Resuspension of hazardous particles from paved surfaces poses significant risks during radiological contamination scenarios. Accurate modeling of particle resuspension dynamics is essential for developing effective mitigation strategies and ensuring public and responder safety. However, default resuspension factors in models may underestimate risks, particularly during emergency operations involving pedestrian and vehicle activity on freshly contaminated surfaces. To address these gaps, we conducted pilot-scale field experiments using Arizona Test Dust (ATD) as a surrogate for threat agents. Human activities included casual walking, vigorous walking (marching), and vacuuming on concrete surfaces, while vehicle tests involved driving a sport utility vehicle (SUV) over asphalt in both drive-through (tires passing over dust) and drive-over (undercarriage passing over dust) configurations. Resuspension factors (Sf) were calculated for particle size ranges from 0.5-10 µm. Casual walking produced low resuspension factors, from <10-5 m-1 for 0.5-1.0 μm particles to <3 × 10-3 m-1 for 5-10 μm particles. In contrast, marching, which served as a surrogate for vigorous pedestrian or personnel movement, substantially increased resuspension, with Sf values ranging from 2 × 10-5 m-1 at 0.1-1 μm to 2 × 10-3 m-1 for 5-10 μm particles. Vacuuming caused measurable resuspension for smaller particles (Sf = 1.4 × 10-3 m-1), while larger particles remained undetectable. Vehicle tests showed higher resuspension factors for larger particles, with Sf values ranging from 3 × 10-4 m-1 to 2 × 10-2 m-1 during the first pass. Subsequent passes eventually reduced resuspension factors by an order of magnitude. These findings reveal significantly higher resuspension during emergency operations than many models assume. Our results apply to scenarios involving radioactive fallout, chemical, and biological agents, offering critical data to improve contamination control, emergency response planning, and risk assessment models.
People living in prison are at increased risk of communicable diseases due to overcrowding and suboptimal living conditions. This study aimed to estimate the uptake of recommended vaccinations among people living in prison, investigate their willingness to be vaccinated during detention, and identify factors influencing both uptake and willingness. This cross-sectional survey was conducted from October 2023 to July 2024 in four penitentiary institutions in Southern Italy. Of the 1137 participants, 13.8% self-reported having received at least one vaccination schedule during their current detention. Those with chronic disease, who had received information about vaccines in prison, and with a longer detention were significantly more likely to have received a vaccination. Conversely, women, those not-at-risk from alcohol consumption, and those having at least one child were significantly less likely to have received at least one vaccination schedule in prison. Less than half of the participants (41.9%) expressed willingness to receive recommended vaccinations if offered in prison. Willingness was significantly higher in subjects of Italian nationality and with a longer detention. Moreover, heterosexuals and those who were married or cohabitant were significantly less willing to receive at least one vaccination schedule in prison. Implementing routine proactive vaccination activities could be effective, and should focus on both standard adult vaccinations and immunizations for individuals with specific risk conditions.
Functional defecation disorders (FDD), a major sub-type of chronic constipation, often exhibit limited response to pharmacotherapy. Anorectal biofeedback therapy (BFT) is the recommended therapy, but there is limited data regarding its long-term effectiveness and predictors of response. We evaluated the short and long-term effectiveness of a six-session anorectal BFT protocol in patients with FDD. In this ambispective cohort study (2018-2024), adult patients diagnosed with FDD by Rome-IV criteria who completed six BFT sessions were included. The primary outcome was at least 30% improvement in the Modified Cleveland Constipation (MCC) score. Secondary outcomes included changes in symptoms on visual analog scale (VAS), individual symptoms, anorectal manometry parameters and predictors of response to BFT. The patients who had completed at least one-year follow-up were contacted to assess long-term response. One hundred sixty-six patients were included (median age = 40 years [IQR = 27-52]; 69.3% male). After BFT, 61.4% achieved improvement in MCC score by > 30%, with significant improvement in VAS score and individual symptoms such as incomplete evacuation, straining and manual evacuation (p < 0.001). Post biofeedback, there was significant increase in defecation index and anal relaxation (p < 0.001). Younger age was predictive of short-term response to BFT regardless of different sub-types of FDD. At long-term follow-up of 110 patients (median = 22 months, IQR = 12-28 months), 56.4% reported sustained improvement in MCC score by > 30%, with initial response to BFT being significant predictor of long-term response. Anorectal BFT is an effective treatment for FDD with sustained benefit over long term.
