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Combination of different intervention strategies for malaria mosquito vector control in Uganda: A review of secondary data of two districts with moderate to high disease transmission
Background Indoor residual spraying (IRS) and insecticide treated bed nets (ITNs) used either singly or in combination are the main mass mosquito vector control measures for malaria control. Despite their widespread use, malaria transmission rates remain high, the burden is unacceptably huge, and yet the disease is completely preventable. This study measured the impact of compounds used in different types and campaigns of IRS and ITNs, different permutations of IRS + ITNs on malaria test positivity rates in high disease transmission settings of Yumbe district and Gulu district. Method The Ministry of Health’s District Health Information System 2 (DHIS 2) records on distribution of ITNs, IRS schedules and malaria cases by gender, age and geographical location (Gulu and Yumbe districts) collected over a five-year period (DHIS 2 records accessed on 11 th February 2025) were used in the final analysis. Data collection was done using a checklist developed in an Excel spreadsheet. Data on the following were extracted; socio-demographic characteristics, number of monthly malaria tests, monthly numbers of positive malaria tests, the type of Insecticide Treated Nets (ITNs) distributed, the type of Indoor Residual Spray (IRS) applied and the time points that the interventions were deployed. The data was exported into STATA ver 17.0,cleaned and additional variables generated prior to the interrupted time series and Difference in Difference analysis. The monthly malaria test positivity rate (TPR) was calculated while adjusting for variability in rainfall, temperature and relative humidity. A regression analysis and graphical plots using the Generalized Estimation Equation (GEE) population average models were performed. Results After controlling for monthly variation in rainfall, temperature, and relative humidity, the deployment of malaria vector control interventions in Yumbe district led to a much faster reduction in TPR of 0.006 units/0.56% per month; p < 0.00 (about 5 times faster than Gulu district). The 2020 distribution of Yorkool ITNs in Yumbe did not significantly change the long-term trend in TPR of the district relative to Gulu that maintained distribution of PermaNets ITN (trend change difference = 0.0111, beta = −0.0054, 95% CI:0.1145, 0.1038, p = 0.923). Fludora Fusion demonstrated a profound impact. The difference-in-differences interaction term was highly statistically significant, showing an absolute 21.2% drop in the Malaria Test Positivity Rate in Yumbe District relative to Gulu district (beta = −0.2123, 95% CI: −0.2801, −0.1444, p < 0.001). Following a co-deployment of Actellic 300 CS IRS+ Royal Guard ITNs in Yumbe and distribution of PermaNet ITNs in Gulu, the difference-in-differences interaction term was highly statistically significant, demonstrating an absolute 25.1% drop in the Malaria Test Positivity Rate in Yumbe District compared to Gulu district (beta = −0.2508, 95%CI:-0.3279, −0.1737,p < 0.001). Conclusion In areas of high malaria transmission, deployment of either ITNs alone, IRS alone, or in combination can be an effective tool for malaria case reduction. However, a more sustained and significant reduction is achieved through the simultaneous deployment of IRS and ITNs. Crucially, the efficacy of these combined interventions is highly shaped by the specific classes of insecticides and active compounds utilized within the deployed ITN types and IRS campaigns.
Health-related quality of life and cost-of-illness in young people seeking peer support at @ease: A Dutch burden of disease study
Introduction The burden of mental health problems remains largely unexplored among vulnerable young people, especially those seeking peer support. Accessing peer support is often a first form of help-seeking, allowing early identification of signs of distress. The lost (mental) health and expenses of these young people upon presenting for peer support can be revealed through monitoring of health-related quality of life (HRQoL) and costs of mental healthcare and productivity loss, examined in this study among young people visiting the @ease peer-to-peer walk-in centres in the Netherlands. Methods From @ease’s inception in January 2018 to mid-2024, a total of 940 answered questionnaires gathered through consecutive sampling contained minimally one required item. This bottom-up prevalence-based study focused on youth aged 12–30 who sought peer counselling at @ease. Burden of disease was estimated by: (1) HRQoL (EQ-5D-5L), and (2) Cost-of-illness through school absenteeism and mental healthcare use. Multiple imputation was used before conducting regression analyses, followed by non-parametric bootstrapping. This study expands upon an earlier publication that analysed data up to May 2019. Results HRQoL was impaired ( M = 0.64, SD = 0.24) and significantly lower if living alone or having parents with mental health problems, and higher if having a higher level of social and occupational functioning. In the three months before presenting, 35.2% of young people had been absent from school (3 days on average, costing €358 per individual) and 33.4% had visited mental healthcare (2 visits on average, costing €234 per individual). Total cost-of-illness was €1,501,743 annually, and €2,318 per individual. Mental healthcare costs were higher for those born in the Netherlands and without occupation, and school absenteeism costs were higher outside the COVID-19 pandemic and if not born in the Netherlands. Conclusions Found impairments and costs underscore the importance of investing in early-stage low-threshold services where substantial burden is already detectable, and of strengthening their capacity and links to stepped-care pathways to ensure timely support. Initiatives that help improve functioning and aid with challenging contexts may be advantageous in lowering the burden. Prospective (cost-)effectiveness studies are needed.
