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Obesity is associated with risk for chronic health problems and increased mortality. Weight stigma, which entails negative attitudes and behaviors directed at people based solely on their body size, is psychologically harmful and contributes to obesity and obesity-related health problems. Yet, weight stigma is pervasive in society and commonly experienced by patients in healthcare settings, which lowers the quality of patients' healthcare experiences. Healthcare providers and trainees report feeling underprepared to treat obesity, which may lead to overreliance on weight-management strategies that are not evidence-based and are susceptible to weight stigma, such as fad diets emphasizing unrealistic dietary restriction. In the current manuscript, we discuss current weight stigma interventions with other populations and the rationale for integrating training in evidence-based approaches to treat obesity with weight stigma interventions, specifically cognitive dissonance-based interventions. Current learning theories emphasize empathic perspective-taking, and current methods to reduce weight stigma use social-cognitive theories to raise awareness of stereotypes. However, current methods are insufficient because they create discomfort but fail to alter internalized bias nor advise providers on how to deliver non-stigmatizing, evidence-based obesity interventions. Cognitive dissonance theory posits that resolving tension between beliefs and behaviors will change future behaviors. Cognitive dissonance-based interventions have effectively reduced personal weight stigma and are promising to be similarly effective in reducing weight stigma among healthcare providers. In this manuscript, we highlight how cognitive dissonance theory can help improve interventions to reduce bias and support providers' efforts treating obesity.

Residual cardiovascular risk remains high after acute coronary syndrome (ACS) despite intensive LDL-cholesterol lowering. Elevated triglycerides may contribute to this risk. Although icosapent ethyl (IPE) has shown cardiovascular benefit in high-risk statin-treated patients, access in Italy is limited by Italian Medicines Agency (AIFA) reimbursement criteria, which are more restrictive than the European Medicines Agency (EMA) indications. We compared EMA and AIFA eligibility for IPE in a real-world post-ACS cohort, assessed the association of triglyceride levels and variability with 12-month ischemic recurrence, and explored the potential economic impact of broader IPE use. This retrospective observational study included 430 consecutive adults admitted for ACS to a tertiary hospital in Italy in 2024, with 12-month follow-up. During follow-up, 48 patients (11.2%) experienced recurrent ACS. Diabetes mellitus was independently associated with recurrence (OR 2.90, 95% CI 1.41-5.97; p = 0.004), whereas male sex was protective (OR 0.46, 95% CI 0.23-0.93; p = 0.030). Absolute triglyceride levels were not significantly associated with recurrence, whereas triglyceride variability was: the coefficient of variation remained independently associated with recurrent events (OR 1.04, 95% CI 1.00-1.09; p = 0.029). According to EMA criteria, 35 patients (8.1%) were eligible at discharge and 15 (3.5%) at first follow-up; under AIFA criteria, only one patient was eligible. A marked discrepancy exists between EMA indications and AIFA reimbursement criteria for IPE, resulting in restricted access for high-risk post-ACS patients. Broader access, aligned with current evidence, may improve secondary prevention and represent a cost-effective strategy.

Transcranial direct current stimulation (tDCS) is a promising intervention for treatment-resistant obsessive-compulsive disorder (OCD), yet clinical outcomes remain inconsistent. To investigate the neural mechanisms underlying therapeutic variability, we conducted a patient-specific finite element (FE) modeling study of electric fields (EF) induced by tDCS in OCD patients. Forty-two patients from a double-blind, randomized clinical trial received active tDCS with the cathode over the pre-supplementary motor area and the anode over the right supraorbital region. Clinical response was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and responders were defined as those achieving ≥35% score reduction. Individual head models were created using SimNIBS, and current density directionality (Jn) and magnitude (Jmagn) were analyzed. Voxel-wise comparisons revealed significantly greater depolarization (Jn> 0) in the left anterior prefrontal cortex (BA10) and right frontal eye field (BA 8) associated with a reduction of Y-BOCS. A link between hyperpolarization of right pars orbitalis (BA47) and improvement in symptoms was also found. Notably, no significant findings emerged using EF magnitude (Jmagn), underscoring the relevance of current directionality in treatment response. To our knowledge, this is the first study to associate directional EF modeling with clinical outcomes in OCD. Our findings highlight the importance of considering both EF direction and anatomical variability when optimizing tDCS protocols. This approach may contribute to more personalized and effective neuromodulation strategies for psychiatric disorders.

