Search Results (5,079)

The transjugular intrahepatic portosystemic shunt (TIPS) is a cornerstone intervention for complications of portal hypertension, including variceal bleeding and refractory ascites. As the population with cirrhosis ages, clinicians increasingly face the question of whether and how to perform TIPS safely in older adults. We reviewed observational cohorts, registry analyses, and systematic reviews/meta-analyses. Existing evidence does not support chronological age as an absolute contraindication; however, multiple studies suggest that advanced age is associated with higher rates of post-TIPS hepatic encephalopathy (HE), early mortality, and readmissions. These findings underscore the need to shift from a binary “eligible vs. ineligible” paradigm to a structured, actionable framework that addresses modifiable risks and anticipates age-related vulnerabilities. Recent clinical practice guidance emphasizes comprehensive pre-TIPS assessment and vigilant post-procedure care, with specific attention to HE risk factors (e.g., prior HE, hyponatremia, renal dysfunction, sarcopenia) and cardiopulmonary reserve. In this narrative review, we propose an elderly-focused clinical pathway built around a four-domain assessment (Liver–Brain–Body–Heart/Kidney) and a traffic-light risk tiering system to guide patient selection, procedural strategy, follow-up scheduling, and triggered management of HE, cardiac decompensation, and renal dysfunction. This pathway aims to preserve the benefits of portal decompression while reducing preventable complications and improving outcomes that are meaningful to older patients, including functional status and quality of life. This narrative review emphasizes that outcomes after TIPS in older adults are determined not by chronological age alone but by multidomain physiological reserve. The proposed pathway informs patient selection, procedural planning, and early post-discharge monitoring in older adults. Full article

Land leveling deep-seated landslides for agricultural use alters soil profile integrity and soil functionality. In the mid-20th century, such interventions in the Transylvanian Basin (Romania) involved grading and converting landslide bodies into arable land. This study evaluates the consequences of interventions on soil physicochemical properties and erosion susceptibility in the case of two deep-seated landslides. Soil samples collected from leveled landslide bodies were analyzed for pH, total nitrogen, available phosphorus (P-AL), available potassium (K-AL), calcium carbonates, humus content, and texture. The results, in the case of the two studied deep-seated landslides, indicate contrasts between areas where the Ah horizon is preserved and where leveling exposed the C horizon or parental material at the surface. Exposed zones exhibit reduced nitrogen and humus content, altered textures, and higher carbonate influence, indicating lower fertility potential despite 65 years of pedogenesis. Spatial assessment using Sentinel-2-derived NDMI and USLE-based erosion modelling confirms increased moisture stress and higher erosion susceptibility in areas with exposed substratum. These findings demonstrate that the leveling of the two studied deep-seated landslide bodies, although effective in expanding arable surfaces, leads to persistent soil degradation patterns and reduced agro-ecological resilience. Sustainable cultivation of such terrains requires targeted soil conservation measures, including erosion control and adapted land management practices. The results provide important implications for land-use planning in landslide-prone agricultural landscapes. Full article

This study aims to examine the improvement of algebra problem-solving ability and metacognitive awareness among junior high school students through the use of visualization based on a deep learning approach. The research employed a quantitative method with a quasi-experimental design, specifically a pretest–posttest control group design. The population consisted of all students from public schools in Tangerang City, Indonesia. The sample comprised seventh-grade students studying algebra. A purposive sampling technique was used to determine the experimental and control groups, with a total sample size of 51 students. The instruments included an algebra problem-solving ability test consisting of nine essay questions and a metacognitive awareness questionnaire with 52 items. Data were collected using these two instruments, with a pretest administered before the intervention and a posttest administered afterward. Data analysis was conducted using a prerequisite test, continued with independent sample t-tests, nonparametric tests, ANCOVA, and multiple linear regression. The results based on statistics indicated a significant improvement in students’ algebra problem-solving ability with a large effect. Nevertheless, the absolute increase in problem-solving scores in the experimental group is very small (N-gain mean = 0.02). Additionally, metacognitive awareness was not found to be a significant predictor of problem-solving ability; instead, initial ability (pretest) emerged as the strongest predictor. Only understanding the problem has a moderate effect; planning strategies has a small effect, and otherwise there is no effect. In conclusion, the use of visualization-based worked examples with a deep learning approach has a statistically significant effect, but its impact on improving students’ abilities should be interpreted with caution. So the practical effects of the intervention are limited; however, metacognitive awareness is not the main predictor in algebra problem-solving ability. Full article

