Atmospheric and Oceanic Sciences

Identifying the role of guilt in post-traumatic stress disorder (PTSD) has important implications for understanding the development and treatment of PTSD. The present study is a secondary analysis of data collected on veterans with combat-related PTSD (N = 61) who enrolled in a clinical trial. Hierarchical regression analyses were used to explore associations between action- and survivor-guilt on the Clinician Administered PTSD Scale (CAPS), PTSD symptom severity on the CAPS, and depression on the Quick Inventory of Depressive Symptomatology (QIDS). Action- and survivor-guilt independently predicted PTSD total symptom severity, but in examining PTSD symptom cluster severity, only action-guilt independently predicted avoidance and numbing severity in PTSD. However, depression symptom severity on QIDS also mediated the association between action-guilt and PTSD total symptom severity and avoidance and numbing severity. Thus, action- and survivor-guilt appear to have independent contributions to PTSD symptom severity, and action-guilt, more specifically, appears to affect avoidance and numbing severity in PTSD through depression. The findings are discussed in terms of the potential role of guilt in PTSD and in relation to previous research on guilt and depression in PTSD and PTSD treatment.

Epilepsy is a common treatable neurological condition characterized by recurrent involuntary brain activity manifested in seizures. It is estimated that around 30% of patients with this disease do not respond to initial pharmacological treatments, developing drug-resistant epilepsy. Among the non-pharmacological treatment options are ketogenic diet therapies (KDT) in its various forms. The objective of this study is to systematically review the randomized controlled trials investigating the use of KDTs in pediatric and adult drug-resistant epilepsy, according to Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The following databases: Embase, PubMed/Medline, LILACS, and the Cochrane Library, were searched and studies fitting the inclusion and exclusion criteria were included for analysis. Randomized controlled trials (RCT) with a minimum follow-up of 28 days were included. There were 1193 articles retrieved after duplicates were removed and 17 met the inclusion criteria. Eleven studies included children (up to 12 yrs) and six included adolescents from 13 years old and adults. Follow-up ranged from 6 to 24 months. In children, 37% may achieve a reduction in seizure frequency of 50% or more with in any form of KDT (moderate-certainty evidence). In addition, about 6 more children per 100 may achieve a ≥ 90% reduction, although this is supported by low-certainty evidence. In adolescents and adults, KDT may lead to a ≥ 50% reduction in seizure frequency in 16 more individuals per 100 compared with usual care (moderate-certainty evidence), but its impact on a 90% or greater reduction is uncertain due to the limited number of reported events and imprecision in available studies. Side effects in children showed no significant differences compared to usual care (low certainty), while in adults, the impact remains uncertain (very low certainty). Adherence to treatment may be slightly lower with KDT in both children and adults/adolescents compared to usual treatment, though results are inconsistent. Regarding quality of life and cognitive and behavioral outcomes, studies are scarce, heterogeneous, and of very low certainty, limiting the ability to draw strong conclusions.

PURPOSE: The study explored the views of organisational stakeholders who participated in the feasibility trial of the Pain-at-Work Toolkit towards the implementation of the toolkit in 'real-world' workplace settings. This digital toolkit was co-created with healthcare professionals, employers, and people with chronic pain and aimed to inform and enable individuals to self-manage their chronic pain at work. DESIGN/METHODOLOGY/APPROACH: A qualitative study using semi-structured interviews with 15 stakeholders from 12 organisations that participated in a feasibility trial of the Pain-at-Work Toolkit. Purposive sampling was used to ensure the inclusion of stakeholders with management or supportive roles who have responsibility for the health and wellbeing of employees. FINDINGS: The findings illuminate three key themes: not all disabilities are visible; not all line managers are equal; and who has control? These surmise that invisible disabilities such as chronic pain are underestimated, poorly understood, and inconsistently provisioned for in organisational policies. It highlights the key role that line managers play in employee disclosure and access to support but demonstrates that line managers vary in their delivery of support to employees. Lastly, it explores stakeholder perceptions of the roles of the employer relative to the employee with chronic pain. It confirms the need for additional resources to plug organisational gaps and give workers tools to self-manage their pain at work. ORIGINALITY: This study indicates the need for resources / supports to upskill line managers so they can intervene to proactively support employees with chronic pain to reduce sickness absence and presenteeism (working when unwell). The research demonstrates organisational stakeholders' interest in a multi-faceted approach to help employees self-manage chronic pain in all types at work, such as that provided by the Pain-at-Work Toolkit. In addition, it clearly identifies the potential for complementary resources to educate and facilitate line managers to better support their staff.

