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MSAFNet: A multi-scale attention fusion network for automated neonatal pain facial expression recognition with clinical validation

Motivations and segmentation of instagram users as a social network site: Their sociodemographic profiles, satisfaction and loyalty

Millions of Internet users interact daily with social network sites (SNS), and these figures are still expected to grow. This study aimed to identify the motivations and typology of different types of Instagram users, specifically pursuing these objectives: (1) to identify the motivations that lead individuals to use Instagram as a SNS; (2) to establish user segments based on these motivations; (3) to determine how these segments relate to user satisfaction and loyalty; and (4) to explore the relationship between the identified segments and key socio‑economic and demographic variables. The study was carried out through an online survey composed of 369 participants. For data analysis, factorial analysis, the K-means segmentation method, and the Chi-square test were used. Four motivational dimensions in the use of Instagram were identified, related to “Curiosity, Creativity, and Documentation,” “Self-expression,” “Socialization,” and “Recreation.” In addition, three distinct segments of Instagram users were identified based on their underlying motivations: “Enthusiasts”, “Spectators”, and “Passive Users”. Among them, the Enthusiasts emerged as the group displaying the highest levels of satisfaction and loyalty within the platform. The study further assessed the socio-economic and demographic profiles of each segment. This study offers original value by categorizing users based on their motivations, examining how these motivations relate to satisfaction and loyalty, and identifying the socio-economic and demographic profiles of the different user segments. The findings contribute to strategic frameworks for digital marketing and audience segmentation, providing organizations and businesses, particularly those that use Instagram as a communication, sales, or business channel, with actionable insights. Overall, this research establishes a solid foundation for future studies and practical applications in social media strategy, consumer behavior, and digital marketing.

Quantum synchronization enhanced via photon hopping in an optomechanical system

Abstract In this paper, we study quantum synchronization in a hybrid optomechanical system that includes photon hopping and atomic ensembles. The covariance matrix method is used to examine synchronization between cavity–cavity, cavity–atom, and cavity–mechanical subsystems. Our results demonstrate that strong photon hopping improves synchronization by enabling efficient transfer of energy and phase between the coupled modes. Furthermore, we reveal that synchronization exhibits a non-monotonic dependence on both the atomic coupling strength and system detuning, initially increasing up to a critical threshold before gradually declining. In contrast, decoherence effects especially atomic decay rate reduce synchronization by destroying phase coherence. While cavity-mechanical synchronization is heavily suppressed by an increasing thermal phonon number, cavity-cavity and cavity-atomic synchronization remain uniquely robust against thermal noise. Ultimately governed by the competition between coherent coupling and environmental dissipation, these results provide valuable insights into controlling quantum synchronization for future applications in quantum information processing, precision metrology, and scalable hybrid quantum networks.

Cultural tightness and scientific capacity: A cross-national study of their synergistic and conflicting roles in COVID-19 pandemic outcomes

Despite their advanced scientific capacity, many nations experienced high COVID-19 cases and deaths during the pre-vaccine phase of the pandemic. In contrast, some countries with tighter cultural norms, where social behaviour is more strongly regulated, appear to have controlled the spread of the virus more effectively. This creates a paradox: the same norm strength that may support compliance with public-health measures may also be less conducive to ideation, creativity, and scientific output. While prior research has associated cultural tightness with lower COVID-19 cases and deaths, its relationship with scientific capacity remains underexplored. This study examines associations between scientific capacity, cultural tightness, and COVID-19 outcomes using cross-national data. Findings show that scientific capacity has no robust direct protective association with pre-vaccine COVID-19 cases or deaths once cultural tightness and structural covariates are included. In contrast, Gelfand’s measure of cultural tightness is consistently associated with lower cases and deaths. These findings suggest that scientific knowledge alone does not automatically translate into population-level protection, and that norm strength, behavioural coordination, and knowledge-to-action capacity may be important conditions of pandemic resilience.

