Browse Articles

Protocol for the establishment of the Pediatric Registry for Stroke as a Multidisciplinary Approach to healthcare research (PRiSMA) study

Background Childhood stroke is a rare but potentially life-threatening event that can occur at any age. It requires prompt diagnosis and appropriate treatment, and, in view of the frequent neurological and neurocognitive sequelae, long-term care in a multidisciplinary and multiprofessional setting. The management of stroke in children, which differs in many aspects from stroke in adults, often relies on local expert opinions and retrospectively collected data rather than high-quality evidence from prospective randomized controlled clinical trials, especially in the acute phase. Aims The Pediatric Registry for Stroke as a Multidisciplinary Approach to healthcare research (PRiSMA) study aims to systematically collect longitudinal prospective observational data across the acute and long-term phases to optimise diagnosis, personalised acute therapy, neurorehabilitation, and prevention of recurrent stroke. The data will inform development of further hypothesis-driven studies of childhood stroke in national and international networks. Furthermore, PRiSMA will facilitate case-specific collaboration within the registry network, allowing treating clinicians to consult experienced colleagues on complex cases. Methods In PRiSMA all children and adolescents (>28 days of life, ≤ 18years) with arterial ischemic stroke (AIS) or hemorrhagic stroke (HS) are eligible for recruitment. The nationwide multicenter, systematic data collection is performed in the acute and chronic phases, extracted from patient medical records supplemented by direct registry-specific medical history provided by caregivers. In addition, a questionnaire-based data on quality of life and behaviour will be collected. International collaborations are established across Germany, Austria and the Netherlands. Status Currently, 16 centres in Germany and 1 centre in Austria have commenced recruitment. 30 patients are currently (17 Nov 25) enrolled after arterial ischaemic stroke and 1 after haemorrhagic stroke.

Assessment of Lasso and Ridge models for soil swelling potential prediction

Intrinsic gradient oxygen-driven second-order memristors for continual reinforcement learning

The problem of the mechanical surface tension of active Brownian particle interfaces

Socioeconomic priorities and stunting in rural indonesia: A mixed-method study

As part of the plan to lower the stunting rate by up to 14% in Indonesia in 2024, a nutritional intervention program for stunted children was implemented in 2023. The program, which ran for four months, involved the daily administration of high-protein supplementary food to 4.9 million stunted children. However, it failed to reduce their number in some districts, including Sukodono, resulting in a high stunting rate of 20.89% (357 toddlers). The aim of this research is therefore to evaluate the major factors related to Supplementary Feeding Program (SFP) inefficiencies in Sukodono by examining the socioeconomic status and lifestyle of the community, and their knowledge of healthy food. A descriptive-exploratory approach with the simple random sampling method was employed. Data were collected through structured interviews with caregivers, observations of community lifestyles, and assessments of caregiver knowledge of healthy food. As demonstrated in the results, out of the 189 participants, 7.4% earned less than IDR 1,000,000.00, implying the necessity for frugal living, especially in the spending of household income. They possessed an adequate understanding of the importance of nutritious food for child growth. 51% were male, and 24% of the parents of stunted children used no form of contraception. Additionally, the parents were relatively young: 50% of the fathers and 46% of the mothers were aged 31–40, while 46% and 49% of the fathers and the mothers respectively were senior high school graduates. Few had continued to tertiary levels, with only 7% of the mothers holding a bachelor’s degree. Efforts by the government are considered necessary to alter community behavior and lifestyles and to highlight the urgency of formal education, as caregivers’ education levels affect children’s health. The study recommendations made include educating caregivers about the significance of fulfilling children’s nutritional needs, promoting healthy feeding practices for toddlers, and better planning of the birthing process.

Construction and initial validation of key gene network for progesterone resistance in endometrial cancer based on genome-wide CRISPR screening

Global economic exposure to climate change amplified by spatially compounding climate extremes

Abstract Despite growing evidence that climate extreme events can significantly affect local economies, the implications of cross-regional and planetary-scale dependencies in climate extremes remain inadequately understood. We demonstrate a crucial link between the projected increase in spatially compounding hot, wet, and dry extremes and the amplification of global economic exposure. Based on Earth System Model projections from the 6th phase of the Coupled Model Intercomparison Project, we analyze how planetary-scale and cross-regional dependencies can exacerbate regional disparities in economic exposure. Our findings reveal that regions with lower present-day economic wealth are more likely to face extreme events simultaneously with other areas, amplifying the potential threats to their economic stability. This study highlights the necessity of considering economic exposure to climate extremes beyond local scales, emphasizing the need for assessing cross-regional exposures and understanding the connections between localized exposures and global economic dynamics.

