To compete successfully in alpine ski racing, not only physical, mental, and skiing technique preparation are important, but also wisely chosen and properly tuned skiing equipment. While equipment related safety aspects are mostly ensured by official rules (e.g., competition rules provided by the International Skiing Federation), the performance optimization and customization of equipment is mostly reliant on coaches and experts in the skiing industry. Therefore, knowledge often is dependent on individual person's experience and not publicly available. This aspect can also hinder companies or teams to spread knowledge within their own team. However, there is the necessity to select the optimal equipment for each athlete individually within a range of available equipment variations. To improve the process of ski boot selection for racers within a whole company, the presented research had the goal to provide a decision model by extracting and objectifying knowledge from few experts within the company. Based on a Delphi-type expert elicitation approach, together with the company's boot experts a data collection sheet was designed, including the relevant parameter to decide which ski boot is appropriate for an individual athlete. Thereafter, data analysis of 198 datasets included classification methods based on random forest models to create boot choice recommendation models. Results revealed well predictable recommendation for boot size (accuracy 77%) and acceptable accuracy (57%) for prediction of boot model. With existing limitations of extracting subjective and individual expertise, this approach helps to objectify personalized expertise and distribute knowledge within relevant interest groups.
Football boots-serving as the critical interface between the player and the playing surface-play a decisive role in modulating the risk of non‑contact lower‑limb injuries. Although numerous studies have investigated the effects of stud configuration, sole‑plate stiffness, and boot-foot-surface interaction on lower‑limb biomechanics, an integrated evaluation of their injury implications remains lacking. Following PRISMA 2020 guidelines, a systematic search (2005-2025) was conducted across Elsevier, EBSCO, Web of Science, PubMed Central, and Footwear Science. Thirty‑two studies met the inclusion criteria after dual‑reviewer screening, and methodological quality was assessed using the PEDro scale. Evidence was triangulated to identify biomechanical mechanisms underpinning injury risk as influenced by boot design. Five principal findings emerged: 1. Stud pattern governs rotational traction. Screw-in (Soft Ground (SG)) and bladed studs generate supra-physiological rotational torque on both natural and artificial turf, producing a "foot-lock" phenomenon that elevates the incidence of anterior cruciate ligament (ACL) rupture, ankle sprain, and metatarsal stress fracture. 2. Sole-plate stiffness shows a U-shaped relationship with injury risk. Excessive rigidity restricts first-ray dorsiflexion and precipitates focal plantar pressures, whereas excessive compliance amplifies ankle dorsiflexion/inversion and knee-valgus angles, thereby increasing ACL loading. 3. Boot-foot-surface mismatch (undersized lasts, stud-surface incompatibility, sex-specific traction overload) redistributes plantar pressure and alters joint moment arms, fostering over-use injuries. 4. Collar height augments ankle stability but induces compensatory knee torsion, shifting the failure locus proximally and raising the likelihood of knee-ligament trauma. 5. High-risk mechanical loading often occurs below athletes' perceptual thresholds, suggesting that asymptomatic microdamage may accumulate over time. Collectively, football‑boot architecture represents a modifiable determinant of non‑contact lower‑limb injury. Establishing standardized testing frameworks that calibrate stud geometry, sole‑plate stiffness, and last morphology-while accounting for surface type, sex, and playing level-will enable optimization of high‑performance yet low‑injury boot design.