Genetics of hypertension in populations affected by the Aral Sea ecological crisis: A case-control study
Objective This research investigates the correlation between nine polymorphic variants and the incidence of hypertension and its clinical manifestations in the Ellikqala District in the Republic of Karakalpakstan, Uzbekistan. This district is known as one of the most challenging areas for human habitation due to its high salinity levels in the environment, which contribute to a higher prevalence of cardiovascular diseases. Methods This was a population-based case-control study. The study included 801 participants from the Karakalpakstan region of Uzbekistan, of which 621 were patients with essential hypertension, and the remaining 180 were the control group. Genetic analysis was conducted using multiplex qPCR with allele-specific probes. A statistical approach based on logistic regression was applied to identify their association with essential hypertension and its clinical manifestations. Logistic regression under a log-additive genetic model was used to calculate unadjusted (crude) and adjusted odds ratios and 95% confidence intervals. Stratified analyses by sex, age (<60 vs. ≥ 60 years), and BMI (<25 vs. ≥ 25 kg/m²) were performed with Bonferroni correction (k = 18 per stratification; threshold p < 2.8e-3). Results The analysis revealed statistically significant associations between essential hypertension and six polymorphic variants after Bonferroni correction (k = 9, corrected threshold: p < 5.6e-3): AGT C521T (rs4762; OR = 0.12, 95% CI: 0.08–0.16, p-Bonferroni = 2.99e-50), AGT T704C (rs699; OR = 0.68, 95% CI: 0.54–0.86, p-Bonferroni = 1.1979e-2), AGTR2 G1675A (rs1403543; OR = 0.52, 95% CI: 0.42–0.64, p-Bonferroni = 4.76e-9), CYP11B2 C(−344)T (rs1799998; OR = 0.47, 95% CI: 0.36–0.60, p-Bonferroni = 8.97e-9), GNB3 C825T (rs5443; OR = 1.66, 95% CI: 1.27–2.18, p-Bonferroni = 1.368e-3), and NOS3 T(−786)C (rs2070744; OR = 0.27, 95% CI: 0.21–0.34, p-Bonferroni = 2.50e-27). NOS3 G894T (rs1799983) showed a nominally significant association prior to correction (OR = 0.68, 95% CI: 0.52–0.89; p = 5.069e-3), but did not survive Bonferroni adjustment (p-Bonferroni = 4.5621e-2) and should be interpreted with caution. Conclusion Six out of nine studied polymorphic variants were associated with essential hypertension and its clinical manifestations in the Ellikqala District in the Republic of Karakalpakstan, Uzbekistan.
DNA barcoding of Austrian terrestrial isopods (Crustacea: Isopoda: Oniscidea) reveals potential cryptic diversity
Terrestrial isopods or Oniscidea are a diverse and ecologically important taxon. Austria has a relatively high species diversity with over 60 known species. In this study, we aim to provide DNA barcode reference data for the Austrian Oniscidea and to update the species inventory, which was last reviewed nearly 50 years ago. Although the focus was on freshly collected specimens, we also successfully sequenced historic museum specimens, thereby testing different museomic techniques including Sanger-based and Illumina-based methods. In total, 533 COI barcodes were generated, representing 49 of the 64 species and subspecies reported from Austria (= 76% of the species diversity), including two species not previously reported: Philoscia muscorum muscorum and P. affinis affinis . Several species exhibited large intraspecific genetic distances and the best-scoring ASAP partition (with a threshold of 6.2%) split the 49 studied species into 59 mOTUs. Even the more conservative partition with a threshold of 9.8% suggested the presence of further hitherto unrecognized species. One example is Ligidium germanicum , where we were able to demonstrate minor but consistent morphological differences in the shape of the endopod of pleopod II. COI data of historic specimens was successfully obtained. Sanger-based approaches using mini-barcodes in combination with a prior DNA repair step were more cost and labor effective than Illumina-based genome skimming approaches. This COI barcoding data plays an important role in bridging gaps in the representation of rare soil species, thus supporting the Austrian Barcode of Life Initiative (ABOL) and providing important reference data for future biodiversity and monitoring studies.