Person-centered practice in the Portuguese healthcare system: A documentary study

Background Person-centered practice has increasingly become a key structural component of health systems, driving the progressive reformulation of public health policies internationally. Despite broad consensus regarding its importance, its integration into clinical practice continues to face significant challenges. The Person-Centred Practice Framework identifies the macro context as a critical domain for sustainable implementation, as it encompasses the structural and strategic factors that shape healthcare delivery. Objective To characterize the person-centered practice framing within the macro context of the Portuguese healthcare system. Methodology Qualitative, descriptive, and retrospective documentary study. A systematic literature search was conducted on the websites of entities responsible for defining, guiding, and regulating healthcare in Portugal. Using predefined eligibility criteria, 40 documents were selected. Textual analysis was performed using IRAMUTEQ® software and guided by the constructs of the macro context domain of the Person-Centred Practice Framework. Results The lexicometric analysis identified five classes, grouped into two thematic fields: i) Structural and organizational determinants of person-centered practice , comprising the classes Systemic vision and integrated response , Organizational culture and participation , Digital transformation and information management , and Political vision and governance structures ; and ii) Operationalization of person-centered practice , represented solely by the class Care approach , reflecting its thematic specificity. Factorial analysis revealed distinct and poorly connected discursive patterns associated with different action levels within the healthcare system. Similarity analysis highlighted a discourse centered on the health-care-person nucleus, showing relations with service organization, care integration, and person participation, albeit with word dispersion suggesting misalignment between organizational and practice levels. Conclusion The macrocontextual framing of person-centered practice in the Portuguese healthcare system demonstrates significant political and strategic advances, as seen in the emphasis on humanized care, investment in health literacy and digitalization, and the introduction of Integrated Care Pathways. However, implementation remains limited due to the absence of clear formative guidelines, biomedical paradigm persistence, and lack of evaluation mechanisms sensitive to care experience.

Impact of contact parameters on lesion dimensions during circular Pulsed-Field ablation in ex vivo and in vivo models

Post-hospital physical rehabilitation for physical function recovery among community-dwelling survivors of critical illness: A systematic review protocol

Introduction Many survivors of critical illness experience lasting physical disability. Post-hospital rehabilitation has the potential to reduce this physical disability; however, primary studies have reported inconsistent results. We aimed to answer the following question: Among community-dwelling adults who survived critical illness, does participation in post-hospital physical rehabilitation, compared with no rehabilitation or alternative non-physical interventions, improve physical functioning 12 months after discharge from acute care? Materials and methods This is a systematic review protocol that was registered with PROSPERO (CRD 420251174065). It will be conducted with Cochrane methods and reported according to the 2020 Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. To optimize the impact of this review, our study team includes a patient partner to guide our methods and interpretation. To be eligible, peer-reviewed randomized controlled trials must have enrolled community-dwelling adults (≥ 18 years) previously admitted to the ICU (≥24 hours) to a post-hospital physical rehabilitation program compared to any control. Outcomes of interest include physical function, return to work, and health care utilization. We will search five databases from their inception. Study screening, selection and extraction will be conducted independently and in duplicate using Covidence. Disagreements will be resolved through discussion or with a third reviewer. We will assess risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). Where appropriate, we will conduct meta-analyses using random-effects modeling. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Conclusion A recent international multiprofessional expert panel highlighted the importance of understanding how follow-up care models can optimize long-term recovery after critical illness. Our review will provide a comprehensive synthesis of the impact of post-hospital rehabilitation on long-term recovery of survivors of critical illness.

Evaluating the relationship between heat waves and urban heat islands in tropical cities: a case study of Kuala Lumpur and George Town

Exploratory study on the impact of Ganoderma australe extract on gut microbiota and immune gene expression in honey bees exposed to Vairimorpha ceranae

