In emergency care, clinicians currently have scarce evidence-based guidance on whether to order diagnostic tests for suspected pulmonary embolism in children. We aimed to test whether the Pulmonary Embolism Rule-Out Criteria in Children (PERC-Peds) can safely rule out pulmonary embolism in children. This multicentre, prospective, observational, diagnostic accuracy study was done in 21 paediatric emergency departments across the USA. We enrolled children aged 4-17 years who presented with symptoms prompting the emergency physician to order, or strongly consider ordering, a diagnostic test for pulmonary embolism. Participants formed a consecutive series. At the point of care, clinicians completed a case report form to record the components of the PERC-Peds rule. Diagnostic testing, including D-dimer testing, was done at clinician discretion. Trained research personnel collected patient-reported demographic data, symptoms, medications, and past medical histories prospectively and cross-checked patient-reported past medical histories and medications against data in the electronic health record. Follow-up was done 45 days after enrolment with a standardised, automated SMS message to caregivers. The criterion standard for pulmonary embolism was the outcome of any venous thromboembolism (VTE; including image-proven pulmonary embolism or proximal deep vein thrombosis [DVT; above knee or elbow, but not including isolated saphenous, brachial, or calf vein clots]) within 45 days, as adjudicated by an independent committee of three board-certified paediatric emergency physicians. Adjudicators viewed all imaging reports, information from the 45-day follow-up, and outside medical records. The primary endpoint was safe exclusion by use of PERC-Peds in all participants who were adjudicated, defined as the upper limit of the 95% CI for the false-negative rate not crossing 1·5%. Between July 29, 2020, and Sept 29, 2024, 4039 children were enrolled, with 4011 participants adjudicated for pulmonary embolism or proximal DVT. Date of last follow-up was Sept 18, 2025. The median age of the adjudicated population was 15 years (IQR 13-16); 2567 (64·0%) were female and 1444 (36·0%) were male. 3988 participants had complete data, and 253 (6·3%, 95% CI 5·6-7·2) were diagnosed with pulmonary embolism or proximal DVT within 45 days. The sensitivity of the PERC-Peds rule was 99·6% (95% CI 97·8-100·0), specificity was 19·6% (18·4-20·9), and false-negative rate was 0·1% (0·0-0·8). D-dimer test was ordered in 3161 (78·8%) of 4011 participants. Sequential use of PERC-Peds followed by D-dimer test ruled out pulmonary embolism or proximal DVT in 2167 (54·3%) with a false-negative rate of 0·9% (0·6-1·4). In this multicentre, prospective, observational, diagnostic accuracy study of children with suspected pulmonary embolism in the emergency department, we found a 6·3% prevalence of pulmonary embolism or proximal DVT; in this population, the PERC-Peds negative rule can safely rule out pulmonary embolism. Use of PERC-Peds might reduce low-value diagnostic testing for pulmonary embolism in children and adolescents. US National Institutes of Health.
With the widespread implementation of automated hematology systems, Reflex testing plays a critical role in result verification. However, overly sensitive Reflex rules may lead to excessive repeat testing, increasing workload and prolonging sample turnaround time. This study optimized Reflex rules to improve workflow efficiency while maintaining analytical safety and accuracy. A retrospective analysis was performed on 78,364 CBC results generated by the Sysmex XN-9100 hematology automation line in June 2025, including 43,758 outpatient and 34,606 emergency/ward samples. Reflex rules involving LW, PLT-F, WPC, and RET channels were optimized by differentiating initial and follow-up visit samples, introducing a 7-day historical result fluctuation safety range, and simplifying IP message combinations. Middleware simulation compared total Reflex rates and special-channel repeat counts before and after optimization. Existing autoverification logic, critical alert rules, manual review workflow, and high-risk disease-related repeat testing rules were retained. After optimization, total Reflex rates decreased significantly in both work areas (p < 0.01), from 16.03% to 14.36% in the outpatient area (relative reduction, 10.43%) and from 24.38% to 15.00% in the emergency/ward area (relative reduction, 38.47%). In the emergency/ward area, PLT-F, WPC, and RET repeat counts decreased by 44.86%, 49.19%, and 61.89%, respectively. XN automation line Reflex rule optimization reduced unnecessary repeat testing through initial/follow-up visit differentiation and historical fluctuation thresholds while retaining core risk-interception rules, supporting improved hematology workflow efficiency and reduced reagent consumption.