An ultra-wide rejection suppressing cell for microwave applications
This paper presents the design and fabrication of a novel suppressing cell (SC) implemented on a RO4003 substrate for microwave circuit applications. Experimental results indicate that the SC functions as a low-pass filter (LPF) with a 3 dB cutoff frequency at 5.7 GHz and a transition band of 0.6 GHz from −3 dB to −20 dB. The design achieves an ultra-wide stopband from 6.3 GHz to 50 GHz, with significant attenuation noted in the S22 parameter around 38 GHz, effectively covering five harmonics of the cutoff frequency. The return loss in the passband is measured at 10 dB, with an insertion loss of just 0.5 dB at 1.3 GHz. Additionally, the size of the SC is compact at 15.3 mm × 10.5 mm (15.3 λg × 10.5 λg), and the group delay in the passband exhibits minimal variation, recorded at only 0.53 ns.
Dynamics of sperm transport and histological structure of the female reproductive system in Octopus vulgaris (Cephalopoda: Octopodidae)
In this study, we aimed to provide a detailed microanatomical description of the female reproductive system of Octopus vulgaris , an internally fertilized cephalopod, and to identify its functional characteristics. The female reproductive system of O. vulgaris consists of the ovary, common oviduct, proximal oviduct, oviducal gland, and distal oviduct, and histologically, the structure is similar to that reported in other octopods. The presence of spermatozoa and spermatophore remnants in the distal oviduct suggests that spermatophoric reaction may occur in this region. The released sperm then migrate to the spermathecae of the oviducal gland, where they are anchored to the epithelial layer via a helical acrosome and stored long-term with the support of secretory cells. During the spent and degenerative stages, sperm detach from the epithelial layer of the spermathecae in the oviducal gland and are released into the central cavity of the oviducal gland, where fertilization is presumed to occur. The fertilized eggs are then coated with secretory substances from the central and peripheral glands and subsequently pass through the acidic distal oviduct before being released. These findings demonstrate that the female reproductive system of O. vulgaris exhibits structural differentiation necessary for spermatophoric reaction, sperm storage, and fertilization. This study provides fundamental insights into the reproductive process of internally fertilized cephalopods and serves as a valuable reference for future research on cephalopod reproductive physiology.
Agreement between EMS provider-assigned prehospital triage and initial emergency department triage in pediatric and adult EMS-transported encounters: A retrospective observational study
Background Prehospital triage supports destination decisions, resource activation, and early risk stratification, yet accurate triage of children in the field remains challenging. In South Korea, a five-level emergency department triage framework has recently been extended to the Prehospital setting through nationwide implementation of a prehospital triage scale. This study aimed to evaluate agreement between EMS provider-assigned prehospital triage and initial ED triage, with a pediatric-focused primary analysis and adults as a secondary comparator. Methods We conducted a retrospective observational study using linked EMS run-sheet and emergency department records from one university hospital during the first year of nationwide implementation (February–December 2024). We included all EMS-transported emergency department encounters that were registered and assigned an initial emergency department triage level on arrival. Agreement between prehospital and emergency department triage levels was assessed using overall exact agreement, Cohen’s unweighted κ, and quadratically weighted κ. Results Among 5,182 EMS-transported emergency department encounters during the study period, 4,729 were included in the final analysis, comprising 1,242 pediatric and 3,487 adult encounters. Overall agreement was 47.7% in pediatric encounters and 52.8% in adults. Quadratically weighted κ indicated modest agreement in children (0.27) and higher agreement in adult encounters (0.40). Disagreement was concentrated at adjacent-level boundaries, particularly between levels 2–3 and 3–4. Discordance toward higher prehospital acuity predominated in pediatric encounters, whereas discordance toward lower prehospital acuity was more common in adults. Conclusions During the first year of nationwide implementation, prehospital and emergency department triage showed modest agreement, with lower concordance and a predominance of discordance toward higher prehospital acuity in pediatric encounters. Adjacent-level boundaries represent practical targets for pediatric-focused training and feedback to improve consistency of prehospital triage assignments.
