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Trends in the incidence of asthma, atopic dermatitis, and multiple sclerosis before, during, and after the COVID-19 pandemic in a US claims database
There is limited evidence on how reduced healthcare resource utilization during the COVID-19 pandemic has affected the detection of inflammatory and immunologic diseases. We aimed to describe the observed incidence rates (IRs) of asthma, atopic dermatitis (AD), and multiple sclerosis (MS) before, during, and after the pandemic. Individuals aged ≥6 years were identified in Optum’s de-identified Clinformatics ® Data Mart Database from 2018 to 2022 to make 20 season-based cohorts. Age- and sex-standardized IRs of asthma, AD, and MS were estimated. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated comparing IRs in seasonal cohorts in 2019–2022 to the corresponding timeframe in 2018. Compared to spring 2018, IRs of asthma, AD, and MS in spring 2020 decreased by 14% (IRR: 0.86, 95% CI: 0.84–0.87), 28% (IRR: 0.72, 95% CI: 0.69–0.75), and 23% (IRR: 0.77, 95% CI: 0.68–0.87), respectively. The observed incidence reduction was most profound in children (6–11 years) and adolescents (12–17 years), followed by senior adults (≥65 years). There was no sex difference. IRs returned to or exceeded pre-pandemic levels for AD and MS in summer 2020 and for asthma in spring 2021. COVID-19 led to an apparent decline in incidence for selected inflammatory and immunologic diseases, which was more pronounced for pediatric and senior populations. The observed decrease in incidence likely reflects delayed access to healthcare, resulting in unrecorded (but still occurring) diagnoses for those time periods. Future studies using data that encompass the pandemic period should exercise caution in the design of study and interpretation of incidence or prevalence data.
TIG welding defect detection using ResNet and Random Forest
Orbital TIG welding is critical in precision manufacturing, where weld defects can affect structural reliability. Manual inspection, analysis, and evaluation of welding defect images are complex because defect characteristics vary in shape, position, and size, making the process time-consuming. This study proposes a method that combines ResNet50 feature extraction with Random Forest classification to improve classification accuracy. A total of 3,219 weld image samples collected from controlled orbital TIG experiments were used for model training and evaluation and divided into four classes: normal weld, lack of fusion, overheating, and uneven weld. Using five-fold cross-validation, the method achieved an overall accuracy of 98% and demonstrated improved performance compared with CNN architectures (VGG16, VGG19, ResNet18, ResNet50) and traditional machine learning approaches such as SVM and Random Forest. ResNet50 extracts hierarchical visual representations through deep residual connections, enabling automatic feature learning, while Random Forest performs the final classification with robustness against overfitting on high-dimensional features.
The role of neutrophil PD-L1 expression in acute exacerbation of COPD
Background and objective The elevation of neutrophil-lymphocyte ratio (NLR) has been shown to be critically involved in unfavorable outcomes among patients with chronic obstructive pulmonary disease (COPD). The mechanism underlying NLR changes during COPD progression remains unclear. This study evaluates the association between neutrophil PD-L1 expression and acute exacerbation of AECOPD and examines its correlation with the NLR. Methods In this prospective observational study from June 1 to December 30 2024, we enrolled 14 patients with acute exacerbation, 27 with stable conditions, and 9 healthy control subjects. Blood samples were collected for neutrophil isolation, and the CD15 + CD274 + neutrophil percentage was measured using flow cytometry. We also recorded and analyzed smoking history, pulmonary function test results, and blood routine test data. Results The percentage of CD15 + CD274 + neutrophils was notably higher in patients with COPD compared to healthy controls and was even more elevated in those experiencing acute exacerbations of COPD (AECOPD) than in patients with stable COPD. This increased percentage was positively correlated with NLR but negatively correlated with FEV 1 % (FEV 1 percentage of the predicted value). The AUC of CD15 + CD274 + neutrophil percentage for predicting AECOPD was 0.894 with 95% CI 0.8–0.989 and a ratio above 3.273 (odds ratio 1.386; 95% CI 1.016–1.891; P = 0.039) independently associated with AECOPD. Conclusion Peripheral blood neutrophil PD-L1 expression was elevated in AECOPD and independently associated with exacerbation status in this pilot cohort. Larger, multi-center studies with mechanistic validation are required to determine its clinical utility.
