Search Results (2,208)

Background: Cervicogenic headache (CEH) is a secondary headache disorder originating from dysfunction in the cervical spine. In addition to pain, individuals with CEH frequently experience disturbances in postural control and sensorimotor integration, which may compromise functional capacity and quality of life. Conventional clinical assessments typically focus on pain intensity and cervical range of motion; however, these measures often fail to capture the multifactorial mechanisms underlying balance impairments in this population. Machine learning (ML) methods offer the ability to integrate multidimensional clinical data and may provide a more comprehensive approach for identifying patterns of postural stability and the factors influencing balance regulation in CEH. Methods: A secondary analysis was conducted using baseline data pooled from three registered randomized controlled trials, comprising 68 independent participants diagnosed by a neurologist according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Postural Stability Class served as the primary outcome and was derived from quantitative stability scores categorized as High, Moderate, or Low. Predictor variables included demographic characteristics (age, gender), clinical measures (pain intensity, headache frequency, symptom duration, cervical range of motion), and sensorimotor parameters (center-of-pressure sway and gaze accuracy). Five machine learning algorithms—Random Forest, XGBoost, Support Vector Machine, Logistic Regression, and Gradient Boosting—were trained and evaluated using 10-fold cross-validation with procedures implemented to reduce overfitting. Results: The Gradient Boosting classifier demonstrated the best performance, achieving an accuracy of 0.857 and an F1 score of 0.857, with a cross-validated accuracy of 0.802 ± 0.063. Random Forest and XGBoost achieved accuracies of 0.786. Feature importance analysis identified center-of-pressure sway and pain intensity as the most influential predictors of stability classification, followed by cervical flexion range of motion and gaze accuracy. Demographic variables showed minimal contribution to model performance. Conclusions: Machine learning models were able to distinguish different levels of postural stability in individuals with CEH. The findings highlight the central role of pain and sensorimotor control in balance regulation and suggest that predictive analytics may support precision physiotherapy by enabling rehabilitation strategies tailored to individual sensorimotor profiles. Full article

Water blockage severely restricts gas transport in deep shale reservoirs, while effective mitigation requires a precise balance of multiple operational variables. This study utilizes core-flooding experiments to optimize the treatment processes of an amphiphobic fluorinated copolymer, focusing on the coupled roles of surfactant concentration, injected volume, and shut-in duration. The results show that permeability damage decreases rapidly with surfactant concentration, optimizing at 0.5 wt.%. Conversely, excessive liquid retention beyond a critical injection threshold of 1.0 PV triggers secondary water-blocking. Extending the shut-in duration to 8 days facilitates surfactant redistribution and interfacial equilibrium, gradually reversing rock wettability to a stable amphiphobic state. Crucially, the concurrent reduction in interfacial tension markedly lowers capillary resistance, allowing trapped water to detach and flow back under significantly lower driving pressures. This optimization effectively minimizes the energetic barrier for fluid displacement and creates a gas-preferential flow environment. The proposed laboratory operational window balances surfactant dosage, injection volume, and shut-in duration under the tested conditions, providing an experimental reference for optimizing post-fracturing cleanup, controlling liquid retention, and improving early-time gas flowback in shale gas reservoirs. Full article

Background/Objectives: Rehospitalization after traumatic spinal cord injury (SCI) is common, but binary or count summaries may obscure heterogeneity in timing, recurrence, frequency, and duration. We aimed to identify clinically interpretable rehospitalization burden profiles in the SCIMS 2021ARPublic dataset and examine descriptive associations with clinical correlates and participation outcomes. Methods: We analyzed Form I, Form II, and Record Status public-use files. Among 29,310 individuals with at least one non-lost follow-up interview, 28,745 with at least one non-missing rehospitalization indicator entered latent class analysis. Four prespecified indicators captured early, recurrent, frequent, and prolonged rehospitalization. Candidate two- through six-class models were compared using AIC, BIC, entropy, class size, posterior probabilities, and interpretability. Pairwise adjusted logistic models examined candidate clinical correlates in 10,407 participants with complete 2016+ follow-up data. Adjusted linear models examined CHART participation domains in 20,766–20,949 participants. Results: A four-profile solution was retained: low rehospitalization burden (59.8%), early/prolonged rehospitalization (18.9%), frequent/prolonged rehospitalization (7.7%), and high recurrent/frequent/prolonged burden (13.6%). UTI and pressure ulcer history showed the most consistent associations with burdened profiles. Severe pain and frequent sleep problems were associated with selected heavier-burden profiles, while depressive symptoms showed smaller and less precise associations. Sensitivity analyses supported structural stability while highlighting observation-time bias and classification uncertainty inherent to wave-based public-use data. Compared with the low-burden profile, burden profiles showed lower CHART scores, especially for mobility and occupation. Conclusions: Rehospitalization after traumatic SCI is heterogeneous. These utilization burden profiles summarize distinct observed patterns but require prospective validation before use in risk stratification or follow-up planning. Full article

