Search Results (4,237)

Flood risk is increasingly shaped by the combined effects of climate change and the vulnerability of built environments, while building-level flood damage severity analysis is often constrained by limited data availability. This study develops a transparent and reproducible framework for analyzing building-level flood damage severity under climate-adjusted hazard conditions in data-constrained environments. The framework integrates administrative post-event damage records, GIS-based terrain information, a terrain-based proxy flood-depth reconstruction procedure, and a standardized Rhine Atlas/ICPR depth–damage relationship. Representative terrain-based proxy flood depths are reconstructed using building locations, terrain elevation, and settlement-level exposure assumptions. Observed damage categories are not used to assign proxy flood depths directly, but serve exclusively as empirical ordinal reference information for ordinal consistency assessment of model-derived damage severity. Climate effects are incorporated through a simplified hazard adjustment based on projected changes in extreme precipitation intensity. The framework is applied to 413 residential buildings affected by flood events in Serbia during the period 2016–2021. Results show a consistent nonlinear relationship between terrain-based proxy flood depth and ICPR-derived structural damage severity, as well as a strong influence of terrain elevation on relative hazard intensity. Climate-adjusted sensitivity scenarios indicate that even moderate increases in extreme precipitation lead to measurable increases in structural damage severity and an upward shift in model-derived damage levels. The proposed framework provides a practical approach for flood damage severity analysis in data-constrained environments, supporting improved decision-making in sustainable flood risk management and climate adaptation planning. Full article

Background/Objectives: Persistent and recurrent symptoms after carpal tunnel release remain challenging, and non-surgical options for post-surgical carpal tunnel syndrome (CTS) are poorly defined. This study evaluated 6-month treatment success after ultrasound-guided 5% dextrose in water (D5W) hydrodissection in persistent or recurrent post-surgical CTS and compared outcomes between subgroups. Methods: In this prospective single-center interventional cohort study, 100 patients with post-surgical CTS were enrolled: 50 with persistent disease and 50 with recurrent disease. All underwent 1–4 treatments with ultrasound-guided D5W hydrodissection using a standardized protocol. Treatment success at 6 months was defined as Patient Global Impression of Change (PGIC) scores of 6–7 together with clinically meaningful improvement in at least two of three domains: ≥30% reduction in 0–10 VAS pain, ≥0.8-point reduction in BCTQ-SSS, and ≥0.5-point reduction in BCTQ-FSS. Secondary outcomes included 12-month durability; longitudinal clinical, ultrasonographic, and electrodiagnostic changes; predictors of treatment success; treatment exposure; and safety. Results: Treatment success at 6 months occurred in 58 of 100 patients (58.0%) and was more frequent in recurrent than persistent CTS (70.0% vs. 46.0%, p = 0.015). At 12 months, treatment success persisted in 52.0% of the cohort (64.0% vs. 40.0%, p = 0.017). Clinical and ultrasonographic outcomes improved significantly over time, with greater improvement in recurrent CTS. Electrodiagnostic improvement was more modest. Recurrent CTS independently predicted success (adjusted OR 2.58, 95% CI 1.10–6.03), whereas severe electrodiagnostic involvement and greater baseline median nerve cross-sectional area were associated with lower odds of success. No serious treatment-related adverse events occurred. Conclusions: Ultrasound-guided D5W hydrodissection was associated with meaningful improvement in post-surgical CTS, particularly recurrent disease. Full article