Contrastive learning with mutual information enhancement and negative sample augmentation combined with KAN for text clustering
This paper proposes a text clustering model based on mutual information-enhanced contrastive learning combined with Kolmogorov-Arnold Networks (KAN) to address challenges in text clustering, including insufficient robustness of text representations, feature redundancy, and the curse of dimensionality. Text clustering is essential for organizing unstructured textual data, yet existing methods often suffer from weak feature representations and limited scalability in high-dimensional spaces. The proposed model jointly addresses these three core issues by maximizing mutual information to capture nonlinear relationships among positive samples, expanding negative samples to enhance discriminability, and employing the KAN architecture to adapt to the complex structures of high-dimensional data. Experimental results on eight benchmark datasets demonstrate that the proposed model achieves state-of-the-art accuracy on seven out of eight datasets and leads normalized mutual information on six datasets, outperforming existing text clustering baselines. To validate its practical utility, the model was applied to cluster Weibo posts collected via web crawlers using “technology” as the keyword during January and February 2025. The case study results reveal that the model effectively identifies meaningful thematic clusters—such as AI applications, technology industry trends, and consumer electronics discussions—confirming its applicability to real-world social media data.
Exploring perceptions, readiness, barriers, and facilitators related to the potential implementation of postpartum depression screening: A mixed-methods study in a Lebanese maternity setting
Background Postpartum depression (PPD) is a common mental health condition affecting mothers, infants, and families, with higher prevalence in middle-income countries. Despite its burden, PPD remains under-screened in Lebanese public hospitals, particularly in disadvantaged areas like Tripoli. Objectives To assess nurses’ knowledge, attitudes, and practices regarding PPD and explore facilitators, and barriers influencing the potential implementation of systematic PPD screening. Methods A mixed-methods study was conducted in a Lebanese public university hospital, combining a quantitative survey with qualitative focus group discussions involving nurses and managers. Descriptive analyses were applied to survey data, and thematic analysis was used for qualitative findings. Results Most nurses were aware of PPD (92.9%) and “baby blues” (92.9%), but only 21.4% were aware of standardized screening tools. Correct identification of key symptoms was reported by 71.4%, while only 35.7% correctly identified all risk factors and 28.6% recognized appropriate combined management (psychotherapy and antidepressants). Regarding attitudes, all participants (100%) agreed that PPD screening should be part of routine postnatal care, and 92.9% recognized its seriousness and the role of nurses in early detection. However, only 78.6% felt confident identifying PPD signs. In terms of practice, only 28.6% consistently assessed mothers’ emotional well-being before discharge. Qualitative findings suggested a generally positive attitude toward the potential implementation of screening, while also highlighting perceived barriers, including insufficient training, unclear role delineation, inadequate referral pathways, time constraints, and weak internal communication regarding mental health services. Conclusion The findings suggest that challenges to the potential implementation of PPD screening may be related to capacity and organizational support than to resistance among participants. Strengthening training, integrating standardized screening into routine postnatal care, clarifying roles and referral pathways may facilitate the implementation of PPD screening. Given the exploratory nature of this single-center study, further research is needed to assess the transferability of these findings to other maternity care settings in Lebanon.
Earth pressure analysis of inclined support structures adjacent to existing structures
This study investigates the earth pressure acting on inclined support structures adjacent to existing structures by combining laboratory physical model tests with theoretical derivation. Five groups of model tests were conducted at a constant width-to-height ratio of 0.95, with support inclination angles of 0°, 5°, 10°, 15°, and 20°. Particle image velocimetry (PIV) and multi-point earth pressure monitoring were employed to reveal the failure surface development in the finite soil mass and the distribution characteristics of earth pressure behind the wall. Based on the assumptions of straight failure surfaces and circular-arc major principal stress trajectories, the finite soil mass was divided into several zones. Force equilibrium equations were established for horizontal differential elements in each zone, and theoretical models for earth pressure intensity, resultant force, and the point of application of the resultant force were derived. The theoretical results were generally in good agreement with the experimental results and reasonably reflected the distribution characteristics of passive earth pressure in the finite soil mass under inclined support conditions. In particular, the theoretical predictions were in good agreement with the measured values in the principal compression zone in the middle and lower portions of the soil mass. The measured earth pressures at the upper monitoring points were markedly lower because of local wall-soil separation, the inability of cohesionless sand to transmit tensile stress, and wall-soil contact relaxation. Within the experimental validation range, the resultant earth pressure decreased and its point of application generally shifted upward as the support inclination angle increased. In contrast, an increase in the soil friction angle caused the point of application to shift downward. The findings of this study can provide a theoretical reference for the design of inclined support structures in projects adjacent to existing structures.