Informing optimal management strategies for an emerging disease across a risk gradient

Spatial intensity modelling of ISIS-related attacks using random forest regression: A GeoAI-based analysis of GTD data (2012–2019)

Spatial information is of crucial importance to understanding terrorist attacks and for security applications. Conventional risk assessments of terrorism are typically focused on retrospective identification of hotspots and may fail to fully account for complex spatial–temporal patterns. This research proposes an approach to modelling the relative intensity of ISIS/ISIL attacks across space using Random Forest regression, a type of Geospatial Artificial Intelligence (GeoAI). A subset of the Global Terrorism Database (GTD) from 2012–2019 is screened to develop a spatially aggregated data set with geographic coordinates, temporal information and some incident details. The modelling strategy estimates the intensity of events in a grid cell, with values normalized based on the count of previous events, allowing for an analysis of spatial patterns rather than the prediction of future events. Modelling results show that the Random Forest model captures spatial variability in historical attack intensity with a high level of fit (R² = 0.84; RMSLE = 0.213). Analysis of variable importance suggests spatial and temporal features play an important role, but this is contextualised by the spatial construction of the response variable. The research presents a repeatable GeoAI process for modelling spatial patterns of terrorism incidents and offers an interpretable model for exploratory spatial analysis and scenario-based spatial analysis development. The approach is not suitable for real-time prediction, but aids in understanding historical spatial concentration patterns in a complex threat environment.

A lightweight deep learning framework for image-based pothole classification and real-time video-based pothole detection

Patient satisfaction towards pharmacists’ services in the community pharmacies in the Hail region

Objectives Research on patient satisfaction with community pharmacy services in Saudi Arabia has mostly concentrated on large cities, leaving a significant gap in understanding these services within the Hail region. Evaluating patient satisfaction in Hail is essential to address regional service gaps in privacy and counseling. Thus, this study was designed to assess the patient satisfaction with community pharmacy services in the Hail region. Methods This cross-sectional study targeting the community pharmacy visitors in Hail region was conducted among 200 participants for a duration of three months (i.e., from 14 June 2024–29 September 2024). Patient satisfaction was assessed by a reliable and valid questionnaire. The instrument consisted of 17 items; and all of them were 5-point Likert scale responses (Poor = 1, Fair = 2, Good = 3, Very good = 4, Excellent = 5). To guarantee diverse geographic representation, 20 community pharmacies were purposefully chosen from several Hail City districts. In order to achieve balanced sample across all sites, a total of 200 participants were recruited, with roughly 10 patients joined from each Pharmacy. The data was analyzed for descriptive statistics using the SPSS, version 29.0. Results The majority of the 200 participants in this study (mean age of 37.5 years) were married (60.5%) and male (56.5%). More than half had only completed high school, and only 16% had insurance. Most of the patients (53%) consistently visited the same pharmacy. Pharmacist-patient relationships received the highest level of satisfaction, but accessibility—specifically, the availability of private consultation areas—received the lowest. Regular pharmacy visitors reported higher levels of satisfaction across multiple domains, whereas younger, male, single, better-educated, insured, and healthier patients had more favorable perceptions of medicine availability, highlighting disparities in demographic and health factors. Conclusion The majority of community pharmacy visitors were young adults, married, had a range of educational backgrounds, and frequently used the services without a prescription or health insurance. Overall, patient satisfaction was good; nevertheless, to further improve patient experience and access to pharmacy services, improvements in private consultation facilities and pharmaceutical pricing are required.

Assessing the applicability of the ICAO carbon emissions calculator at a Chinese plateau airport using operational data

Abstract The International Civil Aviation Organization (ICAO) Carbon Emissions Calculator (ICEC) is widely recognized as an authoritative tool for estimating aviation carbon footprints. However, its globally averaged static assumptions have not been systematically tested in regionally specific operational environments. This study takes Kunming Changshui International Airport (ZPPP)—a high-altitude hub in southwestern China—as a case study and empirically evaluates ICEC’s mapping mechanisms in a regional context using full‑year 2023 operational data from 113,937 flights. The results show that ICEC’s static distance correction does not capture the pronounced directional asymmetry and seasonal variation driven by the mid‑latitude westerly jet and its seasonal intensification. In summer, severe convective weather further induces high daily dispersion in flight times. Regarding emission allocation, passenger load factors exhibit directional asymmetry and seasonal patterns. The average body weight of Chinese adult passengers is approximately 30% lower than ICEC’s default value, and the increased proportion of children during holiday periods further reduces the average passenger mass. Cargo loads show extreme directional imbalance and significant heterogeneity across airlines. These multi‑level biases interact and accumulate, leading to systematic deviations in per‑passenger emission estimates depending on season, route, and airline. This study demonstrates that ICEC’s static assumptions, built upon globally averaged parameters, may produce multidimensional systematic biases when applied to the complex operational environment of a high-altitude airport in China. We recommend that future improvements to international carbon accounting tools introduce direction‑dependent distance corrections, dynamic load parameters, and region-specific passenger mass factors to enhance the fairness and scientific accuracy of emission calculations.

