Search Results (255)

This cross-sectional study investigated the associations between the acute-phase proteins (APP) serum amyloid A (SAA) and haptoglobin (Hp), herd-level factors, and the seroprevalence of respiratory pathogens in Estonian dairy herds. Serum samples were analysed from 938 cows (95 herds) and 921 heifers (94 herds). Seroprevalence was tested for bovine herpesvirus 1 (BHV-1), bovine respiratory syncytial virus (BRSV), bovine parainfluenza virus 3, bovine viral diarrhoea virus, bovine coronavirus, bovine adenovirus, and Mycoplasma bovis (M. bovis). Farm visits included questionnaires on herd management practices. Linear random-intercept regression models showed higher serum SAA concentrations in cows from farms with BHV-1 seroprevalence of >50% and on BRSV-positive farms (p < 0.05), while farms employing a veterinarian had lower serum SAA concentrations. Cows had higher serum Hp concentrations in M. bovis-positive herds (p = 0.030). In heifers, serum SAA concentrations increased with low to moderate BHV-1 seroprevalence, decreased with higher M. bovis seroprevalence, and were higher in free-stall or mixed housing compared to tie-stall housing. Heifers’ serum Hp concentrations were lower in BHV-1-positive herds, but higher in herds with breeding bulls and larger herd sizes. To conclude, APP may reflect the herd health status and management-related effects on animals, supporting their use in herd-level monitoring. Full article

Transport affordability defined as the share of household income devoted to transport expenditure is a key dimension of urban equity and social inclusion, particularly in contexts characterised by spatial inequality and income disparities. This study examines provincial variation in public transport affordability across South Africa using a hierarchical Bayesian regression framework applied to province–year data from 2015 to 2022 (n = 72). Affordability is operationalised as a transport cost burden, with higher values indicating a greater proportion of household income spent on transport, and is modelled as a function of household income, trip frequency, household population, and total provincial employment, with province-level random intercepts capturing unobserved regional heterogeneity. The results indicate that household income is negatively associated with transport cost burden, suggesting that provinces with higher average income devote a smaller share of income to transport and therefore experience better affordability. In contrast, household population and aggregate provincial employment are positively associated with transport cost burden, reflecting higher overall mobility and commuting demands in larger and more economically active provinces rather than improved affordability. Trip frequency shows no statistically meaningful association with affordability once household composition and income capacity are accounted for. After accounting for observed characteristics, between-province variation is limited, indicating that affordability dynamics are broadly similar across provinces over the study period. Methodologically, the hierarchical Bayesian framework enables partial pooling across provinces and supports probabilistic inference through credible intervals, thereby improving the stability of estimates in a small-sample multilevel context. While the analysis is associational rather than causal, the findings provide policy-relevant evidence for monitoring transport affordability, including benchmarking the prevalence of affordability burdens relative to the commonly used 10% threshold. Full article

Problem behaviors among rural adolescents remain a significant public health concern, yet the temporal roles of key psychosocial resources are not well understood. Grounded in Conservation of Resources theory and Problem Behavior Theory, this study examined the longitudinal associations between psychological capital, perceived social support, and problem behaviors among rural Chinese adolescents. A three-wave, one-year longitudinal design was conducted with 770 adolescents (49.86% male, Mage = 16.36, SD = 1.57). Random-intercept cross-lagged panel models were applied to disentangle stable between-person differences from within-person processes. At the between-person level, adolescents with higher overall psychological capital and perceived social support reported lower levels of problem behavior. At the within-person level, psychological capital showed a time-specific protective effect, with short-term increases predicting subsequent reductions in problem behavior, whereas problem behavior did not predict later psychological capital. In contrast, perceived social support demonstrated reciprocal associations with problem behavior: higher support predicted later decreases in problem behavior, while elevated problem behavior predicted subsequent declines in perceived support. These findings indicate that psychological capital and perceived social support operate through distinct temporal mechanisms and highlight the importance of early internal resource development and sustained relational support in rural adolescent populations. Full article

