Search Results (3,312)

Background: Foot-and-mouth disease (FMD) is a highly contagious viral disease causing substantial economic losses in livestock. Conventional intramuscular (IM) vaccination is widely used for FMD control but may be associated with transient reductions in milk production. This study evaluated whether intradermal (ID) vaccination could induce comparable immune responses and protection while minimizing potential impacts on productivity. Methods: In cattle, the immunogenicity of an experimental bivalent ID vaccine was compared with that of a commercially available IM vaccine by measuring antibody responses for up to 140 days post-vaccination (dpv). Milk production was monitored for 7 dpv in a separate cohort of lactating cattle. Protective efficacy was evaluated in goats following ID vaccination and challenge with a 2025 Republic of Korea serotype O field isolate (O/ME-SA/Ind-2001). Results: ID vaccination induced humoral immune responses comparable to those elicited by IM vaccination throughout the 140-day observation period. Although no statistically significant difference in milk production was observed, the ID group showed a smaller numerical reduction in milk yield. Following viral challenge, ID-vaccinated goats developed rapid neutralizing antibody responses, exhibited no clinical signs, and showed lower viral RNA levels than unvaccinated controls. Conclusions: Intradermal vaccination induced long-lasting immune responses comparable to conventional IM vaccination, was associated with a smaller numerical reduction in milk yield, and protected goats against challenge with a contemporary FMDV field isolate. These findings provide preliminary evidence supporting the potential of ID vaccination as an alternative strategy for FMD control in ruminants and warrant further comparative studies with conventional IM vaccination. Full article

Immersive Virtual Reality (IVR) has emerged as a promising instructional technology for STEM education, yet relatively few classroom-based studies have examined student learning experiences through the lens of the Cognitive-Affective Model of Immersive Learning (CAMIL). This study compared undergraduate students’ perceptions of IVR and traditional PowerPoint (PPT)-based instruction across four CAMIL-related constructs: immersion, presence, agency, and intrinsic motivation. A counterbalanced crossover design was implemented with 40 undergraduate STEM students enrolled in a leadership course at a large Midwestern research university. Participants experienced both IVR and PPT instructional modalities across three learning modules. Student perceptions were measured using an adapted questionnaire consisting of validated subscales administered on a six-point Likert scale. Because questionnaire completion varied across instructional sessions, analyses were conducted using 64 complete IVR-PPT paired observations. Repeated-measures ANOVA was used to analyze motivation, presence, and immersion, while the Wilcoxon signed-rank test was used to analyze agency because of non-normality. Results indicated a significant difference in immersion between instructional modalities, whereas motivation and presence did not differ significantly. Agency also differed significantly between conditions based on the Wilcoxon signed-rank test. These findings demonstrate that instructional modality influences selected dimensions of the student learning experience while suggesting that the relationships proposed by the CAMIL framework may depend on implementation context and instructional design. Rather than validating the CAMIL model, this study illustrates its usefulness as an interpretive framework for examining learner perceptions in authentic undergraduate STEM instruction. Limitations include the modest sample size, incomplete questionnaire responses across sessions, the absence of formal testing for sequence effects, and the use of paired observations rather than participant-level analyses. Full article

Accurate fault diagnosis and protection of series-compensated transmission lines remain challenging due to the nonlinear behavior of series capacitors and associated protective devices, which degrade the performance of conventional protection relays under varying operating conditions. To address these challenges, this paper proposes an intelligent ensemble learning-based protection framework for fault detection, fault classification, fault section identification, and fault location estimation in fixed series-compensated transmission networks. The proposed framework integrates an Artificial Neural Network (ANN) and a random subspace ensemble classifier (RSEC), where the ANN performs fault detection, classification, and location estimation, while the RSEC identifies the faulted section using a majority-weighted voting strategy. In addition, four fault indices are formulated to effectively characterize fault conditions and improve diagnostic performance. The proposed framework is evaluated on a 400 kV, 50 Hz series-compensated transmission system under diverse fault scenarios and varying operating conditions, including different fault types, fault resistances, fault locations, compensation levels, and noisy measurements. The results demonstrate an average fault detection time of 4.05 ms, 100% fault classification accuracy, 98.646% fault section identification efficiency, a mean signed fault location error of −0.02988%, and a mean absolute location error of 0.0791%, indicating negligible systematic bias and high localization accuracy. Furthermore, real-time validation using the OPAL-RT digital real-time simulator confirms the computational feasibility of the proposed framework, demonstrating its potential as a reliable, accurate, and computationally efficient solution for intelligent protection and monitoring of modern smart transmission networks. Full article

