central nervous system hemangioblastomas. Methods: A qualitative study based on a semi-structured guide was conducted. Twelve participants were recruited. Data were collected through face-to-face interviews and analyzed using the constant comparative method. Results: Four themes and their subthemes were identified: 1. powerlessness—unpredictable disease progression and uncontrollable continuity; 2. negative emotional experiences—guilt and self-blame, depression, and low self-esteem; 3. compromise—acceptance of fate, positive outlook, and sense of hope; and 4. persistent worry—worries about family members, anxiety regarding finances and employment, and uncertainty regarding the future. Conclusions: This study identified four major themes in the illness experiences of patients with VHL disease accompanied by central nervous system hemangioblastomas, which provided deep insights into the care needs of individuals with VHL disease. Healthcare providers should develop effective measures to enhance patients’ ability to maintain a good quality of life and confront the future with resilience. Full article

Background/Objectives: Diabetes is characterized by multiple metabolic disorders, defined by high blood sugar levels over a prolonged duration. Type 2 diabetes (T2D) comprises defective insulin secretion, its ineffective utilization, or both, resulting in hyperglycemia. The disease is one of the leading causes of mortality, according to the WHO, and necessitates the development of advanced therapeutics. Methods: This systematic review was conducted in accordance with the PRISMA guidelines. The study and execution of the literature review followed a timeframe of 3–6 months, during which the conceptualization, execution, analysis, writing, and editing were conducted. Ginsenosides, triterpenoids from the Panax genus, are widely recognized for their promising antidiabetic effects, mediated through mechanisms that include glucose uptake, insulin secretion, antioxidant activity, and anti-inflammatory pathways. Ongoing clinical trials in patients with IGT or Type 2 diabetes have shown an improvement in insulin sensitivity and glucose control, and consolidate the therapeutic potential of ginseng pharmacotherapy. Results: This viewpoint summarizes the most recent discoveries on the hypoglycemic mechanisms of ginsenosides for Type 2 diabetes and its associated complications, with a major focus on ginseng-based drug development. An emphasis is placed on how ginsenosides control blood glucose levels and regulate signaling pathways, investigating their antidiabetic mechanisms and potential. Conclusions: Preclinical studies suggest that nano-innovations in ginseng have the potential to address therapeutic challenges, improve systemic circulation, lower the toxicity of biomolecules, and improve bioavailability, defining exciting outcomes. Furthermore, well-designed human clinical trials are necessary to understand the antidiabetic mechanisms and pharmacological potential of ginseng and/or ginsenosides in drug development. Full article

Background/Objectives: Diabetic osteoporosis (DOP) is a metabolic bone disorder marked by reduced bone mass, impaired microarchitecture and elevated fracture risk arising from type 1 and type 2 diabetes. Understanding its pathophysiology is essential for developing effective interventions. Method: A broad literature search of Scopus and PubMed (2015–2025) using diabetic osteoporosis-related keywords identified relevant English in vivo studies, which were screened, extracted, and narratively summarised for this review. Results: In vivo models, including high-fat-diet (HFD), streptozotocin (STZ) and combined HFD + STZ protocols, are widely used to investigate DOP mechanisms. HFD models mimic obesity-induced insulin resistance, chronic hyperglycaemia and low-grade inflammation, leading to suppressed osteoblast activity, enhanced osteoclastogenesis and accumulation of advanced glycation end products (AGEs). Ultimately, they compromise bone microarchitecture and mechanical strength. STZ models replicate type 1 diabetes by inducing β-cell destruction, insulin deficiency, oxidative stress, osteoblast apoptosis and inflammatory pathways promoting bone resorption. The combined HFD + STZ model integrates insulin resistance and partial β-cell dysfunction, closely reflecting type 2 diabetes pathology, including trabecular bone loss, collagen glycation and disrupted osteoblast–osteoclast signalling. Mechanistically, DOP involves impaired insulin/IGF-I signalling, AGE–RAGE interactions, oxidative stress and inflammation, resulting in diminished bone formation and quality. These models provide robust platforms for exploring molecular mechanisms and evaluating potential therapies, including Wnt pathway modulators, antioxidants and ferroptosis inhibitors. Conclusions: Collectively, preclinical in vivo models are indispensable for understanding DOP pathophysiology and developing strategies to mitigate diabetic bone fragility. Full article

