Premature pubarche (PP), defined as the early onset of pubic hair and often associated with mild androgen excess, is a common reason for referral to a pediatric endocrinologist. A small proportion of cases may progress to central precocious puberty (CPP). Data on the factors determining pubertal tempo and associated growth outcomes in these individuals are limited. To identify predictors of pubertal progression and final height (FH) in girls with PP and to evaluate growth outcomes in those progressing to CPP. We retrospectively analyzed 88 girls with PP who attained FH; 13 progressed to CPP (PP-to-CPP). Auxological data, bone age (BA), pubertal development, and plasma androgen profiles were evaluated. At presentation, corrected height SDS (CH-SDS) in girls with PP correlated with BA-SDS and BA/chronological age (BA/CA) ratio (p=0.03 and p=0.007). Corrected FH-SDS was positively associated with baseline CH-SDS in both PP and PP-to-CPP groups (p<0.001 and p=0.0002). Compared with PP, the PP-to-CPP group had higher baseline CH-SDS, BA-SDS and BA/CA ratio (all p=0.02). Baseline CH-SDS was the strongest independent predictor of corrected FH-SDS (p<0.001), while BMI-SDS showed a negative association (p=0.003). Baseline dehydroepiandrosterone-sulfate (DHEA-S) was not associated with CH-SDS, BA advancement, progression to CPP, or corrected FH-SDS in either group. Receiver operating characteristic (ROC) analyses for progression to CPP identified a BA/CA cutoff of 1.2; and a CH-SDS cutoff of 1.8 (p=0.01). Growth relative to genetic potential and skeletal maturation at presentation were the strongest predictors of progression to CPP and FH outcomes in girls with PP. Although DHEA-S reflects adrenal maturation and early androgen exposure, baseline DHEA-S concentrations were not associated with progression to CPP or long-term growth outcomes in our cohort.
Wearable Activity Monitoring (WAM) devices have become increasingly prevalent in the last decade for improving quality of life, and the prevention and day-to-day management of a wide range of health disorders. WAM devices based on the Internet of Medical Things (IoMT) paradigm offer a practical means of tracking Physical Activity (PA), but their widespread use raises sustainability concerns. Meanwhile, established methodologies such as Health Technology Assessment (HTA) and Life Cycle Assessment (LCA) are typically applied at very advanced stages of development, when empirical certainty about the final design and operating conditions is available, leaving little room for subsequent improvements. This exploratory work aims to provide the empirical foundations for an information-driven approach that addresses this paradox in the development, early evaluation, and conception of wrist-worn step counters, for which recent evidence suggests overdimensioned and unsustainable electronic designs. Specifically, we seek to identify optimal resource-performance trade-offs in critical electronic components of frugal smartbands, based on the amount of data they can collect and the information they preserve for step counting. In this manner, we explicitly account for uncertainties in device reliability, variability in users' gait speeds, and material and energy consumption in final products. We proceeded in three steps. First, we conducted a secondary analysis of an existing accelerometer dataset characterizing wrist motion in healthy individuals walking at different speeds. The original sampling rate of the x-, y-, and z-axis signals was progressively reduced using cubic spline interpolation and then discretized to quantify the information preserved in the downsampled signals, first as a function of frequency variations and then with respect to changes in motion velocity. Additionally, we assessed preliminarily the viability of the downsampled signals for step detection by estimating percentage errors in peak and valley counts. Based on this analysis, we constructed and evaluated four design archetypes for frugal smartbands, linking energy consumption and sampling frequency for four widely used accelerometers, and combining the capabilities of essential electronic components (transceivers and microcontrollers) required to implement a suboptimal asynchronous First-In-First-Out (FIFO) algorithm operating at different sampling rates. In a third step, we evaluated the environmental impact and circularity of these components through a streamlined analysis focused exclusively on their raw materials. Between 70% and 90% of the information is lost in signals downsampled at very low frequencies (between 2 Hz and 5 Hz), whereas moderate losses below 24% are observed from 20 Hz onwards. Additionally, substantial information loss occurs when individuals walk briskly or jog (≥ 8 km/h), or when they walk at normal speeds below 8 km/h with sampling frequencies below 7 Hz or above 25 Hz. Step-counting accuracy is expected to be acceptable from approximately 11 Hz onwards. Conversely, higher sampling rates rapidly saturate FIFO buffers and increase energy overhead, particularly when implemented in memory-dense components handling both data transfer and processing. Finally, gold and silver in transceivers and microcontrollers contribute significantly to resource depletion, while copper content remains relevant for potential material recovery. These findings provide preliminary insights toward the concurrent assessment and development of frugal WAM devices. This work extends current understanding in step detection under knowledge-constrained conditions and provides concrete mechanisms to reduce uncertainty during early Health Technology Assessment and eco design.