Advancing the WEFE nexus: Expert insights on implementation and challenges
This paper builds on the Water-Energy-Food-Ecosystems (WEFE) nexus approach through insights gleaned from interviews with project coordinators involved in nexus-oriented research and initiatives. By employing a structured interview format, empirical evidence highlighting the perspectives of experts on the methodologies, practices, and challenges within the nexus framework was gathered. The findings indicate that, despite growing understanding of the complexities of the WEFE nexus, its translation into practice remains limited across many project contexts. Interview participants emphasized the importance of recognizing the interdependencies among water, energy, food, and ecosystems to enhance resource efficiency and resilience against climate change. Key opportunities identified include the development of innovative technologies and nexus-specific indicators aimed at improving nexus understanding, fostering stakeholder engagement, and supporting collaborative decision-making. The study also identified pressing challenges, such as data availability, methodological alignment, and the integration of nexus activities with broader policy frameworks. Overall, the analysis examines how the WEFE nexus is conceptualized and operationalized in practice, and how analytical and governance-related challenges shape its implementation in European research and innovation projects. The insights gained from this research underscore the need for enhanced governance, effective communication, and strategic collaboration among stakeholders to capitalize on the full potential of the WEFE nexus. This paper contributes to the discourse on integrated resource management by providing a real-world perspective on the application, efficacy, and impact of the WEFE nexus framework, thereby enriching the existing knowledge stock on sustainable resource utilization.
Cardiovascular hospitalization dynamics in Iran’s second-largest city: A spatial and temporal perspective
Introduction Cardiovascular disease (CVD) is a leading cause of mortality worldwide, with an especially high burden in developing countries such as Iran. Understanding spatial disparities and temporal trends in CVD hospitalizations can guide targeted public health interventions in high-risk regions. Methods Data was sourced from Mashhad University of Medical Sciences for five years (2016–2020) and included CVD cases classified by ICD-10 codes, excluding records with non-resident status or incomplete addresses. Temporal trends were assessed through a monthly classical decomposition, ARIMA modeling for forecasting, and Joinpoint regression (JR) to detect shifts over time. Spatial analyses included calculating relative risks, examining spatial autocorrelation, identifying hotspots, and applying flexible spatial scan statistics (FSSS) to detect clusters with irregular shapes. Results The study included 52,132 CVD cases, with a median age of 64 years (IQR: 53_76) and a male predominance (54.44%). Temporal analysis showed significant fluctuations, with the highest hospitalization rate in 2019 and the seasonal pattern was repeated annually. ARIMA(0,0,0)(0,0,1) 12 modeling revealed a seasonal moving average of −0.722 and a mean of 844.95 hospitalizations/month, capturing seasonal fluctuations with a stable trend reflecting cardiovascular health risks. The JR analysis showed a rising hospitalization trend with a monthly percent change of 1.69 [95% CI: 1.44_2.29; p = 0.001] for males and 1.99 [95% CI: 1.73_2.68; p = 0.001] for females, followed by a sharp decline after November 2019. After a positive spatial autocorrelation (Global Moran’s I of 0.176 ( p < 0.001)), hot spot classification revealed central Mashhad as a high-risk zone with concentrated clusters of CVD hospitalizations. The Flexible Spatial Scan Statistics (FSSS) analysis indicated that the Most Likely Cluster (MLC) was situated in the city center, presenting an approximate 10-fold relative risk [RR: 9.804, LLR: 2328.3, p < 0.001]. Conclusions This study provides the first extensive spatial and temporal analysis of CVD hospitalizations in Mashhad, underscoring critical high-risk areas in need of focused public health interventions. Addressing these spatial disparities can significantly improve cardiovascular health outcomes and bolster resilience within the local populations.
Development and internal validation of an early inpatient risk score for in-hospital mortality in acute pancreatitis: A retrospective cohort study
Introduction Early identification of patients at high risk of mortality remains a clinical challenge in acute pancreatitis. Existing prognostic tools are often complex or require repeated assessments, limiting their routine use. We aimed to develop and internally validate an early admission-phase risk score for predicting in-hospital mortality in patients with acute pancreatitis. Methods We conducted a retrospective cohort study of consecutive adult patients admitted with acute pancreatitis between 2020 and 2024. Acute pancreatitis was defined according to the revised Atlanta criteria. Multivariable logistic regression was used to develop a prediction model for in-hospital mortality using routinely available demographic, clinical, and laboratory variables obtained within the first 24 hours of hospitalization. Missing data were handled using multiple imputation. Model performance was assessed by discrimination and calibration, with internal validation performed using bootstrap resampling and temporal validation conducted in patients admitted during 2023–2024. Results A total of 1,041 patients were included, of whom 53 (5.1%) died during hospitalization. The final model incorporated age, early multi-organ dysfunction within 24 hours of admission, C-reactive protein, and urea levels. The model showed good discrimination (area under the receiver operating characteristic curve, 0.81) and good agreement between predicted and observed in-hospital mortality probabilities. Bootstrap internal validation showed minimal optimism, and temporal validation in patients admitted during 2023–2024 confirmed stable model performance. A simplified risk score derived from the model stratified patients into low-to-intermediate-risk and high-risk categories, with substantially higher observed in-hospital mortality in the high-risk group. Conclusions We developed and internally validated an admission-phase risk score for predicting in-hospital mortality in patients with acute pancreatitis using readily available clinical variables. The proposed score may support early inpatient risk stratification within the first 24 hours of hospitalization. However, external validation in independent cohorts across diverse healthcare settings, patient populations, and pancreatitis etiologies is required before broader clinical application.
