Browse Articles
Discover research articles across all indexed journals
Predicting one-year post-surgical recurrence in colorectal liver metastasis using CT radiomics and machine learning
Background Early recurrence in colorectal cancer liver metastases (CRLM) typically correlates with significantly worse survival outcomes. There is a strong demand for developing robust and interpretable approaches to assist clinicians in identifying patients at high risk of recurrence. Methods In this study, we utilized clinical CT images and associated clinical data from 197 CRLM patients, provided as DICOM images. A total of 993 radiomic features, including shape, texture, and first-order characteristics, were extracted. Eight machine learning models were trained and validated: Random Forest (RF), Multilayer Perceptron (MLP), K-nearest Neighbors (KNN), Extremely Randomized Trees (ET), AdaBoost, Decision Trees (DT), Gradient Boosting (GB), and Linear Discriminant Analysis (LDA). Results In predicting tumor recurrence within one year, the ET model showed the best performance using only radiomic features, with an AUC of 0.9667. RF and GB also performed well, achieving AUCs of 0.9558 and 0.9227, respectively. When combining radiomic and clinical features, the performance of all models improved in terms of AUC. Specifically, the Random Forest (RF) model achieved the highest AUC of 0.9672, followed by Gradient Boosting (GB) with an AUC of 0.9646, and Extra Trees (ET) with an AUC of 0.9459. Conclusion We developed a CT-based machine learning model, using the Random Forest algorithm, that combines clinical (e.g., age, carcinoembryonic antigen, bilobar disease) and radiomic features (e.g., selected features included texture-based metrics such as the 90th percentile of first-order statistics in the high–low–low (HLL) wavelet-decomposed image, and Run Entropy from the gray-level run length matrix (GLRLM) in the low–low–low (LLL) sub-band.) to predict early recurrence after hepatectomy in patients with colorectal liver metastasis (CRLM). This model has the potential to guide personalized postoperative surveillance. However, limitations such as the retrospective single-center design and relatively small sample size may affect the generalizability of the findings. Further validation in larger, multi-center cohorts is warranted to confirm its clinical utility.
Changes in patient-reported outcomes (PROs) and fecal calprotectin levels in patients with inflammatory bowel disease following a three-week gastrointestinal inpatient rehabilitation
Background Inflammatory bowel diseases (IBD) pose a considerable burden on patients and society. Rehabilitation programs are increasingly being considered as a complementary treatment. However, empirical evidence on the effectiveness of this approach is still sparse. We therefore investigated changes in patient-reported outcomes and an objective biomarker throughout a three-week inpatient gastrointestinal rehabilitation. Methods We conducted a longitudinal prospective observational study with a pretest-posttest design. Patients completed questionnaires on their subjective health-related quality of life (HRQoL), psychological distress, disease-specific burden, and work ability. Stool samples were collected to determine fecal calprotectin levels. Mean level changes were analyzed by means of t tests for repeated measurements, while differential changes between Crohn’s disease and ulcerative colitis patients were compared using analysis of variance. Results Subjective disease burden and psychological distress decreased over the course of rehabilitation, whereas HRQoL and work ability increased. Fecal calprotectin levels slightly rose and were not meaningfully related to changes in subjective perception of illness. Conclusions We present evidence on rehabilitation as an important treatment in people with IBD in terms of subjective disease burden and various indicators of personal well-being. Furthermore, we advise against the use of fecal calprotectin as a marker for monitoring disease activity in short-term rehabilitation settings.
