Search Results (3,423)

Background: The hemoglobin-to-red-cell distribution width ratio has emerged as a novel prognostic marker in various clinical settings. However, its association with total bone mineral density in adolescents remains inadequately explored. Methods: This cross-sectional study was based on data from the 2011–2018 National Health and Nutrition Examination Survey, including adolescents aged 12–19 years with complete data on hemoglobin, red cell distribution width, and total bone mineral density. Weighted multivariable linear regression models and generalized additive models were used to evaluate the association between hemoglobin-to-red-cell distribution width and total bone mineral density. A two-piecewise linear regression model was applied to assess potential threshold effects, with log-likelihood ratio tests used to determine the significance of inflection points. Subgroup and interaction analyses were further conducted to examine whether age, sex, race, and milk product consumption modified this association. Results: A total of 3789 adolescents were included. Participants in the highest hemoglobin-to-red-blood-cell distribution width ratio quartile had significantly higher hemoglobin levels, lower red blood cell distribution width, greater total bone mineral density, higher total calcium and blood urea nitrogen levels, and lower body mass index, high-density lipoprotein cholesterol, and serum 25OHD levels compared to lower quartiles. The hemoglobin-to-red-blood-cell distribution width ratio was positively associated with total bone mineral density (fully adjusted β = 0.078, 95% CI: 0.053, 0.104, p < 0.0001). A two-piecewise linear regression model identified an inflection point at the hemoglobin-to-red-cell distribution width ratio = 1.055; the positive association became stronger above this threshold (β = 0.143 vs. β = 0.039 below the threshold, p = 0.003 for nonlinearity). Subgroup analysis revealed significant gender interactions (p < 0.0001). A higher HRR was significantly associated with greater total BMD in males (β = 0.130, 95% CI: 0.089–0.171, p < 0.0001), whereas no significant association was observed in females (β = −0.009, 95% CI: −0.043–0.025, p = 0.604). Positive associations were also observed among participants aged 12–15 years, non-Hispanic Whites, non-Hispanic Blacks, other Hispanics, Mexican Americans, and frequent milk consumers. Conclusions: Our results indicate that the hemoglobin-to-red-cell distribution width ratio shows a potential association with bone mineral density in male adolescents, which may offer supportive value for bone health assessment but requires further validation. Full article

Within the context of global climate change and China’s commitment to the “Dual Carbon” goals (carbon peak and carbon neutrality), this study proposes a novel taxonomy of market-based environmental regulations, dividing them into investment-driven and tax-based supervisory mechanisms. Using panel data from 30 Chinese provinces between 2010 and 2023, we empirically investigate their differential effects on carbon emissions. Results indicate that both regulatory approaches significantly curb carbon emissions, each exhibiting distinct nonlinear patterns: an inverted-U curve for investment-oriented measures and a U-shaped trajectory for tax-oriented policies, implying that excessively stringent tax supervision may lead to a rebound in emissions due to effects such as the “resource curse” and “innovation crowding-out.” Industrial structure transformation functions as a common mediating channel, while green innovation efficiency exerts a distinct moderating influence. Both policy types demonstrate adverse spatial spillover effects, with no support found for the “pollution haven” or “race to the bottom” hypotheses. This study offers new empirical insights into how environmental regulations facilitate green and low-carbon transition through market mechanisms, providing valuable implications for designing ecological policy systems that harmonize emission reduction efficiency with sustainability in China and other emerging economies. Full article