The use of coronary artery calcium score (CACS) to rule out obstructive coronary artery disease (CAD) remains debated, with performance differing across symptomatic patient subgroups. However, in patients with non-anginal chest pain, CACS may be particularly effective in identifying those who can be deferred from further testing. To investigate the ability of zero CACS to rule out obstructive CAD in a large cohort of patients presenting with non-anginal chest pain. Consecutive patients with non-anginal chest pain who were referred for coronary computed tomography angiography (CCTA) were retrospectively included. Obstructive CAD was defined as ≥1 vessel with ≥50% stenosis on CCTA. Hemodynamically significant CAD was defined as CT-FFR ≤0.80. The study included 3212 patients (age 57 ± 10 years; 59% male). Among the 1404 patients (43.7%) with zero CACS, only 7 (0.5%) had obstructive CAD, resulting in a NPV of zero CACS to rule out obstructive CAD of 99.5%. Two patients (0.1%) exhibited hemodynamically significant CAD, resulting in an NPV of zero CACS of 99.9%. Finally, only one patient (0.7‰) was revascularized. Consequently, among patients with zero CACS, the number needed to test with CCTA was 201 to detect one with obstructive CAD, 702 to detect one with hemodynamically significant CAD, and 1404 to identify one requiring revascularization. In a large cohort of patients with non-anginal chest pain who were referred for CCTA, zero CACS offers excellent rule-out capabilities for obstructive CAD and may be used to defer patients from further testing with CCTA.
Semi-active shoulder exoskeletons strike a balance between active and passive exoskeletons for reducing shoulder load during overhead work. Current assistance strategy focuses on assisting with static tasks, neglecting the requirement of dynamic tasks, e.g. overhead wall painting. This study presents a robust rule-based heuristic assistance strategy for a semi-active shoulder exoskeleton to improve task adaptability. Different from previous studies, the robust rule-based heuristic assistance strategy determines assistance by weighing both angular velocity and displacement to accommodate both static and dynamic tasks. A robust detection mechanism is also proposed to improve its stability under non-uniform and abrupt movements, making it better suited for real-world applications. Experiments on the outputs of the robust rule-based heuristic assistance strategy showed that minimal support (Level 0) was provided for tasks below the overhead region, whereas increased assistance was offered for overhead tasks (Levels 1 to 3), with static tasks (Level 3) receiving greater support than dynamic ones (Levels 1 and 2). Results showed that applying the robust detection mechanism can achieve a reduction of up to 60.3% in the switching times the assistance level changes. Electromyography experiments showed that the exoskeleton with our strategy reduced muscle activation with reductions of up to 52.4%. These results indicate that the proposed exoskeleton can provide effective assistance for both static and dynamic overhead tasks. Our study provides valuable insights into the practical utility and robustness of exoskeletons, thereby accelerating their application in occupational scenarios.