Background and Objectives: The volume–outcome relationship in congenital heart surgery (CHS) has been widely reported internationally, but systematic nationwide evidence from Korea remains limited. Given the concentration of high-volume centers in the Seoul Capital Area (SCA), we aimed to examine whether hospital surgical volume was associated with short-term mortality and to what extent regional disparities could be explained by differences in surgical volume. Materials and Methods: We conducted a nationwide retrospective cohort study of 31,150 patients who underwent CHS in 91 hospitals in Korea between 2002 and 2021 using National Health Insurance claims data. Hospitals were classified by location (SCA vs. non-SCA). Annual surgical volume was defined using two approaches, (i) above vs. below the overall mean annual volume (17.1 cases per hospital), and (ii) three categories (≤20, 21–40, and >40 cases/year). The primary outcome was 30-day mortality. Multivariable logistic regression adjusted for case mix, including J-STAT category, sex, hospital type, age, prematurity, and low birth weight. Hospital-level variation was further evaluated using generalized linear mixed models with random hospital intercepts, and intraclass correlation coefficients (ICCs) were estimated to quantify between-hospital variation and the explanatory contribution of surgical volume. Results: Overall 30-day mortality was 1.99%, with higher mortality observed in non-SCA hospitals compared with SCA hospitals (3.19% vs. 1.57%). After adjustment, lower annual surgical volume was strongly associated with higher 30-day mortality. Compared with hospitals performing >40 cases/year, the adjusted odds ratios were 4.13 (95% CI, 3.30–5.17) for hospitals performing 21–40 cases/year and 4.95 (95% CI, 3.98–5.95) for those performing ≤20 cases/year. In multilevel analyses, annual surgical volume accounted for 54% of the between-hospital variation in 30-day mortality. Adjustment for surgical volume substantially attenuated the regional disparity, with the odds ratio for non-SCA versus SCA hospitals decreasing from 2.12 (95% CI, 1.80–2.49) to 1.14 (95% CI, 0.95–1.37). Conclusions: A strong volume–outcome relationship exists in congenital heart surgery in Korea, with excess mortality concentrated in low-volume hospitals rather than regional location itself. Regional disparities in outcomes appear largely attributable to the uneven distribution of surgical volume. Strategies focused on service consolidation and strengthened referral to high-volume centers may be effective in reducing inter-hospital variation and improving national outcomes in pediatric cardiac surgery. Full article

Background/Objectives: Sexual dysfunction is highly prevalent in men with chronic kidney disease (CKD), but longitudinal data across the CKD spectrum, particularly those directly comparing non-dialysis CKD with haemodialysis, are limited. We aimed to characterise longitudinal patterns in erectile and broader sexual function over three years, focusing on persistent between-group stratification and change over time in men with CKD versus community controls, and to identify clinical predictors of poorer outcomes. Methods: We conducted a three-year prospective cohort study in three groups of adult men: a group on haemodialysis, a group with non-dialysis CKD stages 3A/3B, and age-matched community controls without known kidney disease. The primary endpoint was the erectile function (EF) domain score of the International Index of Erectile Function (IIEF-15), assessed annually; the IIEF-15 total score and remaining domains were the secondary outcomes. Participants’ health-related quality of life (EQ-5D-5L), age, and diabetes status were recorded. Linear mixed effects models with participant-level random intercepts estimated the effects of group, year, and group × year, adjusted for age, EQ-5D-5L, and diabetes. Results: We enrolled 267 men (haemodialysis n = 96; CKD n = 88; and controls n = 83). At every time point, EF and other IIEF-15 domain scores showed a graded pattern with controls being the highest, CKD being intermediate, and haemodialysis the lowest. group × year interactions were not significant, indicating parallel trajectories without differential decline between groups over three years. Having a lower EQ-5D-5L, an older age, and diabetes—particularly type 2—were independent predictors of poorer IIEF-15 scores across domains. Conclusions: Male sexual function in CKD is persistently and gradually impaired along the renal disease spectrum, with patients on haemodialysis faring the worst and with no evidence of divergent longitudinal change. Routine EF screening, systematic attention to patients’ quality of life, and aggressive management of diabetes should be embedded in CKD care pathways, and renal-appropriate erectile dysfunction interventions should be considered earlier and more systematically. Full article

