Search Results (6,398)

Computational Thinking (CT) has been an important concept for the computer science education community in the last 20 years. In this work we performed a systematic review of the literature regarding the computational thinking of children from kindergarten to primary school. We compiled a large dataset of one hundred and twenty (120) studies from the literature. Through analysis of these studies, we tried to reveal important insights and draw interesting and valid conclusions. We analyzed various qualitative and quantitative aspects of the studies, including the sample size, the year of publication, the country of origin, the studies’ design and duration, the computational tools used, and so on. An important aspect of the work is to highlight differences between different study designs. We identified a total of 120 studies, with more than half of them (>50%) originating from Asian countries. Most studies (82.5%) conducted some form of intervention, aiming to improve their computational thinking in students. A smaller proportion (17.5%) were assessment studies in which the authors conducted assessments regarding the children’s computational thinking. On average, intervention studies had a smaller number of participants, but differences in duration could not be identified. There was also a lack of large-scale longitudinal studies. Block-based coding (i.e., Scratch) and Plugged and Unplugged activities were observed in high numbers in both categories of studies. CT assessment tools showed great variability. Efforts for standardization and reaching a consensus are needed in this regard. Finally, robotic systems have been found to play a major role in interventions over the last years. Full article

Glioblastoma (GBM) is the most aggressive primary brain tumor, characterized by rapid progression, profound heterogeneity, and resistance to conventional therapies. This review provides an integrated overview of GBM’s pathophysiology, highlighting key mechanisms such as neuroinflammation, genetic alterations (e.g., EGFR, PDGFRA), the tumor microenvironment, microbiome interactions, and molecular dysregulations involving gangliosides and sphingolipids. Current diagnostic strategies, including imaging, histopathology, immunohistochemistry, and emerging liquid biopsy techniques, are explored for their role in improving early detection and monitoring. Treatment remains challenging, with standard therapies—surgery, radiotherapy, and temozolomide—offering limited survival benefits. Innovative therapies are increasingly being explored and implemented, including immune checkpoint inhibitors, CAR-T cell therapy, dendritic and peptide vaccines, and oncolytic virotherapy. Advances in nanotechnology and personalized medicine, such as individualized multimodal immunotherapy and NanoTherm therapy, are also discussed as strategies to overcome the blood–brain barrier and tumor heterogeneity. Additionally, stem cell-based approaches show promise in targeted drug delivery and immune modulation. Non-conventional strategies such as ketogenic diets and palliative care are also evaluated for their adjunctive potential. While novel therapies hold promise, GBM’s complexity demands continued interdisciplinary research to improve prognosis, treatment response, and patient quality of life. This review underscores the urgent need for personalized, multimodal strategies in combating this devastating malignancy. Full article

Background and Objectives: Total hip arthroplasty (THA) following pelvic osteotomy for developmental dysplasia of the hip (DDH) is technically challenging due to altered acetabular morphology. This study aimed to compare radiographic cup position and perioperative characteristics of THA after three common pelvic osteotomies—periacetabular osteotomy (PAO), shelf procedure, and Chiari osteotomy—with primary THA in Crowe type I DDH. Methods: A retrospective review identified 25 hips that underwent conversion THA after pelvic osteotomy (PAO = 12, shelf = 8, Chiari = 5) and 25 primary THAs without prior osteotomy. One-to-one matching was performed based on sex (exact match), age (within 5 years), and BMI (within 2 kg/m²) without the use of propensity scores. Cup inclination, radiographic anteversion, center-edge (CE) angle, and cup height were measured on standardized anteroposterior radiographs (ICC = 0.91). Operative time, estimated blood loss, and use of bulk bone grafts or reinforcement rings were reviewed. One-way ANOVA with Dunnett’s post hoc test and chi-square test were used for statistical comparison. Results: Cup inclination, anteversion, and CE angle did not differ significantly among groups. Cup height was significantly greater in the PAO group than in controls (29.0 mm vs. 21.8 mm; p = 0.0075), indicating a more proximal hip center. The Chiari and shelf groups showed upward trends, though not significant. Mean operative time tended to be longer after PAO (123 min vs. 93 min; p = 0.078). Bulk bone grafts and reinforcement rings were more frequently required in the PAO group (17%; p = 0.036 vs. control), and occasionally in Chiari cases, but not in shelf or control groups. Conclusions: THA after PAO is associated with higher cup placement and greater need for reconstructive devices, indicating increased technical complexity. In contrast, shelf and Chiari conversions more closely resemble primary THA. Preoperative planning should consider hip center translation and bone-stock restoration in post-osteotomy THA. Full article