OBJECTIVE: Unilateral vocal fold paralysis (UVFP) can lead to both voice impairment and dysphagia. Previous studies have suggested that surgeries aimed at improving voice function in patients with UVFP may also incidentally enhance swallowing. However, the preventive effect of such surgeries on pneumonia remains unclear. We evaluated the impact of laryngoplasty on the incidence of pneumonia in Japan using a large employment insurance claims database of corporate employees under 75 years of age and their family members. METHODS: The study cohort consisted of patients diagnosed with UVFP between January 2013 and December 2022, identified from an insurance claims database. A propensity score-matched cohort was created using a 1:3 matching ratio between the treatment and non-treatment groups. Follow-up began at the index date, defined as the initial diagnosis of UVFP, and continued until the end of the study period. The primary analysis compared the cumulative incidence of pneumonia between treatment and non-treatment groups. The secondary analysis employed a self-controlled design to compare pneumonia incidence before and after laryngoplasty within treated patients. RESULTS: The full cohort included 7,641 patients with UVFP, of whom 914 comprised the matched cohort (treatment group, n = 230; non-treatment group, n = 684). The cumulative incidence of pneumonia tended to be higher in the treatment group than in the non-treatment group (hazard ratio, 1.39; 95% CI, 0.93-2.08; p = 0.098). In contrast, the self-controlled analysis demonstrated a lower pneumonia incidence after laryngoplasty compared with the pre-treatment period (incidence rate ratio, 0.36; 95% CI, 0.27-0.52; p < 0.001). CONCLUSIONS: Given the discordant findings across analytical approaches, no definitive conclusion regarding a preventive effect can be drawn from the present study. Further studies are needed to evaluate long-term outcomes and to clarify causal relationships.

Previous research has documented associations between children's emotional understanding (EU) and social-cognitive abilities such as theory of mind (ToM) and executive function (EF); however, findings in preschool-aged children remain inconsistent. One potential explanation is that language ability, which develops rapidly during early childhood, has often not been examined concurrently with these abilities. The present study focused on individual differences in EU and examined how ToM, EF, and language ability relate to EU in Japanese preschool children, with particular attention to the mediating role of language. Participants were 90 children aged 3-6 years (M = 60.34 months, SD = 10.82). Children completed a false belief task, emotional understanding tasks, executive function tasks assessing cognitive flexibility and working memory, and a receptive vocabulary test. Correlational analyses, hierarchical multiple regression analyses, and bootstrapped mediation analyses were conducted. EU was positively associated with ToM, EF, and language ability. Language ability accounted for significant variance in EU beyond age and gender. When language ability was included in the model, the association between ToM and EU was no longer significant, whereas the association between EF and EU remained significant but was attenuated. Mediation analyses revealed significant indirect effects of both ToM and EF on EU through language ability, indicating that the association between ToM and EU was accounted for by language ability, whereas EF showed both direct and indirect associations with EU. These findings suggest that language ability plays a central role in linking social-cognitive abilities to emotional understanding in early childhood. Theory of mind was associated with emotional understanding primarily through language, whereas executive function showed both direct and indirect associations via language ability. By modeling multiple predictors simultaneously, this study provides an integrated account of individual differences in emotional understanding and elucidates the distinct pathways through which cognitive and social-cognitive skills are associated with emotional development.

INTRODUCTION: Electronic Immunization Registries (EIRs) are increasingly being implemented in low- and middle-income countries (LMICs) to support immunization tracking and data management. In Bangladesh, an EIR was introduced in Rajshahi City Corporation (RCC) to strengthen routine immunization services. However, evidence on user perceptions and operational implementation in this context remains limited. We assessed perceptions related to the feasibility and acceptability of the EIR among caregivers and healthcare providers (HCPs) in an urban pilot setting. METHODS: We conducted a cross-sectional study between July and September 2024 in RCC, Bangladesh. Data were collected from caregivers of children receiving vaccinations and HCPs involved in immunization service delivery using a pretested semi-structured questionnaire. Perceptions of EIR-supported services were assessed using a 5-point Likert scale. Responses to open-ended questions were reviewed and summarized descriptively. This study was designed as a descriptive assessment and was not intended to evaluate the effectiveness or causal impact of the EIR system. RESULTS: A total of 321 participants were included, comprising 305 caregivers and 16 HCPs. Electronic registration was conducted primarily at the Expanded Program on Immunization centers (87%), with additional outreach through house-to-house visits. Reported vaccination uptake among children registered in the EIR system was high within the study sample. Caregivers and HCPs reported generally positive perceptions of EIR-supported services. Most respondents selected 'satisfied' or 'highly satisfied' responses across assessed items. HCPs also reported positive experiences, particularly in relation to record management and data accessibility, while noting operational challenges such as intermittent internet connectivity and device-related limitations. CONCLUSIONS: The EIR was perceived as acceptable by caregivers and HCPs in this urban pilot setting. Further studies are needed to assess effectiveness, implementation challenges, and scalability across diverse settings.

Corporate social responsibility (CSR) campaigns play a crucial role in shaping consumer perceptions and behavior. This study examines Delta Air Lines' CSR campaign centered on breast cancer awareness, focusing on how ethical judgment and subjective norms are associated with CSR skepticism and how such skepticism, in turn, relates to CSR engagement and ethical purchasing intention. Drawing on the theory of reasoned action (TRA), a quantitative survey was conducted with 787 Delta Air Lines customers, all of whom provided informed consent prior to participation. The data, analyzed between August 1-7, 2024 using structural equation modeling, show that ethical judgment and subjective norms are associated with lower levels of CSR skepticism. In turn, CSR skepticism is negatively related to both CSR engagement and ethical purchasing intention, while higher levels of CSR engagement are associated with greater ethical purchasing intention. These findings provide insight into the role of ethical and social factors in shaping consumer responses to CSR initiatives and highlight the importance of fostering engagement to enhance the effectiveness of CSR campaigns and promote favorable consumer outcomes.

