Search Results (45,494)

Background: Childhood obesity is a growing public health concern globally and is associated with a wide spectrum of comorbidities, including sleep-disordered breathing (SDB). SDB remains under-recognized in pediatric population with obesity, particularly in Middle Eastern settings, despite its significant impact on cognitive, behavioral, and metabolic health. Objectives: To assess the prevalence of SDB among children with obesity aged 6–12 years attending King Faisal University polyclinics in Saudi Arabia and to identify key demographic and anthropometric predictors, with particular emphasis on the mediating role of neck circumference. Methods: A cross-sectional study was conducted involving 130 children with obesity aged 6–12 years. Data collection included sociodemographic characteristics, anthropometric measurements (BMI percentile, neck and waist circumference), and screening for SDB using the validated Arabic version of the Pediatric Sleep Questionnaire Sleep-Related Breathing Disorder (PSQ-SRBD) scale. Logistic regression and mediation analyses were performed to examine associations and pathways between obesity parameters and SDB risk. Results: Of the 130 participants, 37.7% screened positive for SDB risk. SDB prevalence was higher among males and older children. Neck circumference and BMI percentile were independently associated with SDB risk, with neck circumference mediating the relationship between BMI and SDB. The mediation model indicated that increased BMI contributes to SDB risk both directly and indirectly through increased neck circumference. Conclusion: SDB is highly prevalent among obese Saudi children, and neck circumference is a significant mediator of risk. Incorporating SDB screening and neck circumference measurements into routine pediatric obesity care can facilitate early detection and management. These findings support the need for integrated, multidisciplinary approaches to improve pediatric health outcomes. Full article

Background/Objectives: Folk dance represents an educational and cultural practice that is capable of promoting psychological well-being, social cohesion, and identity formation. However, few studies have integrated students’ voices regarding their lived experiences in these practices. This study aimed to analyze the perceptions of children and adolescents about their participation in school folk dances, exploring their impact on psychological well-being, self-confidence, and body awareness. Methods: A qualitative study with an exploratory and descriptive design was conducted with a purposive sample of 76 elementary and secondary school students who participated in the School Folk Dance Encounter “Heartbeats of My Land”, organized by the Metropolitan University of Educational Sciences (Chile). Semi-structured interviews were applied, and a thematic analysis was performed on 285 statements, organized into two dimensions: Psychological Well-being and Self-Confidence (PWS) and Body Awareness, Expression, and Communication (CEC). Results: The analysis revealed a predominance of the (PWS) dimension (85.3%), focused on positive emotions, self-confidence, and emotional regulation. Students’ testimonies highlighted dance as a means of release, self-esteem, and joy. To a lesser extent (14.7%), the (CEC) dimension reflected the perception of the body as a vehicle for communication and symbolic expression. Conclusions: Folk dance emerges as an integral pedagogical space that enhances emotional well-being, self-confidence, and cultural identity. Its systematic inclusion in Physical Education is proposed as a strategy to foster meaningful learning, mental health, and social cohesion. Full article

Objective: This study characterized Spanish occupational therapists’ knowledge of the national Code of Ethics and perceptions of professional ethics and examined associations with sociodemographic and educational variables. It quantified knowledge of key Code elements (approving body and professional values), described ethics education and participation in formal ethical support structures, and identified resources used to manage ethical conflicts in routine practice. Methods: A descriptive cross-sectional online survey was administered between March and September 2022. The analytical sample included 596 occupational therapists practicing in Spain. The questionnaire assessed participant characteristics, ethics education, knowledge and perceived importance of the Code, participation in ethics committees or similar structures, experience of ethical conflicts, and conflict-management strategies. Descriptive and bivariate analyses were conducted (p < 0.05). Results: Respondents were mostly women (86.6%) and aged 20–40 years. Although 65.3% reported university ethics education and 73.2% rated the Code as important/very important, 11.4% were unaware of its existence. Only 28.2% identified the approving body, and 16.3% correctly identified the professional values included in the Code. Ethical conflicts were reported by 43.1%. When conflicts occurred, respondents most often consulted the interdisciplinary team (25.5%) or occupational therapy colleagues (24.3%), whereas few consulted the Code (4.5%) or an ethics committee (2.7%). Ethics education and greater professional experience were associated with higher Code knowledge. Conclusions: Occupational therapists in Spain endorse professional ethics, yet actionable knowledge and use of the Code and engagement with formal support structures remain limited. Strengthening practice-oriented ethics education and accessible deliberation mechanisms may improve ethical decision-making. Full article

