Search Results (12,961)

Governments worldwide are increasingly adopting intrusive surveillance measures to counter terrorism. However, the psychological and public health consequences of exposure to terrorism remain underexplored. This study examines how exposure to cyber and conventional terrorism affects perceived national threat and support for surveillance policies, using a controlled virtual reality experiment in which participants were immersed in realistic simulations of lethal terror attacks targeting critical railway infrastructure in Israel. Participants were randomly assigned to one of three conditions: cyber (N = 59), conventional (N = 59), or control (N = 45). Outcomes were standardized, but the framing differed by type of attack. Findings show that perceived national threat perceptions are a key mechanism linking exposure to terrorism to surveillance attitudes. At lower threat levels, participants differentiated between cyber and conventional attacks. In contrast, heightened threats led to uniform support for expansive surveillance regardless of the attack modality. Results demonstrate that exposure to terrorism, including cyberattacks on critical infrastructure, can activate psychological responses with implications for public resilience and policy attitudes, shaping preferences concerning privacy and security. These findings underscore the broader societal and public health relevance of understanding how people react to evolving security threats that disrupt essential systems such as transportation, energy, and healthcare. Full article

This narrative review examines the Comprehensive Geriatric Assessment (CGA), a multidisciplinary approach used to evaluate and manage the health of older adults. CGA has been shown to improve functional status, reduce hospital readmissions, delay institutionalization, and lower mortality. Despite these benefits, systematic implementation remains limited. Major barriers include shortages in the workforce and resources, a lack of standardized protocols, and insufficient training in geriatric competencies. These challenges leave many older adults with unmet healthcare needs, particularly in chronic disease management, functional limitations, mental health, and social support. Nurses are well positioned to address these gaps because of their expertise in patient-centered care, care coordination, and chronic disease management. Strengthening geriatric nursing education and integrating CGA into routine nursing practice can improve outcomes for the aging population. Although CGA is often associated with hospital settings, its future lies in broader application. Digital solutions scheduled health assessments, workforce planning, and community- or home-based evaluations can make CGA more accessible. Policymakers, healthcare systems, and educational institutions must work together to develop policies that embed CGA within primary healthcare. Full article

Environmental management systems (EMSs), such as ISO 14001, are commonplace across the architecture, engineering, construction, operations, and management (AECOM) sectors of advanced economies. However, their uptake remains limited across emerging markets and developing economies. This study explores stakeholders’ perceptions of the benefits and barriers to implementing EMSs within the AECOM sectors of Malaysia. Guided by a positivist stance, the study takes a quantitative approach using an online questionnaire to gather the opinions of AECOM professionals. The findings reveal that participants believe the most significant benefits of implementing EMSs in Malaysia are to improve corporate image and contribute to the environmental standards of the sector, whereas the most significant barriers to implementing EMSs are lack of client support and the difficulty in coordinating environmental performance among multi-tier subcontractors. Based on the evidence collected, the study recommends encouragement by the government of Malaysia to drive forward environmental management and further research into the reasons for the lack of reported support for ISO 14001 within the supply chain. Full article

Listeria monocytogenes is a significant foodborne pathogen associated with high rates of hospitalization and death, especially among vulnerable populations. Despite established regulatory standards and available antimicrobial intervention strategies, L. monocytogenes remains as a pathogen of concern in ready-to-eat (RTE) foods. This ultimately can lead to food recalls or listeriosis outbreak, highlighting its ongoing risks to food safety and public health. This review consolidates publicly accessible surveillance case counts and recall data of L. monocytogenes contamination from Australia, Europe, Canada, and the United States to assess the contamination trends in the RTE food supply chain. It also evaluates the effectiveness of antimicrobial intervention strategies, including both those currently implemented in industry and those that have been studied as potential interventions but are not yet widely adopted. Key factors affecting the efficiency of those strategies are identified, including food matrix composition, water activity (a_w), fat content, and strain variability. Emerging multi-hurdle technology that integrates physical, chemical, and biological antimicrobial interventions are highlighted as promising approaches for maintaining both food safety and product quality. It also outlines the role of quantitative microbial risk assessment (QMRA) as a decision-support tool to select appropriate control strategies, predict recall risk and guide evidence-based risk management. Future research directions are proposed to expand the application of QMRA in managing recall risks throughout the RTE food supply chain due to L. monocytogenes. Full article