The role of diet in the management of inflammatory bowel disease (IBD) is increasingly recognized with recent guidelines providing specific dietary recommendations. Although mobile health apps targeting diet and lifestyle habits in IBD are emerging, few are designed for self-management or have been formally evaluated for effectiveness. We have co-designed a diet guidance and tracking app (MyIBDDiet) with and for patients with IBD with the aim of improving overall diet profile. We will be conducting a 60-day single-centre pilot randomized trial of 40 IBD patients randomized in 1:1 ratio to MyIBDDiet app or usual care. Participants in the usual care group will crossover to the MyIBDDiet app group after 30 days. Primary outcome is usability assessed using a mixed method quantitative [Theoretical Framework of Acceptability (TFA), mHealth App Usability Questionnaire (MAUQ)], and qualitative approach (semi-structured interviews). Secondary outcomes include clinical efficacy evaluated by change in diet quality [Mini-EAT questionnaire, Automated Self-administered 24-Hour Dietary Assessment Tool (ASA-24), Healthy Eating Index (HEI), Mediterranean Diet Serving Score (MDSS)], changes in biomarkers of processed food intake (spot urine sodium and chloride), changes in IBD disease activity [Patient Reported Outcome (PRO2 and PRO3), C-reactive protein, fecal calprotectin], changes in quality of life [EuroQol-5 Dimension (EQ-5D), Short Inflammatory Bowel Disease Questionnaire (SIBDQ)] and safety. Exploratory outcomes include changes in fecal microbiome and serum and fecal metabolome. Additional quantitative data will be collected from the digital analytics of MyIBDDiet app. The pilot data generated will inform the design of an adequately powered randomized trial and future mobile app development and evaluation by providing a framework for evaluation of clinical effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06683105. Registered on 8 November 2024.

Refugees and asylum seekers face significant mental health challenges, yet sleep disturbances remain underrecognized despite their critical impact on well-being. This systematic review and meta-analysis assessed sleep quality and insomnia severity across 66 studies (n = 42,956). Pooled analyses of the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) based on studies identified in Cochrane, Embase, and PubMed from database inception to December 2024 revealed clinically significant sleep disturbances. The pooled mean ISI score (13.76, 95% CI 10.39-17.13) falls within the upper end of the subthreshold range, bordering on moderate clinical insomnia, while PSQI scores (8.59, 95% CI 2.11-15.07) exceeded clinical thresholds for poor sleep. The pooled prevalence of sleep adversities was 43.2% in adults and 36.4% in children. Secondary findings highlighted prolonged sleep latency and frequent nightmares. Although subgroup analyses suggested trends across populations and assessment methods, statistical significance was limited by sample heterogeneity. Standardized sleep assessments must be integrated into refugee health protocols, with targeted interventions addressing insomnia risk factors.

BACKGROUND: The rapid advancement of Large Language Models (LLMs) presents unprecedented opportunities for healthcare education and professional credentialing. However, comprehensive longitudinal analyses of their evolving capabilities in nursing contexts remain limited. OBJECTIVE: To conduct a three-year longitudinal performance analysis of major international and Chinese-native LLMs on the Chinese National Nurse Licensing Examination (NNLE) from July 2022 to June 2025, examining performance trajectories, comparative effectiveness, and domain-specific competencies. METHODS: We curated a comprehensive corpus of 9,800 multiple-choice questions from NNLE examinations (2022-2025) through validated educational resources. Fifteen leading LLMs were evaluated using standardized zero-shot prompting protocols, with temporal fidelity ensuring models were tested only on examinations administered after their release dates. Performance was measured as raw accuracy and benchmarked against the approximate 300-point passing threshold. Statistical analyses included trend analysis, comparative performance testing, and qualitative error categorization. RESULTS: LLM performance demonstrated a steep upward trajectory, with top-tier models achieving accuracy rates from 47.0% in 2022 to 78.8% in 2025. Chinese-native models consistently outperformed international counterparts. The mean Chinese-native advantage decreased from 6.1 percentage points in 2023 to 3.0 percentage points in 2025, while the top-model advantage remained present but non-monotonic, measuring 4.5, 3.0, and 3.8 percentage points in 2023, 2024, and 2025, respectively. Models exhibited superior performance in the knowledge-oriented Professional Practice section (81.6% average accuracy) versus the application-oriented Practical Skills section (70.9% average accuracy). Clinical reasoning failures, particularly in nursing intervention prioritization, constituted 43% of errors among top-performing models. CONCLUSION: While state-of-the-art LLMs demonstrate substantial codified nursing knowledge sufficient to achieve approximate passing thresholds on professional licensing examinations, significant deficiencies in complex clinical judgment persist, defining the current boundary between artificial intelligence capabilities and human professional competence. Critically, examination performance should not be interpreted as evidence of clinical readiness or autonomous practice capability.