Portable high-efficiency particulate air (HEPA) filters effectively remove airborne microbes. To investigate whether HEPA filters reduce respiratory infection episodes in care home residents. This 2-arm cluster randomized clinical trial included care homes for older adults in England, with or without nursing and dementia care provision, and capacity for 20 or more residents in individual bedrooms. Data were collected between September 2021 and May 2024, with each care home participating for 1 winter. Up to 5 HEPA filters for communal areas (clean air delivery rate set at 160 m3/h) and up to 16 filters for bedrooms (clean air delivery rate set at 60 m3/h). Both groups continued usual infection prevention and control measures. The primary outcome was respiratory infection rate per winter per bedroom resident (exposed to bedroom and communal room filters). Secondary outcomes included staff absenteeism. All outcomes were also explored for residents exposed only to communal room filters. During the study period, 91 care homes were randomized, 47 to receive communal room filters, with 569 bedroom residents (median [IQR] age, 87 [81-92] years; 398 [70.0%] female), and 44 without communal room filters, with 589 residents without bedroom filters (median [IQR] age, 88 [82-92] years; 23 [71.8%] female). There was no evidence of a difference in the number of respiratory infections per winter per intervention vs control bedroom residents (0.99 vs 1.04; adjusted incident rate ratio, 0.92; 95% CI, 0.64-1.33; P = .67). There was also no evidence of a difference in the rates of staff absenteeism (adjusted incident rate ratio, 0.80 95% CI, 0.55-1.16; P = .24). Results were similar for the residents exposed only to communal room HEPA filters. In this cluster randomized clinical trial, there was no difference in resident respiratory infection rates in care homes with HEPA filters in communal areas and bedrooms. Care homes should continue existing recommended prevention measures to control respiratory and other infections. isrctn.org Identifier: ISRCTN63437172.
Child nutrition and the poor nutritional status of children remain a major public health challenge in many low-resource settings despite significant efforts by public authorities. The World Health Organization (WHO) recommends the weight-for-length z-score, the weight-for-height z-score, and mid-upper arm circumference (MUAC) as screening standards for severe acute malnutrition (SAM). Despite nutritional deficiencies and anomalies, numerous community-based predictors contribute to the establishment of malnutrition (moderate and severe). The present work will help policymakers and clinicians to look after the determinants of SAM. The present study aimed to determine the World Health Organization (WHO) growth standards and confounder predictors of moderate and severe acute malnutrition among children aged 6-60 months in a resource-constrained community setting. A cross-sectional study was performed among children aged 6-60 months within a resource-constrained community setting. The anthropometric measurements were performed using MUAC and weight-for-length z-score and weight-for-height z-score, with values <-3 recommended by the WHO as the standard. Bivariate analysis was used to identify predictive variables and risk factors for severe, acute, and moderate malnutrition. Of 301 children, 8.97%, 10.96%, and 18.93% presented with severe acute, moderate, and acute malnutrition, respectively, with a higher proportion of male children affected. Bivariate analysis showed that malnutrition (severe acute, moderate, and acute) was significantly associated with gender (OR: 5.321; 95% CI: [2.210, 13.25] and RR: 3.370 95% CI: [1.773, 6.275]. Children from resource-constrained urban households (OR: 2.00; 95% CI: [0.336, 22.16] and RR: 1.867; 95% CI: [0.398, 10.75] were two times more likely to be severely malnourished. Higher odds of SAM were observed among children whose parents used tobacco (OR: 6.508; 95% CI: [1.672,28.47] and RR: 5.565; 95% CI: [1.548,20.95]. The findings of the present study showed that gender, household type, tobacco use by parents, family monthly income, anemia, and the status of antenatal care of women received during pregnancy were the major predictors of severe acute malnutrition. The study was conducted in a resource-constrained region, and to reduce the prevalence and causes of malnutrition, food safety and guarantee schemes should be strictly monitored, along with delivering education and awareness within the community, especially to parents and caregivers.