Postoperative knee stiffness following total knee arthroplasty (TKA) is a challenging complication that may require surgical intervention when conservative treatment fails. Although manipulation under anesthesia (MUA) and arthroscopic arthrolysis (AA) are commonly used treatments, their comparative effectiveness and the role of timing in clinical outcomes remain uncertain. To compare clinical outcomes of MUA and AA for postoperative knee stiffness after TKA and to evaluate the impact of timing from index arthroplasty on range of motion (ROM) improvement. A retrospective cohort study was conducted including patients treated for postoperative knee stiffness following TKA between 2003 and 2023, with a minimum 12-month follow-up. Patients underwent MUA or AA. ROM was assessed preoperatively, intraoperatively, and at final follow-up. Outcomes were analysed according to surgical technique and timing of intervention. Complications were recorded. Eighty-four patients were included (mean age 67.8 ± 7.5 years; 63.5% women), with 52 undergoing MUA and 32 AA. Preoperative ROM was comparable between groups (66.1° ± 14.2° vs 61.3° ± 12.3°; p = 0.353). Both techniques significantly improved ROM at final follow-up, with no between-group differences (90.9° ± 11.3° vs 86.7° ± 11.3°; p = 0.361). Mean ROM gain was similar (24.8° ± 12.8° vs 25.4° ± 11.9º; mean difference 0.6, p = 0.732). Earlier intervention was associated with greater ROM gain, with higher improvements observed within 0-3 and 3-6 months compared to > 6 months (28.1° ± 14.2°, 30.1° ± 13.1°, and 21.3° ± 25.9°, respectively; p = 0.038). Subgroup analysis by timing interval showed no differences between MUA and AA. Both MUA and AA were effective and demonstrated no significant difference in ROM improvement following TKA stiffness. Earlier intervention was associated with greater ROM gains, suggesting that timing may be an important factor in optimizing outcomes.
An obstetrical fistula is an abnormal communication between the vagina and adjacent tubular structures, usually the bladder and rectum. If timely and effective treatment is not given, women with a fistula face lifetime embarrassment, isolation, social stigmatization, and marital separation. Although early detection and management of obstetrical fistula often result in improved treatment outcomes, most women do not have access to care due to either the cost, stigma, or lack of awareness. This study aimed to determine the pooled prevalence and predictors of healthcare seeking for obstetrical fistula in sub-Saharan Africa. As this is a systematic review and meta-analysis protocol, the primary data sources will be electronic databases and grey literature. We will systematically search PubMed, Cochrane Library, and Google Scholar to retrieve eligible primary studies. Per our protocol, we apply the CoCoPop (Condition, Context, and Population) mnemonic framework:•Inclusion Criteria: Observational studies (cross-sectional, case-control, cohort) investigating healthcare seeking for obstetric fistula and its determinants; conducted in sub-Saharan Africa (SSA) countries; published in the English language between 2015 and 2025.•Exclusion Criteria: Studies conducted outside of SSA, studies lacking an abstract or full text, qualitative studies, conference summaries, and studies where the primary outcome variable is not formal clinical healthcare-seeking behavior. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Library, Google Scholar, and gray literature were used to search for eligible articles. The quality of the studies was assessed using the Joanna Briggs Institute critical appraisal checklist. All studies on obstetrical fistula care seeking conducted in English from 2015 to 2025 and in sub-Saharan Africa were included. The required data were extracted from each article using Microsoft Excel 2016 (Microsoft, Redmond, WA) and exported to Stata (version 16; StataCorp LLC, College Station, TX). Forest plot and I2 statistics were performed for heterogeneity. A funnel plot and Egger regression test were performed to check for publication bias. Subgroup analysis and meta-regression analysis were performed to identify potential sources of bias. Because this manuscript is a systematic review and meta-analysis protocol, there are no empirical results to report at this stage. The protocol establishes our plan to extract, transform, and pool data using STATA version 17 to determine the pooled magnitude and effect sizes (OR/RR) of predictors once the full review is completed. As a protocol, final study conclusions are not yet available. However, this upcoming systematic review and meta-analysis is designed to provide a comprehensive, pooled magnitude of healthcare-seeking behavior and its multi-level socio-ecological predictors. The final findings will provide robust empirical evidence intended to guide policy makers, program implementers, and healthcare providers in optimizing maternal health interventions across sub-Saharan Africa.