Background: In recent years, growing attention has been paid to the lifestyle factors that influence young adults’ well-being. University students represent young adults at risk of Sedentary Behavior (SB) and mental distress. Sport Science students represent a health-conscious population, less prone to mental distress. This study aims to investigate the associations between physical activity (PA) levels, different determinants of quality of life (QoL), orthorexia nervosa (ON) symptoms, and internet use among Sport Science students living in Naples. Methods: An online survey comprising General Data (GD) and eight validated questionnaires was used to assess PA levels, mood, sleep quality, eating habits, and digital behavior in a population of university students enrolled in Sport Science courses at Parthenope University, Naples. The statistical analyses included descriptive statistics, Student’s t-test, a Mann–Whitney U Test, frequencies, chi-square tests, and a Spearman’s rank correlation. All the analyses were performed using JASP and Jamovi software. Results: We surveyed 775 students (472 M; 303 F; 22.85 ± 3.85 y; BMI 23.74 ± 3.63 kg/m²). Regarding the MET-min/week, 65% of participants reported being highly active, 28% moderately active, and 7% inactive. Poor sleep quality was reported by 20% of those surveyed. Additionally, 84% of participants declared average internet use, which positively correlated with their emotional profile and sleep quality. High PA levels were directly associated with the presence of ON symptoms in 27% of the participants, most of whom exercised in gyms. Conclusions: To our knowledge, this is the first study conducted on a study population of Sport Science University students addressing the complex and interconnected relationships between PA levels, QoL, ON symptoms, and internet use. Full article

This study proposes a multi-objective, multi-class explainable modeling framework to explain country performance profiles in PISA Mathematics (PISAM), Reading (PISAR), and Science (PISAS). Instead of treating PISA as a simple ranking, the study models each country’s Low/Medium/High-achieving class and asks which structural signals the model relies on when assigning a country to this class. To this end, the study combines governance quality (e.g., accountability, control of corruption, and political stability, etc.), economic and administrative capacity, and regional/institutional location in a single prediction pipeline and explains the resulting classifications with SHAP contributions conditional on class. While the findings do not point to a single, universal determinant, in mathematics, high-level profiles cluster around political stability, economic scale barriers, and regional location, along with governance indicators; in reading, economic capacity is explicitly integrated into this institutional core; and in science, in addition to these two dimensions, the shared institutional dynamics of regional blocs come into play. Furthermore, the study not only produces explanations but also quantitatively reports their reliability. The fit with the model output (Fidelity) and the traceability of the decision logic (Faithfulness) are 0.95/0.85 for PISAM, 0.89/0.92 for PISAR, and 0.89/0.89 for PISAS, which demonstrates high internal consistency and traceability of the decision process. Overall, the study reframes the PISA results not as isolated test scores but as structural profiles generated by the combination of governance, capacity, and region, revealing the policy-relevant levers behind “high performance” as a transparent and reproducible decision-making pipeline. This provides policymakers with an important roadmap for creating a sustainable education policy. Full article