User experience and hemostatic efficacy: Comparative analysis of commercial agents in junctional and hepatic hemorrhage models
Background/Objectives Hemorrhage is associated with most preventable combat-related deaths. Management of non-compressible truncal and junctional hemorrhage remains challenging, especially with prolonged evacuations. This study evaluated the efficacy of commercial topical hemostatic agents in uncontrolled hemorrhage models under coagulopathic conditions, examining differences based on applicator experience. Methods Sixty Yorkshire swine were randomized to 5 groups: Combat Gauze (CG), Celox Rapid (CR), ChitoSAM 100 (CS), EVARREST® Fibrin Sealant Patch (EP), and X-Stat 30 (XS). After 50% hemodilution, a 5 mm femoral arteriotomy or 6 cm liver laceration was created, and the agents were applied as per device instructions. Hemostatic agents were placed by experienced (≥5 previous applications) or non-experienced (<5 previous applications) users. Animals were then monitored for rebleeding for 60 minutes. Results In the junctional hemorrhage model, only ChitoSAM required more applications by novice applicators (2.3 vs. 1, p = 0.0104). No significant differences in rebleed rates among devices (CG 0%, CS 33%, CR 17%, EP 17%, XS 33%, p = 0.73) or by user experience were observed. No differences in perfusion were noted on angiography. In the hepatic laceration model, no significant differences in applications or rebleed rates for any agent (CG 0%, CS 50%, CR 17%, EP 17%, XS 0%, p = 0.21) or by user experience were found. Overall survival did not significantly vary by device. Conclusion All 5 hemostatic agents showed similar efficacy in controlling junctional and intra-abdominal hemorrhage, with no significant differences in hemostasis, rebleed rate, or survival by experience level. However, more ChitoSAM applications were needed for junctional hemorrhage control in the absence of experience. All tested dressings show promise for rapid hemorrhage control.
Interest in brief resistance training workouts among older US adults with and without mobility disability
Background/Objectives Resistance training (RT) improves strength and physical function; however, only 35% of older adults meet national guidelines for muscle strengthening activities. Though time is often noted as a barrier to physical activity participation, little is known about the interest of older adults in brief RT programs. This study compared preferences for brief, more frequent vs longer, less frequent RT programs. Methods A nationwide survey was conducted among 611 US adults aged 65 and over. Preference for either (1) a traditional (45 minutes per session, three days per week) RT program or (2) a short (5 minutes per session, daily) RT program was compared. Results Overall, 2.2 times as many older adults preferred the daily 5-minute RT program versus the traditional RT program (68.4% v. 31.6%). Preference for the brief, daily RT program was 5.3 times higher among adults with difficulty walking (84.2% v. 15.8%) than for the traditional RT program. Conclusion Preference for a daily 5-minute RT program is significantly higher than for traditional 45-minute, three times weekly programs. This difference is larger in older adults who have serious difficulty walking or climbing stairs. Significance/Implications Brief daily RT options may help engage older adults in RT at a population level, particularly those with poorer health and mobility disability. Future investigations should evaluate differences in uptake, adherence, and outcomes from two RT programs of varying durations and frequencies.
Spatial patterns and determinants of inter-provincial migration across age groups in China
Individuals in different life stages have different intentions and reasons for migration, which leads to differences in the spatial patterns of migration across age groups. This paper aims to reveal the different patterns of inter-provincial migration across age groups and the underlying driving factors to foster a deeper understanding of migration phenomena in China and support an appropriate policy response. Using data from the 2017 China Migrants Dynamic Survey and an extended gravity model with lasso-penalized Poisson regression, we reveal significant heterogeneity in migration patterns among different age groups. In terms of spatial patterns, while people of all age groups tend to migrate from less developed regions to more developed regions, the migration flows of the working-age population are primarily short-distance relocations from populous central provinces to economically developed areas, whereas elderly individuals migrate predominantly from northern regions to Beijing and from southern regions to Shanghai. In terms of influencing factors, while economic considerations drive migration across all age groups, economic opportunities play a significantly stronger role in the working-age population. In contrast, elderly individuals tend to prioritize environmental comfort in their destination choices and are less constrained by distance.
Health care professionals’ attitudes, behaviours and barriers toward exercise promotion among patients: A systematic review
Objective To determine health care professionals’ (HCPs) attitudes, behaviours, and barriers toward exercise promotion among patients. Method Using systematic review methodology, we included published studies focusing on health care professionals’ attitudes, behaviours, and barriers towards exercise promotion among patients. The search was conducted in June 2023, using the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Scopus databases, and returned 352 records, of which 34 met the inclusion criteria. The Critical Appraisal Skills Programme (CASP) tool was used for quality appraisal. Results Results revealed that HCPs hold a positive attitude towards advocating physical activity. Further physical activity was prescribed to achieve a number of objectives, including enhancing physical function, encouraging an active lifestyle, preventing complications, monitoring progress or compliance, and preventing functional decline. Barriers to exercise promotion identified related to four overarching categories: health professional-based barriers, perceived patient-related barriers, organisational barriers and health system-related barriers. Conclusion This review highlights positive attitudes of healthcare professionals toward promoting physical activity, as well as persistent barriers that hinder effective implementation. Addressing these barriers requires a comprehensive approach, including tailored support for healthcare professionals and improved organisational and systemic structures. Further research is needed to evaluate the effectiveness of strategies aimed at overcoming these obstacles and enhancing physical activity promotion.
