Search Results (107,936)

Background: Migraine is a highly prevalent neurological disorder associated with substantial disability and socioeconomic burden. Although pharmacological therapies remain the mainstay of treatment, their effectiveness may be limited by incomplete response and adverse effects. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive neuromodulatory technique that may modulate cortical excitability and pain-processing networks involved in migraine pathophysiology. This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of rTMS compared with sham stimulation in individuals with migraine. Methods: A systematic search was conducted in PubMed (MEDLINE), PsycNet, and Ovid (including MEDLINE and Embase) from database inception to December 2025 in accordance with PRISMA 2020 guidelines. Studies investigating rTMS in adults with migraine and including a sham comparator were eligible for inclusion. Data regarding study design, participant characteristics, rTMS parameters, outcomes, and adverse events were extracted using a predefined template. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Results: Seven studies comprising a total of 301 participants were included. Most trials evaluated high-frequency rTMS targeting the dorsolateral prefrontal cortex. Across studies, rTMS was generally associated with reductions in migraine frequency and severity compared with sham stimulation, although results varied depending on stimulation parameters and study design. Treatment was consistently well tolerated, with only mild and transient adverse effects reported. However, considerable heterogeneity was observed in diagnostic criteria, stimulation protocols, outcome measures, and follow-up duration. Conclusions: Preliminary evidence suggests that rTMS may represent a promising and well-tolerated neuromodulatory approach for migraine management. Nevertheless, methodological variability, limited sample sizes, and concerns regarding risk of bias restrict definitive conclusions. Larger randomized controlled trials with standardized protocols and longer follow-up periods are needed to clarify the clinical role of rTMS in migraine treatment. Full article

As China advances high-quality agricultural development, promoting green production among farmers has become an important policy priority. Using survey data from 1787 rice farmers in seven major rice-producing provinces in southern China, this study examines whether enterprise-led contract farming can promote farmers’ green production behavior. Green production behavior is measured by a composite index based on six practices, including green control technology, soil testing and formulated fertilization, organic fertilizer substitution, water-saving irrigation, agricultural film recycling, and straw return. Empirical analysis results show that enterprise-led contract farming can significantly promote farmers’ green production behavior. Further analysis suggests that food safety certification, planting technology training, and lower perceived price volatility are important pathways through which contract farming is linked to green production practices. The promoting effect is weaker among older farmers, stronger for farmers cultivating land with medium soil fertility, and more pronounced among small-scale rice farmers. These findings highlight the role of enterprise-led contract farming in promoting farmers’ green production and offer policy implications for encouraging wider participation in green production practices. Full article

Understanding the effects of light on the body at different times of the 24 h solar day is a topic of increasing interest. In this paper, we use a mathematical model from the literature to simulate what would be expected of the human circadian clock on different light schedules. We first reproduce an influential experiment which found eBooks, when compared to a paper book, delayed sleep by roughly 10 min and melatonin onset by 1.5 h. The model is able to match the delay in sleep onset but struggles to reproduce the melatonin phase delay. However, certain initial conditions and parameters are capable of phase shifts consistent with the original study’s magnitude, suggesting that the original study’s finding may have been influenced by the pre-study entrainment or variability among the participants. We next simulate the same protocol under higher daytime light levels (increasing baseline illumination from 90 to 500 lux) and find that brighter daytime exposure reduces both sleep onset latency and the variability in phase delay attributable to evening eBook light. Finally, we explore how the timing of a bright light pulse during the day changes outcomes, such as sleep onset and circadian amplitude, and how these effects interact with light during the other hours of the 24 h day. Together, these modeling results suggest robust daytime light exposure confers resilience against the circadian-disruptive effects of evening light, generating testable predictions regarding the timing and intensity of beneficial light interventions for maintaining circadian alignment. Full article

