Search Results (61,459)

Introduction/Background: Treatment of localized prostate cancer includes radical prostatectomy (RP) with or without pelvic lymph node dissection (PLND). While multiple guidelines recommend PLND for staging purposes, recent data has shown questionable therapeutic benefit. Thus, understanding the morbidity associated with PLND is important for counseling patients. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted prostatectomy database to quantify real-world 30-day postoperative outcomes of patients undergoing contemporary robot-assisted PLND at the time of RP for prostate cancer to quantify the incremental morbidity. Methods: We conducted a retrospective cohort study using the NSQIP database of adult patients undergoing radical prostatectomy from 2019 to 2022. The primary outcomes were procedure-specific outcomes such as lymphocele and rectal injury. Secondary outcomes included a composite of any of the following 30-day major postoperative outcomes: mortality, reoperation, cardiac or neurologic event, as well as the individual components of this outcome, as well as infectious and other complications. We also analyzed yearly trends associated with PLND. Groups were balanced using propensity score matching (PSM) with a 1:1 ratio using demographic characteristics, prior medical history, and cancer staging data. Likelihood of complications was assessed by conditional logistic regression. Results: We identified 13,413 patients between 2019 and 2022 who underwent robotic prostatectomy: 11,341 (85%) had PLND while 2072 (15%) did not. After PSM, our cohort included 2071 matched pairs of patients with and without PLND. Patients who underwent PLND were more likely to be diagnosed with lymphocele (2.14% vs. 0.68%, OR 4.17; 95% CI 2.00, 8.68), have unplanned readmission (4.22% vs. 3.27%, OR 1.31; 95% CI 1.03, 1.65), and develop organ-site/space SSI (1.18% vs. 0.60%) (OR 1.97, 95% CI 1.20, 3.23). There was no significant association between the receipt of PLND and the likelihood of urinary leak or fistula, or ureteral obstruction. There were no significant differences between the two groups with respect to secondary outcomes of interest. Conclusion: Contemporary robotic PLND is associated with a 3-fold increased likelihood of lymphocele, as well as increased likelihood of unplanned readmission and organ-site SSI, though no significant differences in major postoperative complications were identified. We found that the odds of lymphoceles, readmission, and SSI in our study are lower than previously reported. These data provide real-world data to guide patient counseling and optimize patient selection for PLND at the time of RALP. Full article

An unmanned aerial vehicle (UAV) multi-spectral system provides a monitoring platform to rapidly obtain crop spectral information that can reflect crop nitrogen status for the generation of dynamic variable-rate nitrogen (VRN). To improve the accuracy of VRN prescription maps, a method of generating VRN prescription maps on the basis of the vegetation index was proposed, and the effects of UAV flight time and altitude on VRN prescription maps were analyzed. The experimental site was located in Dacaozhuang, Hebei Province, China, and the experimental crop was winter wheat (Lunxuan 145). The flight altitudes of the UAV system were set to 50, 70 and 90 m. The flight times were set to 8:00 a.m., 11:00 a.m., 2:00 p.m. and 5:00 p.m. local time. The flight area was 1.18 ha with a 60° rotation angle under a three-span center pivot irrigation system with an overhang. UAV flight missions were executed during the jointing, heading, and grain filling phases of winter wheat. There were 90 management zones with pie shapes in total, which were composed of a 10° angle in the rotation direction and 4 sprinklers along the lateral direction. The vegetation indices (VIs) which are closely related to crop nutrient status were selected and used to generate distribution maps, which were superimposed with the management zones to generate VRN prescription maps. The results demonstrated that the red-edge soil adjusted vegetation index (RESAVI) was relatively more sensitive to the nitrogen status of winter wheat than the other VIs were. The RESAVI distributions were stable during periods with a solar elevation angle greater than 50° (11:00 a.m.–2:00 p.m. local time), and the VRN prescription maps were similar, with the overlap percentage of the same fertilization grade being greater than 80% and the relative error of the fertilization amount being less than 5%. Compared with that at 2:00 p.m., the overlap percentage of the same fertilization grade was 56.6% in both seasons at 8:00 a.m., whereas flights at 5:00 p.m. exhibited overlaps of 70.9% and 44.6% in the 2023 and 2024 seasons, respectively. Conversely, the flight altitude had little influence on the fertilizer amount and VRN prescription maps. The difference in the amount of fertilizer used was less than 3% at different flight altitudes. The required time is half of that for a 50 m flight when the flight altitude is 70 m and one third of that when the flight altitude is 90 m. Our study recommended operating the UAV multi-spectral system at solar elevation angles greater than 50° when generating VRN prescription maps of winter wheat, and the flight height can be adjusted according to the field area and the endurance time of the UAV. Full article