During a period of intense solar activity and highly disturbed geomagnetic conditions, a large Forbush decrease began on 10 May 2024 accompanied by a historic geomagnetic storm that lasted for four days. This extreme geomagnetic disturbance classified as G5 according to “NOAA Space Weather Scale for Geomagnetic Storms” is referred to in the literature as the Mother’s Day Storm. This resulted from multiple, at least seven, Coronal Mass Ejections (CMEs) that had been occurring since 7 May. In addition, on 11 May, a powerful X5.8 class solar flare, reaching its maximum at 01:32 UT, was followed by an abrupt increase in proton flux with energies > 100 MeV (with onset on 11 May at 01:45 UT and peaking at 02:45 UT), as recorded by GOES satellites. This resulted in a Ground Level Enhancement (GLE), identified as GLE74, occurring on 11 May 2024 during the recovery phase of the deep Forbush decrease (~15%). This Solar Energetic Particle (SEP) event consisted of both impulsive and gradual components, where the high-energy tail of the gradual component was recorded by several stations of the worldwide ground-based neutron monitor network. Approximately 15 minutes after the onset of the SEP event and 40 minutes prior to its peak, an alert was issued by the GLE Alert++ system of the Athens Neutron Monitor Station of the National and Kapodistrian University of Athens (NKUA), available as a federated product on the ESA SWE Portal under the Space Radiation Expert Service Centre. In this paper, a description of the solar activity, i.e., solar flares and CMEs, occurring during this time period is given. Moreover, recordings of cosmic ray data obtained by ground-based neutron monitors are used to perform a detailed analysis of GLE74. Finally, the response of the NKUA GLE Alert++ system to GLE74 is thoroughly presented. Full article

Kolmogorov–Arnold Networks employ learnable univariate activation functions on edges rather than fixed node nonlinearities. Standard B-spline implementations require $O\left(3KW\right)$ parameters per layer (K basis functions, W connections). We introduce shared Gaussian radial basis functions with learnable centers ${\mu }_k^{\left(l\right)}$ and widths ${\sigma }_k^{\left(l\right)}$ maintained globally per layer, reducing parameter complexity to $O(KW+2LK)$ for L layers—a threefold reduction, while preserving Sobolev convergence rates $O\left(h^{s-\Omega }\right)$. Width clamping at ${\sigma }_{min}={10}^{-6}$ and tripartite regularization ensure numerical stability. On MNIST with architecture $[784,128,10]$ and $K=5$, RBF-KAN achieves $87.8\%$ test accuracy versus $89.1\%$ for B-spline KAN with $1.4\times$ speedup and 33% memory reduction, though generalization gap increases from $1.1\%$ to $2.7\%$ due to global Gaussian support. Physics-informed neural networks demonstrate substantial improvements on partial differential equations: elliptic problems exhibit a $45\times$ reduction in PDE residual and maximum pointwise error, decreasing from $1.32$ to $0.18$; parabolic problems achieve a $2.1\times$ accuracy gain; hyperbolic wave equations show a $19.3\times$ improvement in maximum error and a $6.25\times$ reduction in $L^2$ norm. Superior hyperbolic performance derives from infinite differentiability of Gaussian bases, enabling accurate high-order derivatives without polynomial dissipation. Ablation studies confirm that coefficient regularization reduces mean error by 40%, while center diversity prevents basis collapse. Optimal basis count $K\in [3,5]$ balances expressiveness and overfitting. The architecture establishes Gaussian RBFs as efficient alternatives to B-splines for learnable activation networks with advantages in scientific computing. Full article