BACKGROUND: Pancreatic cancer (PC) is a highly malignant tumor with increasing incidence, mortality, and a low five-year survival rate. Mitochondrial metabolic reprogramming plays a crucial role in tumor development, but the molecular mechanisms in different cell subpopulations of PC remain unclear. This study aims to integrate single-cell RNA sequencing (scRNA-seq) and bulk RNA-seq to explore mitochondrial metabolism in PC. METHODS: Transcriptome datasets (GSE183795, GSE16515, GSE197177, and TCGA-PAAD) were downloaded from the GEO and TCGA databases. Differentially expressed genes (DEGs) were identified using the limma package for bulk RNA-seq and the Seurat package for scRNA-seq. Weighted gene co-expression network analysis (WGCNA) was performed to identify key modules and hub genes. Machine learning algorithms screened key genes, and functional enrichment analysis was conducted using clusterProfiler. PPI, ceRNA, and transcription factor networks explored gene regulation. Immune infiltration analysis, drug prediction, and molecular docking were conducted on key genes. The prognostic value of the key genes was evaluated using clinical data from TCGA. RESULTS: A total of 1238 bulk RNA-DEGs and 8231 scRNA-DEGs in fibroblasts were identified. Integration of both datasets revealed 536 DEGs. WGCNA identified 6 modules associated with PC. By intersecting DEGs, hub genes, and mitochondrial metabolism-related genes, 18 candidate genes were obtained. These genes were enriched in glucose metabolism and mitochondrial outer membrane pathways. Three key genes (IFI27, PKM, and RSAD2) were selected using machine learning. PPI, ceRNA, and transcription factor networks provided regulatory insights. Immune infiltration analysis showed significant differences in immune cells, particularly in T cells CD4 memory resting and macrophages M2. Drug prediction and molecular docking identified potential drugs for these genes. Survival analysis indicated that high expression of these genes correlated with poor prognosis. CONCLUSION: This study integrates scRNA-seq and bulk RNA-seq data to identify three key genes (IFI27, PKM, and RSAD2) and their immune-related mechanisms in PC. These findings offer new insights into the pathogenesis and potential therapeutic targets for PC.

BACKGROUND: Spontaneous passage of common bile duct stones (CBDSs) may render endoscopic retrograde cholangiopancreatography (ERCP) unnecessary. Although predictors of passage have been described, most prior studies were limited by a small number of events, and the impact of spontaneous passage on post-ERCP complications remains under-investigated. This study aimed to identify clinical predictors of spontaneous passage and evaluate its association with post-ERCP complications. METHODS: We conducted a retrospective cohort study of patients diagnosed with CBDSs who underwent endoscopic ultrasonography (EUS) or ERCP at a tertiary referral center. Spontaneous passage was defined as the absence of stones confirmed during the procedure. Multivariable risk regression was used to identify predictors of passage and to assess the association between spontaneous passage and post-ERCP complications. RESULTS: Spontaneous passage was observed in 113 of 404 patients (28%). Independent predictors of spontaneous passage included younger age (RR 0.88 per 10 years; 95% CI 0.81-0.96), smaller CBDS size (RR 0.78 per 1 mm; 95% CI 0.71-0.85), and single CBDS (RR 1.64; 95% CI 1.04-2.61). Regarding complications, post-ERCP pancreatitis (PEP) occurred more frequently in patients with spontaneous passage compared to those without (16.5% vs 7.6%, P = 0.01). After adjusting for relevant confounders, including procedural factors, spontaneous passage remained an independent risk factor for PEP (RR 2.48, 95% CI 1.25-4.92). CONCLUSIONS: Spontaneous passage of CBDSs is an independent risk factor for PEP. Younger age, smaller stone size, and a single stone are significant predictors of passage. These findings suggest that pre-procedural risk stratification and non-invasive confirmation of ductal clearance may be beneficial in selecting appropriate candidates, potentially reducing unnecessary ERCP and associated complications.

INTRODUCTION: The EU Medical Device Regulation (MDR), effective since May 25, 2017, aims to enhance the safety and quality of medical devices within the EU. This study models the potential net mortality implications of the MDR in Germany under explicit assumptions about safety improvements, market withdrawals, and certification delays. METHODS: A combined top-down and bottom-up approach was employed to evaluate the impact of the EU MDR on mortality in Germany. The top-down approach estimated avoided deaths using the Keyfitz-Vaupel life-table elasticity, while the bottom-up approach quantified mortality reductions attributable to individual MDR-regulated medical devices. Based on the results of both approaches, the analysis also estimated the number of deaths potentially resulting from market withdrawals and certification delays. RESULTS: Official German reports attribute an average of 17 device-related deaths annually, whereas international estimates suggest the true figure may reach up to 2,500 per year. Market withdrawals and certification delays associated with MDR implementation were modelled as potentially contributing an estimated 163-1,884 additional annual deaths and a one-time mortality burden of 700-4,200 deaths. CONCLUSION: Under central assumptions, the MDR is consistent with long-term reductions in device-related mortality, but transition-period certification bottlenecks and withdrawals-especially for niche/pediatric devices-can offset gains in the short to medium term. Targeted mitigation is warranted to secure benefits and limit unintended harms.