Parental perspectives of prenatal counseling and decision making for termination or hospice birth due to fetal congenital heart defects
Objective To evaluate perspectives of counseling and decision making among birthing parents who chose termination or hospice birth due to a fetal congenital heart defect (CHD). Methods Qualitative analysis of semi-structured interviews with birthing parents who chose either termination or hospice birth due to severe fetal CHD. Participants were recruited from a purposive sample of those who received multidisciplinary counseling at a tertiary congenital heart surgical center between 2019–2023. Thematic analysis was conducted in five stages, using an integrated deductive-inductive approach. Results In total, 20 individuals were eligible; 10 completed interviews. Identified themes were categorized in two domains: Experiences During Counseling and Individual Factors Affecting Decision Making. Themes in the first domain included: areas for improvement during counseling, perceived strengths of counseling, patient attributes affecting counseling, and views on provider recommendations. Themes in the second domain included: emotions affecting decision making, value for reproductive autonomy, family factors, internal factors, outside input, and desire for resources. Conclusions In this study, birthing parents who chose termination or hospice for fetal CHD appreciated information extending beyond clinical outcomes to include family and financial impacts. Their value for reproductive autonomy reflects the need for clinicians to gain skills in empathetic and neutral counseling of all management options.
Ultrasound-guided sacral multifidus plane block versus caudal epidural block for postoperative analgesia in pediatric hypospadias surgery: A randomized double-blind controlled trial
Introduction Hypospadias repair is associated with moderate to severe postoperative pain in children. Caudal epidural block is traditionally considered the standard regional anesthetic technique for sub-umbilical pediatric surgeries; however, its duration of analgesia and potential adverse effects may be limited. The sacral multifidus plane block (SMPB) is a novel ultrasound-guided fascial plane technique that may provide prolonged analgesia with fewer complications. The aim of this study is to compare the analgesic efficacy and safety of ultrasound-guided sacral multifidus plane block versus caudal epidural block in children undergoing hypospadias repair. Materials and methods This prospective, randomized, double-blind controlled trial included 30 children aged 1–5 years (ASA I–II) scheduled for hypospadias repair. Patients were randomly allocated to receive either SMPB (n = 15) or caudal block (n = 15), using 1 mL/kg of 0.25% bupivacaine. The primary outcome was time to first rescue analgesia. Secondary outcomes included postoperative FLACC pain scores, total rescue analgesic consumption, intraoperative fentanyl requirements, hemodynamic variables, and block-related complications. Pain was assessed for 24 hours postoperatively. Results Demographic and intraoperative characteristics were comparable between groups. Time to first rescue analgesia was significantly longer in the SMPB group compared with the caudal group (14.8 ± 3.6 vs 9.3 ± 4.2 hours, p = 0.004). FLACC scores were significantly lower in the SMPB group at 6 and 12 hours postoperatively (p = 0.019 and p = 0.001, respectively). Total diclofenac consumption was lower in the SMPB group (0.40 ± 0.20 mg/kg vs 0.70 ± 0.24 mg/kg, p = 0.010). Intraoperative fentanyl requirements and hemodynamic parameters were similar. No major complications were observed. Conclusion Ultrasound-guided sacral multifidus plane block provides longer-lasting postoperative analgesia and reduces rescue analgesic requirements compared with caudal epidural block in pediatric hypospadias surgery, with a comparable safety profile. SMPB may represent a reliable alternative to caudal block for postoperative pain management in this population.