Background: The oral microbiome has emerged as a potential contributor to cardiovascular physiology through its role in the enterosalivary nitrate–nitrite–nitric oxide pathway. Oral nitrate-reducing bacteria convert dietary nitrate into nitrite, which can subsequently be reduced to nitric oxide, a signaling molecule associated with vascular tone, endothelial function, platelet activity, and blood pressure regulation. Disruption of this pathway has been associated with reduced nitric oxide bioavailability and impaired vascular responses. Methods: This narrative review summarizes current evidence regarding the relationship between the oral microbiome, nitrate metabolism, and cardiovascular function. Relevant literature was identified through searches of PubMed/MEDLINE and Google Scholar up to May 2026. Evidence from mechanistic, observational, and interventional human studies was reviewed and synthesized thematically. Results: Available evidence suggests that oral nitrate-reducing bacteria may influence nitric oxide bioavailability and vascular function. Studies have reported associations between oral microbiome disruption and changes in blood pressure, endothelial responsiveness, plasma nitrite concentrations, and other surrogate cardiovascular markers. However, findings remain heterogeneous and are influenced by factors such as diet, oral hygiene practices, smoking status, medication use, oral health, and underlying cardiometabolic conditions. Most studies are limited by small sample sizes, short intervention durations, and reliance on surrogate outcomes rather than major cardiovascular events. Conclusions: The oral microbiome may influence cardiovascular health through its role in nitrate metabolism and nitric oxide bioavailability. However, current evidence is largely limited to surrogate vascular outcomes, while data on major cardiovascular events remain scarce. Further longitudinal and interventional studies are needed to clarify causality and evaluate microbiome-targeted interventions. Full article

Background and Objectives: Pulmonary sequestration (PS) is a rare congenital lung anomaly with anomalous systemic arterial supply. Surgical resection is the standard treatment, but some children have contraindications. Endovascular embolization (EE) is an established alternative; published pediatric experience is limited, particularly in neonates. We report a two-centre experience with extended follow-up and quantitative hemodynamic data. Methods: Six pediatric patients (five male; median age 6 months, range 11 days to 4 years and 8 months) underwent EE for PS at two centres in Gdańsk, Poland, between 2020 and 2025. Contraindications to surgery were severe pulmonary arterial hypertension, high-output cardiac failure, low body weight with comorbidity, complex extralobar anatomy or refused parental consent. Procedures were performed under general anesthesia via right common femoral arterial access; device strategy was tailored to vessel anatomy. Results: Technical success was 100% with no procedural complications. Median feeding-artery diameter was 3.4 mm (range 2.1 to 5.3 mm). An Amplatzer-family vascular plug was used in five patients (83.3%), pushable platinum coils in two (33.3%) and Onyx-18 in one (16.7%); two had hybrid combinations and one underwent planned staged two-step embolization. Median procedural duration was 51 min. At median follow-up of 50 months (range 11 to 68), all patients showed sequester regression on imaging. Reverse cardiac remodelling occurred within five weeks in the patient with pre-procedural left ventricular dilation (Z-score +2.45 returning to normal); systolic pulmonary artery pressure fell from 35 to 40 to 17 mmHg within six weeks in the neonate treated at 11 days of life for high-output cardiac failure. No patient required surgical resection. Conclusions: Endovascular embolization is safe and effective in pediatric patients with pulmonary sequestration and contraindications to surgery, including neonates with comorbidity. Documented reverse cardiac remodelling and rapid hemodynamic improvement support its use in selected cases. Full article