ContextHospice care is intended for the final phase of life, but trajectories after admission vary widely. Some patients die within days, whereas others stabilize and live longer than expected. Very short stays may limit comprehensive care, while prolonged stays may involve socio-existential concerns and practical challenges. Early symptom profiles may reveal differences between trajectories.ObjectivesTo describe multidimensional symptom profiles at admission and during the first month of hospice care among patients with short, average, and prolonged survival.MethodsPatient-completed Utrecht Symptom Diary-4 Dimensional (USD-4D) data from 15 Dutch hospices (2017-2025) were analyzed. Survival was grouped as short (0-3 days), average (4-93 days), or prolonged (≥94 days). Physical/psychological prevalence (>0) and clinically relevant prevalence (>3) were calculated, and intensity (0-10) was summarized for all items at admission and across five predefined 3-day windows during the first month.ResultsAmong 2112 patients, 82 had short survival, 1825 had average survival, and 205 had prolonged survival. Physical and psychological burden were highest in short survival, intermediate in average survival, and lowest in prolonged survival; in prolonged survival, physical symptoms improved within two weeks and then stabilized. Socio-existential concerns were more prominent in the short and prolonged survival groups than in the average-survival group.ConclusionMultidimensional symptom and concern profiles differed across survival groups, with differences visible at admission and more pronounced within two weeks. Routine multidimensional evaluation within two weeks may help identify emerging prolonged trajectories and align care with changing physical and socio-existential needs.
To address the challenge of difficult small target recognition in the early detection of Pine Wilt Disease (PWD), this study proposes an efficient Unmanned Aerial Vehicle remote sensing detection model named ESE-PWDNet (Efficient Small-scale Early PWD Detection Network). Using a DJI Air3 UAV platform, a multi-temporal and multi-view high-resolution dataset of early-stage PWD was independently constructed in the Tangshan Forest Area, Jiangning District, Nanjing City, Jiangsu Province. Based on this dataset, a key module-the Efficient Visual Linear Unit (EFVLU)-was designed. Serving as the foundational building block of ESE-PWDNet, the EFVLU combines with convolutional modules (Conv) to form the backbone network, which efficiently captures global dependencies and improves the detection of small targets through global context while reducing computational complexity. Furthermore, inspired by the PANet architecture and utilizing the Attention State Space Block (ASSB), a novel neck network was designed to empower the model with efficient high-resolution image processing capabilities while maintaining high computational efficiency. In the prediction head, the introduction of the Efficient Multi-scale Attention (EMA) mechanism and the Lightweight Shared Detail Enhanced Convolutional Detection Head (LSDECD) comprehensively enhances the model's perception and localization capabilities for small targets with almost no additional inference computational cost. Experiments on the constructed multi-environment early PWD dataset demonstrate that ESE-PWDNet significantly improves the recognition performance of tiny disease targets in complex scenes. The final model maintains high inference efficiency, achieving a Precision (P) of 75.9% and a Recall (R) of 75.1%, with a low computational complexity of 6.5 GFLOPs and 2.6M parameters. Its comprehensive performance outperforms mainstream comparative models. This research provides a reliable technical solution and data foundation for the early and precise UAV remote sensing monitoring of forestry pests.