Background/Objectives: Tinnitus and reactions to the tinnitus are different dimensions that can be explored in research and in clinical settings. Notably, these dimensions can elucidate priorities and the most problematic areas for patient-centered approaches. The aim of this study is to determine how tinnitus is perceived and impacts people who have experienced tinnitus for different durations. Methods: People with tinnitus were invited to participate in a survey at the University of Iowa Tinnitus Website. 709 people responded and documented their perceived sound, problems experienced, and duration of tinnitus. We assessed correlations between the duration of tinnitus and the pitch rating, the loudness rating, and the Tinnitus Primary Function Questionnaire scores. Additionally, we performed a multiple linear regression analysis, considering the dependent variable ‘duration of tinnitus’, to explore associations between duration of tinnitus and the aforementioned factors. This was a cross-sectional study based on comparisons of responses from patients with different tinnitus durations, rather than examining the same patients longitudinally. Results: The analysis demonstrated that respondents with a longer duration of tinnitus reported higher loudness ratings (p = 0.010). However, their reactions to tinnitus (Tinnitus Primary Function Questionnaire) were associated with a decrease compared with a shorter duration of tinnitus (p = 0.048). There was no association between pitch rating and duration of tinnitus. Conclusions: Our findings indicated louder tinnitus was associated with a longer duration of tinnitus. However, in general, the functional impact of the tinnitus was associated with a decrease. Notably, there was considerable variability among individuals, suggesting that additional factors contribute to these relationships. These findings can be considered in treatment decisions and counseling strategies. Full article

Postural control is essential for daily function, and while stochastic resonance (SR) enhances balance in clinical populations, its efficacy in healthy young people remains underexplored. This study investigated (1) biomechanical effects of multisite plantar vibration on postural stability using center-of-pressure (CoP) parameters, and (2) short-term and sustained effects on balance performances. Phase 1 enrolled six participants to identify the optimal plantar stimulation configuration and to evaluate acute electromyographic responses under threshold-level vibration. Phase 2 evaluated long-term efficacy through an eight-week sham-controlled parallel-group randomized controlled trial. In this trial, eight participants received vibration combined with balance training, and another eight participants completed the same training protocol using sham insoles without vibration, analyzing CoP parameters (95% ellipse area, path length) and muscle activation (tibialis anterior, medial gastrocnemius, peroneus longus, extensor digitorum longus). Results showed full-site vibration reduced CoP area versus control (265.66 ± 188.6 mm² vs. 437.84 ± 190.95 mm², p < 0.05) without altering ankle muscle activation (all p > 0.05). Longitudinal analysis revealed CoP area reduction (−4.88 ± 10.42%) in the intervention group versus sham (p < 0.001), with maximum anterior displacement increasing by 25.03% during vibration (p < 0.05). Plantar white-noise vibration modulates CoP oscillations without neuromuscular activation changes, demonstrating that full-site stimulation acutely enhances postural stability while sustained intervention improves dynamic balance control. Full article

Background/Objectives: The aim of this study was to translate, culturally adapt, and validate the updated (March 2025) version of the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) in Greek by examining its reliability, validity, and screening efficacy in a Greek sample. Methods: The M-CHAT-R/F was administered to Greek parents/primary caregivers of children aged 16–48 months, with no prior diagnosis of autism spectrum disorder (ASD), severe sensory impairments, or other chronic conditions causing neurodevelopmental delay. Parents/primary caregivers were invited to participate in the nationwide Program “Child and Family Health Promotion through the Paediatric Framework” of the Greek Ministry of Health in collaboration with UNICEF, implemented by the National and Kapodistrian University of Athens. Results: The final sample comprised 280 parents of children 16 to 48 months old (mean age ± SD 24.64 ± 7.75 months) with an almost equal sex distribution. Mean (±SD) parental age was 35.31 (±3.14) years, ranging from 30 to 48 years, and most respondents were mothers (94.3%). The Greek M-CHAT-R/F demonstrated acceptable reliability (KR-20 = 0.789) and acceptable scalability (monotonicity). Conclusions: The present study provides compelling evidence that the Greek M-CHAT-R/F is a reliable, valid, culturally appropriate instrument for screening children for the presence of ASD. The psychometric properties of the Greek version are consistent with previous international reports and warrant its use in routine pediatric practice in Greece. Full article