Pediatric head injury is a frequent cause of emergency department neuroimaging worldwide and a major contributor to health care utilization. Although most children with minor head trauma do not sustain clinically important traumatic brain injury (ciTBI), the risk of acute complications necessitates accurate risk stratification. A central challenge is balancing the need to reliably exclude ciTBI against the potential harms of ionizing radiation. Despite high-sensitivity clinical decision rules, computed tomography (CT) remains the dominant imaging modality, with utilization rates approaching 40% in some settings. Current research focuses on AI-based triage tools, enhanced injury registries, and international efforts to standardize imaging thresholds. A narrative literature review evaluated trends in CT utilization in pediatric head trauma, AI-based triage tools, and the emergence of rapid MRI. Findings are extrapolated from recent years and compared with historical data. Only peer-reviewed, English-language studies were included. The implementation of validated clinical decision rules - primarily PECARN - has contributed to a > 25% decline in unnecessary CT utilization in the pediatric head trauma population over the past decade. This reduction is attributed to the widespread adoption of evidence-based risk stratification, structured observation pathways, and parent-shared decision aids, which together maintain a high negative predictive value (NPV) > 99.9%. Emerging technologies including AI triage tools and rapid MRI are promising adjuncts but are not yet established standards of care. The PECARN algorithm with explicit age stratification safely reduces unnecessary neuroimaging, with no increase in readmissions for missed bleeding. Best practice involves applying PECARN criteria alongside careful clinical observation, shared decision-making, and the use of ultra-low CT or rapid MRI when imaging is indicated. Not applicable.
Intracerebral hemorrhage (ICH) imposes a substantial burden on inpatient resources, yet hospital costs and length of stay (LOS) are often evaluated as separate endpoints. This study aimed to identify interpretable clinical-administrative strata and recurrent high-utilization care patterns among spontaneous ICH hospitalizations. This single-center retrospective cohort study included 1,851 spontaneous ICH hospitalizations from 5 November 2022 to 31 October 2024. Clustering variables were restricted to age, admission source, diagnosis-derived hemorrhage-location category, primary ventricular hemorrhage/intraventricular extension, hypertension-coded status, diabetes, and chronic kidney disease/renal failure. Cost-composition ratios, total cost, LOS, procedures, discharge disposition, departments, and acute in-hospital complications were excluded from cluster formation and reserved for descriptive analyses, adjusted modeling, or association-rule mining. Gower dissimilarities with k-medoids clustering were evaluated across K = 2-8 using elbow analysis, average silhouette coefficient, permutation-based gap statistic, subsampling stability, cluster size, clinical interpretability, and parsimony. The K = 3 solution was retained as the parsimonious working solution, with the highest average silhouette coefficient among K = 2-7 (0.440), a 14.7% reduction in within-cluster dissimilarity from K = 2, acceptable subsampling stability (mean adjusted Rand index, 0.702), and no small outlier cluster (minimum n = 308). The three strata were emergency-presentation (n = 450), hypertension-uncoded/lobar-leaning (n = 308), and non-emergency hypertension-coded/deep-ICH (n = 1,093). Unadjusted total cost and LOS differed across clusters, but these differences were attenuated after adjustment for sex, payment method, admission department, secondary-diagnosis burden, complications, and procedures. High-cost and prolonged-LOS association rules were dominated by tracheostomy-centered combinations involving DVT/PE, CVC/PICC, chronic kidney disease/renal failure, pneumonia, respiratory failure, or major neurosurgery. This pathway-oriented framework organized ICH hospitalizations into interpretable baseline clinical-administrative strata and identified recurrent comorbidity/procedure/complication patterns associated with high utilization. These findings may support risk-aware benchmarking and resource management under diagnosis-related group/diagnosis-intervention packet payment reform, although validation using granular clinical severity data is required.
Vulvovaginal candidiasis (VVC) affects approximately 75% of women during their lifetime, yet current diagnostic methods have limitations. This pilot study evaluated Candida albicans enolase 1 (CaEno1) as a diagnostic biomarker for C. albicans-associated VVC, with a view to informing future point-of-care test (POCT) development. A total of 131 vaginal secretion samples were collected from patients presenting with vulvovaginal symptoms at a gynecology department. Samples underwent routine microscopic examination, fungal culture, and CaEno1 detection using a previously developed double-antibody sandwich ELISA (DAbS-ELISA) with sensitivity of 0.33 ng/mL. ROC curve analysis determined optimal diagnostic performance parameters. Among 131 samples, 33 (25.2%) showed positive fungal growth, with C. albicans predominating (72.7% of positive cultures). CaEno1 levels were significantly higher in C. albicans-positive samples compared to negative samples (Mann-Whitney U test, P < 0.0001). ROC analysis yielded an area under the curve of 0.727 (95% CI: 0.613-0.842). At an optimal cutoff value of 0.052 optical density units at 450 nm (OD450), the assay demonstrated 70.8% sensitivity, 78.5% specificity, 42.5% positive predictive value (PPV), and 92.3% negative predictive value (NPV). This study provides the first clinical evidence that CaEno1 can be detected in vaginal secretions and suggests potential rule-out utility for Candida-associated VVC in settings where C. albicans predominates. The favorable NPV observed in this cohort supports its potential use as a screening tool in comparable clinical settings, though cross-reactivity with non-albicans species warrants cautious interpretation alongside clinical findings.