Background and Objectives: Chronic nonspecific neck pain (NSNP) is among the most common musculoskeletal disorders. Global postural re-education (GPR) might be effective in decreasing neck pain (NP) and dysfunction and improving forward head posture (FHP) by recovering muscle chains and reducing postural alteration. Deep neck flexor activation (DNF) might also decrease NP and improve FHP by improving DNF endurance. This study aimed to compare the effects of GPR versus DNF activation on pain, dysfunction, FHP, and DNF endurance. Materials and Methods: Forty-six physiotherapy students with chronic NSNP participated in this non-randomized comparative study and were allocated into two equal groups based on their availability and preference regarding session duration. Group A underwent GPR exercises combined with active neck exercises, whereas group B received DNF activation in addition to active neck exercises. All participants were assessed pre- and post-intervention for pain intensity using a visual analog scale (VAS), neck disability using the Arabic version of the neck disability index (NDI), FHP via a photometric method with Kinovea software, and DNF endurance using pressure biofeedback. Results: A significant effect of both treatments was reported on reducing pain intensity, improving the FHP and enhancing the neck functional status with no substantial differences between both groups. A significant improvement in DNF endurance was observed in both groups, with substantially higher values between groups in favor of the DNF group. Conclusions: Both GPR and DNF activation exercises were associated with reductions in pain and improvements in neck disability among physiotherapy students with chronic NSNP and FHP. Also, both CVA and DNF endurance improved, with more improvement observed in DNF endurance in the DNF group compared with the GPR group. Full article

Cobalt occupies an irreplaceable strategic position in renewable energy and high-end advanced industries. As high-grade mineral resources gradually deplete, associated sulfide minerals have attracted increasing attention as alternative sources of cobalt. This study investigated a selective extraction of cobalt from low-grade cobalt-bearing pyrite using oxygen-pressure acid leaching. The Gibbs free energy (ΔG) of key chemical reactions in the leaching system was calculated to verify the thermodynamic feasibility of the process. The effects of critical parameters, including oxygen pressure, initial acidity, stirring speed, leaching time, and temperature, on cobalt leaching efficiency and phase transformation characteristics were systematically investigated. Under optimal conditions of oxygen pressure 1.5 MPa, H₂SO₄ initial acidity 7.36 g·L⁻¹ (0.82 mol/L), stirring speed 300 rpm, leaching duration 120 min, and temperature 230 °C, the cobalt leaching rate reached 98.2%, whereas the leaching rates of iron and aluminum were only 19.79% and 28.11%, respectively. Combined with SEM-EDS, XRD, and XPS characterization results, oxygen pressure acid leaching effectively destroyed the lattice structure of cobalt-bearing pyrite and liberates lattice-hosted cobalt, thereby facilitating efficient cobalt leaching. At high-temperature and oxygen pressure conditions, Fe³⁺ underwent hydrolysis and precipitated as hematite (Fe₂O₃) or hydronium jarosite (H₃O)Fe₃(SO₄)₂(OH)₆, enabling the selective extraction of cobalt. Aluminum in cobalt-bearing pyrite primarily occurred as the stable boehmite (AlOOH) phase, exhibiting excellent acid resistance and low dissolution during leaching. This study broadens the utilization pathway of low-grade cobalt resources and provides valuable insights and a scientific theoretical basis for the efficient treatment of cobalt-containing sulfide concentrates and tailings. Full article