Background/Objectives: To evaluate the cost-effectiveness of β-blocker use in addition to standard care compared to standard care alone for women with triple-negative breast cancer (TNBC), with effectiveness measured by years of life lived (YLL), quality-adjusted life years (QALYs), and equal-value life years (evLYs) gained. Methods: A population cohort Markov model was developed to compare clinical and economic outcomes for TNBC treated with 1) lifelong β-blocker prescription initiated at diagnosis in addition to standard care versus 2) standard care alone. Life-table modelling was used to capture mortality over a lifetime horizon for the estimated eligible population of Australian women diagnosed with TNBC in 2022 (n = 767). Costs were derived from Australian healthcare perspective, and measured in Australian dollars (AUD) at 2022 prices with 5 percent annual discounting and AUD 28,000 willingness to pay threshold applied. Results: The model estimated 628 (95% CI 139, 1035) YLL, 526 (116, 865) QALYs, and 566 (125, 932) evLYs gained in the β-blocker group compared to standard care. The difference in health costs between β-blocker and standard care groups was AUD −935,116 (−2,365,417, 405,350). The β-blocker intervention was dominant over standard care in terms of both QALYs and evLYs gained. Conclusions: Preliminary modelling suggests that implementing β-blockers as an adjunct pharmacotherapy in the treatment of TNBC was more effective and less costly than current standard care. Further monitoring of long-term outcomes is recommended to validate the findings of observational and preclinical studies, and define the incidence, severity, and cost of β-blocker associated adverse events in cancer populations. Full article

Bacteremia is a life-threatening condition contributing significantly to sepsis-related mortality worldwide. With delayed appropriate antibiotic therapy, mortality increases by 20% regardless of antimicrobial resistance. This study evaluated the perceived clinical utility of Artificial Intelligence (AI)-powered Clinical Decision Support Systems (CDSSs) (OneChoice and OneChoice Fusion) among specialist physicians managing bacteremia cases. A cross-sectional survey was conducted with 65 unique specialist physicians from multiple medical specialties who were presented with clinical vignettes describing patients with bacteremia and 90 corresponding AI-CDSS recommendations. Participants assessed the perceived helpfulness of AI decision-making, the impact of AI recommendations on their own clinical judgment, and the concordance between AI recommendations and their own clinical judgment, as well as the validity of changing therapy based on CDSS recommendations. The study encompassed a diverse range of bacterial pathogens, with Escherichia coli representing 38.7% of the isolates and 30% being extended-spectrum β-lactamase (ESBL) producers. Findings show that 97.8% [(95% CI: 92.2–99.7%)] of physicians reported that AI facilitated decision-making and substantial concordance (87.8% [95% CI: 79.2–93.7%; Cohen’s κ = 0.76]) between AI recommendations and physicians’ therapeutic recommendations. Stratification by pathogen revealed the highest concordance for Escherichia coli bacteremia (96.6%, 28/29 cases). Implementation analysis revealed a meaningful clinical impact, with 68.9% [(95% CI: 58.3–78.2%)] of cases resulting in AI-guided treatment modifications. These findings indicate that AI-powered CDSSs effectively bridge critical gaps in infectious disease expertise and antimicrobial stewardship, providing clinicians with evidence-based therapeutic recommendations that can be integrated into routine practice to optimize antibiotic selection, particularly in settings with limited access to infectious disease specialists. For optimal clinical integration, we recommend that clinicians utilize AI-CDSS recommendations as an adjunct to clinical judgment rather than a replacement, particularly in complex cases involving immunocompromised hosts or polymicrobial infections. Future research should prioritize prospective clinical trials that evaluate direct patient outcomes to establish evidence of broader clinical effectiveness and applicability across diverse healthcare settings. Full article

