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Background: Pediatric feeding disorder (PFD) is increasingly common and is often treated by speech language pathologists (SLPs) and occupational therapists (OTs) in the community setting. However, the preparedness of these disciplines to effectively address PFD is relatively unknown. Methods: A national (US), online survey was disseminated to providers who assess and treat PFD. For the present analysis, the responses of SLPs (N = 418) and OTs (N = 195) related to their clinical background, educational background, post-graduate training, and self-rated clinical effectiveness were statistically analyzed and compared across the two disciplines. Results: Both SLPs and OTs report feeling underprepared to work with PFD clients immediately following their academic training, but time spent in post-graduate training and years of clinical practice both significantly (p < 0.0001) increased feelings of effectiveness in assessing and treating PFD. Most SLPs and OTs pursued self-directed learning activities to increase competence, with the most common activities being article review, podcasts, and peer case review, although SLPs were significantly more likely to use podcasts (p < 0.0001) and peer review (p = 0.0004) than OTs. The most common barriers for providers were financial, time, travel, and institutional support barriers. Conclusions: While PFD is a key practice area of both SLPs and OTs, both provider groups feel unprepared and under-supported in providing competent care to these patients upon graduation. Future research and policy should support advancements in training for current SLPs and OTs related to PFD and address current barriers to a specialized educational pathway. [ABSTRACT FROM AUTHOR]

The number of device implantation procedures has increased in adult patients with congenital heart disease (ACHD). Despite significant improvements in materials and implantation techniques, these patients are exposed to higher risk of device related complications than general population. Herein, we describe our single tertiary referral center experience on transvenous pacemaker (PM) implantation and follow-up in adult patients with moderate and complex congenital heart disease (CHD) as limited data are available on long-term outcome. We considered all adults with moderate and complex CHD aged more than 16 years who underwent transvenous single-chamber and dual-chamber PM implant for sinus node dysfunction or atrioventricular block between January 2013 to December 2022 at our Unit. Seventy-one ACHD patients were included in the study (mean age 38.6 ± 15.2 years, 64% with moderate CHD, 36% with complex CHD). Among 32 patients implanted with a dual chamber PM (DDD PM), 4 devices were reprogrammed in VDD mode, 3 in VVI and 2 in AAI mode during follow-up because of lead dysfunction or permanent atrial arrhythmia. In addition, 26 patients had a single chamber PM (AAI or VVI PM) and 13 patients had single-lead pacing system with a free-floating atrial electrode pair (VDD PM). Just one of 13 single-lead VDD PM was reprogrammed in VVI mode due to a low atrial sensing. In DDD PM group, 10 re-interventions were needed due to lead dysfunction (8 cases) and lead-related infective endocarditis (2 cases). Only 3 patients in the single-lead PM group developed lead dysfunction with 2 re-interventions needed, but no infective endocarditis was reported. The rate of long-term complications is high in moderate and complex ACHD with transvenous PM devices, and it is mainly lead-related. In our experience, the less leads implanted, the less complications will occur. Considering the heterogeneity of the ACHD population, transvenous single-chamber or dual-chamber PM device implantation should always be tailored on the single patient, balancing risks and benefits in this complex population. [ABSTRACT FROM AUTHOR]

Objectives: Breast cancer (BC) impacts the patients’ quality of life. Peer support can provide emotional understanding and enhances access to information, social support, coping strategies, and empowerment. Comunitats is an online peer support community app for BC survivors that involves healthcare professionals. This study aims to explore how participation in Comunitats promotes empowerment, and to identify the variables related to it. Methods: A prospective, cross-sectional approach was applied. One hundred twenty-one women diagnosed with BC were included in Comunitats. Sociodemographic and clinical variables, along with measures of emotional distress (HADS), post-traumatic growth (PTGI), and empowerment (Van Uden-Kraan’s Empowerment Questionnaire), were collected through an online questionnaire completed by the participants. Additionally, data on participation in the online community were obtained directly from the app. Assessments were conducted at inclusion and again 3 months later. Correlations were used to guide linear regression analysis to identify the variables predicting greater empowerment outcomes. Results: Empowerment assessment indicated that participants felt empowered by their involvement in Comunitats. The most commonly experienced empowerment outcomes were “being better informed” and “improved acceptance of the illness.” “Exchanging information” and “finding recognition” were the most strongly experienced empowerment processes and the strongest predictors of empowerment outcomes in the regression analysis. Conclusion: Involvement in Comunitats enhances empowerment in BC survivors. Empowering processes within the community partially predict overall empowerment outcomes. Practical implications: Empowerment positively impacts self-care autonomy, self-efficacy, and treatment adherence, promoting healthier lifestyles and enhanced treatment outcomes. Therefore, we recommend encouraging participation in online peer support communities, as it might enhance empowerment. [ABSTRACT FROM AUTHOR]

Introduction: In an effort to maximize benefit and minimize morbidity when performing fronto-orbital distraction osteogenesis (FODO) for unilateral coronal synostosis (UCS), we have transitioned to an endoscopic-assisted approach (“endo-FODO”). This study compares photogrammetric outcomes of patients who underwent FODO via an endoscopic-assisted versus open approach. Methods: We retrospectively reviewed patients treated for UCS from 2013 to 2023. Photogrammetric outcomes at one to three years postoperatively were compared between patients who underwent endo-FODO and age- and sex-matched controls who underwent open FODO. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, and orbital dystopia angle (ODA) were calculated. Results: Twenty patients (ten per group) underwent surgery at a mean age of 6.1 ± 1.8 and 5.4 ± 1.1 months (p = 0.426) and were photographed at 1.6 ± 0.9 and 1.8 ± 0.9 years (p = 0.597) postoperatively in the endo-FODO and open FODO groups, respectively. Patients who underwent endo-FODO demonstrated significant improvements in margin-reflex distance 1 (MRD1) symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.004), canthal tilt symmetry (p = 0.020), and ODA (p = 0.009). Patients who underwent open FODO likewise demonstrated significant improvements in MRD1 symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.033), and ODA (p = 0.004). All postoperative measurements as well as degrees of improvement were similar between groups (p > 0.05). Conclusions: Endo- and open FODO were associated with significant and comparable improvements in soft tissue periorbital symmetry and orbital dystopia at nearly two years postoperatively. While continued follow-up until cranial maturity is needed to assess the durability of aesthetic results, these data support a minimally invasive, endoscopic alternative to fronto-orbital distraction. [ABSTRACT FROM AUTHOR]