This study highlights the presentation of inframalleolar ulcers in venous disease not classically described their wound healing factors, recurrence rate, and response to Unna boot treatment with adjunct endovenous and/or iliac vein stenting treatments. This retrospective single-center study included 71 office-based patients with inframalleolar venous ulcers treated between May 2012 and May 2023. Of the 71 patients evaluated, 12 presented with bilateral ulcers, resulting in a total of 83 limbs. Patient demographics including age, sex, ulcer etiology, ulcer location, diabetes status, and treatment modality were evaluated. All patients presented with bilateral leg swelling and venous reflux greater than 500ms suggestive of venous insufficiency. Initially, patients were required to have palpable pedal pulses and a normal ankle-brachial index (ABI) for inclusion. Over time, inclusion criteria were broadened to accept patients with mixed arterial-venous disease, provided their ABI was greater than 0.6. Patients with isolated arterial pathology and an ABI < 0.6 and diabetic neuropathic ulcer etiology were excluded from this study. Patients received compression therapy that included an elastic ACE wrap and an inelastic Unna boot formulated with calamine, zinc oxide, and glycerin, both applied by trained medical assistants. Sixty-five patients received additional endovenous and/or iliac vein stenting treatments. The mean patient age was 67 years +/-14 years (range 25-96 years). Of the 71 patients treated, 12 (mean 16.9%, SE 4.45%) presented with ulcers on both of their limbs resulting in a total of 83 limbs treated. All ulcers were treated with weekly Unna boots with an average treatment duration of 12 weeks +/- 23 weeks (range 1-181 weeks), and median treatment duration of 5 weeks. After wound healing patients were followed for a mean duration of 16 +/- 28 months. The rate of success of > 90% healing for inframalleolar ulcers was 51.8%. Factors associated with wound healing were ulcers that were primarily venous in nature as opposed to mixed (p=0.01). Heel ulcers were not associated with inferior wound healing (p=0.10) as compared to other locations but were associated with higher rates of recurrence (p=0.002). 26.76% of patients had recurring ulcers while 45.13% did not, 8.4% of ulcers were still actively being treated with Unna boots and 19.71% were lost to follow-up. Improved healing of inframalleolar ulcers was significantly associated with the presence of a concomitant supramalleolar ulcer on the same limb (p=0.02). This study brings attention to the uncommon presentation of inframalleolar ulcers in venous stasis disease and is driven by the observation that bilateral leg swelling can lead to poor wound healing. Compression therapy using Unna boots is easily accessible, cost-effective, and should be considered as it offers significant therapeutic benefit in this patient population.
Orthodontic traction of impacted maxillary canines remains a clinical challenge, particularly when the tooth is severely angulated. Conventional force application to the crown may increase the risk of damage to adjacent roots due to insufficient control of root positioning. This case demonstrates the use of a boot loop in combination with a micro-screw to upright the canine root within the alveolar bone before potential root contact. Treatment alternatives and biomechanics are discussed to illustrate the effectiveness of this approach.Diagnosis and treatment plan:A boy aged 14 years 1 month presented with a severely angulated impacted maxillary left canine, with the root apex located above the maxillary left second premolar. The primary treatment objective was to align the impacted canine while preventing injury to adjacent roots. The treatment plan involved uprighting the canine root using a boot loop and micro-screw designed to apply light, controlled forces through loop activation. During active treatment, the root angulation of the impacted canine was corrected from 60° distal to 13° mesial, achieving a maximum angular change of 73° through controlled uprighting. The canine was then successfully repositioned into its ideal position. No root resorption, gingival recession, or loss of supporting tissue was observed. The combination of a boot loop and micro-screw offers effective three-dimensional control of crown and root movement, providing a reliable and effective solution for managing severely angulated impacted canines. A new way to move a severely impacted upper canine toothWhy was the treatment done? The patient had a badly impacted upper left canine. The tooth was tilted and stuck deep in the jaw. It was close to the roots of nearby teeth. If left untreated, it could damage those teeth, cause bite problems, and affect the patient’s appearance. Treatment was needed to move the tooth into the correct position safely. What did the clinicians do? The orthodontic team used a small screw placed in the bone to hold the braces steady. This is called a temporary anchorage device. They also used a special wire loop called a boot loop. Together, these tools applied light and gentle force to the impacted tooth. This allowed the tooth to move slowly and safely into position. What did the clinicians achieve? The impacted canine was moved into the correct place over time. No damage to the nearby teeth was seen. There was no root resorption or gum problems. Normal orthodontic wires were then used to finish the alignment. The final result was both functional and good-looking. What did the patient think? The patient was happy with the result. His natural tooth was saved, and no extraction or artificial tooth was needed. This case shows that using a small screw with a special loop wire can be a safe and effective way to treat difficult impacted canine teeth.