BackgroundVitamin D deficiency is prevalent among pediatric patients with sickle cell disease (SCD) and may be associated with acute clinical complications. Despite its potential impact, the effects of this deficiency in this population are not fully understood.Aims/ObjectivesThis study aims to review the current literature on vitamin D deficiency in children with SCD, focusing on its clinical and laboratory outcomes, and to explore the potential benefits of vitamin D supplementation.Methods/MethodologyA systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were performed across five databases-MEDLINE, LILACS, Cochrane, EMBASE, and Scientific Electronic Library Online. From an initial pool of 497 articles, 12 met the inclusion criteria and were included in the final analysis.Results/FindingsThe review identified several clinical and laboratory outcomes associated with vitamin D deficiency in pediatric SCD patients. Vaso-occlusive crises were the most commonly reported clinical outcome, appearing in 25% of the studies. Similarly, hospitalizations were noted in a quarter of the reviewed articles. Laboratory findings most frequently included anemia and hemolysis.ConclusionVitamin D deficiency in pediatric sickle cell patients is linked to worse clinical and laboratory outcomes, including increased crises and hospitalizations. Supplementation may help, but evidence is insufficient; further studies are needed to guide recommendations.
Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening. To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction. Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity. After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed. Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication reliably demonstrates postoperative anatomy and helps better understand hiatal hernia recurrence.
To date, no instrument with demonstrated structural validity has been available to assess dentists' knowledge, skills, and attitudes regarding the core concepts of Minimal Intervention Dentistry (MID). Therefore, this study aimed to develop and evaluate the psychometric properties of a self-administered instrument designed to measure Brazilian dentists' knowledge, skills, and attitudes towards MID. A cross-sectional study was conducted among dentists practicing in the Federal District of Brazil to evaluate the psychometric properties of the instrument. Item generation was followed by expert review by Brazilian MID specialists. Subsequently, two focus groups and a pre-test were conducted to assess item wording, sequence, and comprehensibility. After the necessary revisions, the instrument was administered to 454 dentists. Exploratory Factor Analysis, combined with parallel analysis, was performed (p < 0.05). A total of 404 dentists comprised the final sample for the psychometric analyses. Parallel analysis indicated a two-factor solution as the most representative, corresponding to knowledge, skills, and attitudes. Composite reliability was adequate for all factors (≥ 0.40). The factorial structure showed acceptable model fit indices, except for the RMSEA (RMSEA = 0.092). Unidimensionality was rejected, as UniCo = 0.939 (0.907-0.975) and ECV = 0.762 (0.719-0.830) did not reach the recommended thresholds. The findings suggest that the instrument presents an appropriate structure and satisfactory reliability for measuring dentists' knowledge, skills, and attitudes related to MID. This is the first study in the field of MID competencies to comprehensively report the steps involved in constructing, adapting, and psychometrically evaluating an instrument for dentists.
Coronary artery disease remains a leading cause of mortality worldwide. Accurate detection and angular quantification of coronary calcification are important for optimizing percutaneous coronary intervention. Intravascular Ultrasound provides high-resolution visualization of plaques, where calcification typically appears as hyperechoic regions with acoustic shadowing. However, grayscale intravascular ultrasound is sensitive to imaging conditions and reconstruction algorithms, making automated calcification analysis challenging. This study aims to automate the detection of calcification and the quantification of angles. We propose a dual-branch deep learning framework that integrates raw intravascular ultrasound radio-frequency (RF) signals with polar-coordinate grayscale images. A physics-consistent complex convolution module is introduced to preserve the intrinsic physical structure of RF signals during feature extraction. The framework further incorporates phase-amplitude guided dual-path cross-attention and a shadow-aware radial A-line classifier to enhance RF-image interaction and angle estimation. Calcification angles are computed from the predicted segmentation combined with lumen centroid localization. Experiments were conducted on a multicenter development dataset from four centers, including 78 patients, 136 pullbacks, and 32,672 IVUS frames. An independent external clinical test set comprising 10 patients, 15 pullbacks, and 2,362 frames was further used for final evaluation. On the internal validation set, the proposed method achieved a Dice coefficient of 0.921 and a Hausdorff distance of 0.251 mm for calcification segmentation, with an A-line classification accuracy of 97.1% for calcification angle quantification. The model also maintained stable performance on the external clinical test set, supporting its potential generalizability in real-world clinical scenarios. Joint modeling of RF signals and grayscale intravascular ultrasound features enables accurate and robust calcification detection and angular quantification, supporting objective and reproducible clinical assessment.