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder encountered in clinical settings and is highly responsive to evidence-based diagnostic and therapeutic interventions. However, variations in practice patterns among physician specialties can compromise timely diagnosis and effective treatment. Understanding these variations is essential for improving clinical outcomes and standardizing care. This study aimed to assess the diagnostic and treatment practices for BPPV among Ear, Nose, and Throat (ENT) specialists, neurologists, general practitioners, and family physicians in Saudi Arabia and to examine how these practices are influenced by clinical experience and patient case exposure. Methods: A cross-sectional, questionnaire-based study was conducted between April 2023 and March 2024 at King Khalid University, Abha, Saudi Arabia. A total of 413 physicians were recruited using purposive sampling. Data were analyzed using IBM SPSS version 24.0. Parametric tests, including one-way ANOVA and chi-square tests, were used to assess differences across groups. A p-value of <0.05 was considered statistically significant. Results: Overall, all physician groups exhibited limited adherence to guideline-recommended positional diagnostic and therapeutic maneuvers. However, ENT specialists and neurologists demonstrated relatively higher compliance, particularly in performing the Dix–Hallpike test, with 46.97% and 26.79% reporting “always” using the maneuver, respectively (p < 0.001, Cramér’s V = 0.22). Neurologists were the most consistent in conducting oculomotor examinations, with 73.68% reporting routine performance (p < 0.001, Cramér’s V = 0.35). Epley maneuver usage was highest among neurologists (86.36%) and ENT specialists (77.14%) compared to family physicians (50.60%) and GPs (67.50%) (p = 0.044). Physicians with 11–15 years of experience and >50 BPPV case exposures consistently showed a greater use of diagnostic maneuvers, repositioning techniques, and guideline-concordant medication use (betahistine 76.67%; p < 0.001). Continuing medical education (CME) participation and the avoidance of unnecessary imaging were also highest in this group (46.67% and 3.33%, respectively; p < 0.001). Conclusions: Significant inter-specialty differences exist in the management of BPPV in Saudi Arabia. Greater clinical experience and higher case exposure are associated with improved adherence to evidence-based practices. Targeted educational interventions are needed, particularly in primary care, to enhance guideline implementation. Full article

Background/Objectives: Nitrogen (N) is an essential macronutrient that strongly influences maize growth and metabolism. While many studies have focused on nitrogen responses during later developmental stages, early-stage physiological and metabolic responses remain less explored. This study investigated the effect of different nitrogen-deficient levels on maize seedling growth and primary metabolite profiles. Methods: Seedlings were treated with N-modified nutrient solution, which contained 0% to 120% of the standard nitrogen level (8.5 mM). Results: Nitrogen starvation (N0) significantly reduced plant height (by 11–14%), shoot fresh weight (over 30%) compared to the optimal N supply (N100). Total leaf nitrogen content under N0–N20 was less than half of that in N100, whereas moderate N deficiency resulted in moderate reductions in growth and nitrogen content. Metabolite analysis revealed that N deficiency induced the accumulation of soluble sugars and organic acids (up to threefold), while sufficient N promoted the synthesis of amino acids related to nitrogen assimilation and protein biosynthesis. Statistical analyses (PCA and ANOVA) showed that both genotypes (MB and TYC) and tissue type (upper vs. lower leaves) influenced the metabolic response to nitrogen, with MB displaying more consistent shifts and TYC exhibiting greater variability under moderate stress. Conclusions: These findings highlight the sensitivity of maize seedlings to early nitrogen deficiency, with severity influenced by nitrogen level, tissue-specific position, and genotype; thus underscore the close coordination between physiological growth and primary metabolic pathways in response to nitrogen availability. These findings expand current knowledge of nitrogen response mechanisms and offer practical insights for improving nitrogen use efficiency in maize cultivation. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article