Energy-delay analysis in advection-diffusion-based wireless body area networks
Molecular communication (MC) emerges as an encouraging concept in wireless body area nanonetworks (WBAN2), which utilizes molecules as information carriers for communication between nanomachines. In this paper, we aim to define an electrical model of a molecular-based nano-transmitter to analyze the effect of the remained transmitted molecules in a fluidic medium. To this end, we will address an advection-diffusion equation with a non-zero initial condition to analyze the residual molecules’ influence the medium. Moreover, considering the energy consumption limitations of nanomachines, we will employ the derived electrical model to further investigate how nanomachines consume the energy in presence of residual molecules. Following this, to enhance the energy consumption of the nano-transmitters, the settle-time method will be proposed to tackle the negative impact of the residual molecules on energy consumption. Nevertheless, since the proposed method increases the delay at nano-transmitters, the energy-delay trade-off relation at nano-transmitters will be investigated. Then, by introducing an interruption period and a control coefficient, we control the trade-off between the energy consumption and the created delay. Finally, by considering insulin molecules as messenger molecules in our simulations, we will demonstrate that implementing short interruption periods significantly enhances energy consumption, while introducing a small amount of delay to the system. Particularly, the energy consumption is reduced by 15% and the latency is increased by 2.2 ms when 1 ms interrupt period is used for 20 mol of insulin molecule.
Inter-organizational conflict and construction project performance: Influencing mechanism based on trust networks
Research on inter-organizational conflicts among the participants of construction projects typically concentrate on the binary perspective of the project owner and contractor, disregarding the correlation of the complex relationship networks on conflict incidents. This research will propose a systematic set of strategies for reducing inter-organizational conflicts and enhancing project performance from the perspective of trust networks governance. Specifically, the research aims to uncover the interactive mechanisms among the trust network of all participants in construction projects, inter-organizational conflicts, and project performance, thereby filling the existing research gaps. The PLS-SEM approach was employed to analyze 207 valid questionnaires from the participants of construction projects. Data analysis revealed that both the density and stability of the trust networks can restrain various forms of inter-organizational conflicts, and inter-organizational conflicts can impede the attainment of project performance. The density of trust networks can enhance project performance, yet the extent to which the stability of network structure is related to this aspect remains unproven. These findings are conducive to optimizing the performance level of engineering projects and reducing the probability of inter-organizational conflicts.
Modelling of strategies for the introduction and routine use of multivalent meningococcal conjugate vaccines (MMCVs) in the African meningitis belt
The introduction of MenAfriVac has significantly reduced group A meningococcal meningitis in the African meningitis belt, but epidemics caused by other groups such as C, W, Y and X (MenCWYX) remain a threat. To address this, a new multivalent meningococcal conjugate vaccine (MMCV) has been developed and pre-qualified by WHO. This study extends a previously established transmission dynamic model for MenA to include MenCWYX, enabling evaluation of the potential impact of MMCVs under various vaccination strategies. Using Burkina Faso as a case study, the model simulates mass campaigns targeting different age groups and routine vaccination through the Essential Programme on Immunization (EPI). The results indicate that campaigns targeting 1–29-year-olds are most effective in averting cases and delaying disease resurgence, while 1–19-year-old campaigns offer a resource-efficient alternative. Vaccine efficacy against carriage and the duration of protection significantly influence outcomes; greater efficacy (90% vs. 60%) and longer protection delay resurgence and reduce the number of cases. Routine- only vaccination demonstrates value in lower-risk settings, though it is less effective than combined strategies. Sensitivity analyses confirm the robustness of the ranking of strategies but highlight the importance of accurate estimates of vaccine efficacy and transmission parameters. The findings suggest that countries in the meningitis belt should integrate MMCVs into their immunisation programs, with high-risk countries prioritising catch-up campaigns for children and young adults. Despite data limitations and uncertainties, this model provides valuable insights for optimising vaccine rollout and highlights critical research needs, such as understanding vaccine effectiveness against carriage. These results support informed decision-making to sustain progress against meningitis and protect populations from future epidemics. MMCVs hold great promise in further reducing meningitis burden and approaching disease elimination in the region.