Background/Objectives: Marginal fit is a key determinant of the clinical performance of CAD/CAM (Computer-Aided DesignComputer-Aided Manufacturing) inlay restorations. This in vitro study compared the vertical marginal gap (VMG) of three chairside CAD/CAM inlay materials—VITA Enamic, CEREC Tessera, and Celtra Duo—using scanning electron microscopy (SEM) under a standardized digital workflow. Methods: Standardized Class I inlay preparations were performed in 15 extracted human molars (n = 5/material). Restorations were fabricated using a chairside workflow (Primescan intraoral scanning, CEREC 5.3 design, Primemill milling) followed by material-specific surface treatment and cementation with a self-adhesive resin cement. VMG was measured on SEM micrographs (500× for quantitative measurements; 200× for orientation) at three sites (mesial, central, distal), with three points per site (nine points/tooth; 135 point measurements). Triplicate points were averaged to site-level means and analyzed using a linear mixed-effects model (fixed effects: material, site, material × site; random intercept: tooth), Type II ANOVA, and Tukey-adjusted pairwise comparisons. Results: Mean VMG values were lowest for Celtra Duo (8.09 ± 1.98 µm), followed by VITA Enamic (27.90 ± 29.76 µm) and CEREC Tessera (32.72 ± 21.80 µm). The model indicated an overall effect of material (F(2,36) = 3.51, p = 0.040), whereas site and material × site effects were not significant. Tukey-adjusted pairwise comparisons did not reach statistical significance. Conclusions: Within the standardized chairside workflow evaluated, an overall material effect on VMG was detected, but pairwise separation was inconclusive in this sample with overlapping distributions. Celtra Duo showed smaller VMG values with narrower dispersion in overall per-tooth means, while VITA Enamic and CEREC Tessera showed wider and overlapping distributions; all group means were below commonly cited clinical acceptability ranges for marginal gap. Full article

Background & Objectives: Quantitative ultrasound (QUS) radiomics extracts microstructure-sensitive spectral features from radiofrequency data and may provide contrast-free, early indicators of neoadjuvant chemotherapy (NAC) response in breast cancer. This review synthesized open access human studies evaluating QUS radiomics for a priori prediction and early on-treatment monitoring. Methods: Following PRISMA-2020, we included English, free full-text clinical studies of biopsy-proven breast cancer receiving NAC that reported QUS spectral parameters (mid-band fit, spectral slope/intercept) ± textures/derivatives and machine learning models against clinical/pathologic response. Data on design, RF acquisition/normalization, features, validation, and performance (area under the curve (AUC), accuracy, sensitivity/specificity, balanced accuracy) were extracted. Results: Twelve cohorts were included. A priori baseline models achieved accuracies of 76–88% with AUCs 0.68–0.90; examples include 87% accuracy in a multi-institutional study, 82% accuracy/AUC 0.86 using texture-derivatives, 86% balanced accuracy with transfer learning, 88% accuracy/AUC 0.86 with deep learning, and AUC 0.90 in a hybrid QUS and molecular-subtype model. Early monitoring improved discrimination: week-1 results ranged from AUC 0.81 to 1.00 and accuracy 70 to 100%, noting that the upper bound was reported in a small cohort using combined QUS and diffuse optical spectroscopy features, while week 4 typically peaked (AUC 0.87–0.91; accuracy 80–86% in observational cohorts), and one series reported week-8 accuracy of 93%. Across reporting cohorts, mean AUC increased with a 0.05 absolute gain. A randomized feasibility study reported prospective week-4 model accuracy of 98% and demonstrated decision impact. Conclusions: QUS radiomics provides informative a priori prediction and strengthens by weeks 1–4 of NAC, supporting adaptive treatment windows without contrast or radiation. Standardized radiofrequency (RF) access, normalization, region of interest (ROI)/margin definitions, and external validation are priorities for clinical translation. Full article