Background/Objectives: Adolescence is a developmental period characterised by intensive use of social media and an increased prevalence of emotional problems such as depression and anxiety. Scientific evidence indicates that the modality of social media use (active or passive) can significantly predict these problems, with active use being linked to a higher likelihood of cyberbullying victimisation. As victimisation is associated with more severe emotional problems, social media represents an important context for understanding adolescent mental health. Following this, the main aim of this study was to examine how the modality of social media use (SMU) is related to emotional problems, and whether cyberbullying victimisation mediates this relationship. Methods: This study was conducted on a convenient sample of N = 1822 students (49.0% boys, 51.0% girls; M_age = 13.22 years, SD_age = 0.629) from a total of 64 elementary schools throughout Croatia. A modified Croatian version of the Active and Passive Use of Social Networks Scale, the Anxiety and Depression subscales of the Depression, Anxiety, Stress Scale—Youth Version, and the Cyber-Victimisation subscale of the European Cyberbullying Intervention Project Questionnaire were used. Results: The results indicate that passive SMU among boys is directly related only to anxiety, while that among girls contributes only to the explanation of depression. Regarding cyberbullying victimisation as a mediator, full mediation in the association between active SMU and emotional problems was found for both girls and boys. Conclusions: This represents a significant theoretical contribution, as well as a contribution to the development of psychosocial interventions. Full article

Background: Diagnosis is the fundamental basis for understanding biomechanics in orthodontic treatment and for accurately designing the treatment plan. Traditionally, the sagittal plane has been the primary focus of assessment; however, it is essential to consider the patient in all three spatial planes. Therefore, it is necessary to explore the transverse plane, which is equally as crucial as the sagittal and vertical planes. With current technological advances, it is now possible to obtain three-dimensional images of the patient using cone-beam computed tomography (CBCT), allowing evaluation of all planes in a single diagnostic test. This study aimed to assess the diagnostic methods used for transverse analysis and the usefulness of CBCT for this purpose. Material and Methods: To select the studies for this review, we searched the PubMed, Scopus, and Cochrane databases for publications between 1965 and 2021. Our inclusion criteria targeted studies that evaluated the transverse plane using CBCT or CT. We assessed the level of evidence according to the OCEBM classification and evaluated the risk of bias using the QUADAS-2 scale. Results: After reviewing 535 articles, we selected 16 that met the established criteria. These studies compared various diagnostic methods for transverse analysis and their reproducibility indices. We identified the absence of a gold standard for measuring transverse discrepancies and high variability among diagnostic methods as the main limitations. Conclusions: Based on the available evidence, it can be concluded that dental and skeletal transverse discrepancies can be reliably differentiated using the diagnostic techniques evaluated in this study, particularly through CBCT-based assessment. Therefore, the diagnosis of transverse discrepancies should not be considered unclear, as it can be established using objective and measurable criteria. These findings reinforce the clinical value of current diagnostic tools and highlight the importance of accurate three-dimensional interpretation for informed and effective treatment decision-making. Full article

Interactive science galleries have transformed how the public engages with science, shifting from object-centred displays to immersive, design-led experiences. This study situates these changes within broader cultural and economic contexts, exploring how design mediates our understanding of science and reflects neoliberal and experiential values. Using archival research, qualitative interviews with museum professionals, and reflective practice, the research examines the evolution of interactive science spaces at the Science Museum in London—The Children’s Gallery, Launch Pad, and Wonderlab. The findings reveal that exhibition design increasingly prioritises entertainment, immersion, and pleasure, aligning with the rise in the experience economy and the influence of corporate models such as Disneyland. While such strategies enhance visitor engagement and accessibility, they risk simplifying complex scientific narratives and reducing learning to consumption. The study concludes that effective science communication design should balance enjoyment with critical inquiry, using both comfort and discomfort to foster curiosity, reflection, and ethical awareness. By analysing design’s role in shaping the “science experience”, this research contributes to understanding how cultural institutions can create more nuanced, thought-provoking encounters between audiences, knowledge, and space. Full article

Background and Objectives: Recent advances in dentistry include microbiological and metabolomic analyses, which have the potential to improve the understanding of oral microbiome–host imbalances during orthodontic treatment. Fixed appliances, functional devices and, more recently, clear aligners have been associated with several oral health conditions, including enamel demineralization, dental caries, gingivitis, periodontitis and root and bone resorption. In this context, metabolomic approaches may enable the identification of metabolites in biological samples that could potentially serve as biomarkers and reflect functional biological changes within the oral ecosystem. Investigating orthodontic appliances and associated metabolomic alterations may therefore contribute to advancing current knowledge in orthodontics. This systematic review aimed to describe the available evidence on oral metabolomic changes during orthodontic treatment. Materials and Methods: A systematic literature search was conducted in PubMed, Web of Science, Scopus and the Cochrane Library. A total of 1632 records were identified. After duplicate removal and screening, 18 full-text articles were assessed for eligibility. Of these, 15 studies were excluded, and three studies met the inclusion criteria. Risk of bias was assessed using the ROBINS-I and RoB 2 tools, and the GRADE approach was applied to evaluate the certainty of evidence. The review protocol was registered in PROSPERO (CRD420251141544). Results: Three studies met the inclusion criteria. Overall, the available evidence was limited and heterogeneous. The included studies suggested potential differences in oral microbiome composition and metabolomic profiles between patients treated with fixed appliances and those treated with clear aligners. Reported metabolomic findings were exploratory and involved amino acid-related, immune-associated, and acidic metabolic pathways. Limitations: Only three studies were included, all conducted in a single country. The small sample size and methodological heterogeneity limit the generalizability of the findings. In addition, potential confounding variables highlight the need for further standardized longitudinal studies. Full article