Ziehl-Neelsen (ZN) smear microscopy remains central to tuberculosis (TB) diagnosis and treatment monitoring; however, its sensitivity is limited by incomplete recovery of Mycobacterium tuberculosis during pre-analytical processing. This study evaluated whether modifying centrifugation force and duration improves bacillary recovery and ZN smear microscopy performance. Laboratory experiments were conducted using M. tuberculosis H37Rv suspensions and clinical sputum specimens. Following NALC-NaOH treatment, samples were centrifuged at 2,000, 3,000, and 6,000 × g for 40 min. The effect of centrifugation duration was assessed at 3,000 × g by comparing 20 and 40 min using the same M. tuberculosis H37Rv cultures and the same clinical sputum specimens at both time points, ensuring paired measurements within each sample type. Smear positivity and ZN smear grading were evaluated from replicate smears and analyzed using non-parametric statistical tests, with significance set at p < 0.05. In M. tuberculosis H37Rv suspensions, no significant differences in smear positivity or grading were observed across centrifugal forces (p = 0.368 and p = 0.212, respectively). In clinical sputum specimens, smear positivity did not differ significantly across forces (p = 0.716), whereas ZN smear grading increased significantly with higher centrifugal force (p = 0.0051). At 3,000 × g, extending centrifugation time from 20 to 40 min did not significantly affect smear positivity in either sample type (both p = 1.000). In contrast, ZN smear grading increased from 1+ to 2+ in clinical specimens with extended centrifugation time (p = 0.016), while no change was observed in M. tuberculosis H37Rv suspensions. These findings indicate that increasing centrifugal force may enhance bacillary concentration in clinical sputum, resulting in improved smear grading without a corresponding increase in detection rate. Extending centrifugation time has limited impact on smear positivity. Optimization of pre-analytical centrifugation parameters may improve ZN smear microscopy performance in clinical specimens.

Electron density (ED) imaging derived from dual-energy CT (DECT) quantifies tissue composition and may reflect changes in red blood cell (RBC) mass associated with anemia. This study aimed to evaluate the utility of ED from DECT in assessing anemia severity using both non-enhanced CT (NECT) and contrast-enhanced CT (CECT), and to investigate its correlation with hemoglobin (Hb), hematocrit (Hct), and RBC count. In this retrospective study, 2,558 patients who underwent NECT and 2,545 who underwent CECT using a dual-layer spectral detector CT (Philips IQon) were included. Mean ED and mean CT attenuation (HU) were measured at five cardiac blood pool sites. Spearman's rank correlation analysis was performed between CT measurements and hematologic parameters. Partial correlation analysis adjusting for age and sex and non-parametric bootstrap internal validation were also conducted. Receiver operating characteristic (ROC) curve analysis was performed to determine diagnostic cutoff values for anemia detection. Mean ED significantly decreased with increasing anemia severity in both NECT and CECT cohorts (all p < 0.001). With NECT, mean ED showed positive correlations with Hb, Hct, and RBC count (rs = 0.726-0.770), with AUCs of 0.825-0.956 for anemia detection. With CECT, mean ED retained positive correlations with hematologic parameters (rs = 0.447-0.583), with AUCs of 0.727-0.895, while mean HU showed no meaningful correlation. After adjustment for age and sex, partial correlation coefficients remained substantial (NECT: rs = 0.694; CECT: rs = 0.509 for Hb), and bootstrap internal validation confirmed negligible overfitting bias. ED derived from DECT demonstrated diagnostic utility for anemia detection on NECT, unlike conventional HU, retained clinically relevant associations with hematologic parameters on CECT. ED-based anemia detection on CECT is best conceptualized as opportunistic detection, particularly for severe anemia, supplementary to laboratory testing. These findings require external validation across diverse DECT platforms before broader clinical implementation.

In response to the situation where it is not allowed to stick CFRP cloth at the bottom of a concrete beam and stick it on both sides of the beam, this article analyzes the factors that affect the ultimate flexural bearing capacity of reinforced concrete beams reinforced with CFRP on the side, and provides a calculation method for the flexural bearing capacity of reinforced concrete beams reinforced with CFRP on the side; At the same time, for the convenience of calculation, this paper explores the comprehensive consideration of the tensile force of carbon fiber cloth pasted on the side and the corresponding correction factor ηf of the force arm, and analyzes it by fitting a quadratic trend function with the ratio of CFRP pasting height to beam height (hf/h). Based on this, the calculation methods for the bending capacity of carbon fiber cloth pasted on the bottom surface according to the "Code" and the bending capacity of carbon fiber cloth pasted on the bottom surface according to the quadratic trend function are proposed. Research has shown that using CFRP to reinforce reinforced concrete beams on the side can effectively improve the flexural bearing capacity. After comparative analysis, the calculation results of three calculation methods are in good agreement with the experimental values; The correction coefficient ηf increases with the increase of the ratio of the bonding height to the beam height (hf/h). When the ratio of the bonding height to the beam height (hf/h) exceeds 0.25, the value of the correction coefficient ηf increases significantly; Especially when the ratio of the pasting height to the beam height (hf/h) exceeds 0.5, it is recommended to calculate the flexural bearing capacity of carbon fiber cloth pasted on the bottom surface according to the proposed quadratic trend function for ηf; At the same time, it is recommended to consider the reduction of the cross-sectional area of carbon fiber cloth as compensation when determining the flexural bearing capacity of reinforced concrete beams with carbon fiber cloth pasted on the side according to the calculation of the beam bottom. In order to reduce errors, the utilization coefficient of ψf is no longer limited. Theoretical analysis shows that there are critical values for the bonding height and thickness of carbon fiber cloth used for reinforcement. When these exceed the critical value, the effect on enhancing load-bearing capacity becomes insignificant or even declines.