Effects of different conditioning activities performed after soccer-specific warm-up on post-activation performance enhancement
The post-activation performance enhancement (PAPE) effect has been widely studied; however, studies conducted under real-world conditions remain limited. Furthermore, investigations into how different conditioning activities (CAs) influence PAPE responses are also scarce. Therefore, this study investigates the acute effects of high-intensity barbell hip thrust (BHT) and back squat (BS) exercises, performed after a soccer-specific warm-up (Wup), on physical performance in soccer players. Seventeen male amateur soccer players participated in the study (mean age: 22.29 ± 3.60 years; height: 1.78 ± 0.06 m; body weight: 73.18 ± 8.44 kg). Participants attended 5 experimental sessions. In the first session, after anthropometric assessments, participants were familiarized with the exercises and tests. In the second session, one-repetition maximum (1RM) was tested for BS and HT exercises. In the following three sessions, two PAPE protocols and one traditional (TRAD) protocol were performed in a randomized order. In the TRAD protocol, players performed physical performance tests including countermovement jump (CMJ), 10-m and 30-m sprint, and zigzag agility 16 minutes after a soccer-specific Wup. In the PAPE protocols, players performed CAs (e.g., hip thrust or back squat) at 85% of 1RM for 2 sets of 3 repetitions following a soccer-specific Wup, and completed the tests 8 minutes later. Results from the linear mixed-effects models revealed no significant effect of protocol on any performance variable, including CMJ (F(2,32) = 1.554, p = 0.227), 10 m sprint (F(2,32) = 0.242, p = 0.786), 30 m sprint (F(2,32) = 0.453, p = 0.640), and change of direction (COD) performance (F(2,32) = 0.946, p = 0.399). Marginal R² values indicated that the protocol explained only a minimal proportion of variance in performance outcomes (0.005–0.030), whereas conditional R² and ICC values suggested that between-participant differences accounted for a substantial proportion of variance, particularly for CMJ and 30 m sprint performance. Bonferroni-adjusted pairwise comparisons further showed no significant differences between PAPE BHT , PAPE BS , and TRAD protocols for CMJ, 10 m sprint, 30 m sprint, or COD performance (all p > 0.05). In conclusion, neither PAPE protocol performed after a soccer-specific warm-up significantly enhanced or impaired subsequent CMJ, sprint, or COD performance compared with the traditional warm-up. These findings suggest that adding PAPE BHT or PAPE BS protocols after a soccer-specific warm-up may maintain subsequent performance without inducing measurable decrements; however, their ergogenic effectiveness may depend on individual factors such as players’ strength levels, recovery capacity, training status, and physical characteristics.
Investigating tryptophan metabolism in colorectal cancer using Single-cell RNA sequencing based on machine learning techniques
Background Colorectal cancer (CRC) is characterized by genetic variation, epigenetic alterations, microenvironmental imbalance, and metabolic reprogramming. Currently, abnormalities amino acid metabolism has been shown to play an important role in the occurrence and progression of CRC. Methods AUCell, UCell, singscore, ssGSEA and AddModuleScore algorithms were used to determine the pattern of tryptophan metabolism in CRC at the cellular level. Differential expression and correlation analyses were performed to identify core candidate genes associated with upregulation of metabolic activity. Four machine learning algorithms——random forest, Boruta, LASSO, and gradient boosting machine—were further integrated for feature selection. Finally, to enhance robustness and reduce algorithm‑specific bias, the results of these algorithms were combined to identify the key feature genes related to tryptophan metabolism in CRC. Results The findings demonstrated significant differences in tryptophan metabolic activity among different cell types in CRC, with macrophages and Paneth cells exhibiting higher activity. Among the tryptophan metabolism-related genes, CYP1A1 and aryl hydrocarbon receptor ( AHR ) were significantly upregulated in CRC, suggesting their involvement in regulating of immune response and inflammatory responses. Conclusions This study reveals, for the first time, the cellular pattern of tryptophan metabolism in CRC, with macrophages and Paneth cells playing a major role in tumor development. CYP1A1 and AHR were identified as consensus feature‑selected genes involved in tryptophan metabolism in CRC, highlighting their potential as biomarkers and therapeutic targets.