Background: Role clarity is a persistent challenge among Patient Care Technicians (PCTs), contributing to inconsistent task performance and safety risks. In Saudi Arabia, little is known about PCTs’ understanding of their responsibilities. This study evaluated the impact of a targeted educational program designed to improve PCTs’ role clarity, safety practices, and communication. Methods: A quasi-experimental pre-post study was conducted in September 2025 with 35 PCTs from the Hail Health Cluster. The one-day intervention included lectures, discussions, role-play, and case scenarios. Outcomes were measured using a validated instrument across four domains: role clarity; core clinical tasks and safety; communication and ethics; and objective knowledge. Pre-post changes were analyzed using paired t-tests (Cohen’s d), and subgroup differences in change scores were examined using one-way ANOVA (η²) in SPSS v29. Results: Baseline scores were lowest in objective knowledge (41.4%) and role clarity (62.8%). Post-training, total composite scores improved significantly (+10.88%, p < 0.001, d = 1.63), with the most significant gain in objective knowledge (+19.8%, p < 0.001, d = 0.99). Role clarity showed only a modest, non-significant increase (+3.98%, p = 0.088, d = 0.30). No demographic differences were found. Conclusions: Targeted training was effective in reducing knowledge gaps; however, improving role clarity may require organizational reinforcement beyond brief training. Full article

Background and Objectives: E-cigarette use among middle and high school students steadily increased in the last decade, raising significant public health concerns. It is argued that e-cigarettes contain a lower level of toxicants than combustible tobacco cigarettes. This perception has contributed to the growing popularity of e-cigarettes among youth. However, lower level of toxicants does not mean addiction is less likely. In this study, we examine trends in the usage of electronic cigarettes among middle and high school students in the U.S. from 2018 to 2023, compare these patterns with traditional cigarette use over the same period and population, and explore the underlying reasons driving e-cigarette use within this demographic. Understanding patterns and motivations are essential for developing effective prevention and intervention strategies. Materials and Methods: Data were derived from the National Youth Tobacco Survey (NYTS), administered by the Centers for Disease Control and Prevention (CDC). Population-level estimates and standard errors were calculated to facilitate comparisons across subgroups and time points. Results: A declining trend in e-cigarette use was observed over the study period. The proportion of students who reported exclusive e-cigarette use was significantly higher than that of those who used combustible cigarettes exclusively. Among reported motivations, anxiety consistently ranked among the top three reasons for vaping for current users. Conclusions: The downward trend in youth e-cigarette experimentation is encouraging. However, the period from 2020 to 2023, which includes the COVID-19 pandemic (2020 and 2021) era, may have impacted usage patterns. Alarmingly, the number of students who vape exclusively is approximately five times greater than that of those who smoke only cigarettes. This finding contradicts claims by e-cigarette manufacturers that their products facilitate smoking cessation. Further rising e-cigarette smoking exclusively is of public health concern, which warrants targeted intervention. Full article

Background: By exploring the principles of Gestalt psychology, the neural mechanisms of perception, and computational models, scientists aim to unravel the complex processes that enable us to perceive a coherent and organized world. This multidisciplinary approach continues to advance our understanding of how the brain constructs a perceptual world from sensory inputs. Objectives and Methods: This study investigates the nature of visual perception through an experimental paradigm and method based on a comparative analysis of human and artificial intelligence (AI) responses to a series of modified square images. We introduce the concept of a “phenomenal gradient” in human visual perception, where different attributes of an object are organized syntactically and hierarchically in terms of their perceptual salience. Results: Our findings reveal that human visual processing involves complex mechanisms including shape prioritization, causal inference, amodal completion, and the perception of visible invisibles. In contrast, AI responses, while geometrically precise, lack these sophisticated interpretative capabilities. These differences highlight the richness of human visual cognition and the current limitations of model-generated descriptions in capturing causal, completion-based, and context-dependent inferences. The present work introduces the notion of a ‘phenomenal gradient’ as a descriptive framework and provides an initial comparative analysis that motivates testable hypotheses for future behavioral and computational studies, rather than direct claims about improving AI systems. Conclusions: By bridging phenomenology, information theory, and cognitive science, this research challenges existing paradigms and suggests a more integrated approach to studying visual consciousness. Full article