Background: Fear of malpractice and its potential legal, financial, and reputational consequences are associated with one of the most complex phenomena in the medical community: defensive medical practice (DMP). DMP is frequently analyzed in the specialized literature from the physician’s perspective; however, the patient’s role in triggering and maintaining defensive behaviors remains under-explored. Methods: This cross-sectional study examined contextual factors associated with fear of malpractice and the convergences between doctors’ and patients’ perspectives within a bilateral model (error–fear–perceived risk–prevention behaviors), without assuming direct causal relationship. Two questionnaires were administered in Romania to 240 dentists (March–June 2023) and 344 patients (June–December 2023). Associations were tested with chi-square and Fisher’s exact tests (reporting Cramér’s V and odds ratios), multivariate binary logistic regression, and post hoc power analysis. Results: Over half of dentists (53.3%) reported fear of malpractice despite minimal actual legal exposure (0.8%); this fear was associated with awareness of its potential consequences and perceiving patients as more demanding. In multivariate analysis, fear was the strongest independent predictor of perceiving patients as a threat (aOR = 3.98, 95% CI [1.67–9.48]). On the patient side, 57.9% would avoid a dentist with a known malpractice case and 34.0% had requested additional procedures for reassurance. Conclusions: The interaction between physician fear and patient pressure suggests the existence of a “reassurance loop”, in which the patient’s need for safety and the doctor’s fear can mutually reinforce each other, fostering defensive behaviors. We propose an exploratory typology of patient-induced DMP—direct induction (explicit requests for additional investigations/procedures) and indirect induction (relational pressure and reassurance seeking)—to guide future research. By integrating the dentist and patient perspectives within a bilateral model, the study provides a context-specific account of patient-induced defensive practice in Romanian dentistry and identifies dual-target educational interventions (addressing both clinician communication and patient health literacy) as a potential preventive direction. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with substantial impact on quality of life. The introduction of biologics and Janus kinase (JAK) inhibitors has markedly transformed systemic treatment strategies. However, long-term prospective real-world registries evaluating drug survival, safety, phenotype-specific treatment response, and post-discontinuation outcomes remain limited, particularly in Asian populations. Methods: The Western Japan Atopic Dermatitis Registry (WJADR) is a multicenter, prospective, observational registry coordinated by Kyushu University and collaborating institutions across western Japan. Patients initiating or currently receiving systemic therapy for AD are enrolled. Longitudinal data collection includes clinical phenotype classification, disease course classification, treatment exposure, physician-assessed severity scores, patient-reported outcomes, biomarkers, and safety information. The primary outcome is drug survival, while secondary outcomes include clinical improvement, adverse events, phenotype–treatment interactions, biomarker–treatment correlations, and treatment-switch patterns. Results: WJADR was designed as a phenotype-integrated real-world registry to evaluate comprehensive systemic treatment strategies and post-discontinuation outcomes in AD prior to the completion of patient enrollment and outcome analyses. Unlike existing registries primarily focused on biologic initiator cohorts or treatment burden, WJADR integrates clinical phenotypes, biomarkers, and longitudinal outcomes to support precision medicine approaches. Conclusions: WJADR represents the first large-scale multicenter prospective AD registry in western Japan and may provide ethnicity-specific real-world evidence to support long-term safety evaluation, treatment optimization, and phenotype-guided therapeutic strategies in AD. Full article