Background/Objective: This study examined whether a brief measure combining subjective cognitive concerns and financial interference, termed Subjective Cognitive Decline-Financial (SCD-F), is associated with excess spending behavior in older adults. Methods: Community-dwelling older adults, some with early memory loss and some with no cognitive complaints (N = 150, M age = 72.6), provided 12 months of checking account statements and participated in interviews to clarify aspects of their personal financial behaviors. SCD-F was defined by asking if memory decline was interfering with financial decision-making or transactions. A 3-point SCD-F measure was created. Excess spending was determined by checking whether account expenditures exceeded all sources of income. Nonparametric tests (Kruskal–Wallis and Mann–Whitney U) and multiple regression models assessed group differences and predictors. Results: Group differences in excess spending were pronounced (H(2) = 15.75, p < 0.001). Those in the high SCD-F group had a significantly greater likelihood of excess spending (Z = −4.11; r = 0.43) and higher excess spending percentages (Z = −4.11; r = 0.43) compared to those with no memory loss. Regression analyses indicated that SCD-F was the strongest predictor of excessive spending (β = 0.40, t = 5.43, p < 0.001), even after controlling for age, gender, race, and education (R² = 0.235, F(5,144) = 8.86, p < 0.001). Conclusions: A brief self-report measure, SCD-F, effectively identifies older adults at risk of financial mismanagement, even absent formal cognitive impairment. Monitoring subjective cognitive concerns together with financial interference could enable early intervention. This brief measure may be useful in clinical settings as a screening tool, and in large national surveys. Full article

Background/Objectives: Solitary plasmacytoma of bone (SPB) results from abnormal proliferation of plasma cells and accounts for 2–5% of all plasmacytic malignancies. Radiation therapy is the standard of care in treating SPB due to its efficacy in controlling disease progression and optimizing patient survival. However, prior studies have highlighted disparities in radiation therapy receipt among various cancer types. In this study, we aim to investigate whether similar sociodemographic and clinical disparities exist in the treatment of SPB through use of the Surveillance, Epidemiology, and End Results (SEER) database. Methods: The SEER database was queried for biopsy-confirmed cases of SPB between 2000 and 2021 using the ICD-O-3 histology code 9731/3 and primary site codes C40.0–41.9. Chi-square tests, Fisher’s exact tests, and multivariable logistic regression were completed using SPSS v29.0.2, with significance set to p < 0.05. Results: A total of 4139 patients were identified, of which 75.3% received treatment with radiation therapy. Multivariable analysis revealed that low-income patients making less than $74,999 annually (aOR 0.80, 95% CI 0.67–0.97), as well as those from non-Hispanic Asian/Pacific Islander (aOR 0.49, 95% CI 0.33–0.73) and Hispanic (aOR 0.77, 95% CI 0.60–0.98) racial and ethnic groups, were significantly less likely to receive radiation therapy. Conclusions: These findings reveal notable disparities in radiation therapy utilization for SPB patients based on income and race and ethnicity, emphasizing the need for interventions to address systemic inequities, improve access to care, and ensure that all patients receive high-quality cancer care to optimize long-term outcomes. Full article

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping. Full article

Blood pressure variability (BPV) is linked to cardiovascular disease (CVD) and systemic inflammation in adults, but its relevance in young, healthy populations remains unclear. This study examined the association between short-term BPV and inflammatory markers in 447 normotensive participants (mean age, 22.9 years) from the Georgia Stress and Heart (GSH) study, a cohort of Non-Hispanic Black and White individuals. Participants underwent 24 h ambulatory blood pressure monitoring and assessment of serum inflammatory markers, including hs-CRP, IFN-γ, IL-6, and TNF-α. BPV was quantified using average real variability (ARV), and generalized estimating equations (GEEs) were used to evaluate associations, adjusting for age, sex, race, and mean blood pressure. Diastolic BPV was significantly, positively associated with hs-CRP and TNF-α, whereas systolic BPV was not associated with any inflammatory marker. Specifically, 24 h diastolic BPV was positively associated with hs-CRP (p = 0.001) and TNF-α (p = 0.015), while daytime diastolic BPV was positively associated with hs-CRP (p = 0.002). Nighttime diastolic BPV was positively associated with both hs-CRP (p = 0.020) and TNF-α (p = 0.007). No significant associations were found between BPV and IL-6 or IFN-γ. These findings suggest diastolic BPV may be a marker of low-grade inflammation in healthy young adults and could represent an early cardiovascular risk factor that warrants longitudinal study. Full article

In plants, resistance genes (R) are key players in combatting diseases caused by various phytopathogens. Typically, resistance relies on detecting a single pathogen-derived molecular pattern. However, R-gene-mediated resistance is often race specific, follows the gene-for-gene hypothesis, and can be overcome in field conditions as pathogens evolve. On the contrary, altering plant susceptibility genes (S-genes) facilitates compatibility and results in broad and durable resistance. S-genes are negative regulators present in plants and exploited by pathogens to facilitate their growth and cause infection. Several studies across crop species have reported manipulation of S-genes using genome editing to confer broad spectrum resistance. This review focuses on the plant defense mechanism against biotic stress, R-genes vs. S-genes, different types/classes of S-genes, different tools for S-gene discovery, and the use of gene editing technologies to target S-genes in addition to their applications, challenges, and future perspectives. Full article