Feedback and feedforward methods in medical and higher health education: A scoping review
Background Programmatic assessment (PA) in health professions education positions continuous feedback and feedforward as key mechanisms for competence development. Feedback focuses on prior performance, whereas feedforward provides future-oriented guidance that supports agency and self-regulated learning. Although their educational value is widely acknowledged, implementation remains challenging and often emphasises performance outcomes rather than action and reflection. Methods A scoping review was conducted to address the research question: “How are feedback and feedforward methods operationalised within assessment situations in medical and higher health professions education? The ECLIPSE framework (Expectation, Client group, Location, Impact, Professionals, Service) guided question formulation and searches in Embase, ERIC and PubMed. Articles published from 2015 up to February 2026 were included. Data were synthesized using descriptive and thematic synthesis. The methodological quality of the included studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Results Database searches identified 3723 records. After deduplication and screening, 91 full texts were assessed, of which 14 studies met inclusion criteria. All studies involved medical students. Five methodological families were identified: expert feedback, self-feedback, peer feedback, video-based feedback, and feedforward. Expert and video-based approaches were consistently associated with performance gains, whereas self- and peer feedback supported reflection and learner agency but showed variable outcomes. Feedforward was rarely explicitly described, although several interventions incorporated forward-looking elements targeting performance. Conclusion Current assessment practices rely on a limited set of recurring methods, with feedforward, predominantly focused on performance, often remaining implicit. Making feedforward explicit and actionable within assessment cycles might strengthen competence development, promote learner agency, and support continuous improvement in PA context.
Motivations and segmentation of instagram users as a social network site: Their sociodemographic profiles, satisfaction and loyalty
Millions of Internet users interact daily with social network sites (SNS), and these figures are still expected to grow. This study aimed to identify the motivations and typology of different types of Instagram users, specifically pursuing these objectives: (1) to identify the motivations that lead individuals to use Instagram as a SNS; (2) to establish user segments based on these motivations; (3) to determine how these segments relate to user satisfaction and loyalty; and (4) to explore the relationship between the identified segments and key socio‑economic and demographic variables. The study was carried out through an online survey composed of 369 participants. For data analysis, factorial analysis, the K-means segmentation method, and the Chi-square test were used. Four motivational dimensions in the use of Instagram were identified, related to “Curiosity, Creativity, and Documentation,” “Self-expression,” “Socialization,” and “Recreation.” In addition, three distinct segments of Instagram users were identified based on their underlying motivations: “Enthusiasts”, “Spectators”, and “Passive Users”. Among them, the Enthusiasts emerged as the group displaying the highest levels of satisfaction and loyalty within the platform. The study further assessed the socio-economic and demographic profiles of each segment. This study offers original value by categorizing users based on their motivations, examining how these motivations relate to satisfaction and loyalty, and identifying the socio-economic and demographic profiles of the different user segments. The findings contribute to strategic frameworks for digital marketing and audience segmentation, providing organizations and businesses, particularly those that use Instagram as a communication, sales, or business channel, with actionable insights. Overall, this research establishes a solid foundation for future studies and practical applications in social media strategy, consumer behavior, and digital marketing.
Cultural tightness and scientific capacity: A cross-national study of their synergistic and conflicting roles in COVID-19 pandemic outcomes
Despite their advanced scientific capacity, many nations experienced high COVID-19 cases and deaths during the pre-vaccine phase of the pandemic. In contrast, some countries with tighter cultural norms, where social behaviour is more strongly regulated, appear to have controlled the spread of the virus more effectively. This creates a paradox: the same norm strength that may support compliance with public-health measures may also be less conducive to ideation, creativity, and scientific output. While prior research has associated cultural tightness with lower COVID-19 cases and deaths, its relationship with scientific capacity remains underexplored. This study examines associations between scientific capacity, cultural tightness, and COVID-19 outcomes using cross-national data. Findings show that scientific capacity has no robust direct protective association with pre-vaccine COVID-19 cases or deaths once cultural tightness and structural covariates are included. In contrast, Gelfand’s measure of cultural tightness is consistently associated with lower cases and deaths. These findings suggest that scientific knowledge alone does not automatically translate into population-level protection, and that norm strength, behavioural coordination, and knowledge-to-action capacity may be important conditions of pandemic resilience.