Introduction: The outcomes of total hip arthroplasty (THA) are highly dependent upon the restoration of native hip biomechanics and optimal component positioning. Robotic technologies for THA have rapidly improved the accuracy of component positioning and maintaining the planned center of rotation. While robotic-assisted THA (RA-THA) has primarily been employed in surgically intricate cases, its potential benefits in scenarios of diminished surgical complexity remain less explored. Therefore, the purpose of this study was to assess the odds of developing systemic and joint complications following RA-THA in cases of reduced surgical complexity. Methods: A retrospective cohort study was conducted using the TriNetX national database to identify patients who underwent primary THA (Current Procedural Terminology code 27,130) and more specifically RA-THA identified by ICD-10-PCS code 8E0Y0CZ and Healthcare Common Procedure Coding System code S2900 from 2013 to 2022. One-to-one propensity score matching was conducted to generate 2 cohorts: (1) RA-THA and (2) conventional THA (C-THA). Systemic and joint complications were assessed at the 30-day, 90-day, 1-year, and 5-year postoperative periods. Results: Patients undergoing RA-THA had a lower risk of needing a revision THA at the 90-day, 1-year, and 5-year time points. RA-THA was associated with a lower risk of prosthetic dislocation at 90 days and 1 year and prosthetic pain at 1 year and 5 years. Dislocation of the hip or fracture of the femur was significantly lower in the RA-THA cohort at all four-time points. Patients undergoing RA-THA had a lower risk of developing deep vein thrombosis at 5 years. Conclusion: These findings suggest that RA-THA has comparable systemic and less joint complication risks at 30-day to 5-year timepoints between RA-THA and C-THA. Future studies with large sample sizes and long-term follow-up are needed to understand the patient-reported outcomes and functional outcomes of RA-THA for cases with reduced surgical complexity. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to compare the vaginal and laparoscopic approaches with natural tissue vaginal repair of pelvic organ prolapse (POP) in terms of recurrence rate and complete remission rate (CRR) of symptoms. Materials and Methods: This retrospective cohort study analyzed women who underwent hysterectomy for uterine prolapse at two Italian hospitals between October 2021 and March 2023. Group A included 89 patients who received vaginal hysterectomy and colposuspension (VCH), whereas group B included 58 patients who underwent laparoscopic hysterectomy followed by laparoscopic colposuspension sec Shull (LPSS). Results: The study included 147 patients with comparable baseline characteristics regarding menopausal age and body mass index. Concerning preoperative data, it is worth mentioning that group A had a higher proportion of patients with more than two previous deliveries and, overall, more severe prolapse stages. Concerning postoperative results, the patients undergoing laparoscopic surgery had longer operation times than group A. Moreover, group B had a higher recurrence rate after surgery (5.6% vs 13%, p = 0.057). Kaplan-Meier analysis indicated a lower rate of prolapse-free patients over time in group B. Cox regression showed a higher hazard ratio for recurrence in the LCSS group than in the VCH group. Complete remission rates for urinary symptoms varied, with group B showing higher CRR for stress incontinence (33% vs 71%, p < 0.001). Conclusion: Both VCH and LCSS are effective for POP treatment, with VCH showing better outcomes in terms of symptom remission and shorter operation times. At the same time, LCSS had better CRR for stress incontinence but a higher recurrence rate. Further high-quality prospective studies are needed to confirm these findings and determine the best surgical approach for POP. [ABSTRACT FROM AUTHOR]

Nonlinear responses of individual neurons are both experimentally established and considered fundamental for the functioning of neuronal circuitry. Consequently, one may envisage the collective dynamics of large networks of neurons exhibiting a large repertoire of nonlinear behaviors. However, an ongoing and central challenge in the modeling of neural dynamics involves the trade-off between tractability and biological realism. This is particularly important in exploring the range of possible dynamics of large networks. Our approach uses Gaussian white noise as a probe, thus capturing the full range of system responses and characteristics by using an approach inspired by the well-established Wiener − Volterra nonlinear system identification approach. We assess model behavior over a range of network architectures and noise stimulation rates and demonstrate non-monotonicity and nonlinearity as a system property. Perhaps surprisingly, our computational model suggests that recurrent systems of nonlinear neurons exhibit a range of complex behaviors that do not readily yield to linear modeling in every setting. Our results suggest that a linear interpretation of experimental data is likely to discount the critical importance of properties emerging from network architecture. The main contribution of this effort is to highlight the importance of the network's architecture operating on the nonlinear properties of individual neurons and the experimental probing approaches of the circuitry. [ABSTRACT FROM AUTHOR]

Purpose: This cross-sectional monocentric study aims to utilize the Early Childhood Attention Battery to investigate early attention patterns in young preterm children and ascertain the extent to which their attentional abilities diverge from those of term peers. Methods: Inclusion criteria encompassed gestational age < 34 weeks, with assessments conducted between 3 and 5 years 11 months. Exclusion criteria included major brain lesions, significant motor or behavioral disorders, and intellectual functioning with IQ < 70. Preterm raw scores converted to scaled scores and percentiles. Frequency analysis compared preterm scores to norms. Non-parametric tests assessed significance between scaled scores and subgroups (age, gestational age, sex, birth weight). Results: One hundred nineteen preterm patients were enrolled in the study between November 2016 and June 2023. Comparisons with published norms showed lower mean scores across all subtests and domains for preterm children. A notable proportion of assessments (13–40%) fell below the 5th percentile, with the dual task item in sustained attention being the highest (40%). Sex did not predict differences, except for auditory sustained and visual search subtests. Gestational age did not correlate with abnormal scores, consistent with previous studies. The prevalence of assessments below the 5th percentile highlights preterm children’s vulnerability to attention issues. The test’s sensitivity to attention deficits in preterm populations suggests its potential in identifying at-risk children early for tailored interventions. Conclusions: The battery effectively detects attentional deficits in preterm children. Early detection and targeted insights support tailored educational interventions. By focusing on specific attention skills, the battery guides clinicians in choosing individualized or group activities based on areas most affected. What is Known: • Attention is often impaired in preterm children but it is not systematically investigated before school age. The ECAB is a tool specifically designed for preschool children. What is New: • Using the ECAB we evidenced a different level of attention between pre-term and term-born children at preschool age. [ABSTRACT FROM AUTHOR]

In this case study, we describe an outbreak of highly pathogenic avian influenza (HPAI) virus subtype H7N3 in an ecological reserve in Chiapas, Mexico, affecting captive and wild birds. The virus was detected mainly in plain chachalacas displaying respiratory and gastrointestinal clinical signs and death within 24 hours. Mortality in white-fronted parrots and a clay-colored thrush was also recorded. We describe control strategies implemented to prevent virus dissemination and active surveillance within the risk area. Phylogenetic analysis revealed that the HPAI H7N3 virus detected in affected birds shared a close genetic relationship with Mexican H7N3 isolates from 2012. [ABSTRACT FROM AUTHOR]

This study investigates the structural and optical properties of hydrothermally synthesized zinc oxide nanorods (ZnO NR) for potential use in photodetectors. ZnO NR, known for their wide-bandgap semiconductor nature and exceptional optical transparency, were synthesized using a hydrothermal method. Structural analysis through XRD, SEM, and TEM revealed hexagonal crystal structure with an average crystallite size of 12.86 nm and uniform distribution of ZnO NR. The EDS analysis confirms the presence of Zn and O elements in the deposited sample, while the SAED analysis further corroborates the XRD results, indicating that the deposited sample is crystalline. The UV–Vis absorption spectra showed intense UV absorption, suggesting suitability for UV photodetection. The optical bandgap of ZnO NR was determined to be approximately 3.27 eV. Overall, the structural and optical properties observed in hydrothermally synthesized ZnO NR highlight their promise for photodetection applications. The well-defined crystallinity, controlled morphology, and optical transparency position hydrothermally synthesized ZnO NR as promising candidates for future advancements in photodetection technology. While direct photodetector measurements were not conducted in this study, the identified characteristics strongly advocate for further exploration of ZnO NR in photodetector technology. [ABSTRACT FROM AUTHOR]