Diagnostic status influences rapport and communicative behaviours in dyadic interactions between autistic and non-autistic people
A growing body of research suggests that the behaviours and experiences of autistic and non-autistic people are influenced by whether they are interacting with someone of the same or different diagnostic status. However, little is known about the relationship between these behaviours and the experiences of rapport in matched and mixed neurotype dyads. Using the Actor–Partner Interdependence Model, our pre-registered analyses examine how participants’ and their partners’ diagnostic statuses influence linguistic, behavioural, and kinematic indices, and how these relate to feelings of rapport among autistic and (n = 57; 17 self-diagnosed) non-autistic (n = 51) participants interacting within autistic (n = 20), non-autistic (n = 17), and mixed autistic–non-autistic (n = 17) dyads. We found that autistic participants reported lower rapport regardless of their partner’s diagnostic status, though awareness of their partner’s diagnostic status had a moderating effect. We observed a linguistic difference, autistic participants produced longer mean utterance lengths, these and other behavioural or kinematic indices did not mediate the relationship between diagnostic status and rapport across neurotypes. The current work highlights the need for a nuanced understanding of communication dynamics in autism.
‘Tsatsu tsɛ̃ɛ̃ bo…’: Societal reactions to male infertility among the Ga’s in Ghana
Patrilineality plays a significant role in determining and confirming an individual’s family membership based on their father’s lineage. However, despite the importance of patrilineality in some societies, male infertility—which contributes significantly to infertility and accounts for half of all cases—has emerged as a significant concern. Thus, the study explores societal reactions to male infertility in Krokobite, a suburb of Accra, which is a predominantly Ga-speaking and patrilineal society. The study adopted a qualitative approach, utilizing in-depth interviews (24), focus group discussions (9), and key informant interviews (3). The study’s findings primarily attribute infertility to women, identifying blood incompatibility between couples as a contributing factor in some situations. The findings additionally show that men who are unable to have children or who delay having children face persistent teasing from their peers, who seek to encourage them to join the group of “responsible” men in society by having a child. The study further concludes that the concept of reproductive masculinity is evident in how participants regard males as fertile and less prone to reproductive harm. However, it does not show a significant relationship between reproductive masculinity and the role of fathers in identifying the cause of infertility in a relationship.
Stochastic modelling of delays and buffering in 5G-IoT ecosystems with programmable P4 switches based on BMAP
This study presents a hybrid stochastic model for evaluating delays and buffering in 5G-IoT ecosystems with programmable P4 switches, where traffic patterns exhibit strong batch-like properties. The proposed approach integrates a batch Markovian arrival process (BMAP) with a phase-type service structure and semi-Markov modelling of control-plane interactions, thereby capturing both the temporal variability of IoT traffic and the hybrid nature of routing logic. Analytical expressions for the expected processing time and queue length were derived using extended G/G/1, H₂/H₂/1, M/G/1, and M/N/1 queueing frameworks. Unlike traditional queueing models, the proposed framework is the first to simultaneously incorporate BMAP-driven bursty arrivals, phase-type service distributions, and semi-Markov representation of control-plane interaction dynamics. This integrated design enables more accurate characterisation of real IoT traffic and significantly improves predictive accuracy. The model was validated on real-world traffic datasets, demonstrating that BMAP more accurately reflects the structure of IoT traffic than classical Poisson or MMPP models. Notably, the BMAP-based approach reduced the modelling error by up to 38% compared to Poisson-based approximations and by 22% compared to MMPP-based ones under bursty traffic conditions. Simulation results confirm that increasing the control-plane involvement probability from 0.2 to 0.7, under a fixed average batch size of 12 requests, leads to a 2.6-fold increase in processing delay. Furthermore, the H₂/H₂/1 model showed the highest alignment with empirical data, accurately reflecting the multi-phase service structure and control flow saturation effects. Additional 3D analyses revealed strong nonlinear dependencies of delay on the batchiness factor, dispersion in processing times, and phase asymmetry parameters.