Ankle injuries can be detrimental due to their long- recovery times. A walking boot (WB) is the most prescribed treatment. However, they disrupt gait biomechanics, increasing the metabolic cost of walking and the risk of further injuries. Does using a hip exosuit minimize the adverse effects of wearing a WB, improving gait spatio-temporal parameters, and reduce energy expenditure? We investigated the effects of a passive hip exosuit and enforced exploration training in users wearing a WB. Subjects wore a WB to simulate the effects of ankle injuries during recovery. The results indicate the benefits of wearing the hip exosuit and training. Metabolic cost reductions of 6.2 ± 1.5% (p < 0.001) between the post training and pre-training and 3.5 ± 2.8% (p = 0.03) between the post training and no exosuit conditions were found. Training with the exosuit resulted in positive gait modifications in patients with ankle injuries associated with gait retraining. The effects of enforced exploration training in gait kinematics wearing the exosuit resulted in an increased maximum hip flexion of 6.04 ± 3.56° and 6.59 ± 5.16° for the boot and free leg, respectively, compared to not wearing the exosuit. Spatiotemporal parameter modifications were adopted after training, resulting in metabolic reductions. Some subjects varied their step frequency, while others varied their step length and width. The outcomes from this study show the potential benefits that hip exosuits could have in clinical sports rehabilitation of ankle injuries wearing a WB.
To evaluate motivational drivers, qualitative experiences, and longitudinal retention patterns among faculty teaching the UK Urology Simulation Boot Camp, and to identify factors influencing the sustainability of the teaching workforce. A convergent mixed-methods design combined (1) quantitative analysis of validated motivation domains (Intrinsic Motivation, Task Value, Self-Efficacy, Extrinsic Motivation, Effort/Cost), and (2) thematic analysis of free-text responses, with (3) a longitudinal retention analysis (2015-2025) using a unified "years-since-entry" approach to examine continuity of faculty participation over time. Non-parametric tests (Friedman, Wilcoxon, Kruskal-Wallis, Spearman correlations) assessed domain differences and associations with retention behaviour. 124 faculty participated. Intrinsic motivation (mean 4.56 ± 0.55), task value (4.18 ± 0.58) and self-efficacy (4.41 ± 0.60) scored highly; extrinsic motivation was moderate (3.89 ± 0.75) and effort/cost lowest (3.05 ± 0.90). Domain differences were significant (Friedman χ²(4)=190.6, p<0.001). Retention category analysis showed only intrinsic motivation differed (p=0.009). Years of participation weakly correlated with intrinsic motivation (ρ=0.23, p=0.010) but not with other domains. Qualitative findings reinforced strong intrinsic and relational motivations, with workload, rota burden and lack of protected time as key constraints. Unified retention analysis revealed an early two-year attrition window, after which participation stabilised for 5-8 years or more. Faculty teaching is driven predominantly by intrinsic enjoyment, educational purpose and professional fulfilment; attrition arises primarily from structural pressures rather than motivational decline. Programme sustainability depends on reducing early-phase barriers, strengthening institutional recognition, and supporting new faculty during the highest-risk period.
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FeIV=O units found in the active sites of nonheme iron oxygenases and related synthetic analogs are intriguing intermediates capable of performing challenging oxygenation reactions. The first crystal structure of such a crucial species in a synthetic complex, [FeIV(O anti )(TMC)(MeCN)]2+ (TMC-anti ), reported in 2003, utilizes a 14-TMC (tetramethylcyclam) N4-macrocyclic ligand. With a half-life of 10 h at 25 °C, TMC-anti is quite a sluggish oxidant, but axial ligand replacements enhance TMC-anti reactivity by as much as 50-fold. Herein we switch to an N4-equatorial modification approach by replacing the N-methyl groups in TMC-anti with N-CH2-aryl groups and fluorinated analogs in the secondary coordination sphere to generate even more reactive FeIV(O)L complexes, namely [FeIV(O anti )(TBF8C)(MeCN)]2+ (2-anti , t 1/2 = 6 min at 25 °C), [FeIV(O syn )(TBF8C)(MeCN)]2+ (2-syn , t 1/2 = 2 min at 25 °C) and [FeIV(O syn )(TBF8C)(Cl)]+ (3-syn , t 1/2 = 1.5 min at -20 °C). Surprisingly, despite the increased steric bulk introduced around the FeIV=O moiety, 2-syn and 3-syn exhibit reaction rates as much as a million-fold higher than TMC-anti in C-H bond cleavage as well as oxo-transfer reactions, including unprecedented catalytic epoxidation of olefins by 2-syn . Computations confirm the dramatic reactivity enhancement upon introduction of polyfluorinated arenes into the second coordination sphere of the nonheme FeIV=O complexes, which distort the Me4cyclam that decreases the energy gap between the ground S = 1 and the excited S = 2 spin states.