A laparoscopic approach has been incorporated into the surgical management of a great variety of gynecologic pathologies during the decades following the first description of the method. As knowledge and experience about the use of laparoscopy is accumulating, it is gradually being recognized as an oncologically safe and effective option for the surgical management of various types of gynecological cancer, and the indications for its applications are increasing, as controversial topics are resolved through research. Endometrial cancer is the gynecological malignancy with the most straightforward indications of laparoscopy in its treatment, since a minimally invasive approach is considered the standard of care for both the surgical treatment of early-stage disease and surgical staging through sentinel lymph node biopsy. The role of laparoscopy was significantly decreased in the surgical management of cervical cancer after the publication of the LACC trial which reported worse survival outcomes for patients treated with laparoscopy, and laparotomy has emerged as the preferred approach. However, laparoscopy can be acceptable for carefully selected cases of early-stage cervical cancer and has also been introduced as an effective method for the surgical staging of the disease. The use of laparoscopy in the diagnostic and therapeutic management of ovarian cancer is not fully established but is receiving growing attention, as increasing evidence supports the safety of this approach, especially in the treatment of early-stage disease, where it is considered an acceptable alternative approach to laparotomy. Finally, as laparoscopic advancements are continuously achieved, new indications for laparoscopy have been explored for both vulvar and breast cancer. Future research will identify and highlight new ways to further integrate laparoscopy into the diagnostic and therapeutic management of gynecological malignancies. Full article

The LRRK2+ SAA− cohort of Parkinson’s disease (PD), characterized by the absence of hallmark α-synuclein pathology, remains under-explored. This limits opportunities for early detection and targeted intervention. This study analyzes data from this under-characterized subgroup and compares it with the LRRK2+ SAA+ cohort using longitudinal data from the Parkinson’s Progression Markers Initiative (PPMI). The PPMI dataset includes 115 LRRK2+ patients (70 SAA+, 45 SAA−) across 52 features encompassing clinical assessments, cognitive scores, DaTScan SPECT imaging, and motor severity. DaTScan binding ratios were selected as imaging-based indicators of early dopaminergic loss, while NP3TOT (MDS-UPDRS Part III total score) was used as a gold-standard clinical measure of motor symptom severity. Linear mixed-effects models were then applied to evaluate longitudinal predictors of DaTScan decline and NP3TOT progression, and statistical analyses of group comparisons revealed distinct drivers of symptoms differentiating SAA− from SAA+ patients. In SAA− patients, a decline in DaTScan was significantly associated with thermoregulatory impairment (p-value = 0.019), while NP3TOT progression was predicted by constipation (p-value = 0.030), sleep disturbances (p-value = 0.046), and longitudinal time effects (p-value = 0.043). In contrast, SAA+ patients showed significantly lower DaTScan values compared to SAA− (p-value = 0.0004) and stronger coupling with classical motor impairments, including freezing of gait (p-value = 0.016), rising from a chair (p-value = 0.007), and turning in bed (p-value = 0.016), along with cognitive decline (MoCA clock-hands test, p-value = 0.037). These findings support the hypothesis that LRRK2+ SAA− patients follow a distinct pathophysiological course, where progression is influenced more by autonomic and non-motor symptoms than by typical motor dysfunction. This study establishes a robust, multimodal modeling framework for examining heterogeneity in genetic PD and highlights the utility of combining DaTScan, NP3TOT, and symptom-specific features for early subtype differentiation. These findings have direct clinical implications, as stratifying LRRK2 carriers by SAA status may enhance patient monitoring, improve prognostic accuracy, and guide the design of targeted clinical trials for disease-modifying therapies. Full article

Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients. Complications occurred in 81% of patients and 23% of procedures and were predominantly rated mild to moderate (CTCAE I–II), including nausea, hypotension, and catheter-related issues. Severe complications (CTCAE III–IV) occurred in 11% of patients; no deaths were reported. Clinical improvement was documented in 84% of patients, with 42% showing significant improvement. Conclusions: TPE is a generally well-tolerated and effective treatment in PNID, with a high rate of clinical improvement and predominantly mild complications. The higher reported complication rate compared to other studies likely reflects more comprehensive documentation of minor adverse events. These findings support the use of TPE in PNID, particularly in cases refractory to first-line therapies. Standardized reporting of outcomes and complications is essential to improve comparability across studies and guide future clinical practice. Full article

Background/Objectives: Low-cost portable load cell dynamometers allow for real-time assessment of muscular strength. This study evaluated the reliability and repeatability of the G-Force load cell system during isometric hip abduction and adduction in young physically active Chilean adults. Methods: In total, 24 participants (19 men, 5 women) performed two maximal voluntary contractions per movement, repeated after a 24 h interval. Measured variables included Peak Force, peak rate of force development (Peak RFD), RFD at 50, 100, and 200 ms (RFD50, RFD100, RFD200), and maximum jerk. Reliability was assessed using intraclass correlation coefficients (ICCs), standard error of measurement (SEM), coefficient of variation (CV%) and Bland–Altman plots. Results: Peak Force showed excellent within-day (ICC = 0.94–0.96) and high between-day reliability (ICC = 0.87–0.89; CV = 20–30%). Bland–Altman analysis indicated negligible bias for Peak Force in abduction (−6.54 N; 95% CI −19.55 to 6.47) and adduction (−17.57 N; 95% CI −37.24 to 2.09), confirming the absence of systematic error. Peak RFD, RFD50–200, and maximum Jerk showed moderate repeatability and lower between-day reliability (ICCs = 0.39–0.70; CVs = 34–57%), indicating higher variability in explosive force indices compared with maximal strength. Conclusions: The G-Force load cell reliably measures maximal isometric hip strength, while Peak RFD, RFD50–200, and maximum jerk should be interpreted cautiously. These findings support the device as a practical, low-cost tool for sports and rehabilitation, though future studies should validate dynamic indices in larger and more diverse populations. Full article

Background/Objectives: The Italian version of the Feeding/Swallowing Impact Survey (FS-IS-IT) is an 18-item caregiver self-report questionnaire assessing the impact of paediatric feeding disorders (PFDs) on health-related quality of life (HR-QoL). The present study sought to evaluate its psychometric properties using Classical Test Theory (CTT), following COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines and criteria. Methods: A total of 145 caregivers of children with PFD of various etiologies were recruited (median age: 60.0 months; IQR: 35.8–108.0), of whom 134 provided sufficiently complete data for psychometric analysis. Structural validity was determined using exploratory factor analysis. Internal consistency was assessed using Cronbach’s alpha coefficient, McDonald’s ω, and inter-item correlations. Hypothesis testing was conducted using Mann–Whitney U-tests and correlation analysis, while interpretability was examined by assessing floor and ceiling effects. Results: Factor analysis indicated that the FS-IS-IT is a unidimensional measure, with an adequate total variance explained of 60.1%. The FS-IS-IT has moderate structural validity, good internal consistency with some evidence of item redundancy, strong construct validity as supported by hypothesis testing, and no floor and ceiling effects. Conclusions: These findings suggest that the FS-IS-IT is a promising caregiver self-report measure for evaluating HR-QoL in PFD. Further validation is recommended to assess potential item redundancy and to examine the dimensionality of the FS-IS-IT using item response theory. Conversely, although the Italian version of the FS-IS demonstrated encouraging psychometric properties, it could be further strengthened in future studies by revising ambiguous items, refining response formats, and removing misfitting items. Full article