This study aimed to compare blood samples from Yili horses with outstanding and average performance in 5000 m races through transcriptome sequencing, identify key differentially expressed genes, lncRNAs, and circRNAs, as well as related enriched pathways, and elucidate their regulatory networks. This study used six healthy four-year-old Yili stallions as subjects, divided into an excellent group (E group, n = 3) and an ordinary group (O group, n = 3) based on their 5000-m race performance. Blood RNA-Seq technology was used to analyze differentially expressed mRNAs, lncRNAs, and circRNAs. A total of 2298 mRNAs, 264 lncRNAs, and 215 circRNAs were identified as differentially expressed. Key genes such as EGR1, FOSB, MRPL1, LOC100049811, SIRPB2, and CYTB regulate athletic performance. These genes and their associated RNAs synergistically participate in energy metabolism, protein homeostasis, and muscle remodeling processes, revealing the molecular mechanisms influencing athletic performance and providing important references for identifying candidate genes associated with equine athletic performance. Full article

Background/Objectives: The U.S. Centers for Disease Control and Prevention recommends some vaccinations using shared clinical decision-making (SCDM). SCDM recommendations are made when not every individual within a given age or risk group would benefit from vaccination, requiring collaborative discussions between patients and providers to assess risks and benefits. Pharmacists play a key role in implementing this recommendation and have frequent opportunities to engage with patients who may be eligible for SCDM-based vaccines. Because SCDM requires provider discussions to assess each patient’s eligibility for the vaccines under SCDM, trust may play a central role in the process. Trust has been suggested to affect patient’s participation in their care and their decision making preferences; however, the nature of this relationship in the context of SCDM vaccines and willingness to engage with pharmacists has yet to be investigated. As the CDC continues to expand the SCDM vaccine category, there is need to assess these. This study aimed to examine relationships between patient characteristics, trust in pharmacists, willingness to engage in SCDM, and vaccination decision control preference. Methods: Using quota sampling, cross-sectional data were collected from Alabama residents aged 18+ between February and March 2024 via a validated online questionnaire. Bivariate and multivariable logistic regression analyses were used to determine the association between trust, patient characteristics and willingness. Structural equation modeling was used to assess the direct and indirect relationships between trust, willingness and vaccination decision control preference. Statistical significance was set at p < 0.05. Results: A substantial portion (45.8%) of participants were unaware that certain vaccinations were based on SCDM. Multivariable logistic regression showed that race (Black vs. White, p = 0.001), age (25–34 vs. 18–24, p = 0.029), highest degree obtained (high school diploma or graduate equivalency degree vs. less than high school, p = 0.001; associate degree or vocational certificate vs. less than high school, p = 0.000; bachelor’s degree or higher vs. less than high school, p = 0.001), political affiliation (Democrat vs. Republican, p = 0.002), confidence in understanding health-related information (high vs. low, p =.029); moderate vs. low, p = 0.002), and patients’ trust in community pharmacists’ communication skills (p = 0.045) and benevolence (p = 0.001) towards their patients were significantly associated with patients’ willingness to engage in SCDM. Trust had a significant direct (p = 0.001) and indirect relationship (p = 0.000) with decision control preference through the willingness variable. Conclusions: Educational interventions are recommended to improve awareness and knowledge of SCDM vaccines among patients. Given their trusted role, pharmacists should actively build and maintain trust with patients, as this may help foster collaborative environments for discussion, encourage patient engagement in SCDM, and support more informed vaccination choices. Full article