The microsporidium Vairimorpha ( Nosema ) ceranae is an emerging threat to honey bees ( Apis mellifera ), known to disrupt gut microbiota and suppress immune responses, potentially contributing to colony losses. Fungal extracts have recently gained interest as sources of bioactive compounds with antimicrobial and immunomodulatory potential. In this study, we explored the effects of different dietary supplements—sugar syrup, HiveAlive™, and a novel Ganoderma australe extract (GanoBee)—on gut bacterial composition and immune-related gene expression in honey bees subjected to experimental exposure to V. ceranae 1 x 10 4 spores per bee. The GanoBee diet altered the gut microbiota, notably reducing the relative abundance of Rhizobiaceae ( Bartonella apis ) and increasing Frischella compared to other treatments. While alpha diversity was not significantly affected by diet or exposure to V. ceranae , beta diversity differed significantly in bees fed with GanoBee. Additionally, the expression of the antimicrobial peptide genes abaecin and hymenoptaecin was elevated in both exposed and unexposed bees fed with GanoBee, depending on the sampling day. However, the establishment of V. ceranae infection appeared limited, likely due to low spore viability, and mortality in control bees was higher than expected. The low Vairimorpha ceranae infection levels observed in this study are likely attributable to reduced spore viability caused by storage conditions and/or suboptimal environmental conditions within the laboratory cages. Post hoc analyses indicated that the high viscosity of GanoBee-supplemented diets likely contributed to the elevated bee mortality observed, underscoring a critical limitation of the experimental design related to diet formulation and delivery method. These physical factors complicate the interpretation of treatment efficacy and highlight the importance of optimizing feeding protocols to avoid confounding effects. Despite these constraints, GanoBee demonstrated promising potential as a modulator of gut microbiota composition and immune-related gene expression, supporting the need for further research under improved and carefully controlled experimental conditions.

Workforce restoration time analysis for a two grade manpower system under heavy tail distribution and dual regime decisions latency

“The system is a bit broken…” a qualitative exploration of barriers in the pathway for diagnosing Developmental Coordination Disorder

Background Approximately 5% of children are affected by a neurodevelopmental disorder of their sensorimotor skills. DSM-V and ICD-10, the two most widely used diagnostic systems, define this diagnostically as ‘Developmental Coordination Disorder’ (DCD) or ‘Specific Developmental Disorder of Motor Function’ (SDDMF), respectively. A diagnosis of DCD has been found to have a detrimental impact on a range of outcomes (e.g., health and education). It is therefore crucial that these children receive timely intervention. This is reliant, however, on effective assessment and support pathways. Research has shown there is great parental dissatisfaction, but there has been limited research exploring a clinical and education perspective. This study therefore aimed to understand barriers and facilitators for clinical and education practitioners in the pathway in a diverse district in the UK (Bradford). Methods Semi-structured interviews were completed with stakeholders across the pathway to identify barriers and facilitators to assessing, diagnosing, and supporting children with sensorimotor skill difficulties. Theoretical thematic analysis aligned to the Capability, Opportunity, Motivation model of Behaviour change (COM-B) was used to analyse the qualitative data. Results Interviews revealed many barriers in the DCD pathway related to capability (confusing terminology, inconsistent knowledge, inappropriate referrals), opportunity (resource constraints, DCD being considered low priority, and disconnected services), and motivation (overlapping job roles, a desire to consider those with difficulties not eligible for a diagnosis). No facilitators were consistently identified across interviews. Conclusion Families face multiple barriers to obtaining a diagnosis for their child through existing clinical pathways for assessment and support. These findings are unlikely to be unique to Bradford, due to international research highlighting these issues via parental interviews. These findings therefore may reflect challenges both nationally and internationally within DCD pathways. There is an urgent need for: (i) clear communication across different services (with consistency in terminology), and (ii) a more collaborative and integrated approach to assessment, diagnosis, and support in order to help these children thrive.

Center-of-gravity shift and inequality of human water use in China over the last half century

Abstract Understanding the spatial dynamics and inequality of human water use is essential for achieving sustainable water management. Although previous studies have examined the spatial evolution of regional water use, comprehensive assessments that couple sectoral decomposition with long-term (> 50 years) national-scale dynamics remain limited. To address this gap, we compiled multi-sectoral water use data from 1970 to 2020 and analyzed spatial trends and inequalities in China’s water use using the center-of-gravity approach and Gini coefficients. Our results reveal distinct directional shifts among sectors: irrigation and industrial water use moved northeastward and southwestward, respectively, while total water use exhibited minimal spatial displacement. Water-use inequality declined from high to moderate levels before 2000 and has since stabilized. Irrigation water use dominated both the spatial redistribution and inequality of total water use, driven primarily by changes in irrigated area and industrial scale. Inter-provincial disparities accounted for the largest share of overall water-use inequality. These findings offer new insights into the spatial evolution of China’s water use and provide an empirical basis for promoting more equitable and sustainable water allocation policies.