Background: Tension-type headache (TTH) is the most prevalent primary headache disorder worldwide and represents a major source of disability related to chronic pain. Despite its high prevalence, uncertainty remains regarding optimal conservative management strategies, and limited evidence is available on how physiotherapists apply existing recommendations in routine clinical practice. Objective: The objective was to explore physiotherapists’ perceptions, clinical experiences, and treatment strategies in the management of tension-type headache, with particular emphasis on commonly used interventions, clinical decision-making, and characteristics of physiotherapy care. Methods: A cross-sectional survey study was conducted using a self-administered online survey developed in accordance with the CHERRIES guidelines. One hundred Spanish physiotherapists with clinical experience in treating patients with TTH participated. Quantitative data were analyzed descriptively, while open-ended responses were examined using inductive thematic analysis following the framework proposed by Braun and Clarke. Results: Manual therapy was the most frequently reported intervention (96%), followed by therapeutic exercise (61%) and invasive techniques, primarily dry needling (48%). The suboccipital and upper cervical regions were consistently identified as primary therapeutic targets, reflecting a predominant craniocervical treatment focus. Most respondents reported individualized treatment plans, typically delivered in weekly sessions lasting 45–60 min, with expected clinical improvement within 4–6 weeks. Pain education strategies were reported infrequently. Considerable variability was observed in the selection and combination of therapeutic techniques. Conclusions: Physiotherapists managing tension-type headache commonly adopt a multimodal approach, largely centered on manual and tissue-focused interventions. Although many reported practices are aligned with current evidence, the substantial heterogeneity observed and the limited integration of biopsychosocial strategies highlight the need for consensus-based guidelines and further research addressing real-world clinical effectiveness. Full article

This paper presents a comprehensive life-cycle analysis of distribution transformers, based on realized measurements of the increased power losses as a result of their long-term service under real-world conditions. The study is based on aggregated measured data from extensive fleets of oil-immersed distribution transformers characterized by diverse designs, manufacturing vintages, and service lives. The evolution of no-load losses and short-circuit losses is analyzed as a function of operational duration, structural characteristics, and the specific technologies employed for windings and magnetic core construction. Statistical models describing the variation in these losses are presented, highlighting the limitations of the static assumptions commonly utilized in power distribution network planning. On this basis, an approximation of the time evolution of the transformer’s total power and energy losses is proposed as appropriate for implementation in a life-cycle analysis model. Furthermore, the impacts of thermal loading and abnormal operating conditions—such as unbalanced loads, frequent short circuits, and repeated overheating of the transformer oil—are analyzed as drivers of accelerated transformer aging. These effects are integrated into a unified life-cycle framework, enabling the quantitative assessment of loss variations and their associated operational expenditures (OPEX). A numerical example is provided to evaluate the cost-effectiveness of “repair vs. replacement” scenarios, utilizing a discounted cash flow analysis that incorporates a carbon component. The findings establish a methodological foundation for a broader assessment of technical condition and energy performance, identifying the optimal intervention point for repair or replacement to support decision-making for Distribution System Operators (DSOs) amidst increasing requirements for efficiency and decarbonization. Full article

Background and Clinical Significance: Dentinogenesis imperfecta is a hereditary dentin disorder that compromises tooth structure, esthetics, and function. Case Presentation: We report the case of a 1.5-year-old female presenting with generalized discoloration of the primary dentition and intermittent sensitivity to thermal stimuli. The diagnosis of dentinogenesis imperfecta was established based on characteristic clinical features, radiographic findings, and a positive family history. The patient was followed longitudinally from 2020 to 2025, with documentation of diagnostic findings, radiographic changes, therapeutic interventions, and outcomes. Management included placement of composite veneers on the maxillary incisors for esthetic rehabilitation and sealants on second primary molars as a preventive measure. Although various management approaches have been described in the literature, evidence regarding optimal strategies and long-term outcomes in the primary dentition remains limited. This case highlights the occurrence of asymptomatic periapical pathology and root resorption despite minimal clinical symptoms, underscoring the challenges of relying on symptom-based assessment alone. Conclusions: Early diagnosis, regular radiographic monitoring, and individualized, risk-based treatment planning are essential in managing dentinogenesis imperfecta. This case emphasizes the importance of recognizing asymptomatic disease progression and integrating psychosocial considerations into comprehensive care. Full article