The psychological mechanisms linking war-related nightmares to psychotic experiences remain insufficiently elucidated, especially among the vulnerable displaced population. The present study investigated the mediating effect of anxiety-depression symptoms in the association between war-related nightmares and psychotic experiences within a sample of internally displaced Lebanese citizens during the 2025 southern Lebanon attack. A cross-sectional study was performed on displaced Lebanese citizens between October 2024 and March 2025 and included 249 displaced Lebanese citizens. Three scales were used: The Community Assessment of Psychic Experiences scale-9, the Patient Health Questionnaire-4 and the Nightmares to War scale. The indirect effect analysis taking psychotic experiences as the dependent variable was accommodated for the subsequent covariates: education, age and nightmares to war. Psychological distress (indirect effect: Beta = .07; Boot SE = 0.03; Boot CI [0.01, 0.13]) partially mediated the association between nightmares to war and psychotic experiences. Greater levels of nightmares to war were notably linked to higher psychological distress and higher psychological distress was significantly associated with higher psychotic experiences. Moreover, higher nightmares to war were directly associated with more psychotic experiences. The effect size was 0.08 [0.01; 0.15]. The sensitivity analyses showed that anxiety (indirect effect: Beta = .07; Boot SE = 0.03; Boot CI [0.02, 0.13]; effect size = 0.08; 95% CI [0.02, 0.15], but not depression (indirect effect: Beta = .03; Boot SE = 0.02; Boot CI [-0.01, 0.08]; effect size = 0.04; 95% CI [-0.01, 0.10], played an indirect role in the association between nightmares to war and psychotic experiences. This study established a significant connection between war-related nightmares and psychotic experiences, with psychological distress partially mediating this relationship and anxiety playing an indirect role in the association. Therefore, our findings highlighted the importance of routine assessment for trauma-related nightmares and affective symptomatology to detect individuals at heightened risk of developing psychotic experiences and thus facilitate timely, evidence-based interventions.
Disordered eating is characterized by abnormal eating habits leading to negative health effects. The goal of this study was to assess the mediating effect of depression and anxiety between nomophobia and disordered eating among a sample of Lebanese young adults. This cross-sectional mediation analysis was conducted between April and July 2024 on 397 participants, utilizing a snowball sampling technique. Current participants recruited future participants through social networks and personal contacts. Data was collected using a self-reported questionnaire that included several scales: Nomophobia questionnaire (NMP-Q) for nomophobia, Eating Attitude Test 7-item (EAT-7) for disordered eating, Generalized Anxiety Disorder 7-item (GAD-7) for generalized anxiety disorder, and Patient Health Questionnaire (PHQ-9) for depression. The mean age was 22.22 ± 3.86 years, and 63.2% were females. The results of the mediation analysis showed that depression (indirect effect: Standardized Beta = 0.03; BootSE = 0.02; Boot CI 0.002; 0.07), but not anxiety (indirect effect: Beta = 0.0004; BootSE = 0.01; Boot CI -0.01; 0.01), partially mediated the association between nomophobia and disordered eating. Higher nomophobia was significantly associated with higher depression, whereas higher depression was significantly associated with more disordered eating. Finally, higher nomophobia was significantly associated with more disordered eating. The proportion mediated was 0.196, meaning that approximately 20% of the total association between nomophobia and disordered eating was accounted for by depressive symptoms. This study revealed a significant positive association between nomophobia and disordered eating, with depression as a mediating factor. Future investigations should dig deeper into understanding the causality of these associations, paving the way for preventive measures as well as effective treatments.