The polymorphism of the bovine β-casein gene (CSN2) is of increasing interest due to its relevance for A2 milk production. This study genotyped 2773 Holstein-Friesian cows for five CSN2 alleles (A1, A2, A3, B, I) using both conventional DNA-based PCR and a newly evaluated direct PCR protocol. Eleven genotypes were detected, with A2/A2 (33.9%) and A1/A2 (30.3%) being the most common, resulting in an A2 allele frequency of 59.0%. Genetic diversity indices indicated moderate polymorphism and a significant deviation from Hardy–Weinberg equilibrium, consistent with ongoing selection for the A2 allele. Associations between CSN2 genotype and milk traits (305-day milk, fat, and protein yield; fat% and protein%) were evaluated using linear mixed-effects models including lactation number, age at calving, and calving year as covariates, and cow ID as a random intercept. Several genotype effects reached statistical significance (p < 0.05); however, all effect sizes were very small (partial η² < 0.01), indicating that any influence of CSN2 on production traits is negligible within this population and management context. These findings suggest that A2-oriented selection is unlikely to compromise productivity. The direct PCR genotyping method achieved 96–100% success and enabled substantially faster and more cost-efficient processing (approximately 80–90% reduction in reagent costs), providing a rapid and scalable approach for large herds. Full article

Background: Exposure to environmental pollutants, especially endocrine-disrupting chemicals, disproportionately affects vulnerable populations like pregnant women, lactating mothers, and preterm infants. This study aimed to assess the detection patterns of DiNP-, DEP-, and DEHP-related metabolites in maternal urine and breast milk, examine agreement between matrices, and explore maternal factors associated with phthalate exposure. Methods: Fifty-five mothers who delivered at ≤32 gestational weeks and whose infants were hospitalized in the Neonatal Intensive Care Unit (NICU) were enrolled. Breast milk and urine samples were analyzed using a validated isotope-dilution LC–MS/MS method. Urinary phthalate metabolite concentrations were adjusted for specific gravity. Linear mixed-effects models with a random intercept for mother were used to examine associations between urinary and breast milk phthalate metabolite concentrations, assess temporal changes, and evaluate the influence of breast milk lipid content. Results: DEHP and DiNP metabolites were detected in nearly all maternal urine samples. Breast milk contained predominantly primary metabolites (MEHP and MiNP), while secondary oxidative metabolites were rarely detected. Urine concentrations consistently exceeded breast milk concentrations. Urinary and breast milk phthalate concentrations were not correlated across sampling periods, indicating limited matrix concordance. Conclusions: Mothers of very preterm infants experience sustained phthalate exposure in the postpartum period; however, limited metabolite transfer to breast milk indicates that maternal urine remains the preferred biomonitoring matrix for assessing systemic phthalate exposure. Breast milk phthalate profiles exhibit compound-specific temporal changes and appear largely independent of concurrent urinary exposure biomarkers. Full article

Lumbar shear forces are increasingly recognized as critical contributors to lower-back injury risk, yet most ergonomic assessment tools—most notably the Revised NIOSH Lifting Equation (RNLE)—do not directly estimate shear loading. This study develops and evaluates a family of linear mixed-effects regression models that statistically predict L4/L5 lumbar shear force exposure using traditional NIOSH lifting parameters combined with posture descriptors extracted from digital human models. A harmonized dataset of 106 peak-shear lifting postures was compiled from five controlled laboratory studies, with lumbar shear forces obtained from validated biomechanical simulations implemented in the Siemens JACK (Siemens software, Plano, TX, USA) platform. Twelve model formulations were examined, varying in fixed-effect structure and hierarchical random effects, to quantify how load magnitude, hand location, sex, and joint posture relate to simulated task-level anterior–posterior shear exposure at the lumbar spine. Across all models, load magnitude and horizontal reach emerged as the strongest and most stable predictors of shear exposure, reflecting their direct mechanical influence on anterior spinal loading. Hip and knee flexion provided substantial additional explanatory power, highlighting the role of whole-body posture strategy in modulating shear demand. Upper-limb posture and coupling quality exhibited minimal or inconsistent effects once load geometry and lower-body posture were accounted for. Random-effects analyses demonstrated that meaningful variability arises from individual movement strategies and task conditions, underscoring the necessity of mixed-effects modeling for representing hierarchical structure in lifting data. Parsimonious models incorporating subject-level random intercepts produced the most stable and interpretable coefficients while maintaining strong goodness-of-fit. Overall, the findings extend the NIOSH framework by identifying posture-dependent determinants of lumbar shear exposure and by demonstrating that simulated shear loading can be reliably predicted using ergonomically accessible task descriptors. The proposed models are intended as statistical predictors of task-level shear exposure that complement—rather than replace—comprehensive biomechanical simulations. This work provides a quantitative foundation for integrating shear-aware metrics into ergonomic risk assessment practices, supporting posture-informed screening of manual material-handling tasks in field and sensor-based applications. Full article