Fibromyalgia is a complex disorder characterized by chronic widespread pain and a variety of related symptoms. Growing evidence suggests that the central and peripheral nervous systems are involved, with small fiber neuropathy playing a key role in its development. We retrospectively reviewed the medical records of 100 patients diagnosed with primary fibromyalgia. Those showing symptoms indicative of small fiber dysfunction who were treated with L-Acetyl Carnitine (LAC) and Palmitoylethanolamide (PEA) alongside standard care (SOC) were compared to matched controls who received only SOC. To ensure comparable groups, propensity score matching was used. Changes in Fibromyalgia Impact Questionnaire Revised (FIQR) scores over 12 weeks were analyzed using non-parametric tests due to the data’s non-normal distribution. After matching, 86 patients (43 in each group) were included. The group receiving LAC and PEA as add-on therapy experienced a significant median reduction in FIQR scores (−19.0 points, p < 0.001), while the SOC-only group showed no significant change. Comparisons between groups confirmed that the improvement was significantly greater in the LAC+PEA group (p < 0.001). These results suggest that adding LAC and PEA to standard care may provide meaningful symptom relief for fibromyalgia patients with suspected small fiber involvement. This supports the hypothesis that peripheral nervous system dysfunction contributes to the disease burden in this subgroup. However, further prospective controlled studies are needed to confirm these promising findings. Full article

Emerging markets face growing pressures to integrate sustainable English business practices while maintaining economic growth, particularly in addressing environmental challenges and achieving carbon neutrality goals. English Financial information extraction becomes crucial for supporting green finance initiatives, Environmental, Social, and Governance (ESG) compliance, and sustainable investment decisions in these markets. This paper presents FinATG, an AI-driven autoregressive framework for extracting sustainability-related English financial information from English texts, specifically designed to support emerging markets in their transition toward sustainable development. The framework addresses the complex challenges of processing ESG reports, green bond disclosures, carbon footprint assessments, and sustainable investment documentation prevalent in emerging economies. FinATG introduces a domain-adaptive span representation method fine-tuned on sustainability-focused English financial corpora, implements constrained decoding mechanisms based on green finance regulations, and integrates FinBERT with autoregressive generation for end-to-end extraction of environmental and governance information. While achieving competitive performance on standard benchmarks, FinATG’s primary contribution lies in its architecture, which prioritizes correctness and compliance for the high-stakes financial domain. Experimental validation demonstrates FinATG’s effectiveness with entity F1 scores of 88.5 and REL F1 scores of 80.2 on standard English datasets, while achieving superior performance (85.7–86.0 entity F1, 73.1–74.0 REL+ F1) on sustainability-focused financial datasets. The framework particularly excels in extracting carbon emission data, green investment relationships, and ESG compliance indicators, achieving average AUC and RGR scores of 0.93 and 0.89 respectively. By automating the extraction of sustainability metrics from complex English financial documents, FinATG supports emerging markets in meeting international ESG standards, facilitating green finance flows, and enhancing transparency in sustainable business practices, ultimately contributing to their sustainable development goals and climate action commitments. Full article

(1) Background: Comparison of clinical outcomes between patients with moderate-severe aortic valve stenosis and those with mild or no aortic valve stenosis undergoing surgical revascularization for critical limb threating ischemia (CLTI). (2) Methods: Single center retrospective analysis of consecutive patients undergoing surgical lower limb revascularization with femoro-distal bypass for critical ischemia between 2016 and 2022. All patients were evaluated preoperatively by echocardiographic examination and divided into two cohorts: group A with moderate-severe aortic valve stenosis (AVA-cm² < or =1.5 cm²) and group B with mild or absent stenosis (AVA-cm² > 1.5 cm²). Primary outcomes were major limb amputation and mortality between the two groups. The rate of major cardiovascular events (stroke, myocardial infarction, sudden cardiac death) and change in “preoperative functional status” were the secondary outcomes. Descriptive statistics for continuous variables were performed by calculating means, standard deviation (SD) medians, and interquartile range (IQR) while, for categorical variables, frequencies and percentages were performed. Intergroup comparison tests, for continuous variables, were performed by t-test or corresponding nonparametric tests (Mann-Whitney test) while, for categorical variables, Chi-square test was used. Evaluation of cut-offs for the variable AVA-fx-cm², in terms of predictive of outcome outcomes, was calculated by ROC curves. Comparison between clinical and outcome variables was performed using logistic regression models. A total of 316 patients were analyzed and divided in two groups: 50 (16%) patients with moderate or severe aortic valve stenosis (group A) and 266 (84%) with no or mild aortic valve stenosis (AVA > 1.5 cm²). Patients in group A were significantly older than those in group B (78 years vs. 74 years, p value = 0.005); no other significant comorbidity differences were found between the two groups. The mean follow-up was 1178 days (SD 991 days; 2–3869 days). There were no statistically significant differences between group A and group B in terms of major amputation rate (20% vs. 16.5%; p = 0.895) and overall mortality (48.0% vs. 40.6%; p = 0.640). In the total cohort, the statistically significant variables associated with the major amputation were systemic perioperative complication (OR 5.83, 95% CI: 2.36, 14.57, p < 0.001), bypass-related complication within 30 days of surgery (OR 2.74, 95% CI: 1.17, 6.45, p = 0.020), surgical revascularization below the knee (OR 7.72, 95% CI: 1.53, 140.68, p = 0.049), and the presence of a previous cardiovascular event (OR 2.65, 95% CI: 1.14, 6.26, p = 0.024). In patients undergoing surgical revascularization for CLTI, no significant difference in major amputation rate and overall mortality was found between subjects with mild or no aortic valve stenosis and those with moderate/severe stenosis. As expected, overall mortality was higher in older patients with worse functional status. A significantly higher rate of limb amputation was found in those subjects undergoing subgenicular revascularization, early bypass failure, or previous cardiovascular event. Full article