Background/Objectives: To date, limited focus has been given to the possible contribution of attachment theory to the comprehension of how paranoia and conspiracy beliefs may develop. Our study aimed to examine the potential mediating effects of the different adult attachment styles on the relationship between childhood trauma and paranoid/conspiracy thinking. Methods: This is a cross-sectional study that was conducted during September-January 2025 among Tunisian young adults (aged 18-35 years) from the general population. The Child Abuse Self Report Scale (CASRS-12), the Relationship Questionnaire (RQ), the eight-item Green et al., Paranoid Thoughts Scale (GPTS-8), and the Generic Conspiracist Beliefs Scale-5 (GCB-5) were administered to participants. Results: After controlling for potential confounders, analyses showed that secure attachment partially mediated the link between childhood trauma and paranoia (indirect effect: Beta = 0.001; Boot SE = 0.001) and conspiracy beliefs (indirect effect: Beta = 0.024; Boot SE = 0.01). On the other hand, preoccupied attachment acted as a significant mediator in the relationship between childhood trauma and paranoid thinking (indirect effect: Beta = 0.001; Boot SE = 0.001). In all these models, greater childhood trauma was directly related to higher paranoia and/or conspiracy thinking. Conclusions: Findings suggest that interventions and policies aimed at promoting a more secure attachment and addressing insecure attachment representations are likely to be effective in diminishing paranoia and conspiracy beliefs, especially for victims of childhood adversity.
Isolated lateral malleolus fractures account for a significant proportion of ankle fractures, and complications related to surgical treatment are common. This study aimed to assess the feasibility of conservative treatment with walker boot and immediate weightbearing as tolerated for Weber B / supination-external rotation (SER) lateral malleolus fracture, by comparing stable (SER2) and potentially unstable (SER4a) fractures. The distinction between stable and unstable fractures is crucial to guide treatment decisions. This prospective study included patients with Weber B/SER lateral malleolus fractures who met specific criteria. Fracture stability was assessed via medial clear space (MCS) measurement on weightbearing radiographs and conservative (walker boot and immediate weightbearing as tolerated) or surgical treatment was determined accordingly. Clinical and functional outcomes-including visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM) scores, and 36-Item Short Form Health Survey (SF-36) scores-were evaluated in outpatient clinic follow-up, with a minimum duration of 12 months. Out of 155 identified Weber B fractures with MCS <7 mm, 141 patients completed follow-up: 114 with SER2 and 27 with SER4a fractures. The SER2 group demonstrated excellent outcomes at 12 months (VAS 0.1, AOFAS 98.9, FAAM activities of daily living (ADL)/Sport 99.4/99.6), with 98.2% return to sport, 100% return to work, and 100% return to ADL. The SER4a group demonstrated comparable outcomes at 12 months (VAS 0.0, AOFAS 100, FAAM ADL/Sport 100/100), with full return to sport, work, and ADL. One patient in the SER4a group evolved to nonunion and required surgery during follow-up. With the numbers available, no significant intergroup differences in outcome scores or return to function could be detected. This study supports conservative treatment-with walker boot and immediate weightbearing as tolerated-for stable SER2 lateral malleolus fractures, and was associated with reduced need for surgery and lower exposure to surgical complications. It also suggests that potentially unstable SER4a fractures may achieve comparable outcomes under the same conservative protocol. Weightbearing radiographs assessment with MCS measurement appears to be an effective method for guiding treatment decisions in Weber B/SER lateral malleolus fractures. Level II, therapeutic, prospective cohort study.
Procrastination among university students has adverse effects on their academic performance, daily life, and physical and mental health. Understanding the mechanisms underlying procrastination facilitates the development of effective interventions to alleviate its adverse impacts. To examine the effect of self-esteem on university students' procrastination, and the chain mediating effects of perfectionism and academic motivation in this process, this study surveyed 2,523 undergraduates from five universities in Fujian Province using validated scales measuring self-esteem, perfectionism, academic motivation, and procrastination, and employed PROCESS Model 6 for statistical analysis. (1) Self-esteem was significantly negatively correlated with procrastination (β = -0.200, p < 0.001); (2) perfectionism partially mediated the relationship between self-esteem and procrastination [95% CI = (0.032, 0.057), Boot SE = 0.007]; (3) academic motivation partially mediated the relationship between self-esteem and procrastination [95% CI = (-0.184, -0.135), Boot SE = 0.014]; (4) perfectionism and academic motivation served as joint sequential mediators in the effect of self-esteem on procrastination [95% CI = (-0.033, -0.019), Boot SE = 0.003]. The findings of this study provide a theoretical basis for universities to design tailored interventions that enhance self-esteem, regulate maladaptive perfectionism, and strengthen academic motivation, thereby reducing procrastination and the associated risks of academic failure and psychological issues among university students.