Performance evaluation of the sysmex XN-1000V automated hematology analyzer in marine fish species: Gilthead seabream (Sparus aurata)
Hematological analyses are widely used to assess the health and physiological status of animals, including fish. Automated hematology analyzers enable rapid and reproducible hematological measurements; however, their application in fish requires species-specific analytical validation due to the presence of nucleated blood cells. This study evaluated the analytical performance of the Sysmex XN-1000V hematology analyzer operated under avian settings (PLT-F channel), in juvenile gilthead seabream ( Sparus aurata ), one of the cornerstone species of Mediterranean marine aquaculture. Analytical validation included assessment of precision, linearity, carryover, and sample stability. Results were compared with manual reference methods (hemocytometer counts and blood smear-based estimates). In addition, the influence of two anticoagulants (lithium heparin and K₂EDTA) was examined, and the analyzer’s ability to detect lipopolysaccharide (LPS)-induced changes in non-erythroid cell population was evaluated. The analyzer showed good precision for most parameters (CV < 5%), although higher variability was observed for granulocyte percentage. Linearity was excellent (R 2 ≥ 0.98), and carryover remained below 1% for all variables. Sample stability was significantly better at 4 °C than at room temperature (25 °C), supporting refrigerated storage for up to 24 hours prior to analysis. Comparison with manual reference methods revealed strong correlations and agreement for red blood cell counts and hematocrit, whereas discrepancies were identified in non-erythroid cells differentials. Among anticoagulants, lithium heparin yielded more consistent and reliable results than K₂EDTA. Erythrocyte-related parameters showed the highest analytical reliability, whereas the leucocyte differentiation within the non-erythroid fraction required complementary microscopic evaluation, particularly when assessing LPS-induced inflammatory changes. Overall, the Sysmex XN-1000V demonstrated suitable analytical performance for routine hematological assessment in gilthead seabream when operated under avian settings. These findings support its application in aquaculture health monitoring programs, provided that appropriate anticoagulants are used, samples are promptly processed or refrigerated, and automated results are complemented by microscopic review when leukocyte counts are suspected.
Age and tumor size as independent predictors of malignancy in BI-RADS 4 and 5 breast lesions: A cross-sectional study in Vietnam
Background Accurate diagnosis of suspicious breast lesions (BI-RADS 4/5) is crucial for appropriate clinical management. The International Academy of Cytology (IAC) Yokohama System standardizes fine-needle aspiration (FNA) cytology reporting, but its performance and the role of independent clinical predictors within this specific high-risk cohort require further investigation. This study aimed to evaluate the diagnostic performance of FNA using the Yokohama system and to identify independent predictors of malignancy in patients with BI-RADS 4 and 5 lesions. Methods and findings We conducted a cross-sectional study of 104 female patients with BI-RADS 4/5 breast lesions at two tertiary hospitals in Vietnam. All patients underwent ultrasound-guided FNA with subsequent histopathological examination as the gold standard. Diagnostic performance metrics were calculated. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of malignancy. Of the 104 lesions, 53 (51.0%) were confirmed to be malignant. FNA cytology, interpreted with the Yokohama System, demonstrated a sensitivity of 92.5%, specificity of 96.1%, and an overall accuracy of 94.2%. In the multivariate analysis, only two factors emerged as strong, independent predictors of malignancy: older age (adjusted odds ratio [aOR] 1.13 per year, 95% CI: 1.07–1.19; p < 0.001) and larger tumor size (aOR 1.10 per mm, 95% CI: 1.04–1.16; p = 0.001). Notably, the predictive value of a BI-RADS 5 classification was not statistically significant after this adjustment (p = 0.540). However, given the small BI-RADS 5 subgroup (n = 11), this non-significant result should not be interpreted as evidence of its lack of clinical utility, as the analysis was likely underpowered for this specific variable. Conclusion FNA cytology, when interpreted using the IAC Yokohama System, is a highly accurate and reliable tool for the initial evaluation of BI-RADS 4 and 5 breast lesions. Importantly, our findings demonstrate that older age and larger tumor size are strong, independent predictors of malignancy in this high-risk cohort, highlighting the need to integrate these clinical parameters to optimize risk stratification.