Introduction: Autophagy, a catabolic process enabling cellular organelles and proteins' reuse for energy, has been observed in varicocele models, but the effect of surgical treatment on this process remains unknown. This study aims to assess autophagy in varicocele models undergoing surgical correction. Materials and Methods: Twenty-one adolescent male rats were induced with varicocele and divided into three groups: sham, varicocele, and varicocele with varicocelectomy. After 21 days, testicles were examined histologically for spermatogenesis (Jonhsen's score) and immunohistochemically for autophagy markers (LC3A, Beclin-1, Ambra-1, ULK-1, p62). Positive germ cells were quantitatively evaluated, and data were statistically analyzed (p < 0.05). Results: Histological examination revealed significantly reduced Jonhsen's scores in varicocele compared to sham and varicocelectomy groups (p < 0.05). Expression of autophagy markers (LC3A, Beclin-1, Ambra-1, ULK-1, p62) was significantly higher in varicocele than sham and varicocelectomy groups (p < 0.05), and in varicocelectomy than sham (p < 0.05). Conclusions: Varicocele activates autophagy markers, with p62 potentially modulating autophagy despite being considered an inhibitor. While varicocelectomy improves histology, it doesn't fully inhibit autophagy, suggesting ongoing germ cell dysfunction despite treatment. This underscores varicocele's detrimental effects on germ cell functionality. [ABSTRACT FROM AUTHOR]

Purpose: Animal reservoirs are important targets for controlling and eliminating schistosomiasis. Prevalence studies showed that dogs (Canis familiaris) and water buffaloes (Bubalus bubalis) are important reservoirs of S. japonicum. Previous studies have validated the use of the recombinant proteins Sj1TR, Sj7TR, and SjTPx-1 in ELISA as diagnostics for dogs and water buffaloes from schistosomiasis-endemic areas. In this study, we aimed to determine the seroprevalence of S. japonicum among dogs and water buffaloes in New Corella, Davao del Norte, Philippines, using the recombinant proteins Sj1TR, Sj7TR, and SjTPx-1 in ELISA format. Methods: Fecal and serum samples were collected from dogs (n = 63) and water buffaloes (n = 57). Schistosome-positive samples were detected using formalin-ether concentration technique (FECT), stool polymerase chain reaction, and enzyme-linked immunosorbent assay (ELISA) using soluble egg antigen (SEA), rSj1TR, rSj7TR, and rSjTPx-1. Positivity rates, sensitivity, specificity, predictive values, accuracy, and kappa values were calculated. Results: Mean positivity rates for schistosome infection were high for both dogs (x = 15.40%) and water buffaloes (x = 6.32%). On dogs, the sensitivity and specificity of the tests are as follows: 66.67% and 100% for rSj7TR-ELISA, while 100% and 93.33% for rSjTPx-1-ELISA, respectively. rSjTPx-1-ELISA showed the highest agreement with stool PCR among all diagnostic tests, with an overall kappa value of 0.824. On water buffaloes, the sensitivity and specificity of both rSj1TR-ELISA and rSjTPx-1-ELISA are 100.0% and 98.15%. Both tests also had an overall kappa value of 0.84. Conclusion: To ensure elimination and prevention of schistosomiasis in humans, the use of validated serological diagnostics such as recombinant antigen ELISA is preferable for field detection in animals, especially in resource-limited areas. [ABSTRACT FROM AUTHOR]

Background: The aesthetic goals of midface surgery in Apert syndrome are to correct the multi-planar midface deficiency and normalize facial ratios. This study characterizes the long-term photogrammetric outcomes of midface advancement in Apert syndrome. Methods: Patients with Apert syndrome who underwent midface distraction from 2000 to 2023 were retrospectively reviewed. Soft tissue measurements were applied to preoperative (T0), short-term postoperative (T1), and long-term postoperative (T2) photographs. Long-term changes were compared between subcranial and transcranial procedures, segmental and non-segmental osteotomies, and individual techniques. Frontal facial dimensions at time T2 were compared to age- and sex-matched normal controls from the NIMH-ChEFS face database. Results: Twenty patients had postoperative follow-up of T1 = 0.6 ± 0.4 and T2 = 4.7 ± 1.1 years and were compared to 40 normal controls. From time T0 to T2, middle facial third height increased (26.1 ± 3.0% to 27.8 ± 2.6%, p = 0.026), canthal tilt improved (− 7.6° ± 3.7° to − 3.9° ± 4.4°, p < 0.001), and facial convexity increased (182.9° ± 6.2° to 167.9° ± 8.6°, p < 0.001). From time T1 to T2, facial convexity flattened (159.4° ± 10.1° to 167.9° ± 8.6°, p < 0.001). Compared to controls, patients at time T2 had shorter middle facial third height (27.8 ± 2.6% vs. 32.0 ± 1.9%, p < 0.001) and reverse canthal tilt (− 3.9° ± 4.4° vs. 5.4° ± 2.6°, p < 0.001). Conclusions: A tailored treatment approach to the Apert midface yields varying degrees of resolution of central midfacial shortening, canthal tilt, and facial concavity at 5 years postoperatively. A slight reduction in facial convexity over time, likely reflecting pseudorelapse in the setting of sagittal overcorrection, should be anticipated. Greater utilization of segmental osteotomies may bring facial third ratios and canthal tilt closer to normal morphometric values. [ABSTRACT FROM AUTHOR]

Purpose: We examined differences in long-term morphometric outcomes of spring-mediated cranioplasty (SMC) for various forms of isolated nonsyndromic sagittal craniosynostosis. Methods: A retrospective review was performed of children who underwent SMC from 2011 to 2020 at the Children's Hospital of Philadelphia. Cephalic indices (CI), Whitaker grades, parietal bone thickness, and degree of suture fusion were assessed. Frontal bossing and vertex-nasion-opisthocranion (VNO) angles were compared to a normal control group. Results: Fifty-four subjects underwent surgery at age 3.6 ± 1.0 months with follow-up of 6.3 ± 1.8 years. Mean CI was 75.2 ± 4.1 at 5.9 ± 2.0 years postoperatively. Mean CI were 75.8 ± 4.1 (n = 32), 76.4 ± 4.0 (n = 22), and 77.1 ± 4.8 (n = 11) at 5, 7, and 9+ years postoperatively, respectively. Three (5.6%) required reoperation for persistent scaphocephalic cranial deformity. Fifty-one (94.4%) were Whitaker Grade I. On physical examination, 12 (22.2%) demonstrated craniofacial abnormalities. At long-term follow-up, there were no differences in frontal bossing angle (102.7 ± 5.2 degrees versus 100.7 ± 5.6 degrees, p =.052) and VNO angle (44.9 ± 3.3 degrees versus 43.9 ± 2.2 degrees, p =.063) between study and control groups. Younger age at surgery predicted a lower Whitaker grade, more normalized VNO angle, and greater change in CI during active expansion. Increased percentage fused of the posterior sagittal suture predicted a higher Whitaker grade, while decreased anterior fusion was associated with frontal bossing and temporal hollowing. Conclusions: Overall, children undergoing spring-mediated cranioplasty for sagittal craniosynostosis demonstrated maintenance of CI, favorable cosmetic outcomes, and a low reoperation rate at mid-term follow-up. Early intervention is associated with improved aesthetic outcomes, and regional fusion patterns may influence long-term craniofacial dysmorphology. [ABSTRACT FROM AUTHOR]