We conducted an online cross-sectional study to assess malnutrition risk, food and nutrition insecurity, and perceived barriers and facilitators to dietary management among adults (18–64 years old) with a self-reported clinical diagnosis of inflammatory bowel disease (IBD) in outpatient and community settings. We assessed malnutrition risk using the Saskatchewan IBD-Nutrition Risk screening tool, food security risk using the two-item Hunger Vital Signs questionnaire, and nutrition security risk using a validated four-item tool. Open-ended questions elucidated barriers and facilitators to dietary management of IBD. Among 57 participants who self-reported a clinical diagnosis of IBD, 52.6% (n = 30/57) had ulcerative colitis, and 47.4% (n = 27/57) had Crohn’s disease. Nutrition insecurity was higher among those at high risk of malnutrition than among those at low-to-medium risk (p = 0.018), and there were no differences in food security status (p = 0.081). Using univariate logistic regression, the odds of being classified as having a high risk of malnutrition were associated with being male, following a special diet or nutrition plan, experiencing IBD-related flare-ups, and nutrition insecurity. Furthermore, healthcare professionals and social support, as well as digital resources/nutrition-related apps, were identified as facilitators to dietary management, while barriers included food access and expense, limited nutrition knowledge and resources, and fear of IBD-related symptom flare-ups. Although self-reported malnutrition risk and food and nutrition insecurity are common, larger prospective studies incorporating validated disease-activity measures and comprehensive nutritional assessment are needed to clarify these relationships and evaluate integrated dietetic and social-support interventions. Full article

Emerging digital technologies are reshaping interior design practice, increasing the need for educational approaches that intentionally support students’ perceived workforce readiness. This study examined the implementation of a mobile 3D scanning application within a university interior design course to examine its association with students’ technology learning self-efficacy and perceived workforce readiness. Using a one-group pre–post survey design, data were collected from interior design students who participated in a classroom-based 3D scanning activity using Polycam and completed surveys before and after the instructional experience. A total of 29 pre-test and 21 post-test responses were collected. Survey instruments assessed students’ perceived importance, familiarity, and experience with 3D scanning, along with technology adoption characteristics. Post-intervention measures also examined technology learning self-efficacy and perceived workforce readiness domains, including career development, self-regulated learning, problem solving, and technological competence. Welch’s independent-samples t-tests and Mann–Whitney U tests indicated that the post-test group reported significantly higher perceptions of familiarity with and experience using 3D scanning, as well as several technology-adoption perceptions, than the pre-test group, including ease of use, work style compatibility, efficiency gains, result observability, and trialability. One-sample Wilcoxon signed-rank tests showed that post-intervention composite scores for technology learning self-efficacy and perceived workforce readiness domains were significantly higher than the neutral scale midpoint. Qualitative thematic analysis of open-ended responses further supported these findings, identifying themes of ease of use, engagement, enhanced visualization, creativity, and professional relevance. Overall, the findings suggest that participation in the classroom-based mobile 3D scanning activity was associated with positive post-intervention perceptions of technology learning self-efficacy and perceived workforce readiness. Full article

The Duolong district in the central Bangong-Nujiang Suture Zone (BNSZ) is a major porphyry–epithermal Cu-Au cluster in Tibet. We combine radially averaged log-power spectra with a five-level db4 two-dimensional discrete wavelet transform (2D-DWT) to compare depth-sensitive frequency bands with their plan-view expressions in complete Bouguer gravity and reduced-to-the-pole (RTP) aeromagnetic grids. The five-level transform yields signed detail reconstructions d1–d5, ordered from fine to coarse scales, and a final cumulative low-pass approximation a5. The gravity/magnetic spectral estimates are 1.02/1.09 km for the shallow ensemble, 5.12/4.85 km for the intermediate ensemble, and 18.60/21.58 km for the deepest resolved ensemble. These values describe statistical source-depth ranges rather than discrete interfaces. The 2.98 km difference between the deep-source estimates (14.8% of the paired mean) is treated as methodological uncertainty and/or a difference in the depths of the density and magnetization transitions rather than as quantitative identity. The coarsest detail d5 and low-pass approximation a5 express a broad upper-to-middle-crustal background transition and do not image the Moho or a mantle source. Co-located mid-scale gravity and magnetic anomalies are consistent with a composite intrusive–basement source region, but the absence of site-specific density and susceptibility measurements prevents a unique lithological assignment. A southeastern anomaly zone centered approximately at 84.0° E, 31.7° N is therefore presented as a first-order regional screening hypothesis within a broad 3–8 km source-depth band, not as a quantitatively closed drill target. The interpretation distinguishes geophysical observations from geological hypotheses and explicitly incorporates the limitations of spectral and wavelet separation. Full article