Jasmine (Jasminum sambac) is a highly valued aromatic plant, widely used for scenting tea and extracting essential oils. Flower quality directly influences the market value of these products. However, the classification of jasmine flowers currently relies on empirical visual inspection and mechanical sieving, lacking objective chemical markers. In this study, freshly picked commercial jasmine buds (grade A and grade B) and fully bloomed flowers (grade I and grade II) were analyzed to examine differences in their volatile compound profiles using headspace solid-phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry (GC-MS). According to the general commercial grading standards used by growers and tea companies, 25 compounds differed significantly between grade A and grade B buds, while 134 compounds differed significantly between grade I and grade II opened flowers (P&#x2009;<&#x2009;0.05). Intersection analysis identified six compounds common across grade comparisons. By comprehensively evaluating their fold changes and relative abundances, three compounds-(E)-3-Hexen-1-ol, Caryophyllene, and (E,E)-3,5-Octadien-2-one-were selected as potential markers. Based on the current dataset, the S-score provides an objective, data-driven approach to distinguish jasmine flower grades. However, as a preliminary model, its proposed threshold (S&#x2009;>&#x2009;9.5) requires independent validation using samples from different seasons, regions, or production batches before any practical application.

Shaken Baby Syndrome and Abusive Head Trauma are significant traumatic brain injuries observed in infants and represent a critical public health issue. Although there is a vast literature on this subject, conducting a descriptive bibliometric analysis is essential to map the topic's quantitative development over time and to reveal its current geographical and conceptual distribution objectively. This study systematically analyzes 3,571 articles published between 1977 and 2025 in the Web of Science Core Collection database, examining the distribution of publications by year and country, leading journals, citation rates, and keyword networks. Our findings indicate a linear increase in the volume of SBS/AHT research publications since the 2000s. The analysis highlights two significant strengths and shifts in the literature. First, the emergence of countries from diverse regions-such as Romania, the United Arab Emirates, Malaysia, and Russia-in the literature network, alongside traditional research hubs, objectively confirms the subject's expanding global scope. Second, the fact that the highest citation rates and publication density are not limited to clinical medicine journals (e.g., Pediatrics) but are simultaneously concentrated in pioneering journals with social and legal content (e.g., Child Abuse & Neglect) highlights the field's multidimensional and interdisciplinary nature. In conclusion, this study provides an objective resource for all stakeholders-including physicians, forensic scientists, and legal professionals-by visualizing the current geographic diversity of scientific output, key terms, and journal dynamics.

Frozen shoulder, also known as adhesive capsulitis, is a common and disabling condition that causes shoulder pain and progressive stiffness. Patient information leaflets (PILs) are produced by UK National Health Service (NHS) Trusts to help patients understand frozen shoulder and treatment options. However, the content and consistency of these PILs and their alignment with national clinical guidance are currently unclear. This study aimed to identify, analyse and describe the non-surgical management recommendations presented in publicly available NHS Trust PILs for frozen shoulder and to assess their alignment with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary and British Elbow and Shoulder Society (BESS) best practice resources. An online search was undertaken by one reviewer to identify publicly available PILs produced by NHS Trusts detailing non-surgical management of frozen shoulder. Relevant data were extracted and analysed by one reviewer and verified by five reviewers. Descriptive statistics were used to summarise findings. Thirty-eight PILs were identified from 38 NHS Trusts with publication dates ranging from April 2013 to March 2025. Considerable variation was observed in the content, including reference to analgesia, activity modification, exercise prescription and corticosteroid injections. No single PIL reflected all key elements recommended in the NICE Clinical Knowledge Summary and BESS best practice. The findings demonstrate substantial variation in content, frequent misalignment with current national guidance and best practice exercise recommendations. Such variation may limit and may reduce the clarity, consistency and usefulness of information provided to patients.