Bridging corpus diagnostics and EAP pedagogy: A corpus-driven study on lexical hedges in Chinese scholars’ spoken academic English
As the internationalization of higher education intensifies — particularly under China’s “Double First-Class” initiative — Chinese scholars are increasingly expected not only to publish in English but also to perform effectively in high-stakes spoken genres such as conference talks, keynote lectures, and doctoral defences. Yet pragmatic features such as hedging remain a persistent barrier, often leading to pragmatic failure in real-time interactions. This study addresses this challenge through an integrated approach that couples corpus-based diagnostics with pedagogical design. Specifically, it investigates the use of lexical verb hedges in Chinese scholars’ spoken academic English by comparing a self-compiled Chinese Scholars’ Academic Spoken English Corpus (CASEC; 696,009 words; 279 events) with the Michigan Corpus of Academic Spoken English (MICASE; 1,848,364 words; 152 events). Following Granger’s reappraised Contrastive Interlanguage Analysis 2.0, MICASE is treated not as a native-speaker benchmark but as one Anglo-American reference variety against which typical L2 patterns can be described. Quantitative analysis revealed that Chinese scholars significantly underused individualized stance markers (e.g., I think) and significantly overused collective, consensus-building markers (e.g., We see). Qualitative analysis interprets these patterns through the lens of cross-cultural pragmatics and genre constraints, suggesting a rhetorical strategy oriented toward collective harmony and the diffusion of authorial responsibility. Crucially, the study moves beyond diagnosis to propose a “diagnosis-to-treatment” pipeline, culminating in a step-by-step Data-Driven Learning (DDL) module complete with full classroom worksheets. The pedagogical design aims to raise scholars’ pragmatic awareness and enhance their international academic communication competence.
Hospital-based descriptive epidemiology of intracranial meningiomas in Palestine: A retrospective study from a major referral center (2018–2023)
Objective Intracranial meningioma is the most common type of primary brain tumor globally. This study aimed to determine the epidemiological characteristics of intracranial meningioma in Palestine from 2018 to 2023. Methods We conducted a retrospective hospital-based descriptive study of radiologically and histologically confirmed intracranial meningiomas treated or referred to Al-Makassed Hospital, the main neurosurgical referral center in Palestine, from September 7 th , 2023, to November 16 th , 2023. Patients’ reports were the main source for data collection. Histopathological types of meningioma were coded according to the 2016 WHO Classification for CNS tumors. The incidence rates of intracranial meningiomas were hospital-based referral-center minimum estimates, calculated based on the total population size. Results A total of 204 cases of intracranial meningioma were identified. The mean age at diagnosis was 51.12 years (±13.96). The estimated minimum hospital-based crude incidence rate was 0.65 per 100,000 person-years (95% CI: 0.56–0.75), with a higher incidence in females than in males (0.88 vs 0.43, (0.88 vs 0.43 per 100,000 person-years, IRR = 2.07 [95% CI: 1.53–2.81]; p = 0.003). Grade I meningiomas were the most common, accounting for 81.4%. Grade II and III meningiomas were more common in males. Focal Neurological Symptoms (39.7%) were the most prevalent presenting symptoms. Intracranial meningiomas were most often managed with surgical resection alone (96.6%). Conclusion This study provided insights into the epidemiological characteristics of meningioma in Palestine. These findings represent hospital-based minimum estimates and are not directly comparable to population-based registry data. Meningiomas were more common in females, while higher-grade meningiomas were more common in males. Further research is needed to ascertain the most common subtypes.
Linking entrepreneurial spirit and entrepreneurial environment perception to entrepreneurial intention: Moderation by entrepreneurial role models
Entrepreneurial intention is widely recognized as a key precursor of entrepreneurial behaviour, yet existing research has more often examined personal entrepreneurial characteristics and perceived environmental support separately, with less attention to how they jointly shape intention and how entrepreneurial role models may condition these relationships. Guided primarily by social cognitive theory and complemented by the Theory of Planned Behavior, this study develops an integrated model to examine how entrepreneurial spirit, reflected in innovativeness and proactiveness, and entrepreneurial environment perception, reflected in perceived access to finance, perceived entrepreneurial education, and perceived policy support, are related to college students’ entrepreneurial intention, and whether these relationships are strengthened by entrepreneurial role models. Using survey data from 1,389 students in higher education institutions in Shandong Province, China, the hypotheses were tested through confirmatory factor analysis, structural equation modelling, and hierarchical regression. The results show that both entrepreneurial spirit and entrepreneurial environment perception are positively associated with entrepreneurial intention. In addition, entrepreneurial role models significantly strengthen the relationships between entrepreneurial spirit and entrepreneurial intention, and between entrepreneurial environment perception and entrepreneurial intention. These findings contribute to entrepreneurship intention research by showing that entrepreneurial intention is shaped not only by person-related dispositions and perceived support conditions, but also by role-model-based social learning that makes entrepreneurial pathways more credible and attainable for students.