Does delayed exercise-based priming improve subsequent athletic performance? A systematic review and multilevel meta-analysis

This systematic review and multilevel meta-analysis examined whether delayed exercise-based priming improves subsequent athletic performance. Following PRISMA 2020 principles, 3,095 records were identified; after removing 1,107 duplicates, 1,988 unique records were screened, 212 full-text reports were assessed, 186 reports were excluded at eligibility, and 26 studies were included. Eighteen studies contributed 46 effect sizes to the quantitative synthesis. Risk of bias was assessed with RoB 2 principles calibrated for crossover exercise trials, and certainty was evaluated using GRADE. A three-level random-effects model showed a small positive average effect of delayed priming on subsequent performance (g = 0.232, 95% CI [0.092, 0.372], p = .002), with cluster-robust inference supporting the same conclusion (p = .004). The prediction interval crossed zero (−0.265 to 0.730), and the overall certainty of evidence was low. Delayed exercise-based priming can be used as a practical competition-day strategy when embedded in planned preparation windows, although protocol selection and athlete response should be checked in training before competition use.

Linking maternal and pup iron mobilization in a diving mammal using iron isotope composition

Understanding the transition to motherhood among adolescent mothers in rural Pakistan: Implications for mental health

Purpose This study explored how adolescent mothers in Pakistan experience the transition to motherhood and the mental health challenges that arise during this period. Methods A focused ethnographic study was conducted with 25 adolescent mothers in Matiari, Sindh. Data were collected through semi‑structured interviews, participant observations, and artifact elicitation. Meleis’ Transition Theory informed the study focus and development of the interview guide. Reflexive thematic analysis guided interpretation, informed by an intersectional lens. Findings Five themes described mothers’ experiences: early educational disruption and redirected aspirations; continuous caregiving with uneven support; barriers to maternal healthcare access; emotional distress and psychological strain; and identity transformation. These intersecting challenges contributed to significant mental health strain and highlighted persistent gaps in access to supportive, adolescent-responsive maternal care. Conclusions Adolescent mothers navigate motherhood with substantial emotional and practical burdens yet demonstrate meaningful resilience. Findings highlight the need for adolescent‑responsive mental health support, accessible care, routine and confidential distress screening, referral pathways, and supportive educational and community‑based interventions tailored to underserved rural settings.

Simulation study on prescribed-time stabilization of 5-DOF exoskeletons using a regularized super-twisting approach

Abstract This paper proposes an enhanced Prescribed-Time Super-Twisting Controller (PT-STC) for 5-DOF upper-limb rehabilitation exoskeletons. A regularized scaling transformation is introduced to ensure tracking error convergence to a tunable $$\varepsilon$$ -neighborhood of the origin within a user-defined time window, independent of initial conditions and disturbance magnitudes. The terminal error bound is characterized as $$\Vert e(T_{user})\Vert \le \mathcal {O}(\varepsilon )$$ , providing a systematic trade-off between convergence precision and control effort through the selection of $$\varepsilon$$ . Unlike conventional prescribed-time approaches, the proposed “Soft-Landing” mechanism eliminates gain explosion singularities, thereby preventing actuator saturation and maintaining control signals within safe operational limits in simulation. The integration of the Super-Twisting Algorithm within the scaled coordinate domain yields chattering-free torque profiles essential for safe human-robot interaction. The theoretical developments are validated through high-fidelity simulations under nominal stabilization and dynamic tracking with impact disturbances. Results demonstrate a settling time of approximately 1.99s, with significant reductions in both settling time and total variation relative to conventional sliding mode control. These findings suggest that the PT-STC offers a promising balance between temporal precision and smooth actuation, warranting further experimental investigation. We emphasize that the current results are simulation-based; experimental validation is required before clinical deployment.