Background/Objectives: Contemporary patient-specific subperiosteal implants have re-emerged as graftless solutions for oral and maxillofacial rehabilitation, driven by advances in digital planning, CAD/CAM workflows, additive manufacturing, and biomaterial engineering. Their indications have progressively expanded from severely atrophic edentulous jaws to segmental defects, single-tooth replacement, congenital craniofacial anomalies, salvage situations, and oncologic reconstruction. This scoping review aimed to map the current evidence on modern patient-specific subperiosteal implants, focusing on indications, workflow, design principles, materials, outcomes, complications, and maintenance. Methods: A scoping review was conducted according to PRISMA-ScR principles to identify clinical studies, case series, case reports, systematic and scoping reviews, technical notes, finite element analyses, in vitro studies, and relevant translational investigations dealing with contemporary custom-made or CAD/CAM subperiosteal implants. The evidence was narratively synthesized according to clinical indication and thematic domains, including full-arch rehabilitation, sectional and single-tooth applications, congenital and post-oncologic defects, rescue indications, biomechanics, material selection, surface response, prosthetic protocols, and complication management. No quantitative meta-analysis was performed because of the scoping design and the substantial heterogeneity of study types, indications, implant systems, outcome definitions, and follow-up durations. Results: The final evidence map included 116 records, of which 56 were unique human clinical records with extractable denominators and 60 were biomechanical, in vitro, surface-biology, review, consensus, historical, or conceptual records. Of the 56 unique clinical records, 49 were mapped within the six indication-level clinical sections, while seven were retained as cross-cutting clinical evidence addressing patient-reported outcomes, design-related complications, bone apposition, anchorage strategy, comparative graftless rehabilitation, or reconstructive/prosthetic principles. The six indication-level sections included 52 clinical-record assignments: 15 for full-arch rehabilitation, 13 for segmental or sectional rehabilitation, one for single-tooth rehabilitation, four for congenital or craniofacial indications, 13 for post-oncologic or post-ablative reconstruction, and six for rescue or salvage indications. Because three records addressed more than one indication, these counts represent indication-level assignments rather than mutually exclusive clinical records. Reported survival in most short- to mid-term clinical series was generally high, commonly ranging from 90% to 100%, although lower values of 70–80% were reported in selected longer-term cohorts and survival clearly overestimated clinical success in some studies. Expanding applications include posterior mandibular and maxillary defects, lateral incisor agenesis, cleft-related or syndromic deformities, maxillectomy reconstruction, obturator support, and hybrid rehabilitation with endosseous implants; however, evidence for the indications at the extremes of this spectrum—single-tooth replacement and primary oncologic reconstruction—remains limited to small, largely single-group case series and reports. Soft-tissue events, including dehiscence, mucositis, recession, and framework exposure, were the dominant complications and showed wide variability, with reported recession/exposure rates ranging from approximately 10% in some sectional and full-arch series to as high as 65% in bilateral maxillary cohorts; their clinical significance varied from asymptomatic stable findings to progressive inflammatory complications requiring revision. Conclusions: Patient-specific subperiosteal implants represent a promising and increasingly versatile reconstructive option; however, the present findings should be interpreted as evidence mapping rather than as definitive comparative evidence. Their clinical use should remain highly selective, prosthetically driven, and supported by meticulous planning, rigid fixation, soft-tissue management, and structured maintenance. Standardized success criteria, longer follow-up, and comparative prospective studies are required. Full article

The ultimate goal of integrating artificial intelligence into education is to ensure the long-term stability, quality, and sustainability of the educational process, turning it into a tool that consistently improves teaching and learning. Yet its sustainable and responsible integration depends largely on a positive mindset and the pedagogical willingness of future teachers. This study examines the attitudes and readiness of pre-service teachers, specializing in preschool, primary, and subject-specific science education, toward AI integration, with a specific focus on sustainable science education and Green Lab concepts. A mixed-methods study was conducted on a sample of 251 students from the University of Split. Data were analyzed using exploratory factor analysis, standard and Welch ANOVA with Tukey’s HSD and Games–Howell post hoc tests, and multiple linear regression in IBM SPSS 20, and qualitative content analysis. The findings reveal perceived usefulness as a primary driver of AI acceptance across all groups. Science students demonstrated the highest levels of ethical and critical sensitivity but provided the lowest ratings for AI’s practical application in sustainable science education, expressing cautious attitudes and distinct concerns about system reliability. However, no significant difference was found between students with and without a science background in regard to AI’s potential to facilitate sustainable scientific concepts. Furthermore, behavioral analysis demonstrated that even initial, occasional exposure to AI tools significantly boosted students’ perceptions of its utility and sustainable application compared to non-users, whereas increasing the frequency of use resulted in no additional gains. The transition toward sustainable science education requires moving beyond technical literacy toward a comprehensive framework that integrates pedagogical usefulness with ethical responsibility and sustainable scientific application. Future studies should explore potential models that combine the methodological creativity of pre-service educators and teachers with the analytical rigor of science students. Ultimately, this research underscores that an educational policy must integrate digital advancements while strictly maintaining ethical standards and the essential role of human supervision. Full article