Purpose: Treatment of subjects with refractory idiopathic intracranial hypertension (IIH) or shunted hydrocephalus with chronic shunt complications is challenging. What is the role for cranial vault expansion, particularly utilizing posterior vault distraction osteogenesis (PVDO), in these cases? This study assesses medium-term efficacy of cranial vault expansion in this unique patient population. Methods: A retrospective review was conducted of patients who underwent cranial vault expansion from 2008 to 2023 at the Children's Hospital of Philadelphia. Subjects who did not have a diagnosis of primary craniosynostosis were included in the study. Demographic information, medical history, and perioperative details were collected from medical records. Primary outcomes were the rate of CSF diversion procedures and resolution of presenting signs and symptoms. Secondary outcomes were perioperative and 90-day complications and reoperation requirement. Results: Among 13 included subjects, nine (69.2%) patients had a primary diagnosis of shunted hydrocephalus and 4 (30.8%) patients had IIH. Twelve (92.3%) subjects underwent posterior vault distraction osteogenesis (PVDO) and one (7.7%) underwent posterior vault remodeling (PVR). All 4 patients with IIH demonstrated symptomatic improvement following PVDO, including resolution of headaches, vomiting, and/or papilledema. Among 9 patients with shunted hydrocephalus, CSF diversion requirement decreased from 2.7 ± 1.6 procedures per year preoperatively to 1.2 ± 1.8 per year following cranial vault expansion (p = 0.030). The mean postoperative follow-up was 4.1 ± 2.1 years and four (30.8%) patients experienced complications within 90 days of surgery, including infection (n = 2), CSF leak (n = 1), and elevated ICP requiring lumbar puncture (n = 1). Four (30.8%) patients underwent repeat cranial vault expansion for recurrence of ICP-related symptoms. At most recent follow-up, 7 of 9 patients with shunted hydrocephalus demonstrated symptomatic improvement. Conclusion: Cranial vault expansion reduced intracranial hypertension-related symptomology as well as the rate of CSF diversion-related procedures in patients with refractory IIH and shunted hydrocephalus without craniosynostosis, and should be considered in those who have significant shunt morbidity. [ABSTRACT FROM AUTHOR]

Metastatic breast cancer (MBC) is still an incurable disease, which eventually develops resistance mechanisms against systemic therapies. While most patients experience widespread disease progression during systemic treatment (ST), in some cases, progression may occur at a limited number of metastatic sites. Evidence from other malignancies suggests that local treatment with stereotactic ablative radiotherapy (SABR) of oligoprogressive disease (OPD) may allow effective disease control without the need to modify ST. Available evidence regarding local treatment of oligoprogressive breast cancer is limited, mostly consisting of retrospective studies. The only randomized data come from the randomized CURB trial, which enrolled patients with oligoprogressive disease, including both small cell lung cancer and breast cancer patients, and did not show a survival benefit from local treatment in the latter group. However, local treatment of oligoprogressive MBC is still considered in clinical practice, especially to delay the switch to more toxic STs. This review aims to identify patients who may benefit from this approach based on the current available knowledge, focusing also on the potential risks associated with the combination of radiotherapy (RT) and ST, as well as on possible future scenarios. [ABSTRACT FROM AUTHOR]

Improvement in water quality of several rivers was noted during COVID lockdowns by several studies but no report was dedicated to trace the water quality after COVID. Our study observed the water quality of Balili River, Philippines from 2018–2023 to address this data gap and learn lessons and ways forward towards the attainment of SDG 6 Water and Sanitation. The river exhibited significant improvement during COVID at TSS, color, DO, BOD, PO4 and Cl. The cumulative parameters namely water quality index and comprehensive pollution index showed that the water quality of Balili River improved during COVID at 27–40% but deteriorated again after COVID, though not as polluted as the pre-COVID state. The fecal coliform got worse during COVID but drastically improved after COVID. The water quality generally is worst during dry season then improves in the rainy months due to dilution from rain. These results show that upland tropical rivers, particularly in the case of Balili River, Benguet, Northern Philippines has a natural means of purification namely dilution from rain. Hence, the floating constructed wetland could be implemented during dry months starting from November to May. During heavy rains, the floating constructed wetland could be allowed to be swept downstream, allowing dilution as the next mode of remediation. Then after the rainy season, another floating constructed wetland would be established for another cycle. [ABSTRACT FROM AUTHOR]

Background: Cystic kidney disease is a heterogeneous group of hereditary and non-hereditary pathologic conditions, associated with the development of renal cysts. These conditions may be present both in children and adults. Cysts can even be observed already during the prenatal age, and pediatric patients with cysts need to be clinically monitored. An early clinical and genetic diagnosis is therefore mandatory for optimal patient management. The aim of this study was to perform genetic analyses in patients with echographic evidence of kidney cysts to provide an early molecular diagnosis. Methods: A cohort of 70 pediatric patients was enrolled and clinically studied at the time of first recruitment and at follow-up. Genetic testing by clinical exome sequencing was performed and a panel of genes responsible for "cystic kidneys" was analyzed to identify causative variants. Sanger validation and segregation studies were exploited for the final classification of the variants and accurate genetic counseling. Results: Data showed that 53/70 of pediatric patients referred with a clinical suspicion of cystic kidney disease presented a causative genetic variant. In a significant proportion of the cohort (24/70), evidence of hyper-echogenic/cystic kidneys was already present in the prenatal period, even in the absence of a positive family history. Conclusions: This study suggests that cystic kidney disease may develop since the very early stages of life and that screening programs based on ultrasound scans and genetic testing play a critical role in diagnosis, allowing for better clinical management and tailored genetic counseling to the family. [ABSTRACT FROM AUTHOR]

Post-neoadjuvant therapy (post-NAT) and post-surgical circulating tumor DNA (ctDNA) risk stratification may enhance the management of patients with locally advanced rectal cancer (LARC). In this study, we assessed the prognostic value of ctDNA-based MRD detection in LARC patients using a personalized, tumor-informed ctDNA assay. Plasma samples from LARC patients (N = 30) were analyzed retrospectively using the Signatera™ assay. The neoadjuvant rectal (NAR) score was calculated and compared to ctDNA status to predict recurrence risk and survival outcomes. ctDNA-positive patients post-NAT and post-surgery had worse Disease Free Survival (DFS) (HR: 7.82; p = 0.001, HR: 19.65; p = 0.001) when compared to ctDNA-negative patients. In the post-NAT setting, patients who responded to NAT had superior DFS compared to patients who did not clear their ctDNA or showed no radiological response (HR: 24.7, p = 0.001 and HR: 5.1, p = 0.054, respectively). When ctDNA status is used alongside the NAR score in the post-NAT setting, patients who were ctDNA-positive with an intermediate or high NAR score showed significantly worse DFS (HR: 47.5, p < 0.001) compared to ctDNA-negative patients with either a low or intermediate/high NAR score (HR: 9.8, p = 0.0301). Post-NAT ctDNA status, whether used alone or in combination with the NAR score, may predict NAT response, and improve risk stratification. [ABSTRACT FROM AUTHOR]

The scanning tunneling microscope (STM) provides access to atomic-scale properties of a conductive sample. While single-molecule tip functionalization has become a standard procedure, fluorescent molecular probes remained absent from the available tool set. Here, the plasmonic tip of an STM is functionalized with a single fluorescent molecule and is scanned on a plasmonic substrate. The tunneling current flowing through the tip-molecule-substrate junction generates a narrow-line emission of light corresponding to the fluorescence of the negatively charged molecule suspended at the apex of the tip, i.e., the emission of the excited molecular anion. The fluorescence of this molecular probe is recorded for tip-substrate nanocavities featuring different plasmonic resonances, for different tip-substrate distances and applied bias voltages, and on different substrates. We demonstrate that the width of the emission peak can be used as a probe of the exciton-plasmon coupling strength and that the energy of the emitted photons is governed by the molecule interactions with its environment. Additionally, we theoretically elucidate why the direct contact of the suspended molecule with the metallic tip does not totally quench the radiative emission of the molecule. Scanning tunneling microscopy (STM) gives access to the atomic-scale properties of matter. Here, the authors showcase the fluorescent functionalization of an STM tip using a single molecule in direct metal contact, permitting the local electrostatic and -dynamic environment to be probed. [ABSTRACT FROM AUTHOR]