The AASHTO Manual for Assessing Safety Hardware (MASH) replaced the NCHRP Report 350 in 2009, becoming the new standard for evaluating safety hardware devices, including concrete bridge parapets; all new permanent installations of bridge rails on the National Highway System must be compliant with the 2016 MASH requirements after 31 December 2019, as agreed by the FHWA and AASHTO. However, due to the complexity of vehicular impact events, there are several different methods for estimating vehicular impact force on the parapets. They can be grouped into three main categories: theoretical, numerical and measurement methods. This paper presents a practical method based on analytical concepts for providing impact force estimates that can help bridge owners to evaluate the structural capacity of bridge parapets at a fraction of the cost of full-scale crash tests and finite element numerical simulations. This approach was developed based on fundamental dynamic principles and refined dynamic analysis of vehicle rigid-body motions during multi-phased impact events. Principles of impulse and momentum were first applied to determine both linear and angular velocities of a vehicle immediately after the initial impact; then coupled differential equations of motion were derived and solved to describe the vehicle’s plane-motion during the subsequent stage, which includes both translational and rotational movements. The proposed method was shown to be capable of providing reasonably accurate force estimates with significantly less demand for time and effort compared to other complex methods. These estimates can help infrastructure owners to make informed and sustainable decisions for bridge projects, which include selecting the most efficient bridge design alternatives, in a cost-effective and timely manner. Recommendations for future studies were also discussed. Full article

In 2011, the International Commission on Radiological Protection (ICRP) recommended reducing the annual equivalent dose limit to the eye lens. This study investigated the effects of physician height and years of experience on lens radiation exposure in a clinical setting. The lens dose was measured using the DOSIRIS dosimeter, which quantified Hp(3) while accounting for the shielding effect of lead glasses, and a neck dosimeter for Hp(0.07). A significant negative correlation was found between physician height and both Hp(0.07) (R = −0.642) and Hp(3) (R = −0.728), suggesting that taller physicians received lower lens doses because of their greater distance from the scatter source. A positive correlation was observed between years of experience and Hp(0.07) (R = 0.650). Two-group comparisons showed that physicians shorter than 170 cm had a 2.77-fold higher median Hp(3) than those ≥170 cm (p < 0.05). As experienced physicians may be exposed to higher radiation levels, regular review of protective practices and continued radiation safety education are essential, regardless of clinical experience. This is the first clinical study to simultaneously evaluate the effects of physician height and experience on lens dose in interventional cardiology. Regular review of protective practices remains essential regardless of operator height or experience. Full article

Background: Understanding visual context in images is essential for enhanced Point-of-Interest (POI) recommender systems. Traditional models often rely on global features, overlooking object-level information, which can limit contextual accuracy. Methods: This study introduces micro-level contextual tagging, a method for extracting metadata from individual objects in images, including object type, frequency, and color. This enriched information is used to train WORLDO, a Vision Transformer model designed for multi-task learning. The model performs scene classification, contextual tag prediction, and object presence detection. It is then integrated into a content-based recommender system that supports feature configurations. Results: The model was evaluated on its ability to classify scenes, predict tags, and detect objects within images. Ablation analysis confirmed the complementary role of tag, object, and scene features in representation learning, while benchmarking against CNN architectures showed the superior performance of the transformer-based model. Additionally, its integration with a POI recommender system demonstrated consistent performance across different feature settings. The recommender system produced relevant suggestions and maintained robustness even when specific components were disabled. Conclusions: Micro-level contextual tagging enhances the representation of scene context and supports more informative recommendations. WORLDO provides a practical framework for incorporating object-level semantics into POI applications through efficient visual modeling. Full article