Background: This study aimed to compare a chemiluminescence immunoassay (CLIA; Siemens Atellica IM 1600) with an automated liquid chromatography–tandem mass spectrometry (LC–MS/MS) analyser (Thermo Scientific Cascadion SM) for serum 25-hydroxyvitamin D [25(OH)D] measurement in unselected outpatients, and its impact on clinical classification. Methods: 25(OH)D was measured on 1064 paired serum samples (828 women, 236 men; age 3–111 years); both platforms participated in the Vitamin D Standardisation Program (VDSP). Agreement was assessed by the Wilcoxon signed-rank test, Passing–Bablok regression, Bland–Altman analysis on log-transformed values, Breusch–Pagan testing for heteroscedasticity, consistency-based intraclass correlation coefficient (ICC), Lin’s concordance correlation coefficient, and Cohen’s kappa with McNemar’s test on six- and two-category clinical classifications. Results: Methods differed significantly ($p<2.2\times {10}^{-16}$). Passing–Bablok regression showed proportional bias (slope 1.33; 95% confidence interval [CI], 1.28–1.38; LC–MS/MS higher). Consistency ICC was 0.928 (95% CI, 0.919–0.936). Log-Bland–Altman bias was 35.5% (limits of agreement, $-18.3$% to $+124.5$%; heteroscedasticity, $p=5.18\times {10}^{-11}$). Cohen’s kappa was 0.32 unweighted and 0.72 weighted on six clinical categories, and 0.56 on a two-class scheme (McNemar $p<2.2\times {10}^{-16}$). In discordant pairs, CLIA classified deficiency 118-fold more often than LC–MS/MS. Conclusions: In our study, despite preserved rank ordering, a non-linear concentration-dependent bias and different limits of agreement caused systematic differences in the classification of vitamin D deficiency. Adoption of automated LC–MS/MS can substantially reclassify outpatients toward sufficiency, with implications for supplementation and laboratory harmonisation. Full article

Neurological disorders drive demand for prolonged upper-limb rehabilitation, yet specialist access is uneven and assessment stays subjective. Marker-based and inertial measurement unit (IMU) systems are accurate but costly and impractical at home, while pose estimation pipelines mostly stop at keypoints, and many process video server-side, raising privacy concerns. We present a markerless pipeline that analyzes monocular RGB video entirely on-device in the browser, so it never leaves the machine. From 33 BlazePose keypoints, it derives five geometric metrics designed to limit body-size dependence—incomplete elbow extension, inter-limb asymmetry, shoulder girdle elevation, lateral trunk lean, and head tilt—compared against empirically calibrated, preliminary thresholds; a finite-state machine segments repetitions, and the flags are pooled into an unvalidated, exploratory quality score. Against an IMU reference over the 0–${62}^{\circ }$ range that the recordings cover, the image-plane angle showed a mean absolute error of ${2.18}^{\circ }$, below the pre-specified $5^{\circ }$ tolerance, a trajectory-averaged bias within $\pm 2^{\circ }$, and Lin’s concordance correlation coefficient of $0.956$; the difference is, however, proportional to the angle—about $4\%$ of the measured value—so the accuracy should not be extrapolated to larger elevations, and because that comparison was made offline, it does not include the timing error of the causal real-time path. On a single seated frontal-plane abduction task, with 18 healthy volunteers simulating the compensations and annotated by two independent clinicians blind to the instructed condition, compensation detection reached a macro-averaged $F_1$ of $0.75$ and $0.72$ against the individual raters. The five signs differ in maturity: near-expert for trunk lean and head tilt, moderate for incomplete elbow extension and inter-limb asymmetry, and weakest for shoulder elevation, which a single frontal view cannot fully disentangle from the abduction motion. Running at 22–30 frames per second on consumer laptops without relying on a discrete GPU, it offers an accessible, privacy-preserving proof-of-concept foundation for home telerehabilitation; generalization beyond this one exercise and effectiveness on genuine post-stroke compensations remain to be established. Full article