Purpose: To investigate the agreement on perfusion parameters derived from two different commercially available solutions for dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with prostate cancer (PCa). Methods: A total of 50 patients (mean age, 71.6; range 56-86) who had undergone radical prostatectomy between December 2021 and September 2022 were included in this retrospective study. All patients had undergone DCE-MRI on a single 3T-MR scanner. Tumor segmentation on MR images was performed by two radiologists in consensus after radiologic-pathologic correlation using topographic maps as a reference standard. Subsequently, four perfusion parameters were calculated by dedicated commercially available solutions from two different vendors. Both solutions adopted a population-based arterial input function and an extended Tofts model as the pharmacokinetic model. The perfusion parameters were as follows; volume transfer constant (Ktrans), rate constant (kep), volume fraction of extravascular extracellular space (ve), and volume fraction of plasma (vp). The differences between paired measurements were compared by Bland-Altman analyses and the reproducibility was evaluated using the intraclass correlation coefficient (ICC). Results: The study population consisted of Gleason score (GS) 6 (n = 12), GS 7 (n = 34), GS 8 (n = 1), and GS 9 (n = 3). Significant differences were found for all parameters (p < 0.0001). Mean differences were as follows: Ktrans, -0.2102 (95% confidence interval; -0.2687 to -0.1518); kep, -0.7632 (-0.9005 to -0.6258); ve, -0.1507 (-0.2422 to -0.05907); vp, -0.02929 (-0.03383 to -0.02476). ICCs for average measures were as follows: Ktrans, 0.2989 (-0.2355 to 0.6021); kep, 0.6883 (0.4507 to 0.8231); ve, -0.1331 (-0.9967 to 0.3570); vp, 0.2653 (-0.3106 to 0.5881). Conclusion: All perfusion parameters were significantly different between the two solutions. Therefore, comparison of perfusion parameters across different solutions is not recommended.
Background: Influenza remains a major global public health threat, and vaccination is one of the most effective preventive measures. However, frequent antigenic drift and occasional antigenic shift, along with the lead time required for vaccine development and regional differences in the evolution of circulating strains, may lead to mismatches between WHO-recommended vaccine strains and circulating viruses. In addition, antiviral resistance further complicates precise influenza prevention and control. Objectives: This study aimed to evaluate the concordance of vaccine strains with circulating influenza viruses and the emergence of neuraminidase inhibitor (NAI) resistance in China. Methods: Data on antigenic characterization and antiviral susceptibility testing were extracted from weekly influenza surveillance reports published by the Chinese National Influenza Center from 2015 to 2025. Viral evolution, substitutions at key antigenic sites, and resistance-associated mutations were further examined based on sequences of circulating influenza viruses in China. Results: The overall vaccine match rates were 95.72% (95% CI: 94.02-97.43%) for A(H1N1)pdm09, 58.96% (95% CI: 54.93-62.96%) for A(H3N2), 64.45% (95% CI: 59.49-69.41%) for B/Victoria, and 95.19% (95% CI: 91.32-99.05%) for B/Yamagata in China during the 2015-2025 influenza seasons, with marked year-to-year fluctuations observed particularly for A(H3N2) and B/Victoria. The vaccine matching for cell-based A(H3N2) (70.41%, 95% CI: 65.04-75.77%) vaccine reference strains was significantly higher than that for egg-based A(H3N2) (48.09%, 95% CI: 42.63-53.55%) vaccine reference strains. Sequence analysis indicated that circulating A(H3N2) viruses showed the greatest genetic divergence from the matched egg-based vaccine strains (2.71%, 95% CI: 2.66-2.75%). Phenotypic NAI resistance was detected only in A(H1N1)pdm09 viruses, with resistance rates of 0.18% (95% CI: 0.07-0.45%) in 2023, 3.47% (95% CI: 2.63-4.57%) in 2024, and 3.01% (95% CI: 2.46-3.68%) in 2025. Neuraminidase (NA) sequence analysis showed that the key NAI resistance-associated substitution H274Y has been detected in A(H1N1)pdm09 viruses since 2015, at relatively high frequencies observed during 2015-2018. The mutation re-emerged in 2023 and presented increase trends thereafter, although no A(H1N1) pdm09 circulated during the COVID-19 pandemic. Conclusions: Antigenic concordance between vaccine strains and circulating A(H3N2) or B/Victoria viruses showed marked year-to-year fluctuations in China. Cell-based A(H3N2) vaccine reference strains showed higher antigenic concordance than egg-based strains, supporting further consideration of vaccine production platforms in A(H3N2)-predominant seasons. Phenotypic NAI resistance in circulating A(H1N1)pdm09 viruses was detected from 2023 onward in China, whereas resistance-associated NA substitutions had been detected earlier at the sequence level.