The proximal tibia is a common site for primary bone tumors in children and presents unique reconstructive challenges. Despite surgical advances, optimal strategies remain controversial, and complication rates are high. While several studies have compared reconstruction methods, few have specifically described the long-term evolution of biological reconstruction strategies for pediatric proximal tibial tumors. The main purpose of this study was to illustrate the development of biological reconstruction techniques for proximal tibial tumors in children and assess associated complications and allograft survival. This retrospective study included 60 pediatric patients who underwent proximal tibial reconstruction with either osteoarticular (OA) or resurfaced osteoarticular (ROA) allografts between 1990 and 2021. OA procedures (n=14) represents the early phase of our experience, with surgeries performed between 1990 and 2000, whereas ROA procedures (n=46) reflect subsequent refinements, and were performed from 1996; differences in sample size, treatment period, and technique are inherent to the study's descriptive, observational design. Clinical outcomes, complication profiles, and allograft survival were analyzed with a minimum 2-year follow-up. Patient characteristics were comparable across groups. The use of ROA increased significantly over time (P<0.001). Postoperative complications occurred in 34 patients (57%), with allograft fracture (44%) and pseudoarthrosis (32%) being the most frequent. Complication rates were associated with reconstruction type (P=0.031). Allograft failure occurred in 82% of complicated cases. Allograft survival was 56% at 5 years and 48% at 10 years. ROA showed higher, though not statistically significant, survival compared with OA (58% vs. 19%, P=0.236). At final follow-up, 67% of patients were alive and disease-free. Biological reconstruction of pediatric proximal tibial tumors remains complex but offers acceptable long-term outcomes. This series illustrates a progressive e transition from OA to ROA techniques, associated with favorable allograft survival and reduced fracture rates. Despite high complication rates, many failures were managed without compromising future reconstructive options. Infection remains a critical concern, emphasizing the importance of surgical precision. Level II-prognostic study.
To determine the prevalence of dome-shaped macula (DSM) in high myopia (HM) and to compare the clinical characteristics of eyes with and without DSM. This retrospective, longitudinal, single-centre cohort study included patients with HM, with or without DSM. Baseline demographic and clinical characteristics were collected. Multimodal imaging was performed at baseline and during follow-up to assess the presence of macular neovascularization (MNV) and serous retinal detachment (SRD). A total of 1133 eyes of 619 HM patients (67% of women; mean [standard deviation] age: 48.9 [16.9] years) were analyzed. The eye-level and patient-level prevalences of DSM were 15% (173/1133 eyes) and 19% (117/619 patients), respectively. Compared to non-DSM eyes, DSM eyes showed a longer axial length (p < 0.001), a worse baseline visual acuity (VA) (p = 0.016) and a higher prevalence of diffuse chorioretinal atrophy (p = 0.013). The longitudinal analysis was limited to DSM eyes, with a mean follow-up of 28.0 (44.2) months. At the final visit, MNV was found in 47 eyes (27%) and SRD in 10 eyes (6%). MNV incidence was 4.02 (95% confidence interval [CI]: 1.79-6.70) per 100 eye-years. The presence of SRD at baseline was associated with a greater dome height (odds ratio = 1.007; p < 0.001). Vitreoretinal interface abnormalities were more frequently observed in eyes with lower dome height. DSM was detected in approximately 15% of HM eyes. Patients with DSM showed a worse baseline VA compared to those without DSM. MNV was the most common and vision-threatening complication, while SRD was relatively uncommon, occurring only in cases of significant bulging.