Soil nitrogen (N) and phosphorus (P) loss in watersheds is a critical source of water pollution. This study explores the spatial distribution, release potential, and environmental impacts of soil N and P in the downstream Daliao River basin by integrating field investigations and simulation experiments. Results showed that total nitrogen content in soils ranged from 256.09 to 3362.75 mg/kg, while that in sediments ranged from 114.85 to 1640.54 mg/kg. Total phosphorus content in soils varied from 250.18 to 1142.69 mg/kg, whereas in sediments it ranged from 327.23 to 586.24 mg/kg. The ammonia nitrogen release potentials of soils collected from rice paddies, corn farmlands, roadsides, and reed wetlands were 0.75, 0.86, 0.70, and 8.65 mg/L, respectively, with corresponding total phosphorus release potentials of 0.61, 1.01, 0.31, and 1.52 mg/L. For sediments, ammonia nitrogen and total phosphorus release potentials ranged from 0.96 to 1.21 mg/L and 0.44 to 0.52 mg/L, respectively. Temperature, pH, and dissolved oxygen were important factors influencing nitrogen and phosphorus release from soils and sediments. The export of nitrogen and phosphorus from soil reached 50.50 t/a and 21.63 t/a, respectively. During the soil erosion process in the Daliao River Basin, phosphorus exhibited a high release potential and served as the primary pollutant, whereas the release mechanism of ammonia nitrogen was more complex, showing seasonal variability. Soils in the downstream Daliao River basin have large specific surface areas and may pose a high pollution risk after discharge into water bodies due to prolonged adsorption of pollutants. It is recommended to propose promoting soil testing-based fertilization, constructing ecological engineering projects, developing sponge cities, and conducting environmental dredging to reduce N and P release from agricultural lands, construction areas, natural wastelands, and sediments. Full article

Chemical Exchange Saturation Transfer (CEST) imaging has emerged as a promising non-invasive molecular MRI technique for investigating neuroinflammation. It offers unique insights into metabolic and molecular alterations in the brain. This review presents a comprehensive overview of CEST principles, methodological developments, and translational applications in neuroinflammation. It covers the basic mechanisms, pulse sequence designs, readout strategies, and various CEST contrasts used to probe molecular changes associated with inflammation. Recent advancements in fast CEST imaging, including optimized undersampling strategies and accelerated reconstruction methods are discussed. Improvements in post-processing and quantification techniques are also highlighted. The growing role of artificial intelligence (AI) in CEST imaging for image reconstruction, artifact correction, and biomarker extraction, is examined. Preclinical and clinical studies show CEST’s potential to detect neuroinflammation across neurological disorders. The impact of high-field MRI on enhancing CEST sensitivity and specificity are also discussed. Despite notable progress, several challenges remain. These include sensitivity to field inhomogeneities, lack of acquisition standardization, and limited clinical validation. We outline current limitations, translational barriers, and provide recommendations for improving reproducibility, facilitating clinical adoption, and integrating AI-based approaches for robust molecular characterization. Overall, CEST imaging shows great potential as a non-invasive biomarker for neuroinflammation. It can deepen understanding of the molecular and metabolic mechanisms underlying neurological diseases, while addressing technical and translational challenges remains key for its broader clinical implementation. Full article

Background: Nutrition problems among primary school children increase the risk of illness, reduce school attendance, and impair academic performance. The Indonesian national school feeding program (ProGAS—Program Gizi Anak Sekolah) was developed to address these issues through the provision of healthy breakfast, nutrition education, and character building. Methods: This study employed a mixed-methods design involving 454 primary school students aged 8–14 years from 24 schools across four provinces. Data collection included structured questionnaires, 24 h dietary recalls, and anthropometric measurements. In-depth interviews with school principals, teachers, cooking teams, parents, students, nutritionists, and district education office staff were conducted to capture experiences and opinions on the ProGAS implementation. Results: ProGAS significantly improved students’ dietary diversity, meal frequency, handwashing with soap, and nutrition knowledge, alongside a positive trend in school attendance. Improvements included higher mean dietary diversity, increased proportion of students eating ≥3 meals/day, greater correct responses on balanced nutrition, and higher rates of handwashing before meals (all p < 0.01). Children also developed positive behaviors such as praying before meals, queuing, and taking responsibility for cleaning dishes. However, students’ breakfast habits did not significantly improve, the delivery of nutrition education was suboptimal, and no significant changes were observed in nutrient intakes or nutritional status based on BMI-for-age. While the energy and protein contributions of the ProGAS menu met the recommended 25–30% of daily requirements for breakfast, its micronutrient contributions remained below the recommended levels. Key management gaps include the delivery of nutrition education to students and the monitoring of implementation by local and national authorities. Conclusions: ProGAS demonstrated positive impacts on some dietary and hygiene practices as well as learning environment. To achieve greater improvements in breakfast habits, nutrient intake and nutritional status, it is recommended to strengthen the school feeding menus not only for dietary diversity but also for nutrient density, enhance capacity building for teachers, deliver regular and engaging nutrition education, and reinforce program monitoring. Full article