Lentil-based matrices are attracting growing interest as sustainable non-dairy alternatives for probiotic food production, yet their suitability is often assessed mainly by endpoint microbial viability, with less attention to growth kinetics, storage stability, and sensory behaviour. In this study, red, yellow, and green lentil milks were evaluated as substrates for probiotic fermentation using a commercial mixed starter culture. Fermentation kinetics were characterised using apparent growth rates (μ_app), while probiotic survival during refrigerated storage was assessed using log-linear inactivation modelling (k, D-values). Physicochemical properties and sugar utilisation patterns were determined, and sensory characteristics were explored through an exploratory hedonic assessment supported by Pearson correlation heatmap analysis and principal component analysis. All lentil-based beverages maintained probiotic populations above recommended levels throughout fermentation and storage. Yellow and green lentil milks supported faster early-stage microbial growth, whereas red lentil milk provided greater protection of probiotic cells during storage. Within the evaluated panel, red and yellow lentil beverages were more favourably perceived, while green lentil beverages showed lower acceptance, mainly associated with darker colour and more pronounced legume-derived notes. Overall, the findings provide a comparative basis for future optimisation of lentil-based probiotic beverages.
To establish imaging-based quantitative indices for assessing midline involvement of laryngeal squamous cell carcinoma (LSCC) and guide surgical management of contralateral cervical lymph nodes according to tumor subsite and ipsilateral lymph node status. Retrospective analysis of midline-involved LSCC patients was conducted. For supraglottic LSCC, the maximum angle between the non-ipsilateral tumor margin and the midline was quantified; receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for predicting contralateral cervical lymph node metastasis. For glottic LSCC, the non-ipsilateral tumor-anterior commissure/arytenoid cartilage-anterior commissure ratio (T-AC/A-AC ratio) was calculated. Among 58 supraglottic LSCC patients, 16 (27.6%) developed contralateral metastasis (cN0 occult 3.2%, cN + 27.3%). The optimal angle cutoff as 33.4° (AUC = 0.809, 95% CI: 0.690-0.928). Among 146 glottic LSCC patients, 5 (3.4%) had contralateral metastasis (cN0 occult 1.6%, cN + 8.3%). The T-AC/A-AC ratio was higher in the metastasis group, though the difference was not statistically significant (p = 0.06). For midline-involved supraglottic LSCC, contralateral neck dissection (levels IIa and III) is recommended for cN0 patients with a margin-midline angle > 33.4°, while bilateral dissection is indicated for all cN+ patients. For midline-involved glottic LSCC, selective contralateral cervical dissection is mainly based on clinical evidence of contralateral metastasis. The quantitative imaging parameters (T-AC/A-AC ratio) require a larger sample size for validation.
Ceftiofur is a third-generation cephalosporin approved for veterinary applications and is used to treat Escherichia coli infections in dogs, particularly urinary tract infections (UTIs), in countries including China. Despite this use, there are no approved breakpoints for interpretation of ceftiofur susceptibility testing results. This absence limits the guidance that veterinarians need to effectively prescribe ceftiofur in dogs. It also limits the analysis of data from resistance monitoring and surveillance programs. This study aimed to establish ceftiofur interpretive categories and breakpoints that can be used to assess antimicrobial susceptibility testing results for canine E. coli isolates. Our methods included a definition of the wild-type cutoff (COWT) based on resistance phenotypes from two sources, deriving the pharmacokinetics/pharmacodynamics (PK-PD) cutoff (COPD) through PK-PD analyses and Monte Carlo simulations and determining the clinical cutoff (COCL) from a trial in dogs. Minimal inhibitory concentration (MIC) data were collected from China and the European database (European Committee on Antimicrobial Susceptibility Testing [EUCAST]). COWT was determined as 1 μg/mL. The COPD was 0.25 μg/mL. Through a canine cystitis trial, a COCL of 2 μg/mL was determined. Based on these findings and Clinical and Laboratory Standards Institute (CLSI)-recommended methods, we propose urinary tract infection-specific MIC breakpoints of ≤1 µg/mL (susceptible), 2 μg/mL (intermediate), and ≥4 µg/mL (resistant) and corresponding disk diffusion zone diameter breakpoints, determined by the error rate-bounded (ERB) method, of ≥23 mm (susceptible), 20-22 mm (intermediate), and ≤19 mm (resistant). The systemic breakpoints (non-urine) were determined to be ≤0.125 µg/mL (susceptible), 0.25 μg/mL (intermediate), and ≥0.5 µg/mL (resistant).IMPORTANCECeftiofur can be legally used, but laboratories and veterinarians lack canine-specific breakpoints to determine whether an isolate is susceptible or resistant. Without such criteria, test results can be inconsistent, treatment choices uncertain, and early signs of emerging resistance overlooked. This study fills that gap by defining evidence-based, canine-specific breakpoints for ceftiofur, particularly for urinary tract infections (UTIs). Adoption of these breakpoints will allow more consistent reporting by diagnostic laboratories, improve therapeutic decision-making for veterinarians, and provide a reliable basis for resistance surveillance. These advances strengthen the One-Health antimicrobial stewardship and help preserve the effectiveness of important antimicrobials for companion animals and the wider community.