Individuals with rare skeletal disorders like Multiple Osteochondromas and Ollier Disease often experience physical and psychological burdens. Adventure therapy, with activities like sailing in outdoor settings, promotes personal growth and psychological well-being, potentially improving health-related quality of life (HRQoL). This study aimed to evaluate the impact of a sailing program on health-related quality of life and participant satisfaction in individuals with Multiple Osteochondromas and Ollier Disease. A quasi-experimental one-group pre-post design was employed, with HRQoL assessed using the EQ-5D® instrument and participant satisfaction measured via a feedback survey. Data were collected before and after the five-day sailing program conducted in the Mediterranean Sea in 2022 and 2023, involving participants diagnosed with Multiple Osteochondromas and Ollier Disease. Statistical analyses were performed using the Wilcoxon signed-rank test and McNemar's test for paired data. A significance level of p < 0.05 and p < 0.10 was considered. A total of 25 participants, predominantly male (52%), with a median age of 16 years (ranking from 11 to 31), were included in the study. The sailing program had mixed impact on HRQoL. Specifically, individuals who were female (p = 0.03), aged 16 and older (p = 0.04), with higher educational attainment (p = 0.10) or stronger self-management (p = 0.09), resilience (p = 0.01) and self-engagement (p = 0.09) skills experienced enhanced HRQoL. Conversely, other participants exhibited an increase in self-care difficulties (p = 0.02) and a trend towards worsening pain/discomfort (p = 0.38). Overall satisfaction with the program was high, with 90% of participants expressing satisfaction. This is the first study which examined HRQoL in Multiple Osteochondromas and Ollier Disease patients within an outdoor adventure therapy setting. Findings suggest that adventure therapy, integrated into healthcare strategies, may offer a valuable complement to conventional treatments for rare skeletal disorders. Future research, including randomized controlled trials, are necessary to confirm these results and develop robust interventions for improving the well-being in this population. [ABSTRACT FROM AUTHOR]

Purpose: The spheno-occipital synchondrosis (SOS) is an important site of endochondral ossification in the cranial base that closes prematurely in Apert, Crouzon, and Pfeiffer syndromes, which contributes to varying degrees of midface hypoplasia. The facial dysmorphology of Muenke syndrome, in contrast, is less severe with low rates of midface hypoplasia. We thus evaluated the timing of SOS fusion and cephalometric landmarks in patients with Muenke syndrome compared to normal controls. Methods: Patients with Muenke syndrome who had at least one fine-cut head computed tomography scan performed from 2000 to 2020 were retrospectively reviewed. A case–control study was performed of patient scans and age- and sex-matched control scans. SOS fusion status was evaluated as open, partially closed, or closed. Results: We included 28 patients and compared 77 patient scans with 77 control scans. Kaplan–Meier analysis demonstrated an insignificantly earlier timeline of SOS fusion in Muenke syndrome (p = 0.300). Mean sella-orbitale (SO) distance was shorter (44.0 ± 6.6 vs. 47.7 ± 6.7 mm, p < 0.001) and mean sella-nasion-Frankfort horizontal (SN-FH) angle was greater (12.1° ± 3.8° vs. 10.1° ± 3.2°, p < 0.001) in the Muenke group, whereas mean sella-nasion-A point (SNA) angle was similar and normal (81.1° ± 5.7° vs. 81.4° ± 4.7°, p = 0.762). Conclusion: Muenke syndrome is characterized by mild and often absent midfacial hypoplasia, with the exception of slight retropositioning of the infraorbital rim. Interestingly, SOS fusion patterns in these patients are not significantly different from age- and sex-matched controls despite an increased odds of fusion. It is possible that differences in timing of SOS fusion may manifest phenotypically at the infraorbital rim rather than at the maxilla. [ABSTRACT FROM AUTHOR]

We classify path polyominoes which are level and pseudo-Gorenstein. Moreover, we compute all level and pseudo-Gorenstein simple thin polyominoes with rank less than or equal to 10. We also compute the regularity of the pseudo-Gorenstein simple thin polyominoes in relation to their rank. [ABSTRACT FROM AUTHOR]

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common liver disease worldwide. The risk of developing MAFLD varies among individuals, due to a combination of environmental inherited and acquired genetic factors. Genome-wide association and next-generation sequencing studies are leading to the discovery of the common and rare genetic determinants of MAFLD. Thanks to the great advances in genomic technologies and bioinformatics analysis, genetic and epigenetic factors involved in the disease can be used to develop genetic risk scores specific for liver-related complications, which can improve risk stratification. Genetic and epigenetic factors lead to the identification of specific sub-phenotypes of MAFLD, and predict the individual response to a pharmacological therapy. Moreover, the variant transcripts and protein themselves represent new therapeutic targets. This review will discuss the current status of research into genetic as well as epigenetic modifiers of MAFLD development and progression. [ABSTRACT FROM AUTHOR]

Appropriate regeneration of jawbone after dental or surgical procedures relies on the recruitment of osteoprogenitor cells able to differentiate into matrix-producing osteoblasts. In this context, photobiomodulation (PBM) has emerged as promising therapy to improve tissue regeneration and to facilitate wound healing processes. The aim of this study was to determine the effect of PBM on human osteoprogenitor cells isolated from mandibular trabecular bone. Bone marrow stromal cell cultures were established from 4 donors and induced toward osteogenic differentiation for 14 days in a standard osteogenic assay. Cells were irradiated with a combined red/near-infrared (NIR) laser following different schedules and expression of osteogenic, matrix-related, osteoclastogenic and inflammatory genes was analyzed by quantitative PCR. Gene expression analysis revealed no overall effects of PBM on osteogenic differentiation. However, a statistically significant reduction was observed in the transcripts of COL1A1 and MMP13, two important genes involved in the bone matrix homeostasis. Most important, PBM significantly downregulated the expression of RANKL, IL6 and IL1B, three genes that are involved in both osteoclastogenesis and inflammation. In conclusion, PBM with a red/NIR laser did not modulate the osteogenic phenotype of mandibular osteoprogenitors but markedly reduced their expression of matrix-related genes and their pro-osteoclastogenic and pro-inflammatory profile. [ABSTRACT FROM AUTHOR]

Bioconjugation is one of the most promising strategies to improve drug delivery, especially in cancer therapy. Biomolecules such as bile acids (BAs) have been intensively explored as carriers, due to their peculiar physicochemical properties and biocompatibility. BAs trafficking is regulated by intracellular lipid-binding proteins and their transport in the liver can be studied using chicken liver Bile Acid-Binding Proteins (cL-BABPs) as a reference model. Therefore, we conceived the idea of developing a BA-conjugate with Mirin, an exonuclease inhibitor of Mre11 endowed with different anticancer activities, to direct its transport to the liver. Following computational analysis of various BAs in complex with cL-BABP, we identified cholic acid (CA) as the most promising candidate as carrier, leading to the synthesis of a novel bioconjugate named CA-M11. As predicted by computational data and confirmed by X-ray crystallographic studies, CA-M11 was able to accommodate into the binding pocket of BABP. Hence, it can enter BAs trafficking in the hepatic compartment and here release Mirin. The effect of CA-M11, evaluated in combination with varying concentrations of Doxorubicin on HepG2 cell line, demonstrated a significant increase in cell mortality compared to the use of the cytotoxic drug or Mirin alone, thus highlighting chemo-sensitizing properties. The promising results regarding plasma stability for CA-M11 validate its potential as a valuable agent or adjuvant for hepatic cancer therapy. [ABSTRACT FROM AUTHOR]