Background and Objectives: Renin-angiotensin system inhibitors (RASIs) are recommended to preserve residual kidney function (RKF) in patients on peritoneal dialysis (PD); however, evidence of benefit is inconsistent. This study evaluated the effect of RASI on RKF decline among patients undergoing PD. Materials and Methods: We conducted a retrospective cohort study among PD patients at a large metropolitan dialysis centre in Australia. RKF was assessed using residual Kt/V and urine volume from PD adequacy tests. Time zero was PD initiation. RASI exposure was modelled as a time-dependent variable to avoid immortal-time bias. Linear mixed-effects models were fitted for each outcome, including random intercepts and slopes for time (years since PD start) with unstructured covariance. Fixed effects included time, RASI(t), time × RASI(t), age, sex, baseline RKF, PD modality, PD infection episodes, loop diuretic use, and comorbidities. Results: Of 307 PD patients, 231 met the inclusion criteria; 111 (48.1%) received RASI. RASI users were younger than non-users [65 years (IQR 56–74) vs. 72 years (IQR 61–77); p = 0.014]. Residual Kt/V declined by 0.26 units/year; RASI exposure showed no significant effect on urine volume trajectory and a borderline slower Kt/V decline (interaction β = +0.038, p = 0.069). Hospitalisation and PD-related infection rates were similar between groups. Conclusions: RASI therapy was not associated with meaningful RKF preservation in PD patients in this cohort. While earlier studies suggested renoprotective effects of RASI while on PD, our findings align with recent evidence of mixed efficacy. Larger prospective trials are needed to clarify the role of RASI in maintaining RKF and improving long-term outcomes in PD. Full article

This study investigates how temporal fluency cues shape human ratings of L2 English pronunciation in Korean learners, using a large read-speech corpus annotated with five-point pronunciation scores. We focus on two timing-derived measures—articulation rate (AR) and mean silence duration (SilMean)—and examine whether these cues predict (i) articulation-accuracy ratings and (ii) prosody/fluency ratings. To account for dependencies in corpus data and to control for key learner- and task-level covariates, we fitted cumulative link mixed models with random intercepts for speakers and scripts, including proficiency band (ability), age, gender, and test type as fixed effects. Across models, faster articulation and shorter silent intervals were associated with higher articulation ratings, and a combined model including both AR and SilMean provided the best fit (lowest AIC). Temporal cues were even more strongly associated with prosody ratings, supporting construct alignment between timing measures and the prosody dimension of the rubric. Marginal predicted probabilities illustrate how the likelihood of receiving high ratings (score ≥ 4) increases with AR across proficiency and linguistic-complexity strata (with SilMean held constant), and how long silent intervals reduce these probabilities when AR is held constant. These findings indicate that temporal organization provides robust information about perceived pronunciation quality in read L2 speech and underscore the importance of construct-aware modeling when developing AI-based scoring and feedback systems trained on human-labeled data. Full article