Circulating angiotensin-converting enzyme 2 concentration is associated with acute kidney injury and mortality in sepsis
Background Beyond the well-established classical renin-angiotensin system (RAS), emerging evidence highlights the critical role of the non-classical RAS, specifically the Angiotensin (1–7)/ACE2/Mas axis. As the key enzyme converting Angiotensin II into Angiotensin (1–7), angiotensin-converting enzyme 2 (ACE2) exerts cardioprotective and anti-inflammatory effects, showing potential therapeutic value in critical care. This study investigates the association between circulating ACE2 levels and clinical outcomes in sepsis, offering insights into its role and potential for predicting sepsis outcomes. Materials and methods In this single-center study, we investigated associations between the circulating ACE2 concentration and outcomes in septic patients admitted to a medical intensive care unit (ICU) between 01/05/2018 and 31/01/2021. Sepsis was defined as infection accompanied by a ≥2-point Sequential Organ Failure Assessment (SOFA) score increase. Patients were categorized into low (<2.5 ng/mL) and high (≥2.5 ng/mL) ACE2 groups based on serum concentrations within 24 hours of ICU admission. Outcomes comprised acute kidney injury (AKI), ICU mortality, and 90-day mortality. Results In total, 414 patients (mean age 68.5 years, 64.7% male) were included in the study. Elevated ACE2 levels correlated positively with SOFA score and total bilirubin and lactate concentrations, and negatively with the hemoglobin concentration. Relative to the low ACE2 group, the high ACE2 group was at increased risk of sepsis-associated AKI development within 48 hours after ICU admission (81.6% vs. 69.6%, p = 0.006), AKI requiring renal replacement therapy (21.3% vs. 11.1%, p = 0.007), ICU mortality (31.9% vs. 17.5%, p = 0.001), and 90-day mortality (51.7% vs. 39.6%, p = 0.018). Kaplan-Meier survival curves demonstrated significantly reduced survival in individuals with high ACE2 concentrations (p = 0.009). Univariate analysis revealed significant associations of high ACE2 concentrations with ICU mortality and AKI development within 48 hours after ICU admission. In a multivariate analysis adjusted for relevant variables, ACE2 elevation remained an independent predictor of ICU mortality (adjusted odds ratio 2.15, 95% confidence interval 1.04–4.41, p = 0.038). Conclusion Elevated circulating ACE2 concentrations comprised an independent predictor of ICU mortality, highlighting intricate RAS dynamics in critical illnesses. Low ACE2 concentrations were associated with greater survival, suggesting their potential as an early prognostic indicator.
How electronic health literacy influences physical activity behaviour among university students: A moderated mediation model
Purpose This study examines how eHealth literacy influences exercise behaviour among university students through a moderated mediation model. Specifically, peer relationships are positioned as mediators, while sleep quality moderates the effect of eHealth literacy on exercise behaviour among university students. The study explores the intricate interactions involved and elucidates how eHealth literacy affects exercise behaviour through multiple dimensions. Methods Student data were collected via questionnaire surveys across multiple academies. A stratified purpose sampling approach was employed for participant selection, targeting four specific universities to ensure regional and typhological representation: Nanjing Xiaozhuang University, Yangzhou University, Shangqiu University, and Yangzhou Polytechnic Institute. This process resulted in 14,892 valid responses for analysis, and SPSS 26.0 along with the PROCESS macro was used to analyses variables such as electronic health literacy, physical activity, sleep quality, and peer relationships. Results The structural equation modeling revealed a significant direct effect of eHealth literacy on university students physical activity behaviour (β=0.065, p<0.001). Mediation analysis delineated an indirect pathway through peer relationships: eHealth literacy significantly enhanced peer relationship quality (β=0.251, p<0.001), which subsequently predicted increased physical activity (β=0.058, p<0.001). Peer relationships significantly mediate between eHealth literacy and university students physical activity (β=0.251, p<0.001). Additionally, sleep quality serves as a moderating variable (β=0.029, p<0.001), significantly moderating the direct effect of eHealth literacy on university students physical activity, with the 95% confidence intervals consistently excluding zero. Conclusion EHealth literacy among university students can significantly and positively predict their exercise behaviour. Peer relationships mediate the effect of eHealth literacy on exercise behaviour. At the same time, sleep quality is a moderating variable influencing eHealth literacy's direct impact on university students exercise behaviour.