Inner strength is increasingly recognized as a protective factor in mental health, but its structure and dynamics remain underexplored, particularly in individuals with borderline personality disorder (BPD) symptoms. This study applied network analysis to investigate the complex relationships among inner strengths in individuals exhibiting BPD symptoms, aiming to identify core and bridging strengths that could inform targeted interventions. The sample comprised 346 Thai university students (25.4% males, 74.6% females; mean age = 21.60 ± 2.24 years) who screened positive for BPD symptoms using the Screening Instrument for Borderline Personality Disorder. Network analysis revealed that inner strengths formed an interconnected system with both core and peripheral features. The strongest association was observed between generosity and loving-kindness. A cognitive behavioral cluster comprising perseverance, wisdom, and determination also emerged. Centrality analysis identified loving-kindness as the most influential node in terms of direct connections, while equanimity exhibited the highest bridge centrality. Generosity and determination demonstrated the greatest expected influence. A negative link between truthfulness and equanimity highlighted a potential conflict between absolute honesty and inner balance in this population. Notably, exploratory analyses by gender revealed distinct network structures. In males, determination, wisdom, and precept emerged as central strengths; however, results for males should be interpreted with caution due to sample size. In females, perseverance, loving-kindness, and meditation were the most influential. These gender-specific patterns suggest that targeting different core strengths according to gender may enhance the effectiveness of interventions for individuals with BPD symptoms. Overall, the findings suggest that fostering specific inner strengths, particularly equanimity, loving-kindness, and those identified as central for each gender, may enhance psychological resilience and inform more tailored intervention strategies for BPD. Full article

Objective: To identify risk factors for intrapartum cesarean delivery (CD) among women with obesity (BMI ≥ 30) and to evaluate whether a machine learning model (XGBoost) can improve prediction of this outcome compared with a previously developed regression-based risk score. Methods: A retrospective cohort study at a single university-affiliated tertiary medical center was conducted. All women with a pre-pregnancy BMI ≥ 30 who initiated a trial of labor between 2012 and 2024 were included. Women who underwent elective CD or had missing outcome data were excluded. Maternal, obstetric, and intrapartum characteristics were compared between women who delivered vaginally and those who required an intrapartum CD. Predictors were evaluated using extreme gradient boosting (XGBoost), and model performance was assessed using receiver operating characteristic (ROC) analysis and SHAP-based interpretability. Results: Among 146,999 women who delivered during the study period, 10,248 (7.0%) had a pre-pregnancy BMI ≥ 30. A total of 7236 obese women attempted a trial of labor, of whom 1031 (14.5%) underwent an intrapartum CD. Key predictors included limited cervical dilatation at admission, epidural anesthesia, nulliparity, maternal BMI and age, oxytocin use, birthweight, inflammatory markers (white blood count and neutrophils to lymphocytes ratio), and previous cesarean scar. The XGBoost model demonstrated excellent discriminatory ability with an AUC of 0.945 (95%CI 0.930–0.960, DeLong), and exceeded the performance of our previous regression-based score, and provided detailed insight into nonlinear effects through SHAP analysis. In a secondary analysis restricted to variables available at admission, a pre-labor model retained a strong discriminatory performance across BMI categories, supporting its applicability for early risk stratification prior to labor onset. Conclusions: A machine learning-based model accurately predicts intrapartum cesarean delivery in women with obesity and may serve as a valuable tool to support individualized counseling and delivery planning. Full article

Background/Objectives: Effective use of health services is essential for universal health coverage, yet many adults in Peru still forgo formal care despite illness. Evidence describing national trends and determinants of non-use of formal health services remains limited. This study aimed to estimate national trends from 2015 to 2024 and identify factors associated with non-use among Peruvian adults. Methods: We conducted a repeated cross-sectional analysis of annual secondary microdata from the Peruvian National Household Survey (ENAHO, 2015–2024). Adults aged ≥ 18 years who reported a health problem in the last four weeks were included. Non-use was defined as not seeking care at any public or private provider (IPRESS). Survey-weighted descriptive analyses and modified Poisson regression models estimated prevalence ratios (PRs) with 95% confidence intervals, adjusting for sex, age, education, marital status, health insurance, chronic illness, disability, area, and region. Results: Among 330,165 adults, 41.5% did not use formal health services. Non-use declined until 2019, rose sharply during 2020–2021, and partially recovered thereafter. In adjusted models, non-use was lower among women (PR = 0.92; 95% CI 0.91–0.93), those with higher education (PR = 0.88; 0.86–0.90), and participants insured by EsSalud (PR = 0.65) or SIS (PR = 0.76). It was higher in the Highlands (PR = 1.07) and lower in Metropolitan Lima (PR = 0.88). Conclusions: Non-use of formal health services in Peru remains high and unequal. Expanding effective coverage, strengthening primary care, and improving health literacy are essential to achieve equitable access. Full article