Submacular hemorrhage (SMH), which may arise from age-related macular degeneration, retinal arterial macroaneurysm, and other causes, can result in severe vision loss and central visual field impairment. Although tissue plasminogen activator (tPA) is used off-label to treat SMH in many countries, no formulation has been approved for this indication. Because early intervention is critical when tPA is used for SMH, limited access to centers that can provide this treatment may delay care and reduce treatment opportunities. Decentralized clinical trials (DCTs) reduce or eliminate the need for participants to travel to trial sites. We therefore designed the investigator-initiated SACLA trial to evaluate subretinal tPA for SMH. The DCT framework is intended to reduce logistical barriers related to the disease severity and rarity. The SACLA trial is a phase II multicenter, open-label, single-arm surgical study with a pre-post comparison design (jRCT2071250003). Twenty eligible participants will undergo pars plana vitrectomy followed by subretinal injection of 0.1 mL (8,000 IU) of tPA. Participants will remain hospitalized at the trial site until the primary outcome, change in central foveal thickness (CFT) from baseline at Week 1, is assessed. Thereafter, follow-up visits will be conducted at either the trial site or partner sites within the DCT framework. Secondary efficacy outcomes include change in CFT from baseline, presence of a foveal hemorrhage measuring at least 1 disc diameter, best-corrected visual acuity (BCVA), and change in BCVA from baseline at Weeks 4 and 12. Adverse events will be collected throughout the 12-week observation period to assess safety. The protocol and related study documents were reviewed and approved by the Saga University Hospital Institutional Review Board. This study is designed to generate prospective evidence on the feasibility, short-term anatomical response, and safety of subretinal tPA for SMH.

BACKGROUND: Osteogenesis imperfecta (OI) is a rare genetic bone disorder. Children with OI have a higher risk of intraoperative pain. The fascia iliaca compartment block (FICB) can reduce pain, improve intraoperative hemodynamic stability, and facilitate postoperative recovery. This study explores the feasibility and potential role of FICB in multimodal analgesia by describing its application experience in children with OI. METHOD: This study involved children with OI who underwent surgery for femoral shaft fractures. The FICB group received ultrasound-guided FICB combined with general anesthesia, whereas the control group received general anesthesia alone. Hemodynamic parameters, serum inflammatory markers, intraoperative opioid consumption, recovery time, postoperative pain scores, and the incidence of postoperative nausea and vomiting (PONV) were recorded. RESULTS: A total of 126 children were enrolled. A significant time × group interaction was observed for changes in MAP and HR during surgery (F3,372 = 21.86 and F3,372 = 16.34, both P < 0.001). At all intraoperative time points, MAP and HR were lower in the FICB group than in the Control group (all P < 0.001). A significant time × group interaction was found for postoperative VAS scores (F2,248 = 3.18, P = 0.04); and they were lower in the FICB group at 2, 4, and 12 hours postoperatively (all P < 0.001). CRP levels also showed a significant time × group interaction (F1,124 = 290.3, P < 0.001); both groups exhibited elevated postoperative CRP versus baseline (P < 0.001), but the FICB group had lower levels. The FICB group had a shorter recovery time (P < 0.001), lower intraoperative fentanyl and remifentanil use (both P < 0.001), and a lower incidence of PONV (P = 0.026) compared to the Control group. CONCLUSION: In pediatric patients with OI undergoing femoral shaft fracture surgery, ultrasound-guided FICB has the potential to enhance intraoperative hemodynamic stability, alleviate postoperative pain, and decrease the incidence of adverse reactions, thereby facilitating the implementation of optimized multimodal analgesia.