Metabolic dysfunction-associated steatohepatitis (MASH) is a rising global disease signaling the urgent need for non-invasive tests (NITs). Recent work demonstrated that dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging can identify MASH by measuring liver glucose transport rate, K1, and liver CT attenuation. By combining dynamic PET/CT with the serum-based fibrosis-4 (FIB-4) test, we were able to better distinguish clinical MASH from fibrotic subtypes, enabling determination of the core tenets of MASH: steatosis, inflammation, and fibrosis. Future studies using FDG-PET technology can further enable concomitant prediction of MASH severity and extrahepatic comorbidities such as cardiovascular disease. [ABSTRACT FROM AUTHOR]

Inspired by the recent algebraic approach to classical field theory, we propose a more general setting based on the manifold of smooth sections of a non-trivial fiber bundle. Central is the notion of observables over such sections, i.e., appropriate smooth functions on them. The kinematics will be further specified by means of the Peierls brackets, which in turn are defined via the causal propagators of linearized field equations. We shall compare the formalism we use with the more traditional ones. [ABSTRACT FROM AUTHOR]

In this paper we study the foundations of the algebraic treatment of classical and quantum field theories for Dirac fermions under external backgrounds following the initial contributions already present in various places in the literature. The treatment is restricted to contractible spacetimes of globally hyperbolic nature in dimensions d ≥ 4 and to external fields modelled with trivial principal bundles. In particular, we construct the classical Møller maps intertwining the configuration spaces of charged and uncharged fermions, and we show some of its properties in the case of a U(1) gauge charge. In the last part, as a first step towards a quantization of the theory, we explore the combination of the classical Møller maps with Hadamard bidistributions and prove that they are involutive isomorphisms (algebraically and topologically) between suitable (formal) algebras of functionals (observables) over the configuration spaces of charged and uncharged Dirac fields. [ABSTRACT FROM AUTHOR]

Background: Early surgical management of syndromic craniosynostosis varies widely between centers, with patients typically undergoing multiple intracranial procedures through childhood. This study evaluates the long-term impact of early posterior vault distraction osteogenesis (PVDO) versus conventional treatment paradigms on the number and timing of subsequent craniofacial procedures. Methods: We retrospectively analyzed the longitudinal operative patterns of patients with syndromic craniosynostosis treated from 2000 to 2023 with greater than five years of follow-up. Outcomes of patients who underwent early PVDO and conventional vault reconstruction were compared. Results: Fifty-five patients met the inclusion criteria (30 PVDO and 25 conventional). Age at initial vault surgery was similar between the PVDO and conventional cohorts (7.6 vs. 8.8 months), as were baseline craniometrics (p > 0.05). Multiple fronto-orbital advancement (FOA) procedures were performed in only 1/30 (3%) PVDO-treated patient versus 12/25 (48%) conventionally-treated patients (p < 0.001). Twelve (40%) PVDO-treated patients did not undergo FOA at all. Among patients with Apert and Crouzon syndromes, fewer PVDO-treated patients required FOA prior to midface surgery (33% vs. 92%, p = 0.004) or repeat FOA (6% vs. 50%, p = 0.005) compared to conventionally-treated patients. Among patients with Muenke and Saethre–Chotzen syndromes, a similar proportion of patients required FOA in the PVDO and conventional cohorts (91% vs. 100%, p = 0.353), though no PVDO-treated patients required repeat FOA (0% vs. 44%, p = 0.018). Conclusions: Early PVDO is associated with a reduction in the high burden of both FOA and, critically, revisionary frontal procedures which are commonly seen in conventionally-treated patients with syndromic craniosynostosis. [ABSTRACT FROM AUTHOR]

The tight relationship of niche breadth (i.e., environmental tolerance and resource use) with ecomorphological traits and extinction risk makes the study of habitat niche breadth (i.e., habitat heterogeneity; HB) crucial to understanding the species' ecological niche and macroecological aspects. Additionally, HB has been associated with the species extinction risk (ER) due to human activity. Bats can be ideal for understanding HB's ecological and conservation relevance due to their diverse diet and other traits, as well as the high number of threatened species. Here, we studied the association between HB, trophic guild (TG), body mass (BoM), and extinction risk (ER) in phyllostomid bat species using a phylogenetic comparative approach. Our results showed that the TG, not BoM, is significantly associated with HB in phyllostomid bats. Omnivorous and sanguinivorous bats have a wider HB than plant-eating and insectivorous bats. Regarding the ER of bats, our results showed that species without risk have wider HB than species at risk. The HB of species without conservation status does not differ from at-risk species, which suggests that at least some species should be considered at risk. In conclusion, our study suggests that diet is a relevant trait that influences the macroecological dynamic of phyllostomid bats due to its relation with HB. Additionally, we provided evidence supporting HB's use as an ER predictor. Finally, we discussed the necessity of finding alternative and quicker ways to assess the ER of the species. [ABSTRACT FROM AUTHOR]

Experimental economics is, nowadays, a well-established approach to investigate agents' behavior under economic incentives. In the last decade, a fast-growing number of studies have focused on the application of experimental methodology to health policy issues. The results of that stream of literature have been intriguing and strongly policy oriented. However, those findings are scattered between different health-related topics, making it difficult to grasp the overall state-of-the-art. Hence, to make the main contributions understandable at a glance, we conduct a systematic literature review of laboratory experiments on the supply of health services. Of the 1248 articles retrieved from 2011, 56 articles published in peer-review journals have met our inclusion criteria. Thus, we have described the experimental designs of each of the selected papers and we have classified them according to their main area of interest. [ABSTRACT FROM AUTHOR]

The controversy surrounding whether serum total cholesterol is a risk factor for the graded progression of knee osteoarthritis (KOA) has prompted this study to develop an authentic prediction model using a machine learning (ML) algorithm. The objective was to investigate whether serum total cholesterol plays a significant role in the progression of KOA. This cross-sectional study utilized data from the public database DRYAD. LASSO regression was employed to identify risk factors associated with the graded progression of KOA. Additionally, six ML algorithms were utilized in conjunction with clinical features and relevant variables to construct a prediction model. The significance and ranking of variables were carefully analyzed. The variables incorporated in the model include JBS3, Diabetes, Hypertension, HDL, TC, BMI, SES, and AGE. Serum total cholesterol emerged as a significant risk factor for the graded progression of KOA in all six ML algorithms used for importance ranking. XGBoost algorithm was based on the combined best performance of the training and validation sets. The ML algorithm enables predictive modeling of risk factors for the progression of the KOA K–L classification and confirms that serum total cholesterol is an important risk factor for the progression of KOA. [ABSTRACT FROM AUTHOR]