Background/Objectives: Cesarean section (C-section) is a common surgical procedure associated with an increased risk of 30-day postpartum hospital readmissions. This study utilized machine learning (ML) to predict readmissions using a nationwide database. Methods: A retrospective analysis of the National Surgical Quality Improvement Project (2012–2022) included 54,593 patients who underwent C-sections. Random Forests (RF) and Extreme Gradient Boosting (XGBoost) models were developed and compared to logistic regression (LR) using demographic, preoperative, and perioperative data. Results: Of the cohort, 1306 (2.39%) patients were readmitted. Readmitted patients had higher rates of being of African American race (17.99% vs. 9.83%), diabetes (11.03% vs. 8.19%), and hypertension (11.49% vs. 4.68%) (p < 0.001). RF achieved the highest performance (AUC = 0.737, sensitivity = 72.03%, specificity: 61.33%), and a preoperative-only RF model achieved a sensitivity of 83.14%. Key predictors included age, BMI, operative time, white blood cell count, and hematocrit. Conclusions: ML effectively predicts C-section readmissions, supporting early identification and interventions to improve patient outcomes and reduce healthcare costs. Full article

This study evaluated emergency preparedness, covering knowledge, challenges, and culturally and linguistically appropriate resources among five resettled refugee communities in Central Ohio: Afghan, Bhutanese, Congolese, Ethiopian/Eritrean, and Somali. It also explored youth perceptions of community engagement and the effectiveness of current crisis support initiatives. A mixed-methods approach was used, consisting of a cross-sectional quantitative survey of 266 adults and a qualitative 60-min focus group discussion with 10 youth from the resettled communities. Quantitative data was analyzed with descriptive statistics and Chi-square tests assessing differences in preparedness across communities. Quantitative findings showed that the Bhutanese group reported the highest familiarity with preparedness concepts (33.3%), while Afghan and Congolese communities showed significant gaps. Of the 266 overall respondents, only 39.5% had an emergency plan, and 15.8% felt extremely confident in handling emergencies. Language barriers were major challenges, along with those related to race and ethnic identity, religious practices, and cultural norms. Effective platforms for engagement included community meetings, religious sites, and social media, with text messages and phone calls preferred for emergency communication. Youth discussion highlighted key public health concerns, particularly gun violence, substance abuse, and mental health crises, with stigma and limited resources further hindering preparedness efforts. Participants emphasized the need for culturally relevant interventions and stronger community engagement. Full article

Objectives: To systematically review and analyze electronic systems in competitive motorcycles (2020–2025), examining their technical specifications, performance impacts, and technological evolution across MotoGP, World Superbike (WSBK), MotoE, British Superbike (BSB), and Spanish Championship (ESBK) categories. Eligibility criteria: Included studies reporting technical specifications or performance data of electronic systems in professional motorcycle racing, published between January 2020 and December 2025 in English, Spanish, Italian, or Japanese. Excluded: opinion pieces, amateur racing, and studies without quantitative data. Information sources: IEEE Xplore, SAE Technical Papers, Web of Science, Scopus, and specialized motorsport databases were searched through 15 December 2025. Risk of bias: Modified Cochrane Risk of Bias tool for experimental studies and Newcastle-Ottawa Scale for observational studies. Synthesis of results: Synthesis of results: Random-effects meta-analysis using DerSimonian-Laird method for homogeneous outcomes; narrative synthesis for heterogeneous data. Included studies: 87 studies met inclusion criteria (52 experimental, 38 simulation, 23 technical descriptions, 14 comparative analyses). Electronic systems were categorized into six domains: Engine Control Units (ECU, 28 studies, 22%), Vehicle Dynamics (23 studies, 18%), Traction Control (19 studies, 15%), Data Acquisition (21 studies, 17%), Braking Systems (18 studies, 14%), and Emerging Technologies (18 studies, 14%). Note that studies could address multiple domains. Limitations of evidence: Proprietary restrictions limited access to 31% of technical details; 43% lacked cross-category comparisons. Interpretation: Electronic systems are primary performance differentiators, with computational power following Moore’s Law. Future developments point toward distributed architectures and 5G telemetry. Full article