Globally, mycotoxin contamination of maize is a fundamental concern due to significant economic losses and toxic health effects on humans and animals. This study analyses the perceived effects of mycotoxin contamination and the use of control measures among smallholder maize farmers in South Africa using Mbombela as a case study. A two-stage sampling procedure was used to select 152 registered smallholder maize farmers in Mbombela, South Africa. Data was collected with a structured questionnaire administered by trained enumerators. Descriptive and multiple linear regression analyses were carried out using SPSS (Version 28). The findings revealed that many farmers had a high perception of the effects of mycotoxin contamination, and the most prominent prevention and control practices were good field management, storage of maize in clean, well-ventilated stores, and proper sorting of harvested grains. Multiple linear regression results revealed that farming experience, media exposure, extension visit, mycotoxin-related training, mycotoxin awareness, and perception index significantly influenced farmers' utilization of mycotoxin prevention and control practices. The study recommended that agricultural professionals develop robust mycotoxin-related training and advisory services to enhance and strengthen farmers' awareness and perceptions, and to promote the sustained use of effective agricultural practices to combat mycotoxin contamination.
The indication for surgery for isolated lateral malleolar fracture (AO/OTA 44B1) is debatable and in many cases, relies upon radiographic assessment of fracture stability. Artificial intelligence chatbots with visual analysis capabilities offer a potential attribute for radiographic assessment. This study compared the diagnostic performance of a commercially available AI chatbot with that of three fellowship-trained orthopedic trauma surgeons in evaluating equivocal isolated lateral malleolar fractures. A retrospective study. 50 patients with isolated lateral malleolar injury at the level of the syndesmosis (AO/OTA 44B1) were evaluated by three blinded fellowship-trained orthopedic trauma surgeons. Each rater measured standardized radiographic ankle parameters, medial clear space, tibiofibular clear space, and tibiofibular overlap, on anteroposterior and mortise views and determined a surgical versus nonoperative treatment recommendation. Subsequently, the same sets of radiographs were independently evaluated by an AI chatbot (Claude, Anthropic). The observers and AI decisions were compared to the actual outcome of the patients (operative vs. nonoperatives). All raters recommended surgery at lower rates (34.0-46.0%) than the actual operative rate (56.0%). The difference in outcomes between the actual treatment and the observers varied and ranged between 67.3-86% with the AI within the same ranges. The AI's radiographic measurements differed systematically from all surgeons across five of six parameters. Inter-rater agreement between the AI and surgeons was slight, while inter-surgeon agreement was moderate (κ = 0.457-0.589). ROC analysis showed comparable AUC values (0.63-0.67) for all raters. The AI chatbot demonstrated diagnostic accuracy comparable to orthopedic trauma surgeons in directing treatment for isolated lateral malleolar fractures, despite using a systematically different measurement strategy. All raters exhibited conservative bias as comparted with the actual outcome with modest discriminatory ability, reflecting the inherent difficulty of this clinical issue. These findings support a potential complementary role for AI in ankle fracture triage, while final clinical management decisions should remain in the hands of the orthopedic surgeon.
Background: Low-birth-weight (LBW, <2500 g) infants are at increased risk of suboptimal hepatitis B vaccine responses; yet, data on their immunogenicity patterns and modifiable determinants remain limited. This study aimed to assess hepatitis B vaccine immunogenicity in LBW infants and to examine whether postnatal catch-up growth and maternal-neonatal characteristics are independently associated with antibody levels. Methods: We enrolled 511 LBW infants who completed the recommended 3-dose hepatitis B vaccination series at 0, 1, and 6 months. Blood samples were collected 4-6 weeks after completion of the full vaccination series. Geometric mean concentration (GMC) and seroprotection rate (SPR, anti-HBs ≥ 10 mIU/mL) were evaluated. Catch-up growth was quantified as the change in weight-for-age Z-score between 6 and 8 months of age (ΔWAZ). Multivariable linear regression was used to identify independent predictors of log-transformed antibody titers, adjusting for gestational age, maternal hepatitis B surface antigen (HBsAg) positivity, maternal body mass index (BMI), maternal fasting glucose, maternal thyroid disease, infant hemoglobin at 6 months, and ΔWAZ. Results: The overall SPR was 99.41% (508/511), with a GMC of 1045.37 mIU/mL (95% CI: 916.24-1192.70). SPR remained consistently high across all subgroups. In multivariable analysis, ΔWAZ was not significantly associated with antibody levels (β = -0.063, p = 0.571). Maternal HBsAg positivity showed no significant association (β = -0.104, p = 0.792). Maternal thyroid disease was independently associated with higher antibody levels (β = 0.793, 95% CI: 0.213-1.373, p = 0.007). None of the other covariates reached statistical significance. Conclusions: Hepatitis B vaccination demonstrated high immunogenicity in LBW infants, with very high seroprotection rates. Postnatal catch-up growth did not independently influence antibody levels. The significant positive association between maternal thyroid disease and infant antibody response warrants further prospective investigation.