Spatial intensity modelling of ISIS-related attacks using random forest regression: A GeoAI-based analysis of GTD data (2012–2019)
Spatial information is of crucial importance to understanding terrorist attacks and for security applications. Conventional risk assessments of terrorism are typically focused on retrospective identification of hotspots and may fail to fully account for complex spatial–temporal patterns. This research proposes an approach to modelling the relative intensity of ISIS/ISIL attacks across space using Random Forest regression, a type of Geospatial Artificial Intelligence (GeoAI). A subset of the Global Terrorism Database (GTD) from 2012–2019 is screened to develop a spatially aggregated data set with geographic coordinates, temporal information and some incident details. The modelling strategy estimates the intensity of events in a grid cell, with values normalized based on the count of previous events, allowing for an analysis of spatial patterns rather than the prediction of future events. Modelling results show that the Random Forest model captures spatial variability in historical attack intensity with a high level of fit (R² = 0.84; RMSLE = 0.213). Analysis of variable importance suggests spatial and temporal features play an important role, but this is contextualised by the spatial construction of the response variable. The research presents a repeatable GeoAI process for modelling spatial patterns of terrorism incidents and offers an interpretable model for exploratory spatial analysis and scenario-based spatial analysis development. The approach is not suitable for real-time prediction, but aids in understanding historical spatial concentration patterns in a complex threat environment.
Patient satisfaction towards pharmacists’ services in the community pharmacies in the Hail region
Objectives Research on patient satisfaction with community pharmacy services in Saudi Arabia has mostly concentrated on large cities, leaving a significant gap in understanding these services within the Hail region. Evaluating patient satisfaction in Hail is essential to address regional service gaps in privacy and counseling. Thus, this study was designed to assess the patient satisfaction with community pharmacy services in the Hail region. Methods This cross-sectional study targeting the community pharmacy visitors in Hail region was conducted among 200 participants for a duration of three months (i.e., from 14 June 2024–29 September 2024). Patient satisfaction was assessed by a reliable and valid questionnaire. The instrument consisted of 17 items; and all of them were 5-point Likert scale responses (Poor = 1, Fair = 2, Good = 3, Very good = 4, Excellent = 5). To guarantee diverse geographic representation, 20 community pharmacies were purposefully chosen from several Hail City districts. In order to achieve balanced sample across all sites, a total of 200 participants were recruited, with roughly 10 patients joined from each Pharmacy. The data was analyzed for descriptive statistics using the SPSS, version 29.0. Results The majority of the 200 participants in this study (mean age of 37.5 years) were married (60.5%) and male (56.5%). More than half had only completed high school, and only 16% had insurance. Most of the patients (53%) consistently visited the same pharmacy. Pharmacist-patient relationships received the highest level of satisfaction, but accessibility—specifically, the availability of private consultation areas—received the lowest. Regular pharmacy visitors reported higher levels of satisfaction across multiple domains, whereas younger, male, single, better-educated, insured, and healthier patients had more favorable perceptions of medicine availability, highlighting disparities in demographic and health factors. Conclusion The majority of community pharmacy visitors were young adults, married, had a range of educational backgrounds, and frequently used the services without a prescription or health insurance. Overall, patient satisfaction was good; nevertheless, to further improve patient experience and access to pharmacy services, improvements in private consultation facilities and pharmaceutical pricing are required.
Does delayed exercise-based priming improve subsequent athletic performance? A systematic review and multilevel meta-analysis
This systematic review and multilevel meta-analysis examined whether delayed exercise-based priming improves subsequent athletic performance. Following PRISMA 2020 principles, 3,095 records were identified; after removing 1,107 duplicates, 1,988 unique records were screened, 212 full-text reports were assessed, 186 reports were excluded at eligibility, and 26 studies were included. Eighteen studies contributed 46 effect sizes to the quantitative synthesis. Risk of bias was assessed with RoB 2 principles calibrated for crossover exercise trials, and certainty was evaluated using GRADE. A three-level random-effects model showed a small positive average effect of delayed priming on subsequent performance (g = 0.232, 95% CI [0.092, 0.372], p = .002), with cluster-robust inference supporting the same conclusion (p = .004). The prediction interval crossed zero (−0.265 to 0.730), and the overall certainty of evidence was low. Delayed exercise-based priming can be used as a practical competition-day strategy when embedded in planned preparation windows, although protocol selection and athlete response should be checked in training before competition use.