Potassium dichromate (Cr) is a ubiquitous inorganic chemical reagent, most frequently employed as an oxidizing agent in variety of laboratory and industrial settings and can result in nephrotoxicity. The current study was done to explore the nephrotoxic effects of Cr with a specific focus on alterations in renal aquaporins (AQPs) expression, renal water channel protein, providing insights into how exposure to Cr may compromise renal water homeostasis in a dose-dependent pattern. Thirty-six Wistar albino male rats were assigned into 3 groups evenly; control rats received only distilled water daily, while Cr-Low and Cr-High groups received, 2.5&#xa0;mg/kg bw, and 7.5&#xa0;mg/kg bw of Cr i.p for 14 days, respectively. Blood and kidney samples were obtained. Cr induced nephrotoxicity in the current study in a dose-dependent manner, as exhibited by a remarkable deterioration of the renal parameters, oxidative status, histopathological and ultrastructural changes. Renal function registered a significant rise in urea and creatinine, as opposed to total protein and albumin, which decreased substantially. A significant dose dependent rise in malondialdehyde (MDA) level as well as dwindle in the antioxidant enzymes level. Furthermore, hematology divulged a notable reduction in hemoglobin concentration (Hb%) while significant upsurge in white blood cells (WBCs) in exposed groups. In addition, our study demonstrated that Cr, alters the expression level of AQP1 and AQP2 in renal tissue which are salutary for detecting the renal damage early. On the other hand, Cr boosted the upregulation of kidney injury molecule-1 (KIM-1) in kidney tissue confirming its disruption. Interestingly, gene expression of KIM-1, AQP1 and AQP2's in renal membrane correlates well with creatine level, reinforcing their role as sensitive markers of tubular damage and reflect impaired tubular water handling. High exposure produced a severe nephrotoxic profile, distinctly different from controls and far more pronounced than the Cr-Low group.

Policy Points Chronic absence should be recognized as a public health indicator and early warning sign that systems are failing to meet the developmental, social, and health needs of students. Improving student attendance requires cross-sector policy action across education, health, and public health to address the structural and social determinants of chronic absence. A prevention-oriented public health approach is essential, focusing on root causes that schools cannot address alone such as poor health, housing instability, and unreliable transportation. Chronic absence, defined as missing more than 10% of time in school, has risen sharply in the United States following the COVID-19 pandemic and now affects more than one in four students. It reflects unmet health and social needs and is patterned by deep structural inequalities. Both short- and long-term consequences include adverse impacts on educational attainment, health, and social outcomes. Despite this, chronic absence remains largely framed and addressed as an education-sector problem, limiting the scope and effectiveness of current responses. This perspective synthesizes interdisciplinary evidence from education, public health, and child development literature, drawing on ecological and life course frameworks to reconceptualize chronic absence as a public health issue. We develop a conceptual model integrating multilevel determinants of attendance across individual, family, school, community, and structural domains, and identify implications for policy and cross-sector action. Viewing chronic absence through a public health lens reframes it from a purely educational outcome to a signal of unmet need and a multidimensional indicator of system performance. Attendance patterns reflect the interaction of health, social, and structural factors that lie largely outside of the control of schools. Current approaches often emphasize individual responsibility, while overlooking the broader conditions that shape attendance. Reframing chronic absence in this way underscores the need for coordinated cross-sector interventions that address underlying determinants. Positioning chronic absence as a public health priority enables a more coherent response. We propose three principles to guide action: (1) use school attendance data as a vital sign of student and system well-being; (2) develop strategic partnerships to align goals and drive progress; and (3) develop strengths-based policies and programs to prevent chronic absence. Without this shift, efforts to reduce chronic absence are likely to remain fragmented and insufficient to achieve equitable improvements in child health and educational outcomes.