Suicidal ideation, mental health services, and barriers to care among syringe services program clients who use opioids

Introduction People who use opioids (PWUO) experience a disproportionately high burden of suicidal risk. Syringe services programs (SSPs) are a critical point of contact for this population, providing low-threshold, harm-reduction services. However, gaps persist in understanding suicidal risk among individuals attending SSPs and the extent to which such risk is associated with mental health service utilization in this setting. This study aimed to assess the prevalence and specific risk factors for suicidal ideation (SI) in PWUO, as well as their use of and barriers to accessing mental health services. Methods We conducted a cross-sectional survey between April and June 2024 among PWUO (N = 199) who were utilizing services in the SSP in New Haven, Connecticut. We used the ninth item from the Patient Health Questionnaire (PHQ-9) scale, which assesses passive thoughts of death and self-harm in the past two weeks, as a proxy measure for the SI. Additionally, participants reported their use of and barriers to accessing mental health services in the past six months. Bivariate and multivariable logistic regression were conducted to examine factors associated with SI. Results Approximately 84% of participants met the criteria for opioid dependence, and more than two-thirds (71.9%) were currently receiving medication for opioid use disorder. Over one-third of the sample reported SI in the past two weeks (34.7%). Additionally, over one-third of participants (36.2%) reported unmet mental health needs, and 84.4% reported experiencing at least one barrier to accessing mental health services. Individuals with depressive symptoms (aOR: 5.4; 95% CI: 2.5–11.7) were more likely to report SI, while those who were aware of naloxone (aOR: 0.2; 95% CI: 0.1–0.6) were less likely to report SI in the past two weeks. Conclusion Our study showed a high prevalence of SI among SSP clients who use opioids and a low use of mental health services due to access barriers. These findings support incorporating a brief suicide risk screening and referral options within SSPs and other settings serving PWUO and addressing key access issues like cost and transportation that can prevent timely linkage to mental health services.

M-truncated bilinear neural network method with qualitative analysis for nonlinear partial differential equations

PM-DUnet: Fusing long-range dependencies and attention in a dual-U architecture for thyroid nodule segmentation

For medical image segmentation, accurately balancing local details and global long-range dependencies is critical to tackling thyroid nodule challenges (variable sizes, ambiguous boundaries, complex context). Traditional CNNs excel at local feature extraction but are constrained by local receptive fields, hindering efficient global dependency modeling. To address this, we propose a Parallel Mamba Dual-U Network (PM-DUNet). It adopts a cascaded dual U-Net encoder-decoder for two-stage “coarse-to-fine” segmentation refinement. We design a Multi-Path Parallel Mamba (MPM) module—using State Space Models (SSMs)—to efficiently model global context with linear complexity. Additionally, Squeeze-Excitation Downsampling (SED) and Spatial Attention Upsampling (SAU) modules are integrated to adaptively enhance key features in encoding/decoding. Results show PM-DUNet achieves highly competitive performance and outperforms state-of-the-art methods on most core metrics, verifying its effectiveness and robustness for complex medical image segmentation. Our code is available on https://github.com/Andrevict/MPDUNet .

Qubit-efficient quantum intrusion detection using dual-parameter encoding and multi-metric calibration

Analysis of the characteristics of spino-pelvic sagittal parameters in Degenerative Thoracolumbar Kyphosis deformity and the mechanism of sagittal imbalance