PurposeTo analyze the surgical results of bilateral medial rectus recession (BMR) versus unilateral medial rectus recession and lateral rectus resection (RNR) in patients with non-alternating esotropia associated with similar visual acuity in both eyes.MethodsData of suitable patients operated between 2010 to 2023 were collected from their electronic records immediately before surgery and during follow-up until the last available visit. Surgical success was defined as deviation of 10 prism diopters (PD) or less.Results473 patients had strabismus surgery for esotropia correction during the study period and 26 (5.5%) of them met the study's inclusion criteria: 12 (46.2%) in the RNR group and 14 (53.8%) in the BMR group. Final angles of deviations after RNR (distance 2.1 ± 2.9PD and near 3.6 ± 3.7PD) were not different than after BMR (distance 1.4 ± 2.4PD and near 4.0 ± 4.5PD, p = 0.54 and p = 0.80 respectively). Additionally, a similar success rate was achieved after both types of surgeries (100% for RNR and 92.8% for BMR, p = 0.35).ConclusionPatients with non-alternating esotropia and equal vision in both eyes who express concerns about the necessity of strabismus surgery on their non-deviating eye can achieve comparable outcomes following RNR performed exclusively in the deviating eye.
ESKAPE pathogens are a major cause of hospital-acquired colonization or infection among very preterm infants in neonatal intensive care units (NICUs). Early identification of high-risk infants can help prioritize infection-control interventions and guide targeted preventive care. A single-center retrospective cohort study was conducted among 465 very preterm infants (gestational age, GA ≤ 32 weeks) admitted to the NICU of a tertiary hospital between January 2015 and June 2025. Infants were randomly divided into training (n = 325) and internal validation (n = 140) cohorts at a 7:3 ratio. Predictors available within 24 h after birth were screened using least absolute shrinkage and selection operator (LASSO) regression. A multivariable logistic regression model was constructed and presented as a nomogram. Overall, 77 infants (16.56%) developed hospital-acquired ESKAPE colonization or infection, of which 67.5% (52/77) were first identified within 14 days after birth. Among 109 non-duplicate ESKAPE isolates, the predominant pathogens were Acinetobacter baumannii (38/109, 34.86%) and Klebsiella pneumoniae (31/109, 28.44%); respiratory specimens were the primary source (90/109, 82.57%). Four predictors were retained in the final model: GA at birth, initial invasive mechanical ventilation, vasoactive exposure within the first 24 h, and 5-minute Apgar score. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.786 (95% CI: 0.718-0.853) in the training cohort and 0.770 (95% CI: 0.673-0.866) in the internal validation cohort, indicating moderate discrimination. Calibration curves and decision curve analysis demonstrated good agreement between predicted probabilities and observed risks, with net benefit across a wide range of clinically relevant threshold probabilities. An online prediction tool was also developed (https://newborn.shinyapps.io/dynnomapp/). We developed and internally validated a nomogram for early prediction of hospital-acquired ESKAPE colonization or infection in very preterm infants using routine clinical indicators obtained within 24 h after birth. The model can support early risk stratification and infection control prioritization in the NICU. External validation and prospective implementation studies are required before routine clinical adoption.
GATT was effective in decreasing the IOP and number of glaucoma medications significantly in patients with UG. Active uveitis at the time of surgery was associated with higher likelihood of requiring glaucoma medications. To study the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG). This was a prospective interventional case series that included 42 eyes of 35 patients with open angle UG who required glaucoma surgery. Cases requiring combined GATT and cataract surgery were excluded. Surgical success was defined as achieving an IOP≤21 mmHg and ≥30% IOP reduction on the same or fewer medications, without additional glaucoma interventions. The primary outcomes were changes in IOP and number of glaucoma medications. Secondary outcomes included success rate and complications. After a 12-month follow-up period, the IOP was reduced from 31 ±10.6 mmHg to 12.5 ±2.5 mmHg (P <0.001, representing a 62.11% ±25.09% reduction). The number of glaucoma medications decreased from 3.67±1.18 to 0.97±1.12 (P <0.001). Mean BCVA (log MAR) improved from 0.62±0.79 preoperatively to 0.51±0.72 at 12 months (P= 0.054). At the final follow up, complete success was achieved in 21 eyes (50%), qualified success in 16 eyes (38.1%) and failure in fives eyes (11.9%). No serious complications were encountered. The only significant adverse prognostic factor was uveitis activity at the time of surgery which was associated with higher likelihood of requiring glaucoma medications (P-value= 0.04- OR=4.85). GATT is a safe and effective procedure for UG. The outcome is influenced by the uveitis activity at the time of surgery, which can result in the need for more antiglaucoma medications postoperatively.