Tobacco use remains a substantial cause of morbidity among patients with noncommunicable diseases, especially in areas with localized tobacco production. This study looked into the tobacco smoking behavior and, adverse health outcomes, and predictors of smoking behavior among chronic disease patients in both tobacco-producing and non-producing areas of Nakhon Si Thammarat, Thailand. An analytical cross-sectional study was undertaken with 879 patients with chronic disease in tobacco producing and non-producing districts. Participants were recruited via simple random sampling from local primary care patient registries, with a fixed allocation technique. Data were collected by face-to-face interviews with a verified structured questionnaire. Ordinal logistic regression was used to identify predictors of smoking status. The overall smoking rate was 19.3% (7.5% current and 11.8% former). Males accounted for 98.5% of individuals who had previously smoked. High morbidity was noted, with 28.8% of smokers having COPD and 54.7% requiring at least four hospitalizations per year. Traditional hand-rolled tobacco (Yasen) dominated usage, especially in production regions (88.1% vs. 75.0%). Multivariable analysis found that females had 99.6% lower odds of smoking (AOR: 0.004, 95% CI: 0.002-0.009). Patients from non-planting areas (AOR: 0.47, 95% CI: 0.28-0.77) and low-income households (AOR: 0.50, 95% CI: 0.26-0.95) had considerably decreased smoking odds. While current prevalence is lower than national averages. Geographic closeness to production and higher household income both contribute to smoking in this group. Therefore, Interventions have to address physical and economic accessibility to traditional tobacco in agricultural communities.

Designing compact, high-gain antennas at 400&#xa0;MHz is challenging due to large size, narrow bandwidth, and low efficiency. This work proposes an interaction-driven Artificial Magnetic Conductor-Defected Ground Structure (AMC-DGS) microstrip antenna for subsurface communication. The design exploits electromagnetic interaction between the slot-type DGS, radiating patch, and AMC surface with spacer layer for performance enhancement. The DGS functions not only for impedance tuning or to attain polarization purity but also as an active radiator, enabling current redistribution and higher order mode perturbation. This interaction, combined with composite superposed mode (CSM) excitation and orthogonal slot radiation, achieves a 400&#xa0;MHz band (379-419&#xa0;MHz) with 10.2% bandwidth and 6.5 dBi peak gain. Additionally, a higher-order mode generates a second band at 700&#xa0;MHz (700-714&#xa0;MHz) with 2% bandwidth and 6.1 dBi gain. The antenna maintains stable broadside radiation with efficiencies of 98% and 70% at 400&#xa0;MHz and 700&#xa0;MHz, respectively. The proposed AMC-DGS antenna provides a compact, dual-band solution for subsurface sensing, Wireless Underground Sensor Networks (WUSN), Internet of Underground Things (IoUT), Ground Penetrating Radar (GPR), and other low-frequency communication systems.

Human and animal electrophysiology often looks noisy and unstructured. While some clearer features exist in the form of bursty oscillations and event-related potentials, recent methodological developments have helped to uncover surprising structure in what otherwise looks like noise. This signal, referred to as aperiodic activity, has received substantial recent attention, examining its physiological generators and relationship to behaviour, cognition, development, ageing and disease. Here we examine the putative physiological basis of aperiodic activity, its relationship to other measures of neural activity and evidence for its functional and clinical relevance. Computational modelling and empirical evidence show that aperiodic activity has many neural origins, primarily postsynaptic transmembrane currents across populations of neurons. While several other signal statistics capture features similar to aperiodic measures, new methods have allowed researchers to more directly link aperiodic activity to underlying physiological processes. We discuss the implications of these findings for our understanding of cognition and disease, and highlight open questions for future research.