The Individuals with Disabilities Education Act (IDEA) provides special education services to students with disabilities, including autistic students, until age 21. However, the ages at which autistic students exit high school—and the reasons for exit—are not well documented, despite their importance for transition planning. We analyzed U.S. Department of Education Section 618 Part B data for special education students ages 14–21 across five school years (2014–2015 to 2018–2019) to examine exit age and exit category, with comparisons among autistic students, students with intellectual disabilities (IDs), and students with other disabilities. Using publicly reported counts of students exiting at each age, we derived mean exit ages by transforming age-specific count data. In 2019, 71% of autistic students graduated with a diploma, compared with 48% of students with IDs and 72.5% of students with other disabilities. Autistic students had lower dropout rates (6–8%) than students with other disabilities (15–18%). The mean exit age for autistic students was approximately 18 years, with an average graduation age of 17.9 years, indicating that many students exited prior to the end of extended IDEA eligibility in their state. These findings provide descriptive context on when autistic students exit high school relative to IDEA eligibility and underscore the importance of transition planning and coordination with adult service systems, though these factors were not directly examined in the present analysis. Full article

Background and Objectives: Visceral artery aneurysms (VAAs) are rare but potentially catastrophic vascular abnormalities, particularly in pregnant patients or women of childbearing age. Rupture is often fatal for both mother and fetus, with mortality rates exceeding 70% in some series. While most VAAs are found incidentally, a subset may present acutely with nonspecific abdominal or flank pain, making early recognition and appropriate referral essential. This review article aims to provide General Practitioners (GPs) and emergency department (ED) clinicians with a practical approach to the recognition, investigation, initial management, and escalation pathways for VAAs. Results: Physiological and hormonal adaptations in pregnancy heighten aneurysm rupture risk. Despite this, imaging is frequently delayed. Computed tomography angiography (CTA) remains the gold standard for diagnosis and is safe in pregnancy when clinically justified, with fetal radiation exposure well below teratogenic thresholds. Guidelines from major vascular societies uniformly recommend repairing VAAs in pregnancy or women planning pregnancy irrespective of aneurysm size, and treating pseudoaneurysms urgently in all patients. Endovascular intervention is first-line where anatomy permits, while open or hybrid approaches remain essential in unstable presentations. The manuscript outlines practical steps for ED and GP settings, including haemodynamic stabilization, early obstetric involvement, transfer considerations for rural environments, reproductive counselling, and post-repair surveillance. Conclusions: With an increasing number of abdominal scans being performed in primary and tertiary settings, there is an associated increased volume of incidental findings that require work-up. This article outlines a practical investigation and management strategy for clinicians presented with VAAs, including in high-risk cohorts, emphasizing early imaging, inter-specialty coordination, and guideline-supported thresholds for intervention. Full article

Background: Hypertension remains one of the leading causes of cardiovascular morbidity and mortality in South Africa. Although extensive evidence exists on modifiable risk factors, the translation of this evidence into strategic and equitable health investments remains limited. Current models such as the Global Burden of Disease (GBD) and WHO “Best Buys” identify key exposures, but lack operational mechanisms for context-specific prioritisation and dynamic resource allocation. The aim of this study is to develop and validate an integrated decision-support model that links evidence-based risk factor prioritisation with dynamic budget allocation to improve hypertension prevention and control in South Africa. Methods: This study adopts a two-phase mixed-methods design. Phase 1 develops a Risk Factor Prioritisation Model that ranks modifiable exposures using composite indices for the causality strength, implementation feasibility, policy integration, and equity. Phase 2 constructs a Dynamic Resource Allocation Model that distributes health budgets across interventions to maximise Disability-Adjusted Life Years (DALYs) averted, subject to budget and equity constraints. The model integrates data from systematic reviews, GBD 2019 estimates, WHO-CHOICE cost data, and national health expenditure databases. A validated quantitative Risk Priority Score (RPS) for major hypertension risk factors, an optimisation model for resource allocation, and an interactive dashboard that visualises efficiency and equity trade-offs under varying budget scenarios are expected. Conclusions: This study will provide a reproducible model for transforming epidemiological and economic evidence into actionable policy guidance. It bridges the gap between evidence generation and health planning, supporting more equitable and data-driven decision making in noncommunicable disease control. Full article