While there is a general consensus on Attention-Deficit/Hyperactivity Disorder (ADHD) serving as a possible suicide risk factor in a broad range of populations, scant research has been dedicated to addressing ADHD and suicidality in schizophrenia. Therefore, there is a pressing need for studies that clarify these connections within the context of schizophrenia. This study was designed as one of the first to explore how impulsivity may serve as an indirect mediator of the impact of ADHD symptoms on suicidal ideation in patients with schizophrenia. This study has a cross-sectional design and was performed between January and June 2025 among Tunisian outpatients with clinically stabilized chronic schizophrenia. 16.9% reported a lifetime personal history of suicidal attempt(s) and 11.3% a lifetime history of self-harm. Impulsivity partially mediated the association between ADHD symptoms and suicidal ideation (indirect effect: Beta = 0.127; Boot SE = 0.033; Boot CI: 0.069; 0.196). Higher ADHD symptoms were significantly associated with greater impulsivity and directly associated with higher suicidal ideation. Additionally, higher impulsivity was significantly associated with higher suicidal ideation. The present results stress the importance of paying more attention to the expression of impulsive personality traits in patients with schizophrenia who exhibit prominent ADHD symptoms and suicidal ideation.
Os vesalianum pedis (OV) is a rare accessory ossicle located posterior to the proximal base of the fifth metatarsal, with an estimated prevalence of 0.6%. It results from the failure of fusion between the secondary ossification site and the primary ossification center. Most cases are asymptomatic and identified incidentally, but symptomatic presentations can occur following acute trauma or repetitive stress. Reported adolescent cases are limited, with prior literature documenting ages 13-19. We present the youngest reported case of a skeletally immature symptomatic OV in our findings of the English literature - a 12-year-old female - managed successfully with surgical excision and peroneus brevis tendon repair. A healthy 12-year-old female developed acute lateral left foot pain after striking her foot against a table. Urgent care radiographs suggested a non-displaced pseudo-Jones fracture. She was initially managed conservatively, being placed in a controlled ankle motion boot. At 4 weeks, persistent pain and absent callus formation prompted contralateral foot radiographs, revealing a similar ossicle. Magnetic resonance imaging (MRI) confirmed bilateral OV with peroneus brevis attachment, with the left side symptomatic. After 6 weeks of activity restriction failed to improve symptoms, surgical excision of the ossicle with tendon reattachment was performed. Postoperatively, she progressed from short-leg casting to gradual weight bearing in a boot, then returned to regular footwear. At final follow-up, she had full, pain-free function with normal gait, strength, and range of motion. This case highlights symptomatic OV as a rare but important differential diagnosis for persistent lateral foot pain in adolescent patients, particularly when presumed fifth metatarsal fractures show no healing by 4-6 weeks. Contralateral radiographs and MRI can help differentiate OV from fractures and guide management. While most cases are treated conservatively, surgical excision with tendon repair can yield excellent short-term outcomes when non-operative measures fail. Given the scarcity of skeletally immature cases and unknown long-term implications for tendon integrity and growth plate behavior, further study is warranted to inform age-specific treatment guidelines.