Background: COVID-19 has been linked to musculoskeletal complications, including femoral head avascular necrosis (AVN). Both COVID-19–related hypercoagulability and corticosteroid therapy have been proposed as contributing factors. This systematic review synthesizes current evidence on the occurrence, clinical characteristics, timing, and risk factors for femoral head AVN following COVID-19. Methods: A PRISMA-compliant systematic search of PubMed, Embase, and Scopus identified observational studies and case series (≥10 patients) reporting femoral head AVN in adults or adolescents with confirmed COVID-19. Data on epidemiology, symptom onset, imaging findings, and corticosteroid exposure were narratively synthesized due to heterogeneity. Results: Fifteen eligible studies described patients with post-COVID femoral head AVN. Symptom onset ranged from days to >12 months after infection. Early MRI often revealed asymptomatic or low-grade disease. Corticosteroid exposure was common and strongly associated with AVN severity; however, several studies reported AVN in patients without steroid use, whether this reflects an independent contribution of COVID-19 or unrecognized confounding cannot be determined from the available uncontrolled data. Higher cumulative steroid doses, severe pulmonary involvement, and elevated inflammatory markers were consistently linked to more advanced AVN stages. Conclusions: Femoral head AVN is an emerging post-COVID complication with variable timing and presentation. Corticosteroid exposure remains the principal risk factor; whether COVID-19 contributes independently of corticosteroids is unproven, and current evidence supports an association rather than a causal relationship. Awareness of this potential complication is warranted, although the role of early MRI screening remains to be established in prospective studies. Full article

This study investigates whether the March 2023 failure of Silicon Valley Bank (SVB) coincided with changes in market-risk exposure, abnormal returns, and return connectedness among five major Chinese financial institutions. Using daily data from January 2022 to December 2023, we apply CAPM and market-model regressions, structural-break tests, event-study methods, and generalized forecast-error variance decompositions. The revised design distinguishes 10 March from the first subsequent Chinese trading day, 13 March, and adds symmetric event windows, placebo tests, an alternative risk-free rate, return-series audits, significance tests, and VAR diagnostics. Full-sample Chow tests identify breaks for ICBC and CITIC Securities, but only ICBC remains significant within the ±60-day window, and none are significant within ±30 days. Only ICBC records a significant positive CAR over [−3, +3]. Overall connectedness falls from 55.53% to 47.98%, while CITIC Securities becomes the largest post-event net transmitter. The evidence therefore indicates selective repricing and reconfigured linkages rather than a system-wide effect, and does not support unique causal attribution to SVB. Full article

The hallmark feature of empty follicle syndrome (EFS) is failure to retrieve oocytes from apparently mature follicles despite adequate ovarian stimulation and appropriate ovulation triggering. Although considered uncommon, with a reported prevalence ranging from 0.2% to 7%, EFS may have a profound clinical and psychological impact and can recur in assisted reproductive technology (ART) cycles. Modern classification systems divide EFS into genuine and false forms. Genuine EFS is potentially associated with intrinsic abnormalities involving luteinizing hormone/choriogonadotropin receptor (LHCGR) signaling, oocyte competence, and cumulus–oocyte interaction, whereas false EFS is primarily attributed to pharmacokinetic or pharmacodynamic factors resulting in inadequate trigger exposure. Borderline EFS represents a third phenotype characterized by incomplete or partial impairment of final oocyte maturation. This review examines the pharmacodynamics of ovulation-triggering agents, including human chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH) agonist protocols, and dual-trigger strategies, and their roles in regulating final oocyte maturation. The molecular aspects of periovulatory signal transduction and the mechanisms of LHCGR activation, epidermal growth factor (EGF)-like pathways, and meiotic resumption in relation to EFS etiopathogenesis will be described. The impact of patient-dependent conditions like obesity, poor ovarian reserve, polycystic ovary syndrome (PCOS), and pituitary response on trigger response will be assessed. New approaches like post-trigger monitoring of hormones and rescue treatment with gonadotropins represent a valuable method for avoiding cycle cancellation in patients at risk. Overall, EFS is increasingly regarded not as a single disorder but as a heterogeneous spectrum of periovulatory dysfunction arising from pharmacological, endocrine, and intrinsic ovarian factors that impair completion of final oocyte maturation. Full article