Walking, a fundamental human activity, has significant implications for health. This study aimed to determine the influence of different types of footwear (boots, running shoes, and indoor court shoes) on maximum plantar force and pressure. The sample included 19 healthy male students. Plantar pressures and forces were measured with a pedobarographic device. The maximum forces on the forefoot were highest when walking barefoot and lowest when wearing boots (p < 0.05). For the midfoot, a significant difference (p < 0.01) was found between the barefoot condition and the other three conditions; forces were lowest when walking barefoot. Compared with the other conditions, the maximum forces on the hindfoot were highest when participants wore boots (p < 0.01). The maximum pressure on the forefoot was highest when participants walked barefoot compared with the footwear conditions (p < 0.01). For the midfoot, wearing running shoes resulted in the highest values, which were significantly different (p < 0.01) from those obtained when wearing indoor court shoes or walking barefoot. Compared with the other three conditions, wearing running shoes resulted in the lowest maximum pressure on the hindfoot (p < 0.01). The plantar force and pressure gait parameters indicate that cushioning has biomechanical significance during movement. Full article

Privacy-preserving truth discovery (PPTD) has garnered significant attention in mobile crowdsensing (MCS). However, existing research lacks sufficient privacy protection and is often vulnerable to collusion attacks among malicious participants. Moreover, incorrect data submitted by unreliable users and their weights may reduce the accuracy of truth discovery. To address these issues, this paper proposes a privacy-preserving truth discovery framework resistant to collusion and reputation fraud (TD-RCRF) that is highly resistant to collusion and reputation fraud. The scheme employs additive secret sharing to protect sensing data, weights, intermediate results, and ground truth. To screen trustworthy users who meet reputation requirements under the non-colluding dual-server model, we propose a privacy-preserving reputation verification algorithm that combines Pedersen commitment and zero-knowledge proof to verify the validity of mobile users’ reputation values. Additionally, we propose a homomorphic strategy that converts shares between multiplication and addition and use it to design a lightweight truth discovery algorithm that further improves the accuracy of the “truth” using reputation values. Security analysis proves that TD-RCRF is privacy-preserving and secure under the non-colluding dual-server assumption. Theoretical analysis and experiments show that it is practical and efficient. Full article

Background and Objectives: Vascular dementia (VaD) and mixed dementia (MD) represent prevalent causes of cognitive decline in the elderly, as they share similar pathological pathways and clinical features. Distinguishing between these two conditions remains a challenge, due to their frequent clinical and neuroimaging overlap. Nevertheless, it is important from a prognostic perspective. Materials and Methods: The study comprised 114 participants, including patients with VaD (n = 33), MD (n = 26), Alzheimer’s disease (AD; n = 26), and 29 cognitively healthy controls (C). We evaluated routinely used cerebrospinal fluid (CSF) biomarkers (total tau, p-tau181, Aβ_1-42) and their ratios to assess inter-group differences, diagnostic accuracy, and correlations with cognitive score. Results: Patients with MD demonstrated significantly higher levels of t-tau and p-tau181, and lower levels of Aβ_1-42, compared to VaD (p < 0.004 for all analyses). With the exception of p-tau181/t-tau, all calculated ratios enabled differentiation between these groups. ROC analysis confirmed the high diagnostic accuracy of CSF Aβ_1-42 and t-tau (AUC 0.82 and 0.79 respectively) for detecting AD pathology in dementia patients. Furthermore, the t-tau/Aβ_1-42, p-tau181/Aβ_1-42 ratios were the most effective in differentiating AD-related from vascular pathologies (AUC 0.78 and 0.80 respectively), and in differentiating MD from VaD (AUC 0.79 and 0.77 respectively). A significant correlation was observed between CSF biomarkers (especially tau markers) and cognitive impairment severity. Conclusions: CSF biomarkers effectively differentiate mixed from vascular dementia by identifying underlying AD pathology independent of the clinical phenotype. This supports the use of CSF biomarkers in clinical practice to reveal the neurodegenerative component in patients with cerebrovascular disease, which is of fundamental importance for emerging disease-modifying treatment strategies in mixed neuropathologies. Full article