The Eurasian Steppe in the first millennium BCE saw the rise of the Scytho-Siberian archaeological horizon, which would come to stretch from the Altai Mountains in the east to the Black Sea in the west. We examined the genetic profiles of Iron Age Scythians to explore how social status shaped biological relatedness and ancestry patterns. We present genome-wide data from 85 individuals (38 elite and 47 non-elite), including 45 newly sequenced individuals and the first genome-wide data for the Scythian "Golden Man." We identify consanguineous unions, a reduced effective population size, and identity-by-descent links among the elites. Dynastic rule is supported by elite grandparent-grandchild relationships across cemeteries. While ancestries are heterogeneous, elite Iron Age Scythians show lower variation and no detectable patrilocal or matrilocal signal. These findings highlight hereditary status transmission and the emergence of social stratification in ancient nomadic societies.
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Bilinguals' language-switching ability is regulated by language control mechanisms associated with executive control system. Cognitive flexibility (CF), one of the executive functions, is closely linked to language switching. Existing functional magnetic resonance imaging data demonstrate diverse patterns of neural activity elicited in language-switching and CF tasks, and the degree of overlap between the respective brain networks remains obscure. To address this, we examined neural correlates of language switching in young late bilinguals, as well as common and distinct neural mechanisms of language-switching tasks and CF. To this end, we conducted activation likelihood estimation meta-analysis of 107 experiments, extracted from 83 eligible articles with a total of 1977 participants. These studies used the Wisconsin card sorting test (WCST) for assessing rule-discovery and the task-switching paradigm (TSP) for rule-retrieval switching-the two most common tasks in CF research. Language switching, in turn, was measured by language-switching paradigms (e.g., cued picture-naming task). We observed no differences in neural correlates of language switching and TSP (rule retrieval), whereas, when compared with WCST (rule discovery), language-switching-specific activity was detected in the left pre-supplementary motor area/anterior cingulate cortex complex. These results indicate a common nature of language switching and TSP, linking both kinds of switching to rule retrieval. Conjunction analysis of the three tasks revealed common activation in the left intraparietal sulcus/inferior parietal lobule, left superior parietal lobule, and pre-supplementary motor area. Based on our findings, we propose a unified neuroanatomical model of mental switching engaged across all three types of tasks.