Global poultry production continues to expand rapidly to meet the growing demand for affordable and high-quality animal protein. However, this growth raises pressing concerns about environmental sustainability, natural resource use, and public health. Although current initiatives, such as improved housing systems, optimized feeding practices, and partial soybean meal substitution, have helped mitigate some impacts, comprehensive integrated solutions remain underexplored. This review synthesizes emerging nutritional and management innovations that enhance the sustainability of poultry production while maintaining profitability. It addresses three central research questions: (1) Which alternative feed ingredients most effectively preserve animal performance while minimizing environmental burdens? (2) How can environmental management practices enhance resource efficiency and waste valorization? (3) What roles do life cycle assessment methodologies and policy frameworks play in advancing sustainable poultry systems? Evidence from 100 peer-reviewed studies, industrial data, and field analyses reveals that incorporating insect meals, algae, and agro-industrial by-products can reduce dependence on soybean meal by 20–40% and improve feed efficiency by 5–12% across various poultry production systems. Furthermore, integrating environmental management strategies, such as manure valorization, efficient water and energy use, and the adoption of renewable energy, substantially reduces greenhouse gas emissions and promotes circular economic principles. Life cycle assessment studies confirm that combined dietary and management interventions yield greater reductions in carbon footprint than isolated measures. Future research should focus on optimizing interactions among feed strategies, environmental management, and policy frameworks through digital technologies, nanomaterial-based feed additives, and region-specific sustainability plans to accelerate the transition toward resilient, climate-smart poultry production systems. Full article

Background: Chronic Kidney Disease-associated Pruritus (CKD-aP) is a frequent, debilitating, and often underestimated symptom in clinical practice, with significant impacts on quality of life, sleep, mental health, and therapeutic adherence. This study aimed to develop a structured, person-centered nursing care overview for the management of CKD-aP. Methods: A comprehensive narrative review of the recent scientific literature on CKD-aP was conducted, adapting the conceptual domains of the European Specialist Nurses Organisation (ESNO) Common Training Framework (CTF) to nephrology nursing practice. The theoretical model guiding the work was Virginia Henderson’s paradigm, selected for its consistency with care models focused on promoting independence and meeting fundamental human needs. The study would answer the main research question “Which nursing evidence, tools, and strategies can support integrated, patient-centered management of CKD-aP?”. Results: A structured nursing care process was developed, articulated in sequential phases (assessment, problem definition, planning, intervention, and re-evaluation), visually represented in an operational flowchart and supported by validated clinical tools. The model emphasizes the nurse’s role in the multidimensional management of the symptom, incorporating educational, relational, therapeutic, and coordination-focused interventions. Conclusions: This proposal contributes to nephrology nursing practice by providing a theoretical and practical framework to standardize the management of CKD-aP. It promotes a holistic, evidence-based approach tailored to individual care needs, establishing a foundation for future clinical, educational, and research developments. Full article

This study develops a data-driven framework for predictive maintenance and prognostic health management in industrial systems using edge-enabled predictive algorithms. The objective is to support early identification of abnormal operating conditions and improve maintenance decision making under real production environments. The proposed approach combines edge-level monitoring, anomaly detection, and predictive modeling to analyze operational signals and estimate system health conditions from high-frequency industrial data. Empirical validation was conducted using operational datasets collected from two industrial production facilities between 2024 and 2025. The model evaluates patterns associated with operational instability and degradation-related anomalies and translates them into interpretable health indicators that can support proactive intervention. The empirical results show strong predictive performance, with R² reaching 0.989, a mean absolute percentage error of 3.67%, and a root mean square error of 0.79. In addition, the mitigation of early anomaly signals was associated with an observed improvement of approximately 3.99% in system stability. Unlike many existing studies that treat anomaly detection, predictive modeling, and prognostic analysis as separate tasks, the proposed framework connects these stages within a unified analytical structure designed for deployment in industrial environments. The findings indicate that edge-generated anomaly signals can provide meaningful early information about potential system deterioration and can assist in planning timely maintenance actions even when explicit failure labels are limited. The study contributes to the development of scalable predictive maintenance solutions that integrate artificial intelligence with edge-based industrial monitoring systems. Full article