Background/Objectives: Dry eye disease (DED) is now widely considered to be the most prevalent ocular surface-related disease and has attracted increasing clinical attention in recent years. DED is well-studied in thyroid orbitopathy, but scarce data are available in patients with papillary thyroid carcinoma (PTC). Methods: We analyzed 29 PTC cases with radioactive iodine (RAI) treatment (Group 1), 22 PTC cases without RAI (Group 2), and 26 normal control individuals (Group 3). All participants were evaluated with the Ocular Surface Disease Index (OSDI), meibomian gland secretion quality, and lid margin grading. Non-contact meibography and non-invasive tear breakup time measurements were completed using the Sirius Scheimpflug camera. Thyrotropin (TSH), free thyroxine, and free triiodothyronine were measured. Results: TSH values were significantly lower in both patient groups than in controls (p < 0.001). The proportion of participants with a lower meibomian gland secretion quality score ≥ 1 was 34.5% in Group 1, 22.7% in Group 2, and 7.1% in Group 3 (p = 0.002). There was a higher proportion of a meibomian gland atrophy score ≥ 1 in Groups 1 and 2 than in controls (p = 0.007). No differences were found between groups in lower lid margin score, Oxford values, upper meibomian gland expressibility or upper meibography scores (p = 0.485, p = 0.064, p = 0.256, p = 0.069). OSDI scores were higher in both PTC groups than in controls (6.25 and 8.12 vs. 2.52), with borderline overall significance (p = 0.050) and higher pairwise scores versus controls (both p = 0.034). Conclusions: Meibomian gland dysfunction was observed in PTC patients regardless of RAI treatment, suggesting that TSH suppression itself may contribute to the development of ocular surface changes. Full article

(1) Background: Driving enables participation and independence for persons with disabilities; however, Korea lacks standardized driver rehabilitation guidelines and clearly defined occupational therapy roles. Current evaluations at the National Rehabilitation Center (NRC) rely heavily on instructors’ experiential judgment, resulting in inconsistent fitness-to-drive decisions. This study developed and field-tested a comprehensive driving evaluation (CDE) tailored to the Korean service context, integrating structured off-road functional assessment with on-road driving evaluation through a collaborative occupational therapist–driving instructor model. (2) Methods: The off-road assessment was refined through a literature review, an analysis of the ICF Core Set for driving rehabilitation, expert surveys, and a workshop with 10 occupational therapists. The on-road assessment was adapted from international tools and validated by NRC driving instructors and an expert committee. The CDE was field-tested with 30 persons with physical disabilities, cerebral palsy, or auditory disabilities enrolled in the NRC Driving Education Program. Eligibility for independent driving was classified as “eligible” or “doubtful.” (3) Results: The CDE was feasible within existing workflows. Off-road deficits predicted on-road difficulties, and cases with discordant judgments benefited from combined assessment. (4) Conclusions: The CDE offers a structured alternative to experience-based evaluations and supports interprofessional collaboration, providing foundational evidence for standardized driver rehabilitation in Korea. Full article

Vagus nerve stimulation (VNS) may improve cognition and promote underlying brain health through various mechanisms including the noradrenaline and cholinergic pathways. Whilst early human studies used invasive devices (iVNS), recent decades have seen the emergence of non-invasive devices that stimulate the vagus nerve transcutaneously (tVNS) via either the cervical branches in the neck (tcVNS) or the auricular branch in the ear (taVNS). With this increase in more accessible devices, tVNS is gaining interest as a novel therapy in mild cognitive impairment (MCI) and Alzheimer’s disease (AD). This targeted review aims to understand the current evidence in human trials in this specific population. PubMed, Cochrane, EMBASE, MEDLINE, and Google Scholar were searched. Six human interventional studies were found (one iVNS; five taVNS). VNS is well tolerated and study designs demonstrate feasibility within this population for future blinded and appropriately powered long-term studies with participants applying tVNS at home. However, protocols and tVNS settings remain variable. Working memory domains such as verbal fluency and 3D processing show the most promise but global cognitive scores were also sensitive in some cases. The role of biomarkers of tVNS activity and its effect on AD markers and neuroinflammation should be considered in the design of future studies. Full article