Background/Objectives: Nutrition plays a core role in chronic disease management, and there is growing interest in the health impact of plant-based diets (PBDs) in people with overweight or obesity. We conducted this systematic review and meta-analysis to summarize the evidence on the health effect of PBDs compared to omnivorous diets in overweight or obese individuals. Methods: We searched the databases Cochrane Central Register of Controlled Trials, MEDLINE, Embase, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to 3 January 2024. Two review authors independently screened studies for eligibility, extracted data, evaluated the risk of bias, and rated the certainty of the evidence using GRADE. This study is registered with PROSPERO, CRD42021225525. We used random-effects meta-analysis to analyze data. Results: Of 2664 records identified, 10 randomized controlled trials (RCTs) and six ongoing studies met the inclusion criteria. The available evidence suggests little to no difference between plant-based and omnivorous diets for body weight, systolic blood pressure, diastolic blood pressure, serum glucose, serum insulin, insulin sensitivity, total cholesterol, triglyceride, HDL cholesterol and body fat mass. Plant-based diets may slightly reduce LDL cholesterol. They may also reduce BMI and HbA1c, although the certainty of the evidence is very low. Longer-duration dietary interventions (14 weeks or more) showed greater improvements in BMI, LDL cholesterol and HbA1c. Conclusions: Plant-based diets may represent a dietary option for people with overweight or obesity and may support modest improvements in selected cardiometabolic outcomes, although the available evidence is limited and uncertain. Most outcomes showed little or no difference between PBDs and comparison diets, while the observed effects on BMI and HbA1c were supported by very low certainty evidence. Full article

Ammonia is a promising zero-carbon energy carrier for maritime decarbonisation, but its deployment is limited by safety risks that are not adequately addressed by conventional marine fuel safety frameworks. This study critically reviews safety assessment, risk management and control strategies for ammonia storage and handling in maritime applications using a PRISMA-informed literature synthesis. Evidence is analysed across hazard characterisation, storage configurations, transfer operations, risk assessment methods, mitigation barriers and regulatory frameworks. The review shows that ammonia safety is governed by coupled release–exposure–barrier interactions shaped by storage condition, tank configuration, pressure–temperature behaviour, material compatibility, transfer mode, ventilation, ship geometry and human intervention. Existing methods, including HAZID, HAZOP, risk matrices and QRA, support hazard screening and prioritisation, but remain limited in representing flashing two-phase releases, dense gas dispersion, confined-space accumulation, exposure duration, ventilation effectiveness and safeguard timing under maritime conditions. CFD, FTA, Bayesian approaches and Monte Carlo analysis offer higher analytical resolution, but their reliability is constrained by limited validation data, uncertain leak-frequency inputs and simplified assumptions for human exposure and emergency response. Effective risk control therefore requires a toxicity-centred barrier strategy linking containment integrity, ammonia-compatible materials, gas and process monitoring, emergency shutdown, ventilation, water-based mitigation, PPE, competency-based training and emergency planning. Current regulatory and classification guidance provides an essential foundation but remains fragmented and insufficiently aligned with ammonia-specific requirements for exposure modelling, safety-zone definition and approval pathways. This review contributes a maritime-specific synthesis of ammonia storage and handling safety by connecting hazard behaviour, storage design, transfer operations, risk assessment limitations, control-barrier logic and regulatory approval needs. The findings highlight the need for validated source-term models, full-scale release and dispersion data, exposure-based safety criteria and harmonised regulatory pathways to support the safe and scalable use of ammonia in maritime decarbonisation. Full article

Laser-induced acoustic communication is a highly adaptable cross-medium technique that combines the advantages of optical transmission through air and acoustic transmission underwater. However, poor signal stability at high repetition frequencies currently hinders its widespread application. To address this, this paper proposes an innovative scanning focal-point method to enhance stability. Traditional methods such as beam scanning, focus control, and distributed interaction are primarily aimed at enhancing sound pressure in a specific direction, achieving near-field/far-field focusing, or improving the signal-to-noise ratio through coherent synthesis of ultrasonic intensity. In contrast, the method proposed in this paper is intended to avoid the interference of droplets and vapor generated by single-point breakdown under high repetition frequencies, which would otherwise degrade the laser-acoustic conversion efficiency. It is therefore an active defense strategy specifically targeting the stability of laser-induced acoustic communication. First, optical simulation software was used to analyze the effects of surface ripples and bubbles on focal spot displacement and size. Next, a single-pulse experimental system was developed to measure the range and duration of surface depressions caused by optical breakdown. Finally, a scanning focal-point system was constructed for comparative experiments, with results recorded via hydrophones and high-speed cameras. The maximum laser-induced acoustic signal generated by the scanning focal-point method is 7.4 times that produced by single-point breakdown. The experimental results demonstrate that the scanning focal-point method can effectively avoid the influence of water surface disturbance and steam on the optoacoustic conversion efficiency and significantly improve the amplitude and stability of the laser-induced acoustic signal. Full article