Background and Objectives: The effect of phacoemulsification on long-term intraocular pressure (IOP) in primary open-angle glaucoma (POAG) remains incompletely defined, particularly in medically controlled disease. This study aimed to evaluate long-term IOP changes following phacoemulsification in eyes with and without POAG using longitudinal statistical modelling. Materials and Methods: This single-centre study, comprising prospective and retrospective components, included 61 patients (30 controls and 31 with medically controlled POAG) who underwent uncomplicated phacoemulsification with intraocular lens implantation. Patients were followed prospectively through six months; long-term IOP values were obtained retrospectively from routine clinical follow-up records. IOP was measured preoperatively and at 1 week, 1 month, 3 months, 6 months, and at final follow-up (44–77 months). Longitudinal IOP changes were analysed using linear mixed-effects models with a piecewise time structure to account for repeated measurements and uneven follow-up. Predictors of postoperative IOP change were evaluated using multivariable linear regression. Changes in antiglaucoma medication burden were assessed using the Wilcoxon signed-rank test. Results: A significant overall effect of time on IOP was observed (p < 0.001), with a significant early postoperative reduction (p < 0.001) followed by long-term stabilisation. No time-by-group interaction reached statistical significance, indicating broadly similar longitudinal IOP trajectories in glaucomatous and non-glaucomatous eyes. Mean preoperative IOP was 14.80 ± 2.50 mmHg in controls and 15.48 ± 3.12 mmHg in the POAG group. At final follow-up (44–77 months), mean IOP was reduced by 1.20 mmHg (8.1%) in the control group and by 1.13 mmHg (7.3%) in the POAG group relative to preoperative values. At 60 months, model-predicted IOP remained below baseline in both groups (control: 13.55 mmHg; POAG: 14.39 mmHg). Higher preoperative IOP showed the strongest association with greater postoperative IOP reduction (p < 0.001). No significant long-term change in antiglaucoma medication burden was observed in the POAG group (p = 0.157). Conclusions: Uncomplicated phacoemulsification produced a modest but sustained reduction in IOP over long-term follow-up in eyes with and without medically controlled POAG. In POAG, IOP remained below baseline over long-term follow-up, with 29 of 31 patients requiring no change in the number of topical agents. Cataract surgery alone provides a limited but durable IOP benefit in medically controlled POAG. Full article

Neighborhood quality is the hardest hedonic component to measure and is usually proxied by coarse census aggregates. I ask whether complaint composition reveals infrastructure quality that markets capitalize, or if it merely reflects unequal engagement and urbanicity. I link 556,882 geolocated complaints from Thailand’s Traffy Fondue platform (January 2025 to June 2026) to 8553 for-sale condominiums across Bangkok, geocoding each project with two independent services (76% building precision, cross-validated to 45 m), and measure the local complaint environment within 250 to 1000 m rings. Across the 45 active districts, price tracks complaint composition strongly, but the fingerprint is collinear with urban density and collapses once complaint density is controlled. The central contribution is a within-area test: conditional on district and sub-district fixed effects, condominiums in a locally more flood-prone micro-location sell for less, 4.4% per standard deviation, strengthening with radius and with geocoding precision, and surviving false-discovery-rate correction. Complaint-mix diversity is likewise capitalized. Footpath share is positively signed but does not survive correction: complaint composition is two-dimensional, some categories indexing disamenity, others urban intensity. Regional PM_2.5 haze carries no within-city signal. Citizen complaints are thus a spatially resolved fingerprint of local environmental quality, capitalizable only where the signal is local. Full article