Salmonella enterica serovar Dublin (S. Dublin) is a host-adapted cattle pathogen that causes systemic disease, chronic carriage, and environmental contamination. Early detection of subclinical infections remains challenging due to low bacterial loads and the limitations of conventional diagnostics. We developed a duplex TaqMan real-time PCR assay targeting a chromosomal locus (SeD_A1104) and a plasmid-encoded gene (vagD). The assay demonstrated strong linearity (R² > 0.99) with amplification efficiencies of 91%-102% and detection limits as low as 1.9 × 10¹ genome copies per reaction. Specificity was confirmed in silico and against 20 non-Dublin Salmonella serovars, with no cross-amplification. Intra- and inter-assay variability was consistently below 3%. Field testing of 40 samples from subclinical cattle and farm environments demonstrated detection in multiple matrices, including feces (50% positive), vaginal swabs (40%), nasal swabs (30%), and environmental boot-swabs (75%). The dual-target design provides improved confidence in detection, reduces false positives, and supports early detection and control of S. Dublin in cattle herds and associated environments, thereby contributing to reduced zoonotic transmission and enhancing food safety within a One Health framework.IMPORTANCEEarly detection of Salmonella Dublin is critical for controlling disease in cattle and reducing zoonotic risk. Existing diagnostics often fail to identify subclinical carriers or low-level environmental contamination, which sustain transmission within herds. We developed a dual-target duplex quantitative real-time PCR assay that simultaneously amplifies a chromosomal locus and a plasmid-encoded gene, improving specificity and reducing false positives caused by genetically related Salmonella serovars. Unlike many current tools, this assay is validated for direct use with challenging samples, including feces, nasal and vaginal swabs, and environmental boot swabs, where inhibitors and low pathogen load commonly interfere with detection. By enhancing sensitivity and reliability across diverse matrices, this method supports farm-level surveillance, rapid outbreak response, and risk-based control strategies. Broader implementation can improve herd health, limit economic losses, and reduce the risk of human exposure through food or environmental sources.
Inadequately cleaned transport vehicles can act as reservoirs for pathogens jeopardizing pigs' health status. Although effective cleaning and disinfection (C&D) of live-pig transport trucks is required by law, there is still no universally accepted protocol for C&D of trucks. This study aimed to evaluate the effectiveness of a standardized hygiene protocol under field conditions and to provide practical guidance, thereby fostering harmonized hygiene procedures. Starting from current legislation for barn C&D, and refining it through available literature, a detailed standardized protocol for truck hygiene was developed. Each vehicle was divided into three functional sections: transport unit, boot-storage compartment, and driver's cabin. The protocol was applied to 15 trial trucks transporting live pigs and compared with 23 market trucks, which served as controls. C&D was assessed through visual inspection, adenosine triphosphate (ATP) testing, and microbiological analyses of environmental samples, including total viable count (TVC) on all trucks. Samples were collected at the three functional sections of the trucks. Trial trucks achieved significantly higher visual scores than control trucks (82.10 ± 9.72 vs. 72.20 ± 7.48; p = 0.0018). The 80% cleanliness threshold required for ATP testing was achieved by nearly half of the trial trucks (46.7%) but by only one control truck (4.3%) (p = 0.0065). Microbiological results further highlighted the protocol effectiveness: all cleaned trial trucks showed low mean TVC values (<10 CFU/cm2 or a 3 log₁₀ CFU/cm2 reduction, as acceptable threshold). In contrast, only 33.3% of driver's cabin swabs and 50.0% of cargo-area swabs from control trucks met this threshold, while none of the boot storage samples did (p = 0.0254). Bacteriological testing revealed MRSA in 100% of trial trucks before C&D, but in 0% after cleaning (p = 0.0079). Overall, the standardized protocol markedly improved the sanitary status of pig-transport vehicles. The combined use of different assessment methods proved valuable for identifying critical control points, particularly the boot-storage area, the most contaminated site. The protocol also showed strong potential for eliminating MRSA from trucks, contributing to reduce antimicrobial resistance transmission. These findings provide a replicable and field-ready model for improving C&D compliance and biosecurity across the swine transport sector.