Background Degenerative thoracolumbar kyphosis (DTLK) is a subtype of adult spinal deformity. If DTLK progresses further, it can develop into global kyphosis (GK). Although numerous studies have described the sagittal parameters of the spino-pelvic in adult spinal deformities, there is currently no report on the sagittal parameters of DTLK. To date, there have been no reports that elucidate the mechanism of sagittal imbalance by comparing it with sagittal balance, or by examining the sagittal parameters of healthy individuals. To address this gap, the study employed a retrospective analysis, measuring parameters such as the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis angle (LL), upper arc of total lumbar lordosis (UALL), lower arc of total lumbar lordosis (LALL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), spino-sacral angle (SSA), and PI-LL. This study aims to clarify the occurrence and compensatory mechanisms of sagittal balance and sagittal imbalance in patients with DTLK. Objective To investigate the spino-pelvic sagittal parameters in patients with degenerative thoracolumbar kyphosis and the compensatory mechanisms for the occurrence of sagittal imbalance. Method Our research is a cross-sectional study. The imaging data used in this study were extracted on August 15, 2025. A retrospective analysis was conducted on the preoperative imaging data of 339 patients diagnosed with DTLK at Fuyang People’s Hospital from 2016 to 2025. The sagittal parameters of the spino-pelvic were measured using Surgimap software and compared to those of healthy individuals as documented in the literature. The data were divided into a balanced group and an imbalanced group based on SVA and the spino-pelvic parameters of healthy individuals. The balanced group was then compared with the imbalanced group. Results The spino-pelvic sagittal parameters of DTLK patients were significantly different from those of healthy individuals. In the balanced group, TK, TLK, LL, and PT were higher than those of normal individuals, while SS, PI, PI-LL, SSA, and UALL were lower than those of normal individuals. Compared with the imbalanced group, the balanced group had higher TK, TLK, LL, LALL, and SSA and lower SS, PT, PI-LL, and UALL. SVA showed significant correlations with multiple sagittal parameters. Conclusions DTLK patients exhibit significant differences from healthy individuals in various sagittal parameters. Balance is primarily maintained through the posterior tilt of the pelvis and a reduction in the lumbar lordosis to compensate. When an imbalance occurs, the LL, LALL, UALL, PT, and PI-LL increase as compensatory mechanisms for the loss of balance. Once the UALL is exhausted, compensation shifts to an anterior convexity of the lower lumbar curve and a posterior rotation of the pelvis.

Metabolic adaptations of starving purple sea urchins (Strongylocentrotus purpuratus) surviving in the barrens

Abstract Sea urchin grazing can drive kelp loss creating low productivity “barrens” with reduced biodiversity that may persist for decades. In these habitats, limited food driven by sea urchin herbivory reciprocally affects sea urchin physiology, yet the metabolic pathways enabling survival in the starvation conditions remain poorly understood. This study employed gas chromatography–mass spectrometry metabolomics to compare gonad metabolite profiles of purple sea urchins, Strongylocentrotus purpuratus , from barrens and adjacent kelp forest margins. Gonads from barren animals showed pronounced metabolic reallocations relative to kelp-margin animals, supporting energy production, redox balance, and membrane integrity. Carbohydrate metabolism was shifted towards increased glucose and gluconeogenesis with reduced alanine and glutamine as substrates for energy production. The pentose phosphate pathway fluxed towards energy production (supported by elevated sedoheptulose and mannoheptulose, and reduced glutamine and glutamate), rather than nucleotide synthesis and growth. Elevated amino acids (cysteine, cystine and lysine) reflected gonad protein catabolism, energy production and redox balance. Changes in lipid metabolism showed elevated monostearin from lipid breakdown, reduced heptanoic acid as energy substrate, and increased malonate supporting membrane integrity. This study reveals the specific metabolic adjustments purple sea urchins employ under food-limited conditions in barrens, diverting energy from reproduction to enhance long-term survival, potentially signaling challenges for kelp restoration.

The mediating role of sleep quality in the association between urinary incontinence and depressive symptoms: A study with older Korean Americans Living in Subsidized Senior Housing

Urinary incontinence (UI) is a prevalent health issue among older adults. Depressive symptoms often accompany UI; however, the pathways linking these conditions remain understudied. In this study, we conceptualized sleep quality as a potential mediator in the association between UI and depressive symptoms. The mental health burden of UI is anticipated to be indirectly associated with impaired sleep quality. The mediating role of sleep quality was tested in a sample of 306 older Korean Americans living in low-income senior housing (mean age = 79.4 years, range = 65–102). Regression analyses showed a significant association between UI and depressive symptoms. Mediation analysis using the Hayes PROCESS macro showed that the indirect effect of UI on depressive symptoms through sleep quality was significant (B [SE] = 0.59 [0.21], bias-corrected 95% CI = [0.20, 1.02]), accounting for approximately 24% of the total effect. The findings suggest that compromised sleep quality may serve as a potential pathway linking UI and depressive symptoms. Sleep quality should be addressed in efforts to promote the mental health of older adults experiencing UI.