The flora of Khyber Pakhtunkhwa, Pakistan, is severely threatened by illegal harvesting of non-timber forest resources, resulting in the genetic loss of native plant species, including Rubus fruticosus L., a genetically diverse shrub of considerable economic and medicinal importance. The present study was designed to assess the morphological diversity, seed protein profiles, and phytochemical composition of fifteen landraces of R. fruticosus collected from different ecological zones of the Malakand Division, Khyber Pakhtunkhwa, Pakistan. Morphological characteristics were evaluated using the International Board for Plant Genetic Resources (IBPGR) descriptors, incorporating both qualitative and quantitative traits in a randomized complete block design. Seed protein diversity was assessed through sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), while phytochemical composition was quantified using high-performance liquid chromatography with ultraviolet detection (HPLC-UV). Morphological traits exhibited significant variability, with a mean coefficient of variation (CV) of 36.72%. The most variable traits were single fruit weight (CV = 73.16%), five-fruit weight (CV = 64.38%), number of branches per plant (CV = 33.33%), plant height (CV = 31.31%), and stalk length (CV = 30.11%). Principal component analysis (PCA) explained 89.71% of the total variation, with plant height, leaflet number, and fruit weight contributing predominantly to landrace differentiation. SDS-PAGE analysis of seed proteins revealed 21 polymorphic bands (molecular weight range: 14.4-97.4 kDa), with high diversity indices recorded for markers B-03, B-06, B-08, B-12, and B-21 (Shannon diversity index H' = 1.10-1.39; CV = 35.36-93.54%). HPLC-UV analysis identified twelve phenolic compounds in selected genotypes, including quercetin (5.12-8.74 µg/mL), morin (3.45-6.89 µg/mL), and epigallocatechin gallate (2.88-7.23 µg/mL). The morphological, biochemical, and phytochemical diversity observed among R. fruticosus landraces highlights their potential for conservation programs and future breeding initiatives.

INTRODUCTION: This study explored the usefulness of estimated lower-limb muscle power, derived from the 5-times sit-to-stand (5xSTS) test, for identifying frailty among community-dwelling older adults in Ireland. METHODS: Data from Wave 3 of The Irish Longitudinal Study on Ageing (TILDA) were analysed, focusing on adults aged 50 years and older. Muscle power was estimated using a standardised equation from the five-time sit-to-stand (5xSTS) test, incorporating body height, mass, and chair height. Frailty status was classified using an Index, according to established criteria. Logistic regression models assessed the predictive capacity of muscle power relative to 5xSTS. Thresholds for frailty risk were explored through Receiver Operating Curves and Locally Weighted Scatterplot Smoothing. RESULTS: Findings reveal a decline in muscle power with advancing age, more pronounced in females and frail individuals. Muscle power estimates showed moderate agreement with frailty status, with sensitivity and specificity comparable to those of the 5xSTS. Muscle power less than 2.5 Watt·kg -¹ in males and 2.08 Watt·kg -¹ in females was associated with increased frailty risk, consistent with other studies. Overall power estimation showed a predictive performance similar to that of traditional assessments such as Timed Up and Go, supporting its utility in clinical and community settings. CONCLUSION: Estimated muscle power derived from the 5xSTS test is a practical, reliable tool for early identification of frailty among older adults. Its accessibility and predictive validity suggest it could complement existing clinical assessments but not replace them.

BACKGROUND: People diagnosed with advanced HIV disease (AHD) are at high risk for mortality even after starting antiretroviral therapy (ART). We determined characteristics, clinical outcomes, and risks of mortality among children and adolescents diagnosed with AHD in western Uganda. METHODS: We conducted a retrospective cohort analysis of routinely collected program data of children and adolescents living with HIV (CALHIV) aged 0-19 years, from outpatient HIV clinic electronic medical records in 48 high-volume health facilities in two regions of western Uganda (Fort Portal and Hoima). Data for clients who initiated ART during January 2016-July 2023 were analysed. AHD was defined as a CD4 cell count <200 cells/μL, or WHO stage 3 or 4, or any child younger than 5 years of age living with HIV who had been on ART for more than 12 months and virally non-suppressed (≥1,000 copies). We used descriptive statistics (i.e., frequencies and percentages) to summarise characteristics and treatment outcomes. Kaplan-Meier curves were used to estimate survival overall and by clients' characteristics; log-rank tests were used to compare survival functions. A gamma-shared frailty model was used to determine factors associated with the rate of mortality. Effect measures were summarized using adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (95%CI). RESULTS: A total of 5,143 CALHIV, including 3,067 (59.6%) females, with a median (interquartile range [IQR]) age of 10 (9) years were assessed. Overall, AHD was high (18.1%) and varied by age-0-4 years (68.4%), 5-9 years (12.6%), 10-14 years (13.2%), and lowest among adolescents, 15-19 years (7.7%). Just over half of the CALHIV with AHD were active in care (51.5% [480/932]), about a quarter (26.4% [264/932]) had transferred out, 13.8% (129/932) were lost to follow-up, and 8.3% (77/932) had died. Survival was significantly higher in CALHIV who were not malnourished compared to those with malnutrition (p = 0.001). Overall mortality rate per 100 person-years among CALHIV with AHD was 4.1 (95%CI:3.2-5.2) and was significantly higher among those who had been on ART for 3 months or less (27.3; 95%CI: 20.6-36.2) compared to 6 months or more (1.0; 95%CI: 0.6-1.7). CONCLUSION: Advanced HIV Disease among CALHIV in western Uganda was consistent with what has been published elsewhere. Risk of death differed by nutrition status and was high among those on ART three months or less. Early screening and management of malnutrition, as well as early ART initiation and adherence initiatives, might improve outcomes and reduce AHD-related mortality among CALHIV.