Background/Objectives: Gunshot wounds in living patients present significant challenges from both a clinical and a forensic perspective. Understanding the exact trajectory of a bullet is crucial not only for guiding treatment but also for providing reliable documentation in legal settings. This work introduces a practical diagnostic workflow that combines OsiriX (V. 14.1.1), a DICOM viewer with advanced 3D tools, with Autodesk Maya, a modeling platform used to recreate the external shooting scene. Methods: CT scans obtained with multidetector systems were analyzed in OsiriX using a structured, seven-step process that included multiplanar reconstructions, 3D renderings, and region-of-interest tracking. The reconstructed trajectories were then exported to Maya, where they were integrated into a virtual model of the shooting scene to correlate internal findings with the incident’s external dynamics. Results: The workflow allowed precise identification of entry and exit points, reliable reconstruction of bullet paths, and effective 3D visualization. While OsiriX provided detailed information for clinical and radiological purposes, the use of Maya enabled simulation of the external scene, improving forensic interpretation and courtroom presentation. The procedure proved reproducible across cases and compatible with emergency timelines. Conclusions: The combined use of OsiriX and Maya offers a reproducible and informative method for analyzing gunshot wounds in living patients. This approach not only supports surgical and diagnostic decisions but also enhances the forensic value of radiological data by linking internal trajectories to external shooting dynamics. Its integration into trauma imaging protocols and forensic workflows could represent a significant step toward standardized ballistic documentation. Full article

Background/Objectives: Endocrine therapy (ET) is a common treatment for hormone-dependent breast cancer and is associated with a significant reduction in recurrence and mortality rates. However, the decision to initiate endocrine therapy is a critical and often distressing juncture for patients. The need to weigh its survival benefits against the potential burden of side effects, including mood changes, pain, muscle stiffness, and fatigue, can render this decision-making phase a source of significant distress. The present systematic review aimed to identify and synthesize the sociodemographic and psychosocial predictors of the decision-making process related to ET adherence among women with breast cancer. Methods: A systematic literature search was conducted in three electronic databases—PubMed Central, ProQuest, and Scopus—to identify studies examining the association between sociodemographic and psychosocial factors and the decision-making process regarding ET among women with breast cancer. Inclusion criteria encompassed cross-sectional studies published between 2000 and 2025. Data were extracted and analyzed to identify recurring predictors across studies. The findings were synthesized through a narrative synthesis. Results: Twelve cross-sectional studies met the inclusion criteria, comprising a total of 8510 women diagnosed with breast cancer and undergoing ET. Ten studies (83%) identified sociodemographic variables—such as age, marital status, educational level, and ethnicity—as significant predictors of decision-making. Moreover, nine studies (75%) reported psychosocial factors, including quality of life (QoL), fear of progression, infertility concerns, and social support, as influential in the decision to initiate or continue ET. Specifically, the decision to adhere to ET is generally supported by younger age, higher education, better perceived quality of life, and greater social support. Conversely, it is hindered by lower income, lower education, fertility concerns related to marital status, and diminished quality of life. Conclusions: The findings of this review indicate that both sociodemographic and psychosocial factors play key roles in shaping women’s decisions regarding adherence to ET. Understanding these predictors can facilitate decision-making and inform the development of targeted interventions aimed at improving treatment adherence and supporting patient-centered care in breast cancer treatment. The focus on decision-making processes, rather than on adherence rates, is what distinguishes this review from other systematic reviews. Full article

Objectives: The Impostor Phenomenon (IP), defined as persistent self-doubt despite objective success, has been extensively researched in adults. In contrast, empirical research on children and adolescents remains limited. Methods: The present study examines the prevalence, correlates, and potential risk as well as protective factors of the IP in a sample of 286 participants (56.6% female, 42.7% male, and 0.7% diverse) aged 8–18 years (M = 11.75, SD = 2.50). Participants were recruited from four distinct German subsamples between 2022 and 2024, including a clinically vulnerable group. The study employed a cross-sectional survey design administered to children and adolescents. Results: The results of the study indicate the presence of the IP as early as primary school age, with increasing intensity during adolescence. The study identified robust correlations between the IP and neuroticism, extraversion, conscientiousness, and self-esteem. In the present study, children and adolescents exhibiting depressive–anxious symptomatology demonstrated significantly elevated impostor scores in comparison to those manifesting other disorders. Furthermore, the study yielded negative associations between impostorism and various personal resources (e.g., optimism, self-efficacy) and family resources (e.g., parental support, authoritative parenting style). Conclusions: The present findings underline the importance of early intervention in addressing impostor feelings among younger age groups. In conclusion, the present findings contribute to our understanding of the IP etiology and underscore the importance of understanding the IP during formative years to inform prevention and intervention strategies. Full article