This paper examines downstream firms’ incentives to accept equity participation by an upstream supplier in a vertically related market. We develop a multi-stage model in which the upstream firm offers an equity stake and sets input prices under price discrimination, while downstream firms subsequently compete à la Cournot. We show that upstream equity ownership induces the upstream firm to lower input prices by partially internalizing downstream profits. This mechanism generates a positive market-expansion effect for downstream firms through lower input costs, while equity ownership simultaneously creates a negative equity-dilution effect by reducing the share of profits retained by downstream firms. When products are homogeneous, the equity-dilution effect dominates the market-expansion effect, leading downstream firms into a Prisoner’s Dilemma. In contrast, under product differentiation, when the ownership share is sufficiently small, the market-expansion effect dominates the equity-dilution effect, resulting in higher downstream profits. In this case, accepting equity participation can be individually optimal for downstream firms, even though mutual acceptance may reduce their retained profits. Full article

Machine unlearning in federated graph learning must satisfy the multi-level indistinguishability requirement of the deletion of a target node being undetectable at the level of the global model, of the unlearning client’s local model, and of every non-target client’s local model. Approximate unlearning methods that pass confidence-based audits may still leave geometric traces through embedding drift at one or more of these $K+1$ levels. We formalize this requirement, introduce a five-model threat taxonomy, and extend the Hub–Ripple embedding drift audit to global, local, and cross-client levels. Across 31,900 trials spanning five graph benchmarks, five federated unlearning methods, and four supplementary ablations (K-value, cross-edge handling, control sampling, and DP-SGD defense), we find that all approximate methods fail the following multi-level requirement: the Confidence–Embedding Gap persists at $0.12$ (versus $0.35$ centralized), cross-client leakage correlates with shared cross-edge count ($r=0.56$, $p<{10}^{-160}$), and a federated participant outperforms a white-box external auditor (AUC $0.83$ versus $0.81$). Client-level unlearning is more detectable at the global level than node-level unlearning (AUC $0.81$ versus $0.77$), contradicting the intuition that coarser deletion yields stronger privacy. FedRetrain satisfies global and local indistinguishability but exhibits residual cross-client leakage (Cross-Mean L2 AUC $=0.62\pm 0.04$) because re-aggregation itself perturbs the global parameter vector. No method evaluated achieves full multi-level indistinguishability. Supplementary studies confirm that this is a structural property of FedAvg; DP-SGD reduces Cross L2 AUC by only $0.013$ at the cost of a $79\%$ accuracy drop, and FedSage-like neighbor sharing does not change the leakage profile. Multi-level geometric auditing, spanning all $K+1$ models, is the necessary evaluation floor that any method claiming verifiable privacy compliance must satisfy. Full article

Background: Cardiorenal syndrome (CRS) arises from interconnected cardiovascular, renal, and metabolic dysfunction driven by shared risk factors such as hypertension, diabetes, and obesity. Cardiac rehabilitation (CR) is a multidisciplinary intervention; however, its impact on CRS risks remains unclear. Methods: This retrospective cohort study analyzed electronic medical record data from 394 participants enrolled in a three-month CR program. Baseline and post-program measures included functional capacity, cardiometabolic risk factors, and psychosocial outcomes. Results: Participants (mean age 62.44 ± 12.15 years; 66.8% male) had a high burden of CRS risk factors, including hypertension (85.8%), diabetes (60.6%), and obesity (57.8%). Significant improvements were observed in functional capacity (6 min walk distance increased by 213 m, p < 0.001), muscular strength, flexibility, and psychosocial outcomes (anxiety, depression, perceived health; all p < 0.001). In contrast, changes in CRS risk factors were modest: fasting blood glucose decreased slightly (p = 0.043), while HbA1c, body fat, and cholesterol showed no significant change. Systolic blood pressure and body weight increased significantly. Cardiac rehabilitation improves functional and psychosocial outcomes but demonstrates limited short-term impact on CRS risk factors. Conclusions: These findings suggest CR may serve as an initial platform for CRS risk modification but requires integration with comprehensive cardio–renal–metabolic management strategies. Full article