The use of super absorbent polymers in agriculture for water and fertilizers retention in soils has become popular with the increasing need for resource optimization. The objective of the present study was to use chitosan extracted from shrimp shell waste and reagent grade carboxymethylcellulose to synthesize a biodegradable super absorbent polymer with potential use for soil amendment in agriculture. The super absorbent polymer was synthesized using epichlorohydrin as a crosslinking agent in an alkaline NaOH/urea medium. The structure of the product was confirmed by FTIR and TGA. The polymer was found to be biodegradable with a progressive weight loss percentage reaching 79.1% after 14 days. An adsorption ratio of 15.8 and 17.2 was obtained for water and 22% w/v urea solution, respectively, so the product was categorized as super absorbent in both conditions. In addition, after two hours in the medium, absorption percentages of 48.3% were recorded for water and 22% w/v for urea solution. The reported method is effective for synthesizing a biodegradable super absorbent polymer with potential use for soil amendment and susceptibility to pH changes for both adsorption equilibrium and over time adsorption.

Human breast milk is a complex bioactive fluid containing multi-functional components that support many infant physiological functions. Maternal diet has been demonstrated to influence human milk components; however, how maternal diet impacts inflammatory markers in human milk remains unclear. This study investigated the association between maternal dietary inflammatory status, assessed using the Dietary Inflammatory Index (DII), and the profile of inflammatory markers in breast milk from healthy lactating women, quantified using cytometric bead array. Dietary intake of lactating mothers (n = 101) was assessed using a 24-hr food recall and categorised using the DII as either pro-inflammatory (score > 0) or anti-inflammatory (score < 0). Thirteen inflammatory markers were quantified in breast milk by flow cytometric bead array (13-plex panel: IL-4, IL-2, IP-10, IL-1β, TNF-α, MCP-1, IL-17A, IL-6, IL-10, IFN-γ, IL-12p70, IL-8, free active TGF-β1). All participant diets were categorised as anti-inflammatory diets (DII score range -4.83 to -1.22). Participants' food intake aligned with dietary guidelines (AUSNUT 2023) for lactating women, with most analysed food parameters classified as anti-inflammatory (19/27). Inflammatory marker analysis revealed a chemokine-dominant profile in breast milk with IP-10, MCP-1 and IL-8 present at the highest concentrations and detected in > 96% of participant human milk samples MCP-1 concentration was weakly associated with DII score (p = 0.025, r2 -0.23, Spearman correlation). This study is the first to investigate the inflammatory index of maternal diets in lactating mothers and characterise inflammatory markers in human milk. Further research is required to fully elucidate the relationship between dietary inflammatory status and inflammatory markers in breast milk and their potential impact on infant health, especially of a more diverse cohort.

The rapid emergence of multi-drug resistant (MDR) pathogenic bacteria as well as the continued burden of malignant diseases requires the safe development of novel and multifunctional therapeutic agents. The WHO designated vancomycin-resistant Staphylococcus aureus (VRSA) as "high priority" AMR pathogen. Thus, this study aimed to ecofriendly synthesis of silver-selenium nanocomposite (Ag-Se NC) and evaluate its in vitro anticancer effect and inhibitory activity against VRSA clinical isolates. Biogenic Ag-Se NC was successfully synthesized using the aqueous peel extract of Cucumis melo (C. melo) through an eco-friendly green synthesis approach. Following visual color transformation of the preparation mixture, nanocomposite formation was validated based on comprehensive physicochemical characterization using different spectroscopic analyses. The greenly synthesized Ag-Se NC revealed the Ag and Se specific surface plasmon resonance (SPR) peaks, high crystallinity, and predominantly spherical morphology with an average particle size of ~35 nm. Biological evaluations revealed that Ag-Se NC possesses selective cytotoxicity, displaying low toxicity toward WI-38 normal lung fibroblasts (IC₅₀ = 203.4 µg/mL) while exerting a potent, concentration-reliant inhibitory effect towards malignant cell lines, including hepatocellular carcinoma (Hep-G2) and breast adenocarcinoma (MCF-7) with IC50 90.97 and 38.18 μg/mL respectively. Furthermore, the Ag-Se NC demonstrated appreciated antibacterial activity, in comparison with the linezolid standard antimicrobial agent, against 11 VRSA clinical isolates, with MIC values ranging from 64 to 512 µg/mL and a mean MIC of 203.64 µg/mL. The marked NC bactericidal effects were indicated by their minimum inhibitory concentration index (MICi) values of 1-4, rapid time-kill kinetics, and significant membrane disruption evidenced by the protein leakage assay. The obtained NC also exhibited a respected inhibitory effect against VRSA biofilm development, in the range of 34.68 ± 2.4-72.89 ± 1.87%, as well as a strain-dependent partial eradication effect on the fully formed bacterial biofilm, ranging from 16.81 ± 0.96 to 42.59 ± 0.78%. Notably, variable interactions were observed when Ag-Se NC was combined with vancomycin against VRSA isolates; one isolate showed synergistic interaction with fractional inhibitory concentration index (FICi) = 0.5 and three isolates exhibited additive effects (FICi ranged from 0.5 to 1). In conclusion, these findings highlight Ag-Se NC as a promising green-synthesized nanoplatform with combined anticancer and bacterial inhibitory effects in both planktonic and biofilm growth forms and antimicrobial-potentiating activities.