Background: Intravenous vancomycin remains a key agent in the treatment of complex orthopedic infections, particularly those involving methicillin-resistant Staphylococcus aureus (MRSA). However, its use is associated with significant risks, most notably nephrotoxicity. Despite guideline recommendations, standardized dosing and monitoring protocols are often absent in orthopedic settings, leading to inconsistent therapeutic drug exposure and preventable adverse events. This study evaluated the clinical impact of implementing a structured standard operating procedure (SOP) for intravenous vancomycin therapy in orthopedic inpatients. Methods: We conducted a single-center, pre-post cohort study at a university orthopedic department. The intervention consisted of a standard operating procedure (SOP) for intravenous vancomycin therapy, which mandated weight-based loading doses, renal function-adjusted maintenance dosing, trough level monitoring, and defined dose adjustments. Patients treated before SOP implementation (n = 58) formed the control group; those treated under the SOP (n = 56) were prospectively included. The primary outcome was the incidence of vancomycin-associated acute kidney injury (VA-AKI) defined by KDIGO Stage 1 criteria. Secondary outcomes included therapeutic trough level attainment and infusion-related or ototoxic adverse events. Results: All patients in the post-SOP group received a loading dose (100% vs. 31% pre-SOP, p < 0.001). The range of measured vancomycin trough levels narrowed substantially after SOP implementation (7.1–36.2 mg/L vs. 4.0–80.0 mg/L). The proportion of patients reaching therapeutic trough levels increased, although this was not statistically significant. Most notably, VA-AKI occurred in 17.2% of patients in the control group, but in none of the patients after SOP implementation (0%, p = 0.0013). No cases of ototoxicity were observed in either group. Infusion-related reactions decreased after the implementation of the SOP, though not significantly. Conclusions: The introduction of a structured vancomycin protocol significantly reduced adverse drug events and improved dosing control in orthopedic inpatients. Incorporating such protocols into routine practice represents a feasible and effective strategy to strengthen antibiotic stewardship and clinical quality in surgical disciplines. Full article

Atmospheric corrosion significantly impacts infrastructure worldwide, with traditional assessment methods being time-intensive and costly. This study developed a comprehensive machine learning framework for predicting atmospheric corrosion rates using environmental and material parameters. Three regression models (Linear Regression, Random Forest, and Gradient Boosting) were trained on a scientifically informed synthetic dataset incorporating established corrosion principles from ISO 9223 standards and peer-reviewed literature. The Gradient Boosting model achieved superior performance with cross-validated R² = 0.835 ± 0.024 and RMSE = 98.99 ± 16.62 μm/year, significantly outperforming the Random Forest (p < 0.001) and Linear Regression approaches. Feature importance analysis revealed the copper content (30%), exposure time (20%), and chloride deposition (15%) as primary predictors, consistent with the established principles of corrosion science. Model diagnostics demonstrated excellent predictive accuracy (R² = 0.863) with normally distributed residuals and homoscedastic variance patterns. This methodology provides a systematic framework for ML-based corrosion prediction, with significant implications for protective coating design, material selection, and infrastructure risk assessment, pending comprehensive experimental validation. Full article