This study advances current discourse by introducing a novel analytic framework-the global quest for genital beauty-to clarify how sociocultural ideals of vulva appearance shape motivations, meanings, and policy responses surrounding female genital cutting (FGC) and female genital cosmetic surgery (FGCS). Using a theory&#x2011;informed narrative synthesis of literature published between 2015 and August 2025 across PubMed, Scopus, and Web of Science, supplemented by seminal theoretical works and agency reports. The analysis demonstrates that although FGC and FGCS arise within distinct sociocultural systems, both are influenced by gendered expectations about bodily propriety and aesthetic norms. The review identifies substantial variations within each category: FGC encompasses procedures with differing degrees of tissue alteration and risk, while FGCS includes a growing array of elective cosmetic interventions shaped by media, pornography, and clinical marketing. An estimated 230 million women and girls in countries with available survey data have undergone FGC, requiring a 27&#x2011;fold acceleration in progress to meet the 2030 Sustainable Development Goal target, while clinical organizations report rising demands for FGCS despite limited evidence of benefit and acknowledged risks. By applying the genital beauty framework, this study reframes the comparison between FGC and FGCS, highlighting both their divergences and their shared entanglement with globalized beauty norms. This perspective supports more precise ethical, clinical, and policy guidance, including rights&#x2011;based strategies to accelerate abandonment of FGC and reduce non&#x2011;therapeutic demand for FGCS through regulation, norm&#x2011;change interventions, and education about genital diversity.

This study involves an integrated approach to predict the mechanical properties of luffa fiber and marble dust- based concrete. It employs Artificial Neural Network (ANN) for mechanical properties prediction aiming for a higher accuracy than currently available models. The composite material used marble dust in the proportion 0-40% as fine aggregate replacement and luffa fiber in the proportion 0-2% as the natural reinforcement. Experimental results implied that the composite containing 20% marble dust and 1% luffa fiber exhibited greatest mechanical characteristics- Compressive strength of 34.5&#xa0;MPa, flexural strength of 6.2&#xa0;MPa and split tensile strength of 4.25&#xa0;MPa. This improvement was attributed to enhanced particle packing by marble dust and effective crack bridging by treated luffa fiber. A single multi-output feedforward multilayer perceptron (MLP) ANN consisting of two hidden layers of 64 and 32 neurons with ReLU activation functions and a three-neuron linear output layer was developed for simultaneously modelling the nonlinear interactions between the input variables and strength outputs. The model was trained on 70% of the dataset, with 15% for validation and 15% for testing. The ANN model was able to predict all three mechanical strength properties simultaneously with a high degree of accuracy as demonstrated by R&#xb2; values of 0.89 (compressive strength), 0.94 (flexural strength), and 0.96 (split tensile strength) for the training data sets and small root mean square error (RMSE) values and negligible bias. The 100% a20 score indicated that all the samples from the predictions fell within &#xb1;&#x2009;20% of the actual experimental values, demonstrating good robustness or generality. This research basically aims to address a major gap in the existing works by exploring the limited application of ANN in predicting the performance of hybrid sustainable concrete mixes incorporating both marble dust and plant-based fibers by developing a predictive model which is capable of capturing the complex interactions between multiple factors and enhancing the prediction efficiency, minimizing the dependency on extensive experimental investigations thereby promoting data driven evaluation of strength characteristics in sustainable concrete composites.