Understanding the transition to motherhood among adolescent mothers in rural Pakistan: Implications for mental health
Purpose This study explored how adolescent mothers in Pakistan experience the transition to motherhood and the mental health challenges that arise during this period. Methods A focused ethnographic study was conducted with 25 adolescent mothers in Matiari, Sindh. Data were collected through semi‑structured interviews, participant observations, and artifact elicitation. Meleis’ Transition Theory informed the study focus and development of the interview guide. Reflexive thematic analysis guided interpretation, informed by an intersectional lens. Findings Five themes described mothers’ experiences: early educational disruption and redirected aspirations; continuous caregiving with uneven support; barriers to maternal healthcare access; emotional distress and psychological strain; and identity transformation. These intersecting challenges contributed to significant mental health strain and highlighted persistent gaps in access to supportive, adolescent-responsive maternal care. Conclusions Adolescent mothers navigate motherhood with substantial emotional and practical burdens yet demonstrate meaningful resilience. Findings highlight the need for adolescent‑responsive mental health support, accessible care, routine and confidential distress screening, referral pathways, and supportive educational and community‑based interventions tailored to underserved rural settings.
Suicidal ideation, mental health services, and barriers to care among syringe services program clients who use opioids
Introduction People who use opioids (PWUO) experience a disproportionately high burden of suicidal risk. Syringe services programs (SSPs) are a critical point of contact for this population, providing low-threshold, harm-reduction services. However, gaps persist in understanding suicidal risk among individuals attending SSPs and the extent to which such risk is associated with mental health service utilization in this setting. This study aimed to assess the prevalence and specific risk factors for suicidal ideation (SI) in PWUO, as well as their use of and barriers to accessing mental health services. Methods We conducted a cross-sectional survey between April and June 2024 among PWUO (N = 199) who were utilizing services in the SSP in New Haven, Connecticut. We used the ninth item from the Patient Health Questionnaire (PHQ-9) scale, which assesses passive thoughts of death and self-harm in the past two weeks, as a proxy measure for the SI. Additionally, participants reported their use of and barriers to accessing mental health services in the past six months. Bivariate and multivariable logistic regression were conducted to examine factors associated with SI. Results Approximately 84% of participants met the criteria for opioid dependence, and more than two-thirds (71.9%) were currently receiving medication for opioid use disorder. Over one-third of the sample reported SI in the past two weeks (34.7%). Additionally, over one-third of participants (36.2%) reported unmet mental health needs, and 84.4% reported experiencing at least one barrier to accessing mental health services. Individuals with depressive symptoms (aOR: 5.4; 95% CI: 2.5–11.7) were more likely to report SI, while those who were aware of naloxone (aOR: 0.2; 95% CI: 0.1–0.6) were less likely to report SI in the past two weeks. Conclusion Our study showed a high prevalence of SI among SSP clients who use opioids and a low use of mental health services due to access barriers. These findings support incorporating a brief suicide risk screening and referral options within SSPs and other settings serving PWUO and addressing key access issues like cost and transportation that can prevent timely linkage to mental health services.
PM-DUnet: Fusing long-range dependencies and attention in a dual-U architecture for thyroid nodule segmentation
For medical image segmentation, accurately balancing local details and global long-range dependencies is critical to tackling thyroid nodule challenges (variable sizes, ambiguous boundaries, complex context). Traditional CNNs excel at local feature extraction but are constrained by local receptive fields, hindering efficient global dependency modeling. To address this, we propose a Parallel Mamba Dual-U Network (PM-DUNet). It adopts a cascaded dual U-Net encoder-decoder for two-stage “coarse-to-fine” segmentation refinement. We design a Multi-Path Parallel Mamba (MPM) module—using State Space Models (SSMs)—to efficiently model global context with linear complexity. Additionally, Squeeze-Excitation Downsampling (SED) and Spatial Attention Upsampling (SAU) modules are integrated to adaptively enhance key features in encoding/decoding. Results show PM-DUNet achieves highly competitive performance and outperforms state-of-the-art methods on most core metrics, verifying its effectiveness and robustness for complex medical image segmentation. Our code is available on https://github.com/Andrevict/MPDUNet .