Background: Effective triage of women testing positive for high-risk HPV DNA is essential to reduce unnecessary colposcopies while preserving cancer prevention. Cytology, the current standard, has limited specificity and reproducibility. The genotype-specific 7-type HPV E6/E7 mRNA test (PreTect HPV-Proofer’7), targeting HPV types 16, 18, 31, 33, 45, 52, and 58, detects transcriptionally active infections and may enhance risk stratification. Methods: Between 2019 and 2023, 34,721 women aged 25–69 underwent primary HPV DNA screening with the Cobas 4800 assay at the University Hospital of North Norway, within the national screening program. Of these, 1896 HPV DNA-positive women were triaged with liquid-based cytology with atypical squamous cells of undetermined significance or worse (≥ASC-US) and the 7-type HPV mRNA test. Histological outcomes were followed through October 2024. Diagnostic performance for CIN2+ was evaluated overall and by genotype. Results: CIN2+ prevalence was 13.3%. The mRNA test reduced test positivity from 50.3% to 33.4% while maintaining comparable sensitivity (70.6% vs. 72.2%) and improving specificity (72.3% vs. 53.0%) and PPV (28.1% vs. 19.1%). Genotype-specific PPVs were highest for HPV16 mRNA (47.7%), followed by HPV33 (39.2%) and HPV31 (32.2%), all exceeding corresponding DNA-based estimates. Conclusion: Genotype-specific HPV mRNA triage offers superior risk discrimination compared to cytology, supporting more targeted, efficient, and accessible cervical cancer screening. Full article

Today’s primary challenges include identifying efficient, affordable, and environmentally sustainable substances to serve as raw materials in industrial, agricultural, and medicinal applications. This study aimed to evaluate the chemical composition and biological properties (namely antioxidant and allelopathic activities) of the methanolic extract derived from the above-ground portions of Artemisia judaica collected in Jazan, Saudi Arabia. GC-MS was used to evaluate the chemical composition of the methanolic extract derived from Artemisia judaica. GC-MS analysis revealed a total of 22 volatile compounds in the extract. The most prominent compounds identified were 2-ethylhexanoic acid, 5-hydroxy-6-(1-hydroxyethyl)-2,7-dimethoxynaphtho-quinone, and piperitone. The extract demonstrated strong antioxidant activity in both the DPPH and ABTS radical scavenging assays, comparable to the standard antioxidant ascorbic acid. The IC₅₀ value for the extract was 31.82 mg/mL in the DPPH assay and 39.93 mg/mL in the ABTS testing. Additionally, the extract exhibited dose-dependent inhibition of seed germination, root growth, and shoot growth of the weed Chenopodium murale in allelopathic bioassays. The most significant suppression was observed in shoot growth with an IC₅₀ value of 45.90 mg/mL, which was lower than the IC₅₀ values for root development and seed germination of C. murale, recorded at 56.16 mg/mL and 88.80 mg/mL, respectively. Furthermore, the findings indicated that methanolic extracts had significant lethal toxic effects on the life cycle of Aedes aegypti. Future research will focus on extracting uncontaminated substances and evaluating the biological effects of each specific constituent. Full article

Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. Methods: Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. Results: Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, p < 0.05) and reduced PN duration (60.3 vs. 95 days, p < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, p < 0.05; 122 vs. 200 days, p < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071–0.319, p < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). Conclusions: Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy. Full article

Background: Androgen deprivation therapy (ADT) is a primary treatment for prostate cancer (PCa) that effectively reduces androgen levels to suppress tumor progression. However, growing evidence suggests potential cognitive side effects, raising concerns about the long-term neurological consequences of this treatment. Objective: This scoping review aims to synthesize the existing evidence linking ADT to cognitive changes in men with PCa, identifying the key cognitive domains affected and outlining gaps in the existing literature. Methods: A systematic literature search was conducted according to the PRISMA-ScR guidelines in CINAHL, PubMed, Scopus, and Web of Science. Studies investigating cognitive function in ADT-treated PCa patients were included, covering randomized controlled trials (RCTs) and cohort, case–control, and cross-sectional studies. The extracted data included the study design, evaluated cognitive characteristics, measurement tools, and overall findings. Results: A total of 22 studies met the inclusion and exclusion criteria. Cognitive assessments varied across studies. While some studies reported cognitive impairments in ADT-treated patients—particularly in working, verbal, and visual memory and executive function—others found no significant effects. The variability in prostate cancer staging, epidemiological study designs, and treatment regimens; the exclusion of comorbid conditions; and the differences in assessment tools, sample sizes, and study durations hinder definitive conclusions about the cognitive effects of ADT. Conclusions: This scoping review highlights the heterogeneous and often contradictory evidence regarding ADT-associated cognitive dysfunction. While certain cognitive domains may be affected, methodological inconsistencies limit robust conclusions. Standardized cognitive assessments and longer longitudinal studies are required to clarify ADT’s role in cognitive decline. As the PCa survival rate increases with extended ADT use, integrating routine cognitive monitoring into clinical practice should be considered for PCa patients. Full article