Motivational interviewing (MI) is an effective approach for supporting health behaviorchange, but face-to-face delivery is resource-intensive and difficult to scale. Rule-based conversational agents (CAs) can improve access; however, their scripted interactions and limited language flexibility constrain MI delivery. While large language models (LLMs) are increasingly being used for MI coaching, their conversational fidelity and quality compared with human coaches and rule-based CAs remain understudied. This study aimed to describe the development of an LLM-based CA, Artificially Intelligent Motivational Interviewing (Aimi), orchestrated with structured workflows, and to evaluate its feasibility, conversational fidelity, and user perceptions during MI coaching interactions. We developed Aimi using structured LLM workflows designed to enhance MI fidelity. We conducted a within-participants study, where 18 adults interacted with (1) Aimi, (2) a novice MI-trained human coach, and (3) a rule-based CA during live text-based role-play coaching sessions. Transcripts were independently evaluated by an MI expert using the Motivational Interviewing Skill Code, Version 2.0 (MISC-2), to assess MI competency and fidelity. Participants completed a user experience questionnaire to provide general feedback and to assess session alliance, dialogue relevance, empathy, engagement, linguistic quality, and perceived motivation to change. Feedback from users was thematically summarized and categorized under strengths and weaknesses for each approach. Aimi achieved fidelity scores comparable to those of the novice human coach and higher than those of the rule-based CA on summary metrics, including higher reflection-to-question ratios (median 0.84, IQR 0.62-0.92 vs 0.62, IQR 0.42-0.74 vs 0.25, IQR 0.17-0.38), more complex reflections (median 66.67%, IQR 46.97%-76.92% vs 50%, IQR 34.38%-61.88% vs 0.00%, IQR 0%-50%), and greater elicitation of client change talk (median 90.83%, IQR 85.89%-100% vs 73.21%, IQR 63.10%-83.19% vs 66.67%, IQR 57.86%-81.94%). User experience ratings showed no significant differences across conditions. User feedback revealed distinct strengths and limitations across the coaching interactions. Participants described Aimi's interactions as personalized, fluid, and adaptive, though sometimes overly reflective and lengthy. The novice human coach was viewed as empathetic and supportive but slow to respond, whereas the rule-based coach was viewed as efficient and structured yet limited in depth and personalization. This study demonstrates the technical feasibility of structured LLM-workflows for MI coaching and their capacity to maintain conversational fidelity comparable to that of a novice MI-trained human coach. Given the role-play paradigm, single-rater coding, and small convenience sample, these comparative findings should be interpreted as exploratory. Our findings serve as a foundational baseline for the development of scalable behavior change interventions in clinical settings.
This country report examines the relationship between populism and Euroscepticism in Montenegro within the framework of the EUPopLink COST Action. It situates Montenegro as a frontrunner in the EU accession process among Western Balkan countries, characterized by sustained pro-European consensus but increasing political fragmentation and institutional instability. The report identifies key populist actors, including the New Serb Democracy (NSD), Democratic People's Party (DNP), Democratic Montenegro (Demokrate), United Reform Action (URA), Europe Now! (PES), and the Democratic Party of Socialists (DPS), and analyses their ideological profiles and positions toward the European Union. The findings indicate that Euroscepticism in Montenegro is predominantly soft, instrumental, and discursive rather than ideological or programmatic. While identity-based narratives are evident among right-wing actors such as NSD and DNP, other parties employ valence or technocratic populism, using the EU as a benchmark for governance reform or as a rhetorical tool in domestic political competition. Despite growing criticism of EU conditionality and perceived inconsistency, no major political actor advocates withdrawal from the EU integration process. The report further demonstrates that responses to Euroscepticism rely on a combination of institutional reforms, particularly in the rule of law, media governance, and anti-corruption measures, alongside strategic communication of EU benefits. Overall, populist Euroscepticism in Montenegro remains limited in its capacity to shape policy direction, functioning primarily as a mechanism of political contestation rather than a transformative force. This report examines how political parties in Montenegro position themselves toward the European Union (EU) and how populism shapes this dynamic. Montenegro has been advancing toward EU membership for many years, and most political actors continue to support this objective. However, the political landscape has become more polarized, and trust in institutions has declined. Some parties use populist narratives to challenge political elites, corruption, or external influence. Others invoke the idea of Europe to present themselves as modern, reform-oriented, and effective. Even when parties express criticism toward the EU, they rarely oppose accession itself. Instead, they question the EU’s role, consistency, or level of engagement in supporting reforms in Montenegro. Overall, Euroscepticism in Montenegro remains relatively mild and is primarily used as a political tool rather than a basis for policy change. The country’s EU trajectory remains stable, with most actors continuing to view the EU as essential for economic development, strengthening the rule of law, and improving governance.