A camera-guided warehouse robot keeps its bearings by repeatedly estimating its pose against known visual references, and it must relocalize whenever that estimate is lost. What limits this process is often not identification but the availability of a usable reference along the route. The references used in practice are usually single-sided planar fiducial markers such as QR-like codes, ArUco markers, and AprilTags, which stay readable only within a limited cone about their surface normal; a spatial reference, by contrast, can in principle be recognized from any azimuth. We quantify what that difference is worth at the navigation level. The framework is built in Unity with NavMesh navigation and a purely geometric-availability model, rather than an image-based recognizer, whose single switchable property is the availability rule. In the idealized all-azimuth spatial-reference regime (the spatial regime), a reference is available from any direction; in the single-sided, angularly constrained planar-reference regime (the planar regime) it is available only within $\pm 20°$ of the surface normal. A full-factorial experiment with 54 configurations ($3\times 3\times 2\times 3$) and $n=100$ paired replications, 10,800 runs in all, was run in both regimes over four deployment factors: deployment scheme, camera field of view, recovery step, and detection range. Under this geometric model, the spatial regime reached $5.7\times$ higher reference coverage ($41.6\%$ vs. $7.3\%$) and a mission-completion rate 30 percentage points higher (86.2% vs. 55.9%). A paired Wilcoxon signed-rank test confirms the coverage difference ($p<0.001$, matched-pairs $d_z=1.84$), and McNemar’s test together with a logistic regression confirms the completion difference. In a factorial analysis of variance, the detection range dominates (partial ${\eta }^2=0.903$), and a strong deployment × range interaction concentrates the advantage in the rack aisles, where a planar reference is seen edge-on. Three further analyses point the same way: an angular-threshold sweep from $10°$ to $60°$, an equal-count deployment control, and route- and time-normalized visibility and relocalization metrics. The advantage also held across square, L-shaped, and U-shaped aisle layouts (32,400 runs in total), with a negligible regime × layout interaction. All these numbers are model-based estimates under an explicitly stated availability model: they measure the navigation-level value of azimuthal reference availability and do not validate any particular physical object, decoding algorithm, or AR device. Full article

Equine herpesvirus type 1 (EHV-1) is a major cause of reproductive loss in mares. This cross-sectional field study evaluated serum concentrations of interleukin-2 (IL-2), interleukin-10 (IL-10), interferon-alpha (IFN-α), and interferon-gamma (IFN-γ), together with the IL-10/IL-2 and IFN-γ/IL-10 ratios, in 26 vaccinated pregnant Thoroughbred mares. The analytical cohort comprised healthy, EHV-1 PCR-negative mares (HM, n = 10), EHV-1 PCR-positive mares sampled within 4 h after fetal expulsion at approximately the sixth month of gestation (AM, n = 9), and EHV-1 PCR-positive pregnant mares without clinically relevant signs (WCS, n = 7). EHV-1 DNA was detected using an EHV-1-specific real-time PCR assay, and serum cytokine concentrations were measured using equine-specific ELISA kits. Serum IFN-α, IFN-γ, and IL-2 concentrations were significantly higher in both AM and WCS mares than in HM mares (all Holm-adjusted p < 0.001), whereas no statistically significant differences in these cytokines were observed between the AM and WCS groups. IL-10 concentrations were significantly higher in WCS mares than in both HM and AM mares (both adjusted p < 0.01), and HM and AM mares did not differ significantly. The IL-10/IL-2 ratio was highest in HM mares, intermediate in WCS mares, and lowest in AM mares, with significant differences among all pairwise comparisons (adjusted p ≤ 0.019). Conversely, the IFN-γ/IL-10 ratio was highest in AM mares, intermediate in WCS mares, and lowest in HM mares, again with significant differences among all pairwise comparisons (adjusted p ≤ 0.044). These findings indicate substantial antiviral immune activation in both EHV-1-positive groups, with a comparatively stronger regulatory immune component in WCS mares and a predominantly pro-inflammatory profile in mares sampled after abortion. Full article

Background/Objectives: Breast imaging reports contain Breast Imaging Reporting and Data System (BI-RADS) assessments and management recommendations that may be difficult for patients to understand across languages. Large language models (LLMs) may support patient-facing communication, but clinically important details must be preserved. This study compared radiologists’ opinions regarding the quality, clinical fidelity, safety of wording, and communication usefulness of patient-friendly Arabic translations of BI-RADS breast imaging reports generated by three LLMs. Methods: Five de-identified reports representing BI-RADS categories 0, 2, 3, 4, and 6 were translated from English into Arabic by DeepSeek, ChatGPT, and Gemini using an identical structured prompt. Fifty radiologists rated the blinded outputs across eight 5-point domains. Model ratings were compared using Friedman tests, Kendall’s W, and multiplicity-adjusted Wilcoxon signed-rank tests. Laterality was also verified against the source reports. Results: Gemini achieved the highest overall mean score (3.73 ± 0.78), followed by DeepSeek (3.54 ± 0.73) and ChatGPT (3.03 ± 0.70). The overall model effect was significant (χ² = 34.11, df = 2, p < 0.001; Kendall’s W = 0.341). Gemini and DeepSeek each outperformed ChatGPT across all eight domains (adjusted p < 0.001), and Gemini outperformed DeepSeek overall (adjusted p = 0.009). No laterality errors were identified among the 15 translations. Conclusions: Performance remained model-dependent despite the shared prompt. Among the participating radiologists, Gemini received the highest expert ratings, while DeepSeek remained competitive. Because errors involving BI-RADS categories, laterality, measurements, lesion location, or recommendations could change diagnostic understanding, LLM-generated Arabic translations should serve as radiologist-reviewed communication aids rather than autonomous substitutes for clinical explanation. Full article