There is a paucity of data on the cost-utility of endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) compared with surgical gastrojejunostomy (SGJ) as palliative treatment of malignant gastric outlet obstruction. In the ENDURO trial, 98 patients with malignant gastric outlet obstruction from 12 Dutch hospitals were randomized between EUS-GE (N = 48) and SGJ (N = 50). Cost utility was evaluated from a healthcare perspective with a time horizon of 1 month. A bottom-up approach was used to calculate the costs of each intervention, including the per-minute price of the endoscopy and operating room (OR), considering personnel, construction, inventory and overhead costs. Other in-hospital costs were calculated using insurance claim data. Effectiveness was displayed as quality-adjusted life years (QALY). Bootstrapping was performed to estimate uncertainty. The calculated per-minute price for the endoscopy room was €8.64 (US $9.34). The per-minute price for an OR was €11.78 (US $12.74). The mean intervention costs were estimated at €4405.40 (US $4762.68) for EUS-GE and €3393.71 (US $3668.93) for SGJ. Mean total in-hospital costs were lower following EUS-GE (€5172 [US $5591]) than after SGJ (€10,458 [US $11,306]), mainly due to a shorter length of hospital stay following EUS-GE. Bootstrapping showed that 99.9% of iterations resulted in lower costs for EUS-GE. Mean difference in 1-month QALY contribution was 0.004 in favor of EUS-GE. Most iterations fall within the bottom right quadrant (95.6%) of the cost-effectiveness plane, indicating lower costs and improved QALY contribution for EUS-GE. In this study, EUS-GE was more cost effective than SGJ. The additional intervention costs were clearly outweighed by a decrease in in-hospital costs after the procedure.
Over the last few years, Lebanese adolescents have survived multiple traumatic events, including continuous conflict and political instability, a spiraling economic crisis, the COVID-19 pandemic, the 2020 Beirut port blast, and the February 2023 earthquake. These repetitive exposures to trauma have put this vulnerable group at a high risk for developing a variety of mental health issues, including post-traumatic stress symptoms (PTSS) and psychotic experiences (PEs). Community-based research on PEs following multiple trauma exposure offers the opportunity to extend our understating of the stress-vulnerability model of schizophrenia, and how severe stress may affect mental health. The present study aimed at testing the hypothesis that insomnia severity mediates the relationship from PTSS to PEs in Lebanese adolescents (aged 12-18 years), 4-6 weeks after the February 2023 earthquake. This was a web-based, cross-sectional study. A total of 546 community adolescents from Lebanon were enrolled (mean age 15.76 ± 1.65 years, 60.1% females). We found a prevalence of PTSS, insomnia and PEs of 21.4%, 45.8% and 51.1% respectively. Insomnia severity mediated the association between PTSS and PEs (indirect effect: Beta = .03; Boot SE = .01; Boot CI .02; .05). Higher PTSS was significantly associated with more insomnia severity and directly associated with more PEs. Finally, higher insomnia severity was significantly associated with more PEs. Findings confirm the partial mediating effects of insomnia between PTSS and PEs, preliminarily suggesting sleep problems as a promising modifiable factor for reducing the risk for developing psychotic symptoms in the aftermath of natural disasters among vulnerable individuals. Given that, this is the first study to examine insomnia as mediator between PTSS and PEs, the present findings should be considered tentative pending future longitudinal research in larger populations and different settings.
The global obesity epidemic necessitates a comprehensive understanding of the cognitive and motivational processes underlying unhealthy eating behaviors. This study investigated whether obesity moderates the indirect effect of automatic approach bias toward high-calorie foods on food choice, mediated by subjective appetite. A total of 164 participants (83 normal-weight and 81 with obesity) were recruited. Participants completed a joystick-based Approach-Avoidance Task to assess approach bias for high-calorie foods, a Food Choice Task to evaluate the selection of unhealthy items, and visual analog scales to calculate subjective appetite. A moderated mediation analysis was performed. The moderated mediation analysis revealed that obesity significantly moderated the relationship between approach bias and subjective appetite (β = 0.648, p < 0.001), and between approach bias and food choice (β = 0.398, p = 0.018). Simple slope analyses showed that approach bias was positively associated with subjective appetite and food choice only in the obesity group (both ps < 0.001). Crucially, the indirect effect of approach bias on food choice via subjective appetite was significant only in the obesity group (β = 0.220, 95% Boot CI: [0.092, 0.384]), but not in the normal-weight group (β = 0.031, 95% Boot CI: [-0.028, 0.125]). Among individuals with obesity, a stronger automatic approach bias towards high-calorie foods was associated with increased subjective appetite, which in turn was associated with the selection of more unhealthy foods. These findings illuminate an obesity-specific cognitive-affective pathway and emphasize the potential for targeted interventions aimed at modifying approach bias and managing appetite within this population.