Analysis of the characteristics of spino-pelvic sagittal parameters in Degenerative Thoracolumbar Kyphosis deformity and the mechanism of sagittal imbalance
Background Degenerative thoracolumbar kyphosis (DTLK) is a subtype of adult spinal deformity. If DTLK progresses further, it can develop into global kyphosis (GK). Although numerous studies have described the sagittal parameters of the spino-pelvic in adult spinal deformities, there is currently no report on the sagittal parameters of DTLK. To date, there have been no reports that elucidate the mechanism of sagittal imbalance by comparing it with sagittal balance, or by examining the sagittal parameters of healthy individuals. To address this gap, the study employed a retrospective analysis, measuring parameters such as the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis angle (LL), upper arc of total lumbar lordosis (UALL), lower arc of total lumbar lordosis (LALL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), spino-sacral angle (SSA), and PI-LL. This study aims to clarify the occurrence and compensatory mechanisms of sagittal balance and sagittal imbalance in patients with DTLK. Objective To investigate the spino-pelvic sagittal parameters in patients with degenerative thoracolumbar kyphosis and the compensatory mechanisms for the occurrence of sagittal imbalance. Method Our research is a cross-sectional study. The imaging data used in this study were extracted on August 15, 2025. A retrospective analysis was conducted on the preoperative imaging data of 339 patients diagnosed with DTLK at Fuyang People’s Hospital from 2016 to 2025. The sagittal parameters of the spino-pelvic were measured using Surgimap software and compared to those of healthy individuals as documented in the literature. The data were divided into a balanced group and an imbalanced group based on SVA and the spino-pelvic parameters of healthy individuals. The balanced group was then compared with the imbalanced group. Results The spino-pelvic sagittal parameters of DTLK patients were significantly different from those of healthy individuals. In the balanced group, TK, TLK, LL, and PT were higher than those of normal individuals, while SS, PI, PI-LL, SSA, and UALL were lower than those of normal individuals. Compared with the imbalanced group, the balanced group had higher TK, TLK, LL, LALL, and SSA and lower SS, PT, PI-LL, and UALL. SVA showed significant correlations with multiple sagittal parameters. Conclusions DTLK patients exhibit significant differences from healthy individuals in various sagittal parameters. Balance is primarily maintained through the posterior tilt of the pelvis and a reduction in the lumbar lordosis to compensate. When an imbalance occurs, the LL, LALL, UALL, PT, and PI-LL increase as compensatory mechanisms for the loss of balance. Once the UALL is exhausted, compensation shifts to an anterior convexity of the lower lumbar curve and a posterior rotation of the pelvis.
The mediating role of sleep quality in the association between urinary incontinence and depressive symptoms: A study with older Korean Americans Living in Subsidized Senior Housing
Urinary incontinence (UI) is a prevalent health issue among older adults. Depressive symptoms often accompany UI; however, the pathways linking these conditions remain understudied. In this study, we conceptualized sleep quality as a potential mediator in the association between UI and depressive symptoms. The mental health burden of UI is anticipated to be indirectly associated with impaired sleep quality. The mediating role of sleep quality was tested in a sample of 306 older Korean Americans living in low-income senior housing (mean age = 79.4 years, range = 65–102). Regression analyses showed a significant association between UI and depressive symptoms. Mediation analysis using the Hayes PROCESS macro showed that the indirect effect of UI on depressive symptoms through sleep quality was significant (B [SE] = 0.59 [0.21], bias-corrected 95% CI = [0.20, 1.02]), accounting for approximately 24% of the total effect. The findings suggest that compromised sleep quality may serve as a potential pathway linking UI and depressive symptoms. Sleep quality should be addressed in efforts to promote the mental health of older adults experiencing UI.
Lessons learned from youth-engaged research methods to conduct qualitative analysis with a transgender and gender-diverse youth advisory board
Although community-engaged research is becoming more common, youth-engaged research methods, particularly its application to qualitative analysis, remains rare. The Research on Identity Specific Eating Disorder Symptoms (RISES) Project developed, partnered with, and maintained a youth advisory board of five transgender, non-binary, and gender-diverse youth in all stages of a qualitative study, including qualitative analysis. Youth advisory board members contributed to a codebook, coded two to six transcripts each, provided feedback on themes and supporting quotes, and authored this paper. After one year, we achieved a retention rate of 83.3% of all youth advisory board members, and 100% of youth advisory board members trained in qualitative analysis. This paper describes the lessons learned from partnering with and training a transgender, non-binary, and gender-diverse youth advisory board to conduct qualitative analysis.