To compare the effect of laser and other four traditional root canal disinfection methods on the removal of microorganisms in the root canal of refractory periapical periodontitis. 155 single-canal premolars were made into 13 mm long standard roots, infected with E. faecalis and C. albicans, randomly divided into five groups, and treated with A: lateral syringe irrigation group; B: ultrasonic irrigation group; C: sonic irrigation group; D: Er∶ YAG laser in SWEEPS mode group; E: photodynamic therapy group for root canal irrigation. Root canal samples were collected with 25# K files before and after irrigation. The irrigation effectiveness was quantitatively analyzed by flat colony counting method and observed by scanning electron microscope and confocal laser scanning electron microscope. The Er∶ YAG laser group had the highest clearance efficiency for E. faecalis (P < 0.05), and the ultrasonic irrigation effect was lower than that of Er∶ YAG laser (P < 0.05), while there was no difference between that of sonic irrigation group, photodynamic therapy group and lateral syringe irrigation group (P > 0.05). These five methods were all able to clear C. albicans well without significant difference (P > 0.05). SEM and confocal laser SEM showed that Er∶ YAG laser groups were more effective at removing smear layers and total bacteria. The performance of Er∶ YAG laser eliminating E. faecalis and C. albicans and the smear layer was found superior in the root canal of refractory apical periodontitis. It is recommended to employ Er∶ YAG laser for subsequent root canal decontamination following root canal preparation. Clinical trial number: Not applicable.
Background/Objectives: Lead acrylic shields (LASs) enhance radiation protection, with variation of their usage among different specialties. This prospective multicentric observational study aimed to explore patterns of ocular radiation exposure and LAS usage among interventionalists from different disciplines and to assess behavioral dose changes in a longitudinally monitored subgroup. Methods: From July 2019 to July 2020, ocular doses (protected and unprotected) were measured in 15 interventionalists from four specialties (radiology, neuroradiology, cardiology and vascular surgery) across 2286 procedures using thermoluminescent dosimeters. Procedure type, operator position, total body dose, fluoroscopy time, dose area product, LAS usage and dose exceedances were documented. Ocular doses of five interventionalists, who participated in our previous study, allowed a longitudinal comparison of radiation doses and protective behavior. Results: Cumulative annual unprotected ocular doses ranged from 0 to 59 mSv, with five participants exceeding the annual limit of 20 mSv, whereas protected doses (0 to 18 mSv) remained within the limits. Procedural LAS usage was seen in 89% of radiologists and 82% of vascular surgeons. Participants with 100% LAS usage recorded minimal measurable ocular doses, whereas lower LAS compliance resulted in higher ocular doses. Longitudinal subgroup data analyses showed a decrease in ocular dose per procedure in all five participants, suggesting a potential learning effect, without statistical significance. Conclusions: Unprotected ocular doses exceeded the annual occupational eye lens dose limit in several participants, whereas protected doses remained within recommended limits in all participants. No specialty demonstrated universally lower ocular doses, while consistent LAS use proved highly effective in reducing the dose in all groups. Longitudinal findings suggest that structured dose monitoring and repeated training may support behavioral improvements in radiation protection over time.