Hybrid lightweight vision transformers with attention mechanism for feature extraction and classification of product designs

In modern consumer markets, product packaging strongly influences customer attention and buying decisions. Attractive and informative designs help brands stand out in competitive environments. Recently, Artificial Intelligence (AI) has been widely used to support packaging evaluation, especially for design analysis, personalized user experiences, and product recommendation systems. However, traditional deep learning models, such as CNN-based ResNet-50 architectures, often fail to capture long-range relationships and global visual context. These limitations reduce their effectiveness in complex visual tasks like packaging classification. To address this issue, this study investigates the use of vision transformer-based models for packaging design analysis. We propose LeViT, an efficient hybrid architecture that combines convolutional neural networks with vision transformers. This design enables the model to learn both local visual details and global contextual features. The proposed approach improves feature representation while maintaining computational efficiency. Experiments were conducted on an image dataset of packaging designs. The performance of LeViT was compared with state-of-the-art models, including CNN-ResNet-50, RegNet, and ConvNeXt. The results show that the proposed model achieves the highest classification accuracy of 95%, outperforming all comparison methods. These findings demonstrate the effectiveness of transformer-based architectures for packaging classification. The proposed approach offers practical benefits for retail analytics, brand assessment, and marketing decision-making.

Camel milk extracellular vesicles as a promising antibiotic alternative: gastrointestinal stability, antimicrobial, and immunoregulatory activities

Integrated light and electron microscopy workflow for morphological, molecular and ultrastructural analysis of spheroids

Traditional two-dimensional cell cultures are limited in their ability to accurately model cancer progression and treatment response, which has prompted researchers to develop three-dimensional in vitro models, such as spheroids. These models better mimic the cellular interactions and microenvironment found in solid tumors, including features like hypoxic cores and acidic pH, which activate survival pathways and closely mirror in vivo tumor cell behavior. To fully harness the potential of spheroids in cancer research, comprehensive characterization at the morphological, molecular, and ultrastructural levels using various microscopy workflows is essential. Given the challenges associated with traditional handling and processing methods due to the small size of spheroids, we have developed and present here detailed protocols for light and electron microscopy analysis of spheroids formed from the human noncancerous urothelial cell line SV-HUC-1 and the malignant urothelial cancer cell line T24. Spheroids were analyzed by light microscopy using histological staining and immunofluorescence labelling, following either cryosectioning or paraffin embedding. Whole-mount immunofluorescence combined with optical clearing and confocal microscopy enabled visualization of protein expression and localization throughout the entire spheroid. Scanning and transmission electron microscopy provided high-resolution insights into surface morphology and internal ultrastructure, respectively. Each imaging modality, paired with optimized sample preparation, contributed to a comprehensive workflow offering distinct and complementary views of spheroid morphology, protein distribution, and cellular organization. This integrated approach, combining various light and electron microscopy workflows, enables accurate and thorough characterization of spheroids and establishes a comprehensive baseline for downstream functional investigations. The described protocols are adaptable to spheroids derived from various cell types and tissue origins, making them a versatile tool for a broad range of applications.

Correction: Transdiagnostic dimensions of psychopathology in chronic tinnitus patients with and without hearing loss

RETRACTED: A novel method based on clustering and decision-making for construction project portfolio selection

Nowadays, the problem of project portfolio selection is one of the important tasks in many construction organizations, especially project-based ones. On the other hand, project portfolio selection usually faces many challenges due to the complexity of project evaluation as well as limited resources. The present research aims to present a new method based on clustering and decision-making for project portfolio selection in project-based companies. The proposed integrated method includes the K-means method for clustering projects, the SWARA method for prioritizing the identified criteria, and the MULTIMOORA method for ranking and selecting the projects of the studied company. In addition, the results of the MULTIMOORA method was compared with the results of the WASPAS method for verification. First, five criteria (including 18 sub-criteria) were selected using literature review and expert judgment for clustering and ranking project portfolios. Then, the research data was collected from a questionnaire containing identified criteria and sub-criteria. Based on the obtained results, 25 available construction projects were placed and ranked in 4 clusters. The findings show that the proposed integrated method was able to cluster the project portfolios and select the best project portfolios by ranking the project portfolios based on the identified criteria and sub-criteria. Also, the findings indicate that the rankings using five main criteria were different from the rankings using 18 sub-criteria, and therefore due to the nature of the sub-criteria and the importance of paying attention to the “desirability or undesirability of the criteria/sub-criteria in using the MULTIMOORA”, the rankings using the sub-criteria were more preferable.