Background: Data on long-term sequelae after severe imported Plasmodium falciparum malaria in adults are scarce in non-endemic settings. We aimed to quantify early and medium term renal and neurological outcomes and identify prognostic factors. Therapeutic strategies have evolved with widespread intravenous artesunate, yet survivorship data remain limited. Methods: We performed a retrospective study of cases of severe malaria at the University Hospital of Marseille (France) between January 2018 and December 2024. This study is a single-centre retrospective cohort with prospective follow-up using standardised questionnaires. Adults meeting the criteria for severe falciparum malaria were included. The primary endpoint was a composite of renal impairment and/or neurological sequelae assessed at day 28 (D28) and at remote post-discharge follow-up. Patient-reported outcomes were collected at one year. Associations with baseline features were tested using the Fisher’s exact and Wilcoxon–Mann–Whitney tests. Results: Among 474 malaria cases, 66 (13.9%) were severe; of these, 57 met inclusion criteria. Fifty-seven of them were included. All received intravenous artesunate with oral step-down; 35% required ICU care. At D28, 6/41 patients (14.6%) had sequelae (four renal, one neurological, one both). Sequelae at D28 were associated with neurological failure (66.7% vs. 14.3%; p = 0.015), severe metabolic acidosis (50.0% vs. 2.9%; p = 0.007) and renal impairment at admission (83.3% vs. 2.9%; p < 0.001). At remote follow-up, 6/33 patients (18.2%) had sequelae (two renal, three neurological, one both), associated with older age (61.0 ± 5.3 vs. 39.8 ± 15.8 years; p = 0.008), D3 blood smear positivity (66.7% vs. 11.5%; p = 0.012), neurological failure (66.7% vs. 18.5%; p = 0.034) and renal impairment (50.0% vs. 7.4%; p = 0.031). No deaths or relapses occurred. At one year, patient-reported outcomes (n = 14) showed persistent symptoms in 8/14, chiefly fatigue and cognitive complaints. Conclusions: In a high-resource, non-endemic setting, renal and neurological sequelae after severe imported malaria are frequent at D28 and persist in nearly one-fifth of cases during post-discharge follow-up. Neurological failure, metabolic acidosis, renal impairment at presentation, older age and D3 blood smear positivity identify patients at risk and support risk-stratified post-discharge follow-up. Full article

Background: Atrial Fibrillation (AF) is associated with a prothrombotic state and increased risk of ischemic stroke. Type 2 diabetes mellitus (T2DM) is a major cardiometabolic comorbidity in AF and independently increases thromboembolic risk. D-dimer is a well-established biomarker of coagulation activation and fibrin turnover, but the specific contribution of T2DM to D-dimer levels in AF remains insufficiently characterized in real-world cohorts. Methods: We conducted a retrospective, observational, single-center study including 300 adult patients with non-valvular AF evaluated at a tertiary university hospital. Patients were stratified according to the presence of T2DM (150 with T2DM and 150 without diabetes). Plasma D-dimer levels were compared between groups and analyzed across clinically relevant thresholds and CHA₂DS₂-VASc categories. Multivariable linear and logistic regression models were used to assess the independent association between T2DM and D-dimer levels after adjustment for demographic factors, comorbidities, renal function, prior stroke, CHA₂DS₂-VASc score components, and oral anticoagulation. Results: Patients with T2DM exhibited significantly higher D-dimer levels than non-diabetic patients (median 0.94 vs. 0.63 µg/mL FEU, p < 0.001). T2DM was independently associated with higher log-transformed D-dimer levels (adjusted β = 0.19, p < 0.001) and with increased odds of elevated D-dimer above both 0.5 µg/mL and 1.0 µg/mL thresholds. Across all CHA₂DS₂-VASc categories, patients with T2DM consistently showed higher D-dimer concentrations. Findings remained robust in sensitivity analyses restricted to anticoagulated patients. Conclusions: In patients with atrial fibrillation, type 2 diabetes mellitus is associated with increased coagulation activity as reflected by higher D-dimer levels, independent of clinical thromboembolic risk. These results support the concept of a diabetes-associated hypercoagulable AF phenotype and highlight the potential role of coagulation biomarkers in refining risk stratification. Full article