Background. Five-a-side soccer for the blind (F5) is a Paralympic sport that has been the subject of research aimed at identifying variables that influence performance. However, despite its growing popularity, there is limited scientific literature on quantitative analyses of offensive performance in this sport. Objective. To analyze 164 offensive plays by the Argentine men's national team during the 2022 International Blind Sports Federation (IBSA) Copa América to determine the spatiotemporal progression and the decline in intra-match offensive performance. Materials and Methods. Each play was reconstructed with its progression vector, its finishing zone, and its absolute game minute. Multivariate logistic regression models and weighted trend analysis (Cochran-Armitage) were applied to examine the relationship between these variables and the offensive outcome (shot on-target and goal). Results. Plays originating from high-pressure recovery showed a favorable trend toward shooting on-target. The goal rate showed an empirical decline from 26.1% in the 6th-10th minutes to 6.7% in the final minutes, without reaching statistical significance. Conclusions. The results of this study suggest that the magnitude of the offensive progression vector and offensive effectiveness show an asymmetry toward the right side, as well as a pattern consistent with an intra-match decline toward the end of games. These variables appear to influence the offensive performance of the Argentine men's national blind football (F5) in the 2022 Copa América. These findings provide one of the first integrated vector analyses of offensive performance in F5 and propose metrics applicable to coaching staff, the design of specific training programs, and the functional assessment of athletes with visual impairments; therefore, further studies are needed to analyze these metrics in different official competitions and to account for various competitive levels. It is recommended to design training exercises focused on recovery under high pressure near the right side of the offensive zone and maintain the intensity of play in the final minutes of the game.
Background: Vaccinations are highly effective in preventing infectious diseases, which otherwise present a serious challenge to the health of individuals and public health. To identify potential gaps in vaccination coverage, we examined childhood vaccination levels in Frankfurt am Main (FFM) and the Rhein Neckar district (including Heidelberg city, RNHD) prior to, during and following the COVID-19 pandemic. Moreover, we explored various factors that appear to contribute to lower vaccination levels in specific communities in either or both locations. The results are intended to guide strategies for designing and improving vaccination services for specific groups in local health settings. Methods: A retrospective analysis was conducted to examine the vaccination rates of children in Frankfurt am Main and the Rhein Neckar district (including Heidelberg city) by using anonymized data from school entry examinations spanning the years 2017 to 2024. Data pre-processing, analysis, and visualization were performed using R (5.4.2). Frequencies and percentages were calculated for sociodemographic and vaccination rates (the completeness of the vaccination schedule recommended by STIKO for children). Multivariate logistic regression was performed to determine factors with a significant impact on vaccination uptake. Results: Multinomial logistic regression with 'measles-only' (Measles) as the reference category revealed distinct predictor patterns across vaccination levels. In both regions, children who completed preventive medical check-ups had higher odds of completing the schedule of vaccination plus at least one additional vaccine (ScheduledPlus) versus, measles-only vaccination. In RNHD, children from Eastern European language families and low- and medium-social-status backgrounds showed higher odds of completing the scheduled vaccinations without the recently introduced rotavirus vaccination (ScheduledNotRota), versus measles-only vaccination. In FFM, strong interaction effects were observed between medical examination completion and migration background, with children from non-German birthplaces showing dramatically reduced odds of complete vaccination when preventive care was incomplete. Discussion: The proportion of children with a complete vaccination status remained stable over the study period in both locations, with no evidence of post-pandemic decline. Nevertheless, this stability masks important heterogeneity in vaccine coverage patterns across sociodemographic groups. Systematic identification and modeling of interactions between nationality, parental employment, and healthcare utilization tell a compelling "double jeopardy" story that the effects of these risk factors are not additive but synergistic. Regular medical check-ups remain an important factor in ensuring high vaccination coverage among children until they start school and underscore the justification for such established preventive care programs. A nuanced understanding, however, is crucial for moving beyond simplistic, one-size-fits-all public health messaging.
Growing use of inertial measurement units (IMUs) in velocity-based training has outpaced the evidence supporting their accuracy, making device-specific validation an essential aspect before adoption in research or practice. This study evaluated the concurrent validity of the GPath 6-axis inertial sensor against the Chronojump linear position transducer (LPT) for mean propulsive velocity (MPV) measurement during the bench press exercise. Twelve physically active males performed repetitions at 20%, 40%, 60%, and 80% of one-repetition maximum (1RM) across two separate testing sessions. Concurrent validity was evaluated using Pearson's correlation, concordance correlation coefficient (CCC), Bland-Altman analysis, typical error, and coefficient of variation (CV). The GPath systematically overestimated MPV relative to the LPT at all loading conditions (p < 0.001), with bias decreasing from 0.253 m/s (20% 1RM) to 0.091 m/s (80% 1RM). CV remained low and consistent across conditions (5.12-5.98%). CCC was trivial > 1 m/s (20-40% 1RM: 0.079-0.056; combined: 0.331) and moderate < 1 m/s (60-80% 1RM: 0.430-0.433; combined: 0.833), with an overall CCC of 0.877. Between-session reproducibility of agreement was high (Session 1: CCC = 0.878; Session 2: CCC = 0.877), with between-session bias differences not exceeding 0.026 m/s. Despite its systematic overestimation, the GPath showed a reproducible bias structure between sessions, which may indicate utility for longitudinal within-athlete monitoring of relative MPV changes. Although, it cannot be recommended for absolute velocity measurement or 1RM estimation without prior correction.