Background: To understand the state of the art of how artificial intelligence (AI) and cybersecurity are taught together, this paper conducts a systematic literature review on integrating AI into the cybersecurity curriculum in higher education. Methods: The peer-reviewed works were screened from major databases published between 2020 and 2025. Integrating AI and cybersecurity typically requires new learning designs. To address this gap in higher education, this review is organized by three categories of research questions: (1) who we teach (audiences and delivery modes), (2) what we teach (related AI topics and cybersecurity topics and how they are integrated), and (3) how we teach (instructional activities and tools used in teaching). Results: The course delivery is mostly face-to-face. The course curricula focus mostly on perception AI. Teaching methods are active and practical, with hands-on labs, interactive tasks, and game-based activities, supported by hardware, programming notebooks, and interactive visualizations. Conclusion: This paper provides the state of the art of integrating AI into the cybersecurity curriculum in higher education, actionable recommendations, and implications for further research. Therefore, it is relevant and transferable for instructors in the field of artificial intelligence education and cybersecurity education. Full article

Background and Objectives: Antimicrobial stewardship plays a key role in the surgical setting by reducing the incidence of healthcare-associated infections and limiting the emergence of antimicrobial resistance. Clinical Decision Support Systems (CDSSs), when integrated into routine practice, are valuable tools for optimizing antimicrobial prescribing. However, evidence regarding their impact on surgical patients, particularly across different specialties, remains limited. Materials and Methods: We conducted a quasi-experimental time series study in surgical patients at a primary-level hospital, evaluating the effect of a CDSS on postoperative antimicrobial therapy. The pre-intervention period included patients admitted from April 2017 to September 2020, and the post-intervention period included those admitted from October 2020 to March 2024. Antimicrobial consumption and expenditures were measured as defined daily doses (DDDs) per 1000 patient-days and euros (€) per 1000 patient-days, respectively. Subgroup analyses were performed by the surgical service. Clinical outcomes included mortality and length of stay (LOS). Results: Following CDSS implementation, overall antimicrobial consumption decreased by 4.4%. Significant reductions were observed in aminoglycosides (−52.0%), macrolides, lincosamides and streptogramins (−40.6%), and fluoroquinolones (−32.3%). Reductions were heterogeneous across surgical services, with significant reductions in Traumatology (−21.3%) and Urology (−14.3%). Expenditures decreased from 3185.4 to 2733.9€/1000 patient-days (−14.2%; p = 0.17). Mortality remained stable, whereas significant reductions in LOS were observed in Urology (5 to 4 days, p = 0.03) and traumatology (16 to 8.5 days, p < 0.01). During the post-intervention period, 476 stewardship recommendations were issued for 330 patients, with an acceptance rate of 76.1%. The most frequent interventions were discontinuation of antimicrobials (25.8%), transition to oral therapy (21.0%), and de-escalation (18.7%). Conclusions: Implementation of a CDSS in the surgical setting was associated with reduced antimicrobial consumption, a downward trend in expenditures, and high acceptance of stewardship recommendations. Mortality remained unchanged, while reductions in LOS in selected services support the safety and potential efficiency of this approach. Full article