Effects of immersive virtual reality on limb motor function, balance, gait and quality of life after stroke: A systematic review and meta-analysis
Immersive virtual reality (IVR) has been increasingly integrated into stroke rehabilitation albeit the effectiveness across different outcome domains remains unclear. This study aimed to review evidence from randomized controlled trials evaluating the effects of IVR, used alone or in combination with conventional rehabilitation, on motor-, functional-, and participation-related outcomes after stroke. Ovid MEDLINE, Embase, Cochrane Library and CINAHL were screened up to April 2025 to identify eligible randomized controlled trials (RCTs). A systematic literature search was conducted. Randomized controlled trials including adults with stroke and evaluating immersive virtual reality interventions were eligible. Studies using non-immersive VR, non-randomized designs, or not reporting motor, functional, or participation outcomes were excluded. Meta-analyses were performed where data were sufficiently homogeneous; otherwise, outcomes were summarized descriptively. Risk of bias was assessed using standardized appraisal tools, and certainty of evidence was evaluated using the GRADE approach. Out of 3,574, we included 34 RCTs involving post-acute, subacute and chronic stroke survivors, with a total of1200 participants. Meta-analyses showed IVR, most commonly delivered in combination with conventional rehabilitation, to be associated with improvements in upper extremity motor impairment, particularly measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE). Small but significant effects were also found for selected gait parameters. In contrast, effects on functional performance, balance, and quality of life were inconsistent and could not be robustly quantified. The overall certainty of evidence ranged from low to very low, primarily due to heterogeneity, methodological limitations, and small sample sizes. In conclusion, IVR appears to be a promising and safe supplement to conventional stroke rehabilitation, particularly for improving motor impairment. However, evidence remains limited and inconsistent across functional outcomes. More well-designed, adequately powered trials with standardized interventions and clinically meaningful outcome measures are needed to clarify the role of IVR in stroke rehabilitation. PROSPERO (Registration number: CRD420250639792).
Comment on “Can Charge Transfer Across C─H···O Hydrogen Bonds Stabilize Oil Droplets in Water?”
ABSTRACT Kinetically stable oil nanodroplets in water display an electrophoretic mobility linked to a negative surface charge. The source of this charge is proposed to arise from the adsorption of hydroxide ions or through charge transfer (CT), that is displacement of electronic charge across improper C─H···O hydrogen bonds. Zhao et al. [R. Q. Zhao, H. Y. Shen, R. A. Lacour, J. P. Heindel, M. Head‐ Gordon, and T. Head‐Gordon, Angewandte Chemie‐ International Edition 64 (2025): e202508145, https://doi.org/10.1002/anie.202508145 .] questioned the possibility of CT across an oil droplet interface based on density functional theory simulations of hexane molecules in water. Here, we introduce the two prevalent explanations for the surface charge on oil droplets in water, hydroxide adsorption and CT through improper H‐bonds, showing that, while the hydroxide hypothesis is most intuitive, there is no molecular level experimental evidence from a range of surface specific techniques. We correct a misconception about the origin of the blue shift in the original sum frequency scattering work [S. Pullanchery, S. Kulik, B. Rehl, A. Hassanali, and S. Roke, Science 374 (2021): 13661370, https://doi.org/10.1126/science.abj3007 .], and comment on the choice of hexane clusters in water: Hexane does not form kinetically stable droplets in water, as it is 9 orders of magnitude more soluble in water than hexadecane. Without exhibiting kinetic stability—the behavior the simulations seek to explain—there is limited predictive ability on CT through improper H‐bonds as a mechanism to stabilize droplets.
Work scheduling through communication tools and job satisfaction: The roles of work-family conflict and perceived work pressure
The expansion of digital communication has increasingly blurred the boundaries between work and personal life, making work scheduling through communication tools more common. In China, mobile platforms such as WeChat are widely used to facilitate work-related scheduling and coordination, allowing work instructions and messages to be communicated without being confined to fixed time periods. Using nationally representative data from the 2021 China General Social Survey (CGSS), this study examines the association between communication-tool-mediated work scheduling and employees’ job satisfaction. We use multiple linear regression models to assess whether respondents’ work could be scheduled at any time via WeChat or phone and whether this workplace practice is associated with job satisfaction. Then, we further examine the mediating roles of work–family conflict and perceived work pressure using the KHB method, and conduct supplementary subgroup analyses by socioeconomic status (SES). The results show that work scheduling through communication tools is negatively associated with job satisfaction, and that this relationship is largely mediated by higher levels of work–family conflict and perceived work pressure. In addition, SES-based subgroup regressions provide suggestive evidence that this negative association is mainly observed among individuals with higher educational attainment and those in professional occupations. These findings document how work scheduling through communication tools is related to employees’ subjective evaluations of work and highlight heterogeneity in these associations across socioeconomic groups in contemporary Chinese workplaces.