E-commerce has reshaped short-term financial management by altering transaction speed, payment structures, and supply chain coordination. This study examines how large publicly listed e-commerce firms, viewed as complex digital business systems, adjusted their working capital policies during and after the COVID-19 shock. The sample is based on the 100 largest e-commerce companies worldwide by market capitalization, as reported by CompaniesMarketCap (February 2026), and is reduced to 76 firms from 23 countries due to data availability, yielding 802 firm-year observations. Firm-level data are obtained from LSEG Datastream, while macroeconomic variables are sourced from the World Bank. The analysis distinguishes between two dimensions of working capital: flow-based operational adjustment, measured by the cash conversion cycle (CCC), and stock-based balance-sheet adjustment, captured by net working capital relative to total assets (WC/TA). Fixed-effects models with firm-clustered standard errors are employed. The results indicate a substantial contraction of the CCC during the pandemic, followed by partial persistence of that contraction rather than a return to pre-pandemic norms. In contrast, WC/TA remains broadly stable during the crisis but declines in the post-pandemic period, suggesting a delayed balance-sheet adjustment. Business-model heterogeneity is not statistically significant, which may reflect a common system-level response across e-commerce firm types. Leverage and supply-chain pressures are associated with working capital intensity (WC/TA), while inflation shapes operate cycle duration (CCC). The findings are consistent with a two-stage adaptive response to systemic disruption. Full article

This study utilized the age-stage, two-sex life table method to evaluate the toxic effects of polyethylene microplastics (PE, 300 mg/kg) and cadmium (Cd, 30 mg/kg), both individually and combined, on Leptinotarsa decemlineata. Compared to controls, all treatments significantly prolonged larval development and reduced survival, lifespan, and fecundity. The combined exposure (PE + Cd) exerted the strongest inhibition: the total pre-adult developmental duration (TPOP) increased by 18.8% (38.00 days), while the intrinsic growth rate ($r$) dropped by 59.0% to 0.0273 d⁻¹. Additionally, the net reproduction rate ($R_0$) and fecundity fell to their lowest levels (5.08 and 19.06, respectively), significantly lower than in single-treatment groups. Age-stage life expectancy analysis confirmed severe survival pressure in the combined group, evidenced by a 30% reduction in first-instar survival and a 14-day shortened adult lifespan. These findings demonstrate the synergistic toxicity of PE and Cd co-contamination, providing critical data for ecological risk assessment in the “soil–plant–herbivore” system and integrated pest management strategies. Full article

Background: Catheter-associated urinary tract infection (CAUTI) remains a major healthcare-associated infection, particularly in intensive care units (ICUs). Nurse-driven urinary catheter removal protocols can reduce catheter duration and improve patient safety; however, their implementation remains inconsistent. This study explored barriers and facilitators influencing the implementation of nurse-driven CAUTI prevention protocols in Saudi ICUs. Methods: A qualitative study guided by the Consolidated Framework for Implementation Research was conducted in two tertiary hospitals in Riyadh, Saudi Arabia. A purposive sample of 23 ICU nurses, infection control nurses, and nurse managers participated in semi-structured interviews. Data were analyzed using Braun and Clarke’s thematic analysis approach, supported by NVivo. Results: Two overarching themes emerged. Facilitators included interprofessional communication and shared decision-making, clinical experience, and professional commitment. Barriers included workload and staffing pressures, physician dominance and nurse hesitation, knowledge deficits and poor adherence to guidelines, inconsistent documentation, and reduced awareness of catheter presence. Implementation was influenced by interconnected individual, organizational, and cognitive factors. Conclusions: Implementation of nurse-driven CAUTI prevention protocols is shaped by both enabling and limiting factors. Strengthening interprofessional collaboration, supporting nurse autonomy, improving documentation, and providing ongoing education may enhance protocol uptake and sustainability, ultimately improving patient safety. Full article