Canine distemper virus (CDV), currently classified within the species Morbillivirus canis, is a major vaccine-preventable pathogen of domestic dogs and a wide range of susceptible wildlife species. Still, laboratory-confirmed epidemiological data from Portugal remain scarce. This retrospective study investigated CDV molecular detection in 637 diagnostic samples from dogs with clinical suspicion of canine distemper, received from 190 veterinary medical centres across Portugal between 2013 and 2025. Cerebrospinal fluid, EDTA-anticoagulated whole blood, rectal swabs, and conjunctival swabs were tested for CDV RNA using a reverse transcription real-time PCR (RT-qPCR) assay in a qualitative approach. Overall, 215 submissions were CDV RT-qPCR-positive, corresponding to a positivity of 33.8% (95% confidence interval: 30.2–37.5%). Positivity was not significantly associated with sex, age, or Nomenclature of Territorial Units for Statistics level 2 (NUTS 2) region, but differed significantly according to specimen type, with the highest detection observed in EDTA-anticoagulated whole blood and conjunctival swabs. Mixed-breed dogs were over-represented among submitted samples and positive cases, probably reflecting management, exposure, and vaccination-related factors rather than intrinsic breed susceptibility. The central finding was a pronounced post-2020 decline in CDV RT-qPCR positivity, with very low or absent annual detection between 2021 and 2025. This pattern indicates reduced molecular detection within a passive diagnostic population but should not be interpreted as evidence of national elimination. Continued vaccination and strengthened surveillance at the domestic dog–wildlife interface remain essential. Full article

Background: The COVID-19 pandemic was accompanied by an infodemic that promoted the use of so-called “miracle products” lacking scientific evidence, posing significant public health risks. Despite increasing concern, evidence on effective educational strategies to counteract this misinformation remains limited, particularly in Latin America. Methods: A quasi-experimental pre–post study without a control group was conducted among university students in Mexico City between February and June 2021. Participants were recruited via Facebook using a snowball sampling approach. A validated nine-item questionnaire assessed knowledge about miracle products before and after exposure to an educational video intervention. Paired statistical analyses were performed to evaluate changes in knowledge. Results: A total of 157 participants completed the pre-test, and 103 completed the post-test. The intervention resulted in a significant increase in knowledge scores, from a mean of 5.98 (SD = 1.73) to 9.05 (SD = 1.54) (p < 0.001). Significant improvements were observed in eight of nine items, with the largest increases in knowledge related to high-risk substances and reporting mechanisms. No significant baseline differences were found between participants who completed and those who did not complete the post-test. Conclusions: The video-based educational intervention was effective in improving knowledge about miracle products during COVID-19. These findings support the use of digital health education strategies as scalable tools to combat misinformation, particularly in resource-constrained settings. However, further research using controlled designs is needed to assess long-term effects and behavioral outcomes. Full article

Background/Objective: Francisella tularensis is a highly infectious intracellular pathogen that causes severe pulmonary tularemia following aerosol exposure, yet no licensed vaccine exists. Because infection initiates at the respiratory mucosa, understanding mechanisms of protective pulmonary immunity is critical for mucosal vaccine development. This study investigated the role of lung-resident γδ T cells following intranasal immunization with inactivated F. tularensis (iFt) and subsequent lethal challenge with live vaccine strain (LVS). Methods: Mice were intranasally immunized with iFt and later challenged with lethal LVS. Pulmonary immune responses were evaluated using flow cytometry and cytokine analysis. Recruitment of γδ and αβ T cells, production of IL-17 and IFN-γ, neutrophil infiltration, and γδ T cell memory phenotypes were assessed in naïve and immunized mice following infection. Results: Primary LVS infection induced rapid recruitment of γδ T cells to the lung beginning on Day 2 post-infection, preceding significant αβ T cell accumulation. Increased pulmonary IL-17 and IFN-γ correlated with expansion of IL-17– and IFN-γ–associated γδ T cell populations. Following iFt immunization, mice demonstrated enhanced survival after lethal LVS challenge, accompanied by early increases in pulmonary IL-17 and IL-17 producing γδ T cells. Immunized mice also exhibited expansion of effector memory and central memory γδ T cell populations associated with IL-17 production. Conclusions: These findings identify IL-17 producing γδ T cells as contributors to early mucosal immunity following intranasal vaccination against F. tularensis and suggest that targeting lung-resident γδ T cells may support the development of next-generation mucosal vaccines against respiratory pathogens. Full article