Introduction: Many minimally invasive techniques have been developed over the years to treat primary ventral hernias and rectus abdominis diastasis, all of which have their advantages and disadvantages in terms of complications, reproducibility, and cost. We present a case-series of a novel approach that was safe and reproducible in a cohort of 17 patients. Patients and methods: All patients in the study underwent the novel procedure between October 2022 and July 2023. We collected data retrospectively, including patient general characteristics, surgical outcomes, and complications. Patient follow-up lasted 12 months to exclude recurrences. Results: Seventeen patients underwent the procedure for primary uncomplicated ventral hernias and rectus diastasis. The median length of hospital stay was 2 days (IQR 2–3). In 4 out of 17 cases minor complications occurred within 30 days, of which 3 were class I and 1 was a class II complication according to the Clavien–Dindo classification. There were no recurrences. Conclusion: Although limited by a small cohort of patients and a non-comparative study design, our study presents encouraging results in regards to the safety of this technique. More studies with a larger study population are needed to evaluate the benefits and pitfalls of this new technique.[query names]. [ABSTRACT FROM AUTHOR]

Purpose: Multiple groups have created clinical practice guidelines (CPGs) for the management of primary hyperparathyroidism (PHPT). This report provides a rigorous quality assessment using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) to identify high-performing guidelines and areas for improvement. Methods: A systematic review was conducted to isolate CPGs addressing the management of PHPT. Guideline data was extracted and quality ratings were assigned by four independent reviewers. Intraclass correlation coefficients (ICC) were calculated to ensure interrater reliability. Results: Twelve guidelines were assessed. The American Association of Endocrine Surgeons (AAES) guideline had the highest mean scaled score across all domains (73.6 ± 31.4%). No other published guideline achieved a "high" quality designation. The highest scoring domain was "clarity of presentation" (mean 60.5 ± 26.5%). The lowest scoring domain was "applicability" (mean 19.8 ± 18.2%). Scoring reliability was excellent, with ICC ≥ 0.89 for all AGREE II 6 domains. Conclusion: Although several working groups have developed guidelines to address PHPT management, only those published by the AAES meet all methodologic quality criteria necessary to ensure incorporation of recommendations into clinical practice. Future guidelines would benefit from the development of tools, resources, monitoring criteria that enhance applicability. [ABSTRACT FROM AUTHOR]

Microcephaly is characterized by an occipitofrontal circumference at least two standard deviations below the mean for age and sex. Neurodevelopmental disorders (NDD) are commonly associated with microcephaly, due to perturbations in brain development and functioning. Given the extensive genetic heterogeneity of microcephaly, managing patients is hindered by the broad spectrum of diagnostic possibilities that exist before conducting molecular testing. We investigated the genetic basis of syndromic microcephaly accompanied by NDD in a Brazilian cohort of 45 individuals and characterized associated clinical features, as well as evaluated the effectiveness of whole-exome sequencing (WES) as a diagnostic tool for this condition. Patients previously negative for pathogenic copy number variants underwent WES, which was performed using a trio approach for isolated index cases (n = 31), only the index in isolated cases with parental consanguinity (n = 8) or affected siblings in familial cases (n = 3). Pathogenic/likely pathogenic variants were identified in 19 families (18 genes) with a diagnostic yield of approximately 45%. Nearly 86% of the individuals had global developmental delay/intellectual disability and 51% presented with behavioral disturbances. Additional frequent clinical features included facial dysmorphisms (80%), brain malformations (67%), musculoskeletal (71%) or cardiovascular (47%) defects, and short stature (54%). Our findings unraveled the underlying genetic basis of microcephaly in half of the patients, demonstrating a high diagnostic yield of WES for microcephaly and reinforcing its genetic heterogeneity. We expanded the phenotypic spectrum associated with the condition and identified a potentially novel gene (CCDC17) for congenital microcephaly. [ABSTRACT FROM AUTHOR]

The integration of Clinical Decision Support Systems (CDSS) based on artificial intelligence (AI) in healthcare is groundbreaking evolution with enormous potential, but its development and ethical implementation, presents unique challenges, particularly in critical care, where physicians often deal with life-threating conditions requiring rapid actions and patients unable to participate in the decisional process. Moreover, development of AI-based CDSS is complex and should address different sources of bias, including data acquisition, health disparities, domain shifts during clinical use, and cognitive biases in decision-making. In this scenario algor-ethics is mandatory and emphasizes the integration of 'Human-in-the-Loop' and 'Algorithmic Stewardship' principles, and the benefits of advanced data engineering. The establishment of Clinical AI Departments (CAID) is necessary to lead AI innovation in healthcare, ensuring ethical integrity and human-centered development in this rapidly evolving field. [ABSTRACT FROM AUTHOR]

We present a novel frailty model for modeling clustered survival data. In particular, we consider the Birnbaum–Saunders (BS) distribution for the frailty terms with a new directly parameterized on the variance of the frailty distribution. This allows, among other things, compare the estimated frailty terms among traditional models, such as the gamma frailty model. Some mathematical properties of the new model are studied including the conditional distribution of frailties among the survivors, the frailty of individuals dying at time t, and the Kendall’s τ measure. Furthermore, an explicit form to the derivatives of the Laplace transform for the BS distribution using the di Bruno’s formula is found. Parametric, non-parametric and semiparametric versions of the BS frailty model are studied. We use a simple Expectation-Maximization (EM) algorithm to estimate the model parameters and evaluate its performance under different censoring proportion by a Monte Carlo simulation study. We also show that the BS frailty model is competitive over the gamma and weighted Lindley frailty models under misspecification. We illustrate our methodology by using a real data sets. [ABSTRACT FROM AUTHOR]

We present a detailed study concerning a new physics scenario involving four fermion operators of the Nambu-Jona-Lasinio type characterized by a strong-coupling ultraviolet fixed point where composite particles are formed as bound states of elementary fermions at the scale Λ = O TeV . After implementing the model in the Universal FeynRules Output format, we focus on the phenomenology of the scalar leptoquarks at the LHC and the High-Luminosity option. Leptoquark particles have undergone extensive scrutiny in the literature and experimental searches, primarily relying on pair production and, more recently, incorporating single, Drell-Yan t-channel, and lepton-induced processes. This study marks, for the first time, the examination of these production modes at varying jet multiplicities. Novel mechanisms emerge, enhancing the total production cross section. A global strategy is devised to capture all final state particles produced in association with leptoquarks or originating from their decay, which we termed "exclusive", in an analogy to the nomenclature used in nuclear reactions. The assessment of the significance in current and future LHC runs, focusing on the case of a leptoquark coupling to a muon–c quark pair, reveals greater sensitivity compared to ongoing searches. Given this heightened discovery potential, we advocate the incorporation of exclusive leptoquark searches in future investigations at the LHC. [ABSTRACT FROM AUTHOR]

The intrusion of relatively warm water onto the continental shelf is widely recognized as a threat to Antarctic ice shelves and glaciers grounded below sea level, as enhanced ocean heat increases their basal melt. While the circulation of warm water has been documented on the East Antarctic continental shelf, the modes of warm water transport from the deep ocean onto the shelf are still uncertain. This makes predicting the future responses of major East Antarctic marine-grounded glaciers, such as Totten and Ninnis glaciers, particularly challenging. Here, we outline the key role of submarine canyons to convey southward flowing currents that transport warm Circumpolar Deep Water toward the East Antarctic shelf break, thus facilitating warm water intrusion on the continental shelf. Sediment drifts on the eastern flank of the canyons provide evidence for sustained southward-directed flows. These morpho-sedimentary features thus highlight areas potentially prone to enhanced ocean heat transport toward the continental shelf, with repercussions for past, present, and future glacial melting and consequent sea level rise. Sediment drifts record long-lasting southward flowing currents within submarine canyons, which convey warm Circumpolar Deep Water toward the East Antarctic shelf break, thus facilitating warm water intrusion on the continental shelf. [ABSTRACT FROM AUTHOR]