Optimal subsidy design for sports tourism under demand uncertainty: A multi-agent strategic interaction framework
This study develops a dynamic game model to analyze subsidy mechanisms for sports tourism integrated destination (STID), examining interactions between a core operator (major projects) and multiple supporting operators (ancillary services). It compares three scenarios: no subsidy, investment-based subsidies (core operator only), and visitor-driven subsidies (tied to tourist numbers). Results show investment-based subsidies increase core operator spending but not supporting operators’ investments, while boosting tourist numbers and supporting operators’ profits. Visitor-driven subsidies benefit all operators, increasing investments, profits and tourist volumes. When subsidy budgets are equal, visitor-driven subsidies yield better outcomes across all metrics if demand fluctuations remain stable. Demand shocks amplify both subsidy types’ effectiveness. Findings suggest visitor-driven subsidies better coordinate tourism ecosystems, with demand volatility enhancing subsidy impacts, while core and supporting operators require differentiated policy approaches due to asymmetric responses.
Construction of a nomogram based on disinfection methods and clinical characteristics of ICU patients to forecast hospital-acquired respiratory infections: A single-center study from China
Background Hospital-acquired respiratory tract infections (HARTI) are increasingly recognized by healthcare workers, especially among critically ill patients who are particularly susceptible. The selection of effective surface disinfectants can effectively block the transmission of pathogens, with chlorine-based disinfectants being widely used at present. This study constructs a nomogram by analyzing the choice of surface disinfection methods and clinical information of patients, to predict the occurrence of HARTI in ICU patients. Method This study collected 592 patients admitted to the ICU from 01/01/2020–31/12/2023, and used binary logistic regression analysis to predict the predictive effect of Malignant tumor, Admission ICU unit, CRP, APTT, Any norepinephrine use, Blood.transfusion, Chlorine disinfectant, Tracheotomy on the occurrence of HARTI in ICU patients. And use R studio to construct nomogram model. Result The results indicate that MONO (7.16[2.16,23.71]), BUN (0.24[0.06,0.88]), SOFA (4.5[1.48,13.74]), chlorine disinfectant (500 mg/L) (0.02[0,0.07]) in the choice of disinfection method, and bed railing (0.14[0.04,0.48]), micro-infusion pump (0.31[0.1,0.98]) in the area of disinfection are independent predictors of HARTI occurrence. The nomogram derived from the study demonstrated good predictive performance and showed minor errors in both the training and validation sets, providing significant clinical benefits to most patients. Subgroup analysis also well demonstrated this point, showing that it can better reduce the occurrence of HARTI patients in the ICU compared to two other types of disinfectants. Conclusion Regulation of MONO and BUN values in blood indicators for ICU patients, intervention on corresponding indicators in the SOFA score, and the use of Chlorine disinfectant (500 mg/L) for surface disinfection, with a focus on disinfecting bed railings and micro-infusion pumps, can significantly reduce the incidence of HARTI, allow for early prevention and adjustment of HARI, and simultaneously benefit more patients.
Computational Fluid Dynamics (CFD) interpretation of backfill pipeline system damage caused by paste-like slurry in water hammers
Paste-like slurry which made up of gangue particles and fly ash consolidated in the goaf could effectively reduce surface subsidence and improve resource recovery. The technology relies on efficient transport. However, there are many pipeline explosion accidents caused by water hammer due to rapid valve closure. The density and elasticity modulus of the paste-like slurry are significantly greater than other fluids. That makes the pressure exerted on the pipeline and valve by the slurry water hammer is significantly greater than the other fluids. The research established the relationship between valve closing time and peak pressure using dynamic meshes combining theoretical analysis and numerical simulations. The results show that the velocity at which the valve closes significantly affects the pressure on the valve and nearby pipelines. However, when the valve large open, the impact only on the local flow velocity and has no substantial impact on the flow state throughout the system. Finally, the optimal closing time of the butterfly valve was determined by comparing pressure magnitudes.. The paper focuses on the phenomenon of water hammer in dense slurries, which is different from other fluids. However, theoretical and simulation models have reference value for the study of other fluid water hammer.