Background/Objectives: This study aimed to assess the feasibility and acceptability of a 3-month health coaching intervention to promote PNF and healthy diet for men on ADT for PCa. Methods: The study was carried out via a two-armed randomized controlled trial including 40 patients with PCa at a medical center in Philadelphia. During the 3-month period, the intervention group (PNF+) received health coaching utilizing an interactive text message system, and the control group received healthy eating text messages for the same duration. The outcome variables were feasibility and acceptability. Results: The PNF+ group (n = 27) had high adherence to health coaching (82%), picture response (85%) and moderate adherence to the PNF window (69%). The intervention was rated highly acceptable with no reported A/E associated with the intervention, and most participants planning to continue in some capacity. At 3 months, the PNF+ group had numerically lower BMI (29.1) and body weight (195.2 lbs) compared to the control group (n = 13; BMI 31.6, weight 223.3 lbs). Improvements in patient-reported outcomes were observed in both groups. FACIT-F scores (higher scores indicate less fatigue) increased in the PNF+ group (43.6 to 45.2) and in the control group (42.5 to 45.5). FACT-P scores (higher scores indicate better quality of life) increased in the PNF+ group (121.3 to 125.5) but decreased slightly in the control group (121.1 to 119.8). Between-group comparisons of change from baseline showed no statistically significant differences across outcomes (all p > 0.05). Conclusions: The intervention demonstrated partial feasibility and high acceptability. It was associated with numerically lower BMI and body weight and favorable changes in patient-reported outcomes, particularly quality of life; however, no statistically significant differences were observed between groups. These findings should be interpreted cautiously given the small sample size and require confirmation in larger, adequately powered trials. Full article

Background: Current guidelines acknowledge that early discharge is not associated with late mortality and that in-hospital length of stay (LOS) of 48–72 h should be considered following successful primary percutaneous coronary intervention (PPCI) in low-risk patients. Recent studies have highlighted the safety of very early discharge after PPCI in highly selected low-risk patients; however, objective tools to guide discharge timing remain limited. The Index of Microcirculatory Resistance (IMR) offers a quantitative assessment of microvascular function and may help identify patients suitable for very early discharge. We aimed to evaluate the feasibility of using IMR to guide very early discharge in patients who underwent uncomplicated PPCI. Study design and objectives: The Safety of Early Discharge Using Index Microcirculatory Resistance in Patients with Acute Myocardial Infarction (SECURE) study is designed to assess the feasibility of using IMR, measured immediately following successful PPCI, to guide early discharge from hospital within 24 h. The SECURE study is a prospective, proof-of-concept, functional non-inferiority, single-centre, randomised, open-label trial to determine if patients with low IMR can be safely discharged when compared to standard discharge policy. The SECURE study will recruit 82 patients with low IMR following successful PPCI. Participants will be 1:1 randomised to either standard discharge timing or very early discharge (within 24 h). The left ventricle ejection fraction will be assessed using cardiac magnetic resonance imaging. A telephone follow-up at 3 months will be arranged. Clinical events are collected as secondary and exploratory safety endpoints. Conclusions: The SECURE study will provide proof-of-concept data about the feasibility of using IMR to guide very early discharge following PPCI. If successful, this study will provide data to plan for a larger study to determine the safety of this personalised approach. Full article

Constructing resilient Ecological Security Patterns (ESPs) in polycentric urban agglomerations is computationally challenging due to persistent scale mismatches between local planning and regional strategies. To address this, we developed a novel Proactive Integration Mechanism (PIM), a computational framework that dynamically optimizes ESPs by algorithmically fusing multi-source geospatial data. The PIM integrates three innovative components: (1) a Function–Structure–Policy data fusion approach that couples Self-Organizing Map clustering of ecosystem services with Morphological Spatial Pattern Analysis and policy data to identify ecological sources; (2) a Dual-Feedback Mechanism that hybridizes circuit theory with an Improved Ant Colony Optimization algorithm for dynamic corridor delineation; and (3) complex network analysis to derive targeted interventions from topological properties. Applied to a node city of the Chengdu-Chongqing Economic Circle, the PIM identified 22 integrated ecological sources and 37 corridors. The optimized network showed enhanced resilience: a deterministic 20.5% increase in circuit redundancy (α-index) and an 8.6% improvement in overall connectivity (γ-index), achieved through minimal topological modifications. Temporal validation (2000–2020) confirmed the high stability of the identified patterns. This study provides a potentially replicable and computationally robust framework that bridges spatial ecology with optimization algorithms, offering a promising paradigm for constructing ESPs in node cities within subtropical urban agglomerations. Full article