Background: Primary care overload, limited access to physicians, and rising antimicrobial resistance highlight the role of pharmacists in managing minor ailments such as sore throats. We evaluated pharmacy-based counseling in Poland supported by point-of-care testing and symptomatic therapy. Methods: Multicenter, prospective observational study across 23 community pharmacies. Adults (≥18 years) with sore throat underwent group A streptococcus (GAS) rapid antigen testing. Patients with a positive test result were referred to physicians, while others received pharmacist counseling and ketoprofen throat spray. Standardized questionnaires captured symptom severity, perceived effectiveness, onset/duration, convenience, adherence, and patient-reported outcomes. Results: 142 patients were included. Among ketoprofen users, 98.4% reported improvement, and 75% rated relief ≥8/10. Compared with prior remedies, 88.3% judged ketoprofen more effective, and 86.7% reported faster onset. The spray was convenient for 91.4% of participants; no overdosing occurred. Qualitative feedback emphasized rapid relief, easier swallowing/speaking, and return to daily activities without physician consultation. Conclusions: Polish community pharmacy practice, an integrated sore throat pathway combining point-of-care RADT with structured pharmacist counseling and symptomatic treatment, was feasible, acceptable, and without notable safety concerns. As a pilot, these practice-based findings warrant larger comparative and economic studies to confirm clinical effects and assess potential impact on antibiotic use. Full article

Reliable field estimation of soil moisture supports hydrology and water resources management. This study develops a drone-based hyperspectral approach in which visible and near-infrared reflectance is paired one-to-one with gravimetric water content measured by oven drying, yielding 1000 matched samples. After standardization, outlier control, ranked wavelength selection, and light feature engineering, several predictors were evaluated. Conventional machine learning methods, including simple and multiple regression and tree-based ensembles, were limited by band collinearity and piecewise approximations and therefore failed to meet the accuracy target. Gradient boosting reached the target but used different trade-offs in variable sensitivity. An artificial neural network with three hidden layers, rectified linear unit activations, and dropout was trained using a feature count sweep and early stopping. With ten predictors, the model achieved a coefficient of determination of 0.9557, demonstrating accurate mapping from hyperspectral reflectance to gravimetric water content and providing a reproducible framework suitable for larger, multi date acquisitions and operational decision support. Full article

Background: Multimodal large language models (LLMs) are increasingly being explored as clinical support tools, yet their capacity for orthodontic biomechanical reasoning has not been systematically evaluated. This retrospective study assessed their ability to analyze treatment mechanics and explored their potential role in supporting orthodontic decision-making. Methods: Five publicly available models (GPT-o3, Claude 3.7 Sonnet, Gemini 2.5 Pro, GPT-4.0, and Grok) analyzed 56 standardized intraoral photographs illustrating a diverse range of active orthodontic force systems commonly encountered in clinical practice. Three experienced orthodontists independently scored the outputs across four domains—observation, interpretation, biomechanics, and confidence—using a 5-point scale. Inter-rater agreement and consistency were assessed, and statistical comparisons were made between models. Results: GPT-o3 achieved the highest composite score (3.34/5.00; 66.8%), significantly outperforming all other models. The performance ranking was followed by Claude (57.8%), Gemini (52.6%), GPT-4.0 (48.8%), and Grok (38.8%). Inter-rater reliability among the expert evaluators was excellent, with ICC values ranging from 0.786 (Confidence Evaluation) to 0.802 (Observation). Model self-reported confidence showed poor calibration against expert-rated output quality. Conclusions: Multimodal LLMs show emerging potential for assisting orthodontic biomechanical assessment. With expert-guided validation, these models may contribute meaningfully to clinical decision support across diverse biomechanical scenarios encountered in routine orthodontic care. Full article