Many countries have introduced HPV screening and vaccination programs to reduce the burden of cervical cancer. In Poland, before 2023, HPV vaccination was available only on an individual, non-universal basis, using all types of vaccines, while in 2023, a nationwide vaccination program for boys and girls aged 12–13 years was introduced alongside updated screening guidelines. This retrospective study analyzed 2296 HPV-positive test results obtained from adult patients in Poland, including demographic data, HPV genotypes distribution, infection intensity, and cytological findings. HPV genotyping was performed using the Anyplex™ II HPV28 assay. HR-HPV genotypes accounted for 64.53% of all detected infections, with the highest prevalence observed in individuals aged 26–35 years of both sexes. HPV-18 was significantly more frequently in women (p = 0.0430), whereas HPV-53 predominated in men (p = 0.0030). Men more often presented low-intensity infections, while women showed higher viral load. Multigenotypic infections occurred in 46.5% of cases, particularly among younger patients (p < 0.001), and were significantly associated with LSIL changes in cytology. The HSIL type correlated most strongly with HPV-16 (p < 0.001). These findings confirm the high burden of HR-HPV infections in the Polish adult population and provide an essential epidemiological baseline for evaluating the impact of universal HPV vaccination and updated screening strategies. Full article

The desire to discover the nature of existence and one’s proper role in the universe has been a matter of concern throughout the ages, and individuals have endeavoured to examine the events that occur around them accordingly. In their pursuit, some have embarked on a deeper search for meaning, independent of common perceptions, and have posited that forms of expression beyond the limits of language could potentially provide important clues about the course of their lives. Transcending the limits of language can essentially be achieved by choosing a form of expression that goes beyond sounds, letters, words, or speech. Explained by certain scholars as beyond words, silence (Ar. al-ṣamt) is a discourse or mode of expression that involves the ability to speak inwardly (Ar. al-nuṭq). Thus, silence encompasses the ability to speak through remaining silent—a mode that, at first glance, appears to be paradoxical. This study focuses on one of the ways of attaining truth in theoretical and practical Ṣūfīsm: by remaining silent and finding the key to inner silence simultaneously. To reach such a level of understanding, it is crucial to examine how Ṣūfīs attempt to assimilate the inherent meaning beyond the boundaries of ordinary speech and approach the concept of silence from various aspects. By way of examining the possibility of communicating through silence according to some Ṣūfīs, the ways to a life in contemplation may be analysed to the extent that one could find a language that goes beyond letters or words. Full article

We introduce Lehmer Activation Units (LAUs), a class of aggregation-based neural activations derived from the Lehmer transform that unify feature weighting and nonlinearity within a single differentiable operator. Unlike conventional pointwise activations, LAUs operate on collections of features and adapt their aggregation behavior through learnable parameters, yielding intrinsically interpretable representations. We develop both real-valued and complex-valued formulations, with the complex extension enabling phase-sensitive interactions and enhanced expressive capacity. We establish a universal approximation theorem for LAU-based networks, providing formal guarantees of expressive completeness. Empirically, we show that LAUs enable highly compact architectures to achieve strong predictive performance under tightly controlled experimental settings, demonstrating that expressive power can be concentrated within individual neurons rather than architectural depth. These results position LAUs as a principled, interpretable, and efficient alternative to conventional activation functions. Full article