Yellow fever vaccination is recommended for travelers visiting endemic regions in South America and Africa. The live-attenuated vaccine (Stamaril®, Sanofi Pasteur) is produced in embryonated chicken eggs and contains residual ovalbumin, posing a challenge for individuals with egg protein allergy. We report the case of a 35-year-old male disaster relief worker with confirmed egg protein allergy and moderate sensitization but no history of anaphylaxis. Under normal circumstances, a statement confirming that vaccination is not possible would be sufficient for entry. However, due to his work-related duties and the relevant guidelines from his employer, there was an urgent need for vaccination despite his egg protein allergy. A comprehensive allergy work-up including skin prick testing, serum-specific IgE, and oral provocation testing revealed a moderate allergy without systemic reactions. Following informed consent and risk assessment, a fractional dose (0.1 mL) of the reconstituted yellow fever vaccine was administered under close monitoring. The patient developed a localized dermal reaction without systemic symptoms. Post-vaccination neutralization testing confirmed seroconversion indicating protective immunity. Although yellow fever vaccination is considered contraindicated in individuals with severe egg protein allergy, the literature supports its cautious use in selected cases. Fractional dosing has emerged as an effective dose-sparing strategy. Studies show that even in egg protein-allergic individuals, adverse events are rare. In this case, a fractional yellow fever vaccination was safe and an effective option for an egg-allergic individual in a high-risk occupational setting, supporting a personalized approach based on clinical risk assessment and current evidence.
Biliary atresia (BA), a rare but life-threatening neonatal cholestatic disorder, necessitates Kasai portoenterostomy (KPE) as the primary surgical intervention. However, despite timely KPE within the recommended 60-day window, approximately 60% of infants ultimately require liver transplantation before age 2. Current prognostic tools lack the capacity to predict long-term native liver survival (NLS) using early perioperative biomarkers. The study subjects were BA patients treated by a senior KPE surgeon at our center (93 cases) and another senior KPE surgeon at Jiangxi Children's Hospital (61 cases) from January 2017 to December 2022. Clinical and pathological follow-up data were collected. Five traditional machine learning (ML) algorithms (LRM, DET, MLP, SVC, RF) were trained on preoperative, intraoperative, and postoperative biomarkers up to 3 months post-KPE, encompassing biochemical profiles. The best-performing RF model was further enhanced using transfer learning (TL). For a combined cohort of 154 patients, traditional statistical analysis revealed significant differences in perioperative factors between NLS and non-NLS groups, with multivariate logistic regression identifying surgical age (P = 0.029), globular proteins at 1 week postoperatively (GLO_1W, P < 0.001), aspartate aminotransferase at 1 month postoperatively (AST_1M, P = 0.007), albumin at 3 months postoperatively (ALB_3M, P = 0.029), gamma-glutamyl transpeptidase at 3 months postoperatively (GGT_3M, P < 0.001), direct bilirubin at 3 months postoperatively (DBIL_3M, P = 0.005), and prealbumin at 3 months postoperatively (PALB_3M, P = 0.004) as independent risk factors. The five traditional ML models showed varying performance, with RF demonstrating the highest average AUC in the training set (AUC = 0.795, 95% CI 0.709-0.881). The TL model, built on the RF base, achieved superior performance in the training set (AUC = 0.888, 95% CI 0.819-0.943) and validation set (AUC = 0.856, 95% CI 0.738-0.947). GGT_3M, ALB_3M, DBIL_3M, DBIL_1M and GLO_1W were identified as the most critical predictive features. A TL-based clinical decision support system was deployed, providing dynamic visualization of individualized 24-month NLS trajectories. Early perioperative biochemical data-driven ML models, enhanced by transfer learning, enable accurate prediction of 2-year NLS in BA. GGT_3M, ALB_3M, DBIL_3M, DBIL_1M, and GLO_1W are among the most influential predictors for 2-year NLS after KPE procedure.