Overtourism management increasingly uses public communication to frame how visitors are expected to move, behave, and understand their responsibilities in pressured destination spaces. Yet, in heritage cities, such communication is often examined through isolated signs, etiquette campaigns, visitor advisories, or congestion notices rather than as part of a wider visitor-management communication system. This paper examines Kyoto as a case of overtourism communication in an urban heritage setting. Using document-based content analysis supported by exploratory statistical tests, it maps 64 public-facing communication artifacts published between 2016 and 2025 and codes them by message orientation, artifact type, source environment, and spatial focus. The findings show that exclusionary messaging does not dominate Kyoto’s public-facing overtourism communication within the analyzed corpus. Dispersal and behavioral guidance is the most common orientation, while restriction is targeted and secondary, and invitational place guidance remains comparatively limited. Message orientation is significantly associated with artifact type, with restriction concentrated in signs and posters and invitational place guidance appearing mainly in guides and brochures. Semi-institutional actors account for most artifacts, indicating the central role of destination-management organizations and other visitor-facing tourism bodies in translating management concerns into public guidance. Spatially, guidance-oriented communication appears broadly across the city, while restriction has its clearest place-based concentration in Eastern Kyoto, especially Gion-related areas. A smaller set of messages invites visitors to explore wider Kyoto or less conventional places beyond standard guidebook routes. Drawing on the lens of soft urban governance, the paper argues that public-facing overtourism communication can be understood as one visible layer through which visitor-management expectations are framed, spatially differentiated, and made publicly legible. As a document-based analysis, the study does not measure visitor reception, compliance, or behavioral effects, which remain priorities for future research. Full article

Background/Objectives: Hypoxic–ischemic encephalopathy (HIE) remains a leading cause of neonatal death and long-term neurodisability. Cardiovascular dysfunction commonly accompanies HIE and influences neurological recovery, yet it is difficult to recognize because conventional clinical signs correlate poorly with the myocardial function. This review summarizes the current evidence on cardiac dysfunction in neonates with HIE, with particular attention to the diagnostic tools used to evaluate cardiovascular function and the clinical outcomes associated with myocardial injury. Methods: We conducted a narrative review informed by a systematic, reproducible search of four databases (PubMed, Embase, Cochrane Library, and Web of Science) from 2000 to 2026, using a Population–Concept–Context framework to identify studies of term and near-term neonates (≥35 weeks gestation) with HIE or perinatal asphyxia reporting a measure of cardiac dysfunction (electrocardiographic, biomarker, echocardiographic, or clinical hemodynamic). Records were screened and selected using Covidence systematic review software; eligible studies were original, primary-data reports with a minimum sample size of 20 neonates. Findings were synthesized narratively and grouped thematically by diagnostic modality and clinical outcome. Results: Eighty-one studies met the pre-specified eligibility criteria following a systematic multi-database search and structured screening process. As a subset of included studies are secondary analyses or overlapping cohorts, an aggregate patient count is not reported. Reported prevalence of cardiac dysfunction varied widely with the definition applied, reaching 70–90% when multimodal assessment was used. Blood pressure, heart rate, urine output, and lactate were inconsistently reliable indicators of myocardial function, and ejection fraction and fractional shortening often remained normal despite injury. Tissue Doppler imaging and speckle-tracking strain appeared to be more sensitive, with impaired left ventricular global longitudinal strain associated with brain injury. The right ventricle was more commonly and severely affected, with reduced TAPSE, RV fractional area change, and RV strain associated with death or MRI-defined injury. Each additional 24 h of inotropic support was associated with increased odds of adverse short- and long-term outcomes by 14% and 12%, respectively. Conclusions: Cardiac dysfunction is common and prognostically important but remains underrecognized by the routine clinical assessment and cardiovascular monitoring. Multimodal monitoring centered on TnECHO, near infra-red spectroscopy, and specific biomarkers may enable earlier, physiology-based management. Full article