Adult obesity rates have risen steadily across the United States over the past decade, with more than 40% of adults affected. Persistent geographic and demographic disparities exist in obesity prevalence across the nation. While prior research has examined individual or environmental associated factors of obesity, limited studies have addressed both physical activity and food environments across the nation using multilevel approaches. This cross-sectional ecological study (2014–2024) used a two-level random intercept model to assess the association between county- and state-level factors and adult obesity prevalence across over 3000 U.S. counties nested within 51 states. County-level associated factors included food insecurity, poverty, unemployment, median household income, limited access to stores, and the density of various food outlets (grocery stores, convenience stores, supercenters, fast-food restaurants, Supplemental Nutrition Assistance Program (SNAP)-authorized retailers, and farmers’ markets), along with access to recreational facilities. State-level factors included SNAP benefits per capita and the presence of soda and chip taxes. Variables were group-mean- or grand-mean-centered to distinguish within- and between-state effects. Results showed that food insecurity, poverty, unemployment, limited access to stores, and a higher density of fast-food and convenience stores were positively associated with adult obesity prevalence. While higher recreational facility access, supercenter availability, median household income, SNAP benefits per capita were associated with lower adult obesity prevalence, these associations varied in strength across counties and states. These results emphasize the need for place-based strategies that address both the physical activity and food environment in shaping obesity disparities. Full article

Wireless sensor networks comprise many resource-constrained nodes that must protect both local readings and routing metadata. The sensors collect data from the environment or from the individual to whom they are attached and transmit it to the nearest gateway node via a wireless network for further delivery to external users. Due to wireless communication, the transmitted messages may be intercepted, rerouted, or even modified by an attacker. Consequently, security and privacy issues are of utmost importance, and the nodes must be protected against unauthorized access during transmission over a public wireless channel. To address these issues, we propose the Probabilistic Bit-Similarity-Based Key Agreement Protocol (PBS-KAP). This novel method enables two nodes to iteratively converge on a shared secret key without transmitting it or relying on pre-installed keys. PBS-KAP enables two nodes to agree on a symmetric session key using probabilistic similarity alignment with explicit key confirmation (MAC). Optimized Garbled Circuits facilitate secure computation with minimal computational and communication overhead, while Secure Sketches combined with Fuzzy Extractors correct residual errors and amplify entropy, producing reliable and uniformly random session keys. The resulting protocol provides a balance between security, privacy, and usability, standing as a practical solution for real-world WSN and IoT applications without imposing excessive computational or communication burdens. Security relies on standard computational assumptions via a one-time elliptic–curve–based base Oblivious Transfer, followed by an IKNP Oblivious Transfer extension and a small garbled threshold circuit. No pre-deployed long-term keys are required. After the bootstrap, only symmetric operations are used. We analyze confidentiality in the semi-honest model. However, entity authentication, though feasible, requires an additional Authenticated Key Exchange step or malicious-secure OT/GC. Under the semi-honest OT/GC assumption, we prove session-key secrecy/indistinguishability; full entity authentication requires an additional AKE binding step or malicious-secure OT/GC. Full article

Although there are theoretically expected associations between problematic smartphone use (PSU) and materialism, there is a lack of research that examines these associations using a longitudinal design, focusing on both within-person and between-person effects. Clarifying this relationship may inform interventions for these related conditions. Accordingly, data from three annual waves collected from a substantial group of Chinese adolescents (N = 3029, M_age = 12.26 ± 2.36, male: 50.00%) were used to assess within-person and between-person effects in the association between PSU and materialism. Traditional cross-lagged panel models were utilized to analyze the data, which consistently showed reciprocal positive associations between PSU and materialism across all waves. In contrast, the random intercept cross-lagged panel model revealed that PSU and materialism exhibited reciprocal associations over time at the between-person level. However, no significant cross-lagged linkage was observed between PSU and materialism at the within-person level. These findings enhance our understanding of the temporal dynamic relationship between PSU and materialism and underscore the necessity to disaggregate within-person and between-person effects to elucidate the nature of the longitudinal associations between PSU and materialism. The study also has implications for theoretical and practical understanding. Full article