Background and Objectives: Quantifying nasal proportions is central to facial plastic and reconstructive surgery, yet manual measurements are time-consuming and variable. We sought to develop a simple, reproducible deep learning pipeline that localizes the nose in a single frontal photograph and automatically computes the two-dimensional, photograph-derived apparent nasal index (aNI)—width/height × 100—enabling classification into five standard anthropometric categories. Materials and Methods: From CelebA we curated 29,998 high-quality near-frontal images (training 20,998; validation 5999; test 3001). Nose masks were manually annotated with the VGG Image Annotator and rasterized to binary masks. Ground-truth aNI was computed from the mask’s axis-aligned bounding box. A lightweight one-class YOLOv8n detector was trained to localize the nose; predicted aNI was computed from the detected bounding box. Performance was assessed on the held-out test set using detection coverage and mAP, agreement metrics between detector- and mask-based aNI (MAE, RMSE, R²; Bland–Altman), and five-class classification metrics (accuracy, macro-F1). Results: The detector returned at least one accepted nose box in 3000/3001 test images (99.97% coverage). Agreement with ground truth was strong: MAE 3.04 nasal index units (95% CI 2.95–3.14), RMSE 4.05, and R² 0.819. Bland–Altman analysis showed a small negative bias (−0.40, 95% CI −0.54 to −0.26) with limits of agreement −8.30 to 7.50 (95% CIs −8.54 to −8.05 and 7.25 to 7.74). After excluding out-of-range cases (<40.0), five-class classification on n = 2976 images achieved macro-F1 0.705 (95% CI 0.608–0.772) and 80.7% accuracy; errors were predominantly adjacent-class swaps, consistent with the small aNI error. Additional analyses confirmed strong ordinal agreement (weighted κ = 0.71 linear, 0.78 quadratic; Spearman ρ = 0.76) and near-perfect adjacent-class accuracy (0.999); performance remained stable when thresholds were shifted ±2 NI units and across sex and age subgroups. Conclusions: A compact detector can deliver near-universal nose localization and accurate automatic estimation of the nasal index from a single photograph, enabling reliable five-class categorization without manual measurements. The approach is fast, reproducible, and promising as a calibrated decision-support adjunct for surgical planning, outcomes tracking, and large-scale morphometric research. Full article

This study examined the impact of early robotics experiences on kindergarten children’s self-efficacy and performance across multiple domains, including building, following visual instructions, problem-solving, and object repair. Ninety-seven children (ages 4–6) were assigned to either a research group (n = 46) receiving a year-long robotics curriculum or a control group (n = 51) following the standard curriculum. A quasi-experimental pre-test–post-test design was employed. Self-efficacy was measured using dichotomous questionnaire items, and performance was assessed through hands-on age-appropriate repair tasks. Baseline comparisons showed no significant differences between groups, supporting equivalence at the start of the study. Results indicated that children who participated in the robotics program reported greater confidence in building, following visual instructions, and solving problems compared to the control group. Importantly, children in the robotics group not only reported greater confidence in their repair abilities but also outperformed peers in the post-test repair task. These findings indicate that early robotics fosters both beliefs of capability and tangible problem-solving skills in early childhood. Embedding robotics into kindergarten curricula may therefore strengthen foundational self-efficacy and support transferable skills relevant for long-term learning and well-being. Full article

Colorectal cancer (CRC) is among the most prevalent malignancies worldwide, representing the second leading cause of cancer-related mortality and accounting for approximately 2 million new cases and nearly half a million deaths annually. Global age-standardized incidence rates are highest in Australia/New Zealand and other Western countries, and lowest in parts of sub-Saharan Africa and South Asia, reflecting variations in demographics, lifestyle exposures, and screening practices. Colon cancer constitutes the larger fraction of CRC cases, with rectal cancer contributing substantially, and early-onset CRC (<50 years) is increasing across both high-income and emerging regions. Established risk factors include age, hereditary syndromes, obesity, sedentary behavior, dietary patterns, metabolic disorders, and chronic inflammation, with notable distinctions between colon and rectal subsites. This narrative review provides a comprehensive overview of CRC epidemiology, molecular and genetic pathogenesis, staging, and modern therapeutic approaches, addressing colon and rectal cancers separately due to their distinct biology, clinical behavior, and treatment strategies. By integrating current knowledge on genetic drivers, systemic and local therapies, and patient stratification, the review aims to inform clinical practice, support clinical trial design, discuss ongoing challenges and future perspectives, and foster further research toward precision-guided management of CRC. Full article