This research aims to develop a novel spatial optimization model for locating obnoxious facilities. While various obnoxious facility location problems (OFLP) have been introduced, the optimal spatial arrangements in existing models may not adequately reflect the real-world conditions, such as the distribution of population and locational restrictions across areas in a region, often offering extreme peripheral or clustered recommendations that ignore such conditions. To address this gap, this research introduces an alternative location model named the Spatially Informed Obnoxious Location (SI-OBNOX) model. The SI-OBNOX model was developed to address the extreme spatial arrangements produced by existing models by incorporating a unique set of constraints derived from the spatial characteristics of a planning region. The constraints integrate spatial–statistical measures into the model formulation to restrict extreme facility location behaviors, resulting in more reasonably distributed obnoxious facility sites while avoiding residential areas for them. The findings demonstrate that the spatial arrangements generated by the SI-OBNOX model outperform those of existing OFLPs in terms of three planning-related indices, namely separation, externality, and proximity, based on a case study of the East Tennessee region. The SI-OBNOX model can be adapted to other planning contexts where it is necessary to locate undesirable yet essential facilities for public welfare. Full article

Background/Objectives: Chronic lymphocytic leukemia (CLL) is a hematologic malignancy characterized by uncontrolled accumulation of B lymphocytes. A key feature of CLL is the presence of genetic aberrations, particularly alterations of chromosome 17, such as deletion of 17q and/or mutations in the TP53 gene. Since these abnormalities are highly relevant for therapeutic decision-making, assessment of TP53 mutational status is strongly recommended in routine diagnostics. This study aimed to evaluate the reliability of TP53 sequencing results depending on the type of DNA sample analyzed. Methods: DNA was isolated from two different sample types of the same patient: mononuclear cells (CLL1) and purified CD19+ cells (CLL2). The entire coding region of TP53 (exons 2–11), including splice sites (+/− 10 bp), was analyzed using capture-based next-generation sequencing (NGS). Reads were aligned to the GRCh37/hg19 reference genome, and variants were interpreted using DRAGEN Enrichment (Illumina) and Franklin (QIAGEN). Results: In sample CLL1, the NM_000546.6:c.626_627del mutation (Tier I) was identified with a variant allele frequency (VAF) of 57.06%. The same mutation was confirmed in CLL2, but with a higher VAF of 94.78%. Importantly, an additional Tier I mutation (NM_000546.6:c.825_826del) was detected exclusively in CLL2 at a VAF of 1.59%. Both findings met the required sequencing depth as well as coverage per sample, confirming their validity. Conclusions: The study demonstrates that inadequate starting material for DNA isolation may mask low-frequency TP53 mutations, resulting in false-negative results. Accurate detection requires ensuring sufficient CD19+ cell content, which is critical for reliable diagnostics and supports personalized treatment approaches in CLL. Full article

Background: Age-related hearing loss (ARHL) is associated with decreased communication, reduced social engagement, cognitive decline and an increased risk of dementia globally. Although increasing studies report the benefits of combing auditory and cognitive training for older adults with ARHL, more evidence is needed to examine its effects. Moreover, existing training programs have been developed with minimal end-user involvement leading to low adherence rates. This study aimed to investigate the role of co-design in the development of an auditory–cognitive training system for older adults with ARHL. Methods: A co-design methodology was employed. Digital recordings of the co-design workshops were transcribed verbatim. An established reflexive thematic analysis methodology was used. Results: Fifteen older adults with ARHL, referred to as “co-researchers”, participated in three co-design workshops until data saturation was achieved. Consultations were held with two key service providers. Three key themes emerged: (1) older adults with ARHL prefer a user-friendly auditory–cognitive training system; (2) clear, localized and colloquial instructions for the training tasks are necessary; and (3) diversified, tailor-made and dual-task training tasks, performed in an interactive and game-like mode, can motivate and sustain usage of the training system. As a result, a prototype of a web-based, gamified, and adaptive auditory–cognitive dual-task training system was co-designed. Conclusions: Our findings affirmed the importance of genuinely listening to the voices of end-users and creating a system that is responsive to their needs and preferences. Future study is recommended to examine the effects of this system on older adults with ARHL. Full article