A critical part of omics analysis is the transition from early data exploration to final interpretation, often including different analytical platforms and the proliferation of figures, tables, and files. To minimize potential errors and delays that can occur during this process, we have developed an R package called "Hotgenes" that contains a wide range of flexible utilities available in a single modular Shiny application. With Hotgenes, differential expression results generated from bulk omics platforms can be imported and shared among collaborators with minimal coding. Furthermore, the modular Hotgenes user interface can be customized by advanced users to fit the needs of their evolving pipelines. Hotgenes is implemented in R and is freely available at https://github.com/pfizer-opensource/Open-Hotgenes. A permanent archived version is available at https://doi.org/10.5281/zenodo.20129460. Supplementary data are available at Bioinformatics online.
As the global population ages, declines in sensory, cognitive, and motor functions increase fall risk and compromise postural stability. Despite growing research, systematic reviews examining visual attention and postural stability-particularly through eye-tracking-remain scarce. Grounded in a network physiology perspective, this review aimed to (1) describe bibliometric characteristics, (2) thematize study purposes and outcomes, (3) map conceptual linkages through keyword network analysis, and (4) generate insights into the relationship between visual attention and postural stability in older adults during physical exercise interventions. Following a five-stage integrative review process using Covidence, 15 studies were included in the final analysis. Bibliometric findings show that publications were multi-authored (93.33%), appeared in health-related journals (100%), peaked in 2022 (20.00%), and originated predominantly from the Americas (46.67%). Most studies focused on diagnosis (26.67%), involved healthy participants (46.67%), and used small samples (Md = 30; IQR = 28) in laboratory or clinical settings. Thematic analysis yielded five domains-Performance, Program, Process, Product, and Person (5Ps)-while keyword network analysis identified seven clusters: Vision, Virtual, Vulnerability, Visual-Motor, Velocity, Vestibular, and Vergence, collectively emphasizing a multifaceted, systems-oriented approach to fall prevention. Among visual attention metrics, fixation (21.15%) and saccades (19.23%) were most frequently assessed, and both were consistently associated with posture, balance, gait, and stability outcomes. Advanced metrics such as heat maps, pupil dilation, dwell time, and re-fixation remain underutilized. Overall, this review establishes visual attention as a central and modifiable determinant of postural stability, with gaze-based, technology-assisted, multicomponent approaches warranting priority in fall prevention assessment and intervention. https://osf.io/bmsw6/overview.
This study aimed to evaluate the vermicomposting of a 7:3 (biogas residue: poplar leaves, dry weight) mixture employing Eisenia fetida over 90 days, focusing on physicochemical evolution, humification, heavy metal dynamics, microbial community composition, and final product maturity. The results indicated that vermicomposting significantly reduced pH, total organic carbon (TOC), and organic matter (OM). The carbon-to-nitrogen (C/N) ratio decreased to 12.0, meeting maturity standards. The germination index (GI) reached 88.41%, confirming the absence of phytotoxicity. Earthworm population size and total biomass increased by 60.7-fold and 25.28-fold, respectively, demonstrating excellent substrate suitability. Notably, Fe and Cu concentrations decreased significantly by 47.72% and 39.95%, respectively, owing to combined mechanisms of earthworm bioaccumulation, leaching of mobilized fractions, and organic matter mineralization. The bacterial community was dominated by Pseudomonadota, Actinomycetota, and Bacillota, while the fungal community was overwhelmingly dominated by Ascomycota (89.32%), providing a microbial explanation for efficient lignocellulose degradation and nitrogen enrichment. Scanning electron microscopy and Fourier transform infrared spectroscopy confirmed the porous, granular structure and progressive stabilization of organic matter. These findings demonstrate that vermicomposting effectively converts biogas residue and poplar leaves into a stable, non-phytotoxic, and agriculturally safe organic fertilizer.