Plasma wakefield acceleration revolutionized the field of particle accelerators by generating gigavolt-per-centimeter fields. To compete with conventional radio-frequency (RF) accelerators, plasma technology must demonstrate operation at high repetition rates, with a recent research showing feasibility at megahertz levels using an Argon source that recovered after about 60 ns. Here we report about a proof-of-principle experiment that demonstrates the recovery of a Hydrogen plasma at the sub-nanosecond timescale. The result is obtained with a pump-and-probe setup and has been characterized for a wide range of plasma densities. We observed that large plasma densities reestablish their initial state soon after the injection of the pump beam (< 0.7 ns). Conversely, at lower densities we observe the formation of a local dense plasma channel affecting the probe beam dynamics even at long delay times (> 13 ns). The results are supported with numerical simulations and represent a step forward for the next-generation of compact high-repetition rate accelerators. The authors report about a proof-of-principle experiment that demonstrates the recovery of a Hydrogen plasma accelerator at the sub-nanosecond timescale. The result is obtained with a pump-andprobe setup and represent a step forward for the next-generation of compact high-repetition rate plasma-based accelerators. [ABSTRACT FROM AUTHOR]

The classification of medical devices by the Food and Drug Administration (FDA) involves rigorous scrutiny from specialized panels that designate devices as Class I, II, or III depending on their levels of relative risk to patient health. Posterior rigid pedicle screw systems were first classified by the FDA in 1984 and have since revolutionized the treatment of many spine pathologies. Despite this early classification by the FDA, posterior cervical pedicle and lateral mass screws were not reclassified from unclassified to Class III and then to Class II until 2019, nearly 35 years after their initial classification. This reclassification process involved a decades-long interplay between the FDA, formal panels, manufacturers, academic leaders, practicing physicians, and patients. It was delayed by lawsuits and a paucity of data demonstrating the ability to improve outcomes for cervical spinal pathologies. The off-label use of thoracolumbar pedicle screw rigid fixation systems by early adopters assisted manufacturers and professional organizations in providing the necessary data for the reclassification process. This case study highlights the collaboration between physicians and professional organizations in facilitating FDA reclassification and underscores changes to the current classification process that could avoid the prolonged dichotomy between common medical practice and FDA guidelines. [ABSTRACT FROM AUTHOR]

Objective: Patients with normocephalic pansynostosis, who have a grossly normal head shape, are often overlooked early in life and present late with elevated intracranial pressure (ICP) requiring timely cranial vault expansion. This study evaluates the long-term clinical outcomes of patients with normocephalic pansynostosis. Methods: We retrospectively reviewed patients with a clinical and radiographic diagnosis of primary pansynostosis who underwent vault reconstruction between 2000 and 2023. Clinical and treatment course after craniofacial interventions was followed in patients with normocephaly to assess outcomes. Results: Thirty-five patients with primary pansynostosis were identified, of which eight (23.5%) had normocephaly and underwent initial vault expansion at a mean age of 5.0 ± 2.4 years. All eight patients (50.0% male) presented with symptoms of elevated ICP including headaches (50.0%), nausea and vomiting (50.0%), and developmental delay (62.5%) and/or signs of elevated ICP including papilledema (75.0%) and radiologic thumbprinting on head computed tomography scan (87.5%). Three of the four normocephalic patients who had over 7 years of postoperative follow-up developed subjective headaches, vision changes, or learning and behavioral issues in the long-term despite successful vault reconstruction. Conclusions: Our longitudinal experience with this rare but insidious entity demonstrates the importance of timely intervention and frequent postoperative monitoring, which are critical to limiting long-term neurological sequelae. Multidisciplinary care by craniofacial surgery, neurosurgery, ophthalmology, and neuropsychology with follow-up into adolescence are recommended to assess for possible recurrence of elevated ICP secondary to cranio-cerebral disproportion. [ABSTRACT FROM AUTHOR]

In the contemporary digital era, images are omnipresent, serving as pivotal entities in conveying information, authenticating experiences, and substantiating facts. The ubiquity of image editing tools has precipitated a surge in image forgeries, notably through copy-move attacks where a portion of an image is copied and pasted within the same image to concoct deceptive narratives. This phenomenon is particularly perturbing considering the pivotal role images play in legal, journalistic, and scientific domains, necessitating robust forgery detection mechanisms to uphold image integrity and veracity. While advancements in Convolutional Neural Networks (CNN) have propelled copy-move forgery detection, existing methodologies grapple with limitations concerning the detection efficacy amidst complex manipulations and varied dataset characteristics. Additionally, a palpable void exists in comprehensively understanding and exploiting dataset heterogeneity to enhance detection capabilities. This heralds a pronounced exigency for innovative CNN architectures and nuanced understandings of dataset intricacies to augment detection capabilities, which has remained notably underexplored in the prevailing literature. Against this backdrop, our research broaches novel frontiers in copy-move forgery detection by introducing an innovative CNN architecture meticulously tailored to discern the subtlest manipulations, even amidst intricate image contexts. An extensive analysis of multiple datasets – MICC-F220, MICC-F600, and a combined variant – enables us to delineate a granular understanding of their attributes, thereby shedding unprecedented light on their influences on detection performance. Further, our research goes beyond mere detection, delving deep into comprehensive analyses of varied datasets and conducting additional experiments with differential training-validation sets and randomly labeled data to scrutinize the robustness and reliability of our model. We not only meticulously document and analyze our findings but also juxtapose them against extant models, offering an exhaustive comparative analysis. [ABSTRACT FROM AUTHOR]

Aim: To compare the effectiveness of commonly used offloading devices for the treatment of neuropathic foot ulcers in patients with diabetes mellitus. This meta-analysis (MA) has been performed for giving an answer to clinical questions on this topic of the Italian guideline on diabetic foot syndrome. Methods: The present MA includes randomized controlled studies (duration > 12 weeks) comparing, in patients with diabetes mellitus and non-infected neuropathic foot ulcer: any offloading device vs either no offloading device or conventional footwear; removable versus non-removable offloading devices; surgical procedure vs other offloading approaches. The primary endpoint was ulcer healing. Results: A total of 184 studies were identified, and 18 were considered eligible for the analysis. We found that: any plantar off-loading, when compared to the absence of plantar offloading device, is associated with a higher ulcer healing (MH-OR: 3.13 [1.08, 9.11], p = 0.04, I2 = 0%); total contact cast or nonremovable knee-high walker, compared to other offloading devices, had a higher ulcer healing rate (MH-OR: 2.64 [1.43, 4.89], p = 0.002, I2 = 51%); surgical offloading for active ulcers in combination with post-surgery offloading achieves higher ulcer healing rate when compared to offloading devices alone (MH-OR: 6.77 [1.64, 27.93], p = 0.008, I2 = 0%). Conclusions: Any plantar offloading, compared to the absence of plantar offloading device, is associated with a higher ulcer healing rate. Total contact cast or nonremovable knee-high walker, compared to other offloading devices, is preferable. Surgical offloading for active ulcers, in combination with post-surgery offloading devices, achieves a higher ulcer healing rate when compared to other offloading devices alone. Further studies with a larger cohort of patients with diabetic neuropathic foot ulcers and extended follow-up periods are necessary. [ABSTRACT FROM AUTHOR]