Option talk and risk communication with people with limited health literacy: A qualitative focus group study with key stakeholders
Purpose To explore stakeholders’ views on acceptable and feasible strategies for discussion of treatment options and risk communication with people with limited health literacy (LHL in the context of shared decision-making (SDM)). Methods This qualitative descriptive study used purposive sampling to conduct focus groups with stakeholders including experts in health literacy, SDM, or risk communication (RC); experienced General Practitioners (GPs); and individuals with LHL. Each session included a brief presentation defining SDM, option talk, and RC, followed by an introduction to various RC strategies and decision aids to facilitate discussion. Verbatim transcripts were analysed by two independent researchers using inductive and deductive content analysis. Results Five focus groups were conducted, involving experts (two FGs, n = 5 and n = 6), GPs (one FG, n = 8) and people with LHL (two FGs, 2x n = 3). Experts and GPs emphasised the need to tailor communication to the patient’s context and noted challenges in identifying patients with LHL. All participants highlighted the importance of using illustrations of treatment options (e.g., knee injections) to support the discussion of options. Views on the level of detail required for RC varied, with some GPs questioning whether RC was understandable to people with LHL. Most people with LHL preferred RC in natural frequencies and icon arrays but noted that RC can fan fear. GPs found contextualisation (e.g., comparing the probability of a treatment outcome with the probability of a car accident) a helpful strategy, but patients found it confusing. Decision aids were seen as supportive for RC. Overall, people with LHL preferred their doctor to discuss options face-face with them, using a layered step-by-step manner, adding details on RC as preferred by patients. Conclusion SDM for people with LHL benefits from a tailored, layered approach with visual aids. These strategies are potentially useful for all patients, but further research is needed to confirm this.
Assessing the impact of sodium intake on kidney function deterioration and proteinuria in the general population: A prospective cohort study
Excessive sodium intake is recognized as a potential risk factor for various diseases, including kidney disease. However, limited research has been conducted on the relationship between sodium intake and kidney disease in the general population. This study aimed to explore the association between sodium intake and the risk of kidney disease, utilizing multivariable logistic regression and spline interpolation models. Twelve-year prospective cohort data were analyzed, and participants were categorized based on their sodium intake. Kidney disease was defined by the presence of proteinuria and a reduction in estimated glomerular filtration rate below 60 ml/min/1.73m². In the overall population, sodium intake exceeding 2g/day was not significantly associated with kidney dysfunction (adjusted OR: 0.84, 95% CI: 0.67–1.04, p = 0.113). However, in subgroup analyses, individuals with diabetes who consumed more than 5g/day of sodium had a significantly increased risk of kidney dysfunction (adjusted OR: 3.76, 95% CI: 1.36–10.30, p = 0.01). Across both the general population and subgroup analyses, sodium intake was not significantly associated with proteinuria. These findings suggest that while sodium intake may not have a substantial impact on kidney function in the general population, it may play a critical role in accelerating kidney dysfunction in individuals with comorbidities such as diabetes.
Sci-tech analysis and related research on three glass beads unearthed from M686 in the Qin cemetery of Warring States Period in Hejia, Zhouling
This study presents a systematic analysis of three glass beads excavated from Tomb M686 in the Qin Cemetery of Warring States Period (475 BC-207 BC) in Hejia,Zhouling. The aim is to reveal their material characteristics and weathering mechanisms. Using super-depth-of-field 3D video microscopy system (OM), X-ray fluorescence spectroscopy (XRF), and micro-Raman spectroscopy (Raman), all three glass beads were identified as the unique lead-barium silicate glass system of ancient China. The primary coloring element in the glass is Cu(II), and the main weathering products include PbCO₃ and BaSO₄. Focusing mainly on the cross-section of Sample 2, scanning electron microscopy with energy dispersive spectroscopy (SEM-EDS) and X-ray photoelectron spectroscopy (XPS) were employed to investigate the microstructural and compositional changes. The results revealed continuous leaching of Pb, Ba, and S elements from the glass substrate during the weathering process, interacting with substances in the burial environment to form stable weathering products PbCO₃ and BaSO₄. Based on the analysis of elements in the buried environment soil, indicated that barium has higher water solubility than lead. The weathering process was also accompanied by the conversion of Cu(Ⅱ) to Cu(Ⅰ), which explains the color alteration associated with glass weathering. This research is the first to integrate multiple microscopic techniques to systematically explore the weathering processes of lead-barium glass from the Warring States period, elucidating both its coloring mechanism and the formation pathways of weathering minerals. The findings provide technical support and a theoretical foundation for the understanding and preservation of related cultural relics.