Sleep and dietary behavior are deeply conserved biological processes that co-evolved under ecological pressures shaping human anatomy, metabolism, immunity, cognition, and life history strategies. Major transitions in human dietary ecology, including plant-dominant hominin foraging, increased meat consumption, control of fire and cooking, agricultural domestication, industrialization, and postindustrial globalization, restructured nutrient intake, pathogen exposure, microbial ecology, metabolic demands, and temporal organization of behavior. Emerging evidence from evolutionary genomics, chronobiology, neuroendocrinology, and microbiome science indicates that sleep–feeding interactions represent a conserved adaptive regulatory module optimized for fluctuating energy availability and strong photoperiodic entrainment. Modern environments characterized by widespread availability of highly palatable, energy-dense foods rich in refined carbohydrates, added sugars, and multiple industrial additives, together with artificial light at night, continuous caloric access, sedentary behavior, and psychosocial stress produce a profound evolutionary mismatch destabilizing circadian–metabolic homeostasis. This mismatch is characterized by circadian disruption, temporal misalignment of feeding and sleep behaviors, and, in many populations, insufficient sleep duration. Within this conceptual landscape, the emerging framework of “evolutionary chrononutrition” proposes that metabolic health and sleep integrity depend not only on what humans eat, but critically on when food is consumed in relation to endogenous circadian architecture shaped across deep evolutionary time. This review synthesizes anthropological, physiological, and molecular evidence to develop an integrative evolutionary framework linking sleep and diet to contemporary cardiometabolic, neurodegenerative, inflammatory, and psychiatric disorders, with particular emphasis on how each major dietary transition plausibly altered sleep duration, architecture, circadian timing, neuroendocrine regulation, and the temporal alignment between feeding behavior and biological rhythms. Full article

Background and Objectives: Postoperative pulmonary complications (PPCs) remain an important cause of morbidity after cardiac surgery. Driving pressure (DP), defined as the difference between plateau pressure and positive end-expiratory pressure, has been proposed as a bedside marker of respiratory system mechanics during lung-protective ventilation. However, its relationship with PPCs in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) remains uncertain. This study aimed to evaluate the association between intraoperative DP and PPCs following CPB-supported cardiac surgery. Materials and Methods: This single-center prospective observational study included 99 adult patients undergoing elective cardiac surgery with CPB. All patients were ventilated using a standardized lung-protective strategy with a tidal volume of 6 mL/kg predicted body weight and a fixed PEEP of 5 cmH₂O. Patients were categorized according to intraoperative DP as Group I (DP < 13 cmH₂O, n = 66) and Group II (DP ≥ 13 cmH₂O, n = 33). The primary outcome was a composite PPC endpoint, defined as the occurrence of at least one EPCO-defined pulmonary complication during the postoperative hospital stay. Multivariable logistic regression was performed to assess whether pre-CPB DP was independently associated with PPCs after adjustment for body mass index, CPB time, and age. Results: Patients with DP ≥13 cmH₂O had higher post-CPB and ICU-admission lactate concentrations. Pneumothorax, pleural effusion, atelectasis, CPAP requirement, and prolonged mechanical ventilation were more frequent in the elevated-DP group. Mechanical ventilation duration, ICU stay, and hospital stay were also longer in this group. Composite PPCs occurred in 41 patients (41.4%). Although higher pre-CPB DP showed a non-significant trend toward increased PPC risk in univariable analysis (OR 1.121, 95% CI 0.988–1.273; p = 0.077), it was not independently associated with the composite PPC endpoint after adjustment (adjusted OR 1.091, 95% CI 0.952–1.251; p = 0.212). In contrast, higher pre-CPB DP was significantly associated with prolonged postoperative ventilation and longer mechanical ventilation, ICU, and hospital stay durations. Conclusions: Elevated intraoperative DP was associated with a higher unadjusted burden of PPCs and delayed postoperative recovery after CPB-supported cardiac surgery. However, pre-CPB DP was not an independent predictor of the composite PPC endpoint after adjustment for relevant confounders. These findings suggest that DP may serve as a clinically useful marker of impaired respiratory mechanics and postoperative vulnerability rather than as an independent causal determinant of PPCs. Full article