Accurate interpretation of pediatric elbow imaging depends on understanding the developmental relationship between the radial head and the capitellum. While the traditional sequence of pediatric elbow ossification centers provides a useful framework, it does not capture morphologic variability, asynchronous maturation, and eccentric ossification patterns that may mimic pathology. This review synthesizes current evidence on pediatric elbow ossification with particular emphasis on normal and variant radial head development. The following key questions are addressed: (1) How frequently does eccentric radial head ossification occur on MRI? (2) What is its magnitude and relationship to age and sex? (3) How should normal variants be distinguished from pathology? Recent findings reveal that the capitellum commonly ossifies eccentrically before centralizing with growth. In our cohort of 66 children, radial head ossification was eccentric in 68-71% of cases in both sagittal and coronal planes. Offsets were small (average magnitude&#x2009;<&#x2009;3%), predominantly posterior and radial, and generally did not correlate with age except for progressive centralization in the coronal plane among males. The radiocapitellar line remained reliable on the lateral view but demonstrated expected lateral offset on AP views. Eccentric radial head ossification represents a common physiologic pattern that does not reliably centralize with age. Recognition of this variant can reduce misdiagnosis and unnecessary intervention, and has implications for fracture assessment, surgical planning, and longitudinal research. Future studies should include prospective MRI tracking across diverse populations to establish normative ranges and develop quantitative tools for clinical applications.

Recent technological advances have resulted in synthetic faces and voices being perceptually indistinguishable from real faces and voices in typical populations. Faces and voices possess rich personal and social information, meaning synthetic faces and voices, commonly known as "deepfakes" can be used for identity theft, financial fraud, and misinformation campaigns. It is currently unknown whether detection of real versus synthetic content is modality-specific, or whether it generalizes across sensory domains. We conducted a preregistered study in which participants classified real and AI-generated faces and voices. Performance for both face and voice classification was significantly above chance. Using signal detection theory to analyze individuals' ability to classify stimuli, we observed no evidence of a domain-general effect, indicating detection ability may not generalize across face and voice domains and is instead domain-specific. Participants' confidence tracked accuracy for faces but not for voices, suggesting metacognitive insight may be modality-specific. The findings are discussed in terms of whether the absence of an effect reflects classification driven solely by domain-specific abilities or arises from the experimental design itself. Ultimately, in applied contexts, it is important to recognize that expertise in detecting synthetic content might be modality specific.

Circulating tumor DNA (ctDNA) genomic testing is increasingly used in advanced prostate cancer (aPC) to identify actionable alterations, however the longitudinal nature of tumor mutation burden (TMB) remains poorly characterized. Current guidelines recommend somatic testing at diagnosis of metastatic hormone-sensitive or castration-resistant disease, but do not address serial testing. While prior studies suggest modest increases in TMB with advanced disease, longitudinal trends and treatment-associated changes have not been systematically examined. Here we evaluate how TMB changes over time and in relation to treatment exposures in a large real-world aPC cohort. We retrospectively identified 714 men with aPC who underwent &#x2265; 1 ctDNA-based genomic profiling test with evaluable TMB between November 2018 and May 2025. For patients with multiple tests, sequential TMB values were mapped to discrete treatment episodes, used as a surrogate for lines of therapy. Univariable linear mixed-effects models with fixed effects for timeframe and treatment exposures, and random intercepts for repeated measurements, assessed associations between TMB, episode number, age, individual therapies, and treatment combinations. An exploratory multivariable mixed-effects model was also performed. Median age at diagnosis was 63.3 years (interquartile ranges [IQR] 56.8-69.0); median prostate specific antigen 13.9 ng/mL (IQR 6.8-60.9). Median first-test TMB was 7.8 mutations per megabase (mut/Mb) (IQR 4.8-11.2). TMB increased significantly across episodes (P = .001). Age was associated with higher TMB (+ 0.20 mut/Mb per year, P < .0001). In univariable analyses, radiotherapy (RT) was associated with higher TMB (+ 1.9 mut/Mb, P = .004). In multivariable models adjusting for age and treatment episode, RT remained associated with higher TMB (+ 2.4 mut/Mb, 95% confidence intervals 1.1-3.7; P = .0004). Combination regimens, particularly androgen deprivation therapy + androgen receptor pathway inhibitors + RT, were associated with marked increases in absolute TMB. We demonstrate that TMB is dynamic and rises over time and with select treatment exposures. These findings reinforce how TMB should be interpreted within the broader context and not necessarily viewed as a standalone threshold for initiating immunotherapy in advanced prostate cancer.