To investigate the predictability of long-term intraocular pressure (IOP) fluctuations in open-angle glaucoma eyes implanted with a telemetric IOP sensor. A prospective, open-label, single-arm, multicenter study. Twenty-four patients were enrolled, including 20 with primary open-angle glaucoma, 2 with pseudoexfoliative, 1 with pigmentary, and 1 with uveitic glaucoma. Mean age was 65.2 ± 10.2 years. Telemetric IOP measurements were aggregated into nyctohemeral means. The first 90 postoperative days were excluded. A rolling reference framework was applied, in which temporally paired observations were generated by comparing each eligible day with a future time point at fixed prediction horizons. The relationship between short-term (7, 14, or 28 days) and long-term (273 or 364 days) fluctuations was assessed using Pearson correlation. Multivariate regression was applied to predict long-term fluctuations based on short-term data. In addition, supervised machine learning with a Random Forest Classifier was used to predict long-term fluctuations from clinical, demographic, and IOP-derived features. For each horizon (273 or 364 days) and threshold (+2.0, +3.0, and +4.0 mmHg), changes in mean nyctohemeral IOP were calculated. Outcomes were labeled as "1" if the increase met or exceeded the threshold and "0" otherwise. Predictability of long-term IOP fluctuations at 273 and 364 days. Short-term fluctuations correlated only weakly with long-term variability (Pearson r ≤ 0.33) and explained at most 15.2% in regression analysis. Across 1224 Random Forest Classifier models, 47 met inclusion criteria of area under the receiver operating characteristic curve (AUROC) >0.8 and sensitivity and specificity >0.7 (27 for 364 days, 20 for 273 days). On average, 5563 ± 116 valid pairings from 9.2 ± 0.8 patients were used per configuration. Five final configurations were selected for each threshold-horizon combination based on the highest F1 values. Performance metrics included AUROC 0.81 to 0.86, cross-validated AUROC 0.78 to 0.83, accuracy 0.72 to 0.81, sensitivity 0.72 to 0.78, specificity 0.70 to 0.82, precision 0.32 to 0.44, and F1 value 0.44 to 0.56. All models included 7, 14, and 28-day fluctuations, mean nyctohemeral IOP, ocular pulse amplitude, age, body mass index, and central corneal thickness as predictors, with mean nyctohemeral IOP contributing most (38%-55%). Long-term IOP fluctuations can be predicted from baseline clinical and demographic data combined with IOP-related features. Telemetric devices and remote IOP monitoring, combined with predictive modeling, could reduce the burden of time-intensive procedures and health care costs while supporting individualized care in the face of rising demand. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Evidence-based quality improvement (EBQI) is an approach to co-develop implementation strategies with implementation partners. This study describes an EBQI approach for co-developing implementation strategies to support the adoption of the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) falls prevention initiative in outpatient physical therapy. A multidisciplinary panel (n = 10), representing key partner groups including physical therapists, clinic managers, a referring physician, an older adult with prior physical therapy experience, and a caregiver, collaborated with a research team across 5 outpatient physical therapy clinics within a U.S. health system. Eight virtual EBQI panel sessions conducted over 9 months included meetings, barriers/facilitator ranking, strategy identification/rating, concept mapping, consensus building, and group discussion. Strategies were evaluated on feasibility and importance using Likert-scale surveys and iteratively refined. The main outcome measures were partner-rated rankings of barriers and facilitators to address implementation challenges, rankings of strategy feasibility and importance, and a finalized package of tailored implementation strategies. Twenty barriers and 20 facilitators were prioritized and ranked by each partner group. Prioritized barriers were matched with prioritized facilitators and/or implementation strategies to address barriers. Of the 78 implementation strategies considered, 39 unique specifications from 22 strategies were identified. Key strategies included clinician education, workflow and electronic health record integration, clinician and older adult-facing materials, clinic champions, and communication templates. EBQI effectively engaged implementation partners in identifying and prioritizing barriers, facilitators, and co-developing tailored, actionable implementation strategies to support STEADI adoption in outpatient physical therapy.