The rapid expansion of video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) has reshaped thoracic surgical practice over the last two decades, offering reduced perioperative morbidity, shorter hospital stay, and oncological outcomes comparable to conventional thoracotomy in appropriately selected patients. Minimally invasive techniques now account for the majority of anatomical pulmonary resections in many high-volume centers and are being explored, in selected patients at experienced institutions, for increasingly complex procedures. This shift, however, raises a question that has received comparatively little attention: whether reduced trainee exposure to open thoracotomy may, over time, erode open thoracic surgical competence. As minimally invasive approaches become the institutional default, exposure to open surgery is declining, and the skills required to perform complex open resections or to manage intraoperative emergencies may become confined to a diminishing cohort of senior surgeons. In this narrative review, we examine the current boundaries of minimally invasive thoracic surgery, define the clinical scenarios in which open surgery remains indispensable—including bronchoplastic and angioplastic resections, post-induction hostile surgical fields, and unplanned conversion—and consider the implications of the ongoing paradigm shift for training, taking into account the substantial variability of thoracic surgical practice across different regions. We argue that open thoracic surgery is not an obsolete discipline but a foundational competence whose preservation may warrant deliberate attention through structured exposure, simulation, mentorship, and dedicated competence assessment. Throughout, we have sought to distinguish documented trends from reasonable concern and from speculative future risk, and we frame the central issue explicitly as a credible and foreseeable risk rather than a demonstrated decline. Full article

This study examines associations between participation in a culturally responsive inventive learning experience featuring women engineers as guides and middle school students’ reported equity beliefs about belonging in inventing, interest in inventing, and their identification of women inventors. the students’ inventive interests. Following a single-session STEM outreach experience across five sites, which included family sessions held at a local museum, after-school STEM night family activities, and in-class visits (N = 215 students), participants completed a retrospective pre-post survey. Results indicated statistically significant positive shifts in students’ reported equity beliefs and interest in inventing following the session. However, findings were context-dependent: interest gains were more strongly associated with instructor connection and prior inventing experience, while equity belief shifts were observed broadly across participants and did not appear to depend on individual instructor connection. Instructor connection was not significantly associated with students’ identification of women inventors, suggesting that cognitive recognition of diverse inventors may require more sustained exposure than a single session provides. These findings suggest that single-session culturally responsive inventive learning experiences may be associated with positive motivational shifts in equity beliefs and interest, while deeper cognitive change in students’ inventor associations may require repeated and sustained engagement. Implications for the design of culturally responsive invention education programs are discussed. Full article

MAFLD progression is closely linked to a systemic failure of antioxidant defense systems. Se and Zn play crucial roles in maintaining redox balance in the liver. This study evaluated the effects of micronutrient-biofortified chickpea flours as functional ingredients for the prevention and management of MAFLD disturbances. Chickpea seeds were germinated with Na₂SeO₃, ZnSO₄, ZnSeO₃, or ZnSO₄ + Na₂SeO₃, processed into flours, and then subjected to gastrointestinal digestion to obtain biofortified-chickpea digests (BCD). SDS-PAGE and FTIR indicated treatment-dependent changes in the protein/peptide profile and in the structural organization of the digested matrix. Isoflavone content was higher in ZnSO₄-BCDs. The oleic acid-induced HepG2 cell model was used to emulate MAFLD conditions. Under preventive conditions, except for ZnSeO₃-BCD, all treatments reduce triglyceride accumulation from 17.1 to 38.6%. Non-biofortified (GC) chickpea flour and ZnSeO₃-BCD had greater effects on lipolysis and glycerol release. Overall, Se-BCD affected redox regulation 1.2–1.3-fold, suggesting potential improvement in lipid utilization. GC and ZnSO₄ + Na₂SeO₃ BCDs decreased triglyceride accumulation (21.1 and 20.5%, respectively) when evaluated post lipid exposure. In both experimental conditions, BCDs significantly reduced IL-6 levels by 25.1 to 34.7%, demonstrating their immunomodulatory potential. Biofortified chickpea flours exhibit complementary and coordinated biological activities against the main metabolic disturbances associated with MAFLD. Zn/Se-biofortification of chickpea is a valuable strategy for addressing micronutrient deficiencies and for producing functional ingredients to prevent or ameliorate MAFLD-associated disturbances and improve liver health. Full article