This study proposes a novel framework to enhance inner race fault features in servo motor bearings by acquiring rotary encoder-derived instantaneous angular speed (IAS) signals, which are obtained from a servo motor encoder without requiring additional external sensors. However, such signals are often obscured by strong periodic interferences from motor pole-pair and shaft rotation order components. To address this issue, three key improvements are introduced within the cyclic blind deconvolution (CYCBD) framework: (1) a comb-notch filtering strategy based on rotation domain synchronous averaging (RDA) to suppress dominant periodic interferences; (2) an adaptive fault order estimation method using the autocorrelation of the squared envelope spectrum (SES) for robust localization of the true fault modulation order; and (3) an improved envelope harmonic product (IEHP), based on the geometric mean of harmonics, which optimizes the deconvolution filter length. These combined enhancements enable the proposed improved CYCBD (ICYCBD) method to accurately extract weak fault-induced cyclic impulses under complex interference conditions. Experimental validation on a test rig demonstrates the effectiveness of the approach in enhancing and extracting the fault-related features associated with the inner race defect. Full article

Stigmatized views of emotionality form within familial, cultural, and societal contexts and serve as a mechanism impacting youth mental health and substance misuse with notable ties to health equity. Yet critical questions remain regarding the impact of racial identity on emotionality stigma in urban groups and the moderating relationship between race and emotionality stigma on youth mental health and substance misuse. The current study aimed to investigate emotionality stigma as a mechanism of health inequity by exploring the relationships between racial identity, emotionality stigma, and adolescent mental health and substance misuse. Urban adolescents (n = 85) recruited from a combined mental health and substance use treatment program reported on their stigmatized views of emotionality, mental health, and substance use. Participants primarily identified as multicultural (60.3%) and socioeconomically disadvantaged, with 55.2% requiring transportation assistance and 63.8% being either insured through Medicaid or uninsured. Findings suggest a link between racial identity and emotionality stigma that was associated with attachment (β = −3.43, p < 0.001) as well as substance misuse type (β = 5.36, p < 0.001) and polysubstance use (β = −6.53, p < 0.001) for urban adolescents in combined treatment. This study is the first to provide empirical support for the interconnected role of sociocultural factors and emotionality stigma and calls for systems-level change to address emotionality stigma individually, communally, and socially. Full article

Background: Liver biopsy performed after less invasive workup, including imaging, for evaluation of abnormal liver function studies occasionally reveals large bile duct obstruction on histology without evidence of biliary obstruction on prior imaging. The utility of ERCP in this setting has not been studied in pediatrics. In the present study, we address this important clinical issue. Methods: A retrospective review of pediatric pathology and clinical records from 2010 to 2019 identified 123 pediatric patients with large duct obstruction on liver biopsy performed after imaging revealed no evidence of biliary obstruction. The absolute standardized difference (ASD) was used to compare baseline covariates between patients who underwent ERCP vs. all others. Covariates included age, gender, race, ethnicity, BMI, and labs (total bilirubin, GGT, alkaline phosphatase, AST, ALT, platelets, and INR). Results: Of 85 unique patients who met inclusion/exclusion criteria, 15 (17.6%) underwent ERCP. The majority of these patients who underwent ERCP (80%) had a therapeutic endoscopic intervention with a favorable impact on clinical trajectory. The mean age of patients with large duct obstruction was 7 years old. Most patients were white (47%), followed by Asian (17%). Only 25% of patients identified as Hispanic. The mean laboratory values were as follows: total bilirubin 4.61 mg/dL, GGT 353 U/L, alkaline phosphatase 403 U/L, AST 343 U/L, ALT 251 U/L, platelets 289 K/uL, and INR 1.19. Absolute standardized differences comparing baseline covariates between the ERCP and non-ERCP groups are included in Table 1. The largest absolute standardized difference between the two groups was for race (1.17), ethnicity (0.553), and GGT (0.463). Age, alkaline phosphatase, and INR were not significantly different between the two groups (ASD <0.2 for both). Conclusions: Only 17.6% of pediatric patients with large ducts undergo ERCP. Pediatric patients who underwent ERCP were more likely to be white, non-Hispanic, and have elevated GGT. Of interest, age did not differ significantly between the two groups, which may reflect enhanced uniformity of utilization of ERCP across age groups in pediatrics. Additional multi-center studies, including more patients and focused on understanding the utility of ERCP and the range of outcomes following the diagnosis of large duct obstruction in pediatrics, would be informative to guide pediatric hepatology and endoscopic practices. Full article