To estimate the sensitivity and specificity of eye temperature (ET) and rectal temperature (RT) for detecting abnormal temperature in dogs. This single-shelter observational study enrolled dogs without clinical ocular disease. Tests were dichotomized using prespecified reference intervals. A hierarchical Bayesian latent-class model included 2 subpopulations (puppy and adult), dog-level random intercept, and between-test dependence terms. Posterior draws estimated predictive values across pretest probabilities, and prior sensitivity analysis was conducted to evaluate the robustness of the results. Utilizing 238 visit-level observations from 121 dogs (89 puppy visits; 149 adult visits), both tests demonstrated high specificity but low-to-moderate sensitivity. Posterior median sensitivities were 0.40 for ET and 0.32 for RT, while specificities were 0.94 for ET and 0.99 for RT. The parallel rule (OR [any positive]) maximized negative predictive value, whereas the series rule (AND [both positive]) maximized positive predictive value across observed prevalences. Ocular thermography and rectal thermometry demonstrated similar diagnostic performance. For both tests, given that the dog has an abnormal core body temperature, the reading is more likely to be wrong. Given the dog has a normal core body temperature, the reading is likely to be correct. Abnormal temperature readings can inform clinical judgement about the likelihood that the dog's core temperature is abnormal. However, normal readings are not informative about what was already known based on clinical judgment. Abnormal results from either test increase the probability of abnormal body temperature, whereas normal readings should not override clinical suspicion of abnormal temperature status.
Severe dengue is a vascular immunopathology characterized by plasma leakage, thrombocytopenia, hemorrhage, and, in its most critical form, dengue shock syndrome. Although NS1-mediated endothelial injury, glycocalyx disruption, inflammatory myeloid activation, and coagulation/platelet abnormalities have all been implicated, it remains unclear which mechanisms are most consistently supported and whether they form a coherent functional architecture capable of explaining vascular decompensation. This review asks two linked questions: which dengue mechanisms are supported by the contemporary evidence base, and whether the strongest supported components are logically sufficient, when coupled, to generate a synthetic analog of connected endothelial-barrier failure. We conducted a PubMed-indexed systematic review of dengue mechanistic studies published from 2020 to 2025 under a dengue-only eligibility policy. Full texts were assigned to six mechanism families, graded on a five-tier evidence scale, and classified using predefined claim ceilings: C0 empirical restriction, C1_conditional regularity, or C2 exploratory evidence. Meta-analysis readiness was assessed using PICOS criteria. A constraint-first agent-based model (ABM) was then used as a permanent C2 logical sufficiency evaluator to test whether the three strongest evidence families could jointly generate a synthetic analogue of connected endothelial-barrier failure under explicit assumptions. Of 200 retrieved records, 59 were included after full-text adjudication. Three mechanism families reached C1_conditional evidence: NS1-linked vascular permeability (DENV-M01, n=23), endothelial glycocalyx/barrier disruption (DENV-M02, n=17), and myeloid effector activation (DENV-M03, n=12). Receptor gating, coagulopathy/platelet dysregulation, and therapeutic mechanistic targets remained C2 evidence-gap families. Two null randomized trials imposed C0 restrictions: rupatadine did not significantly reduce plasma leakage (RR = 0.68, 95% CI 0.41-1.12), and oseltamivir did not improve time to defervescence (MD =+ 0.1 days, p=0.055). No mechanism family was eligible for quantitative pooling because CI-bearing estimates were sparse and outcome definitions were insufficiently harmonized. In the ABM, the review-supported NS1-barrier-myeloid set generated a spatially connected endothelial-barrier failure analog. This analog emerged when upstream viral/NS1 pressure and myeloid collateral cost exceeded barrier reserve and repair capacity. The regime remained stable under changes in update rule, rule form, and spatial patch scale, indicating that it was not a single implementation artefact. Boundary location was more stable than local execution timing, whereas high heterogeneity intensity produced only bounded boundary displacement. Minimality ablation showed partial, not complete, minimality: upstream pressure and barrier fragility were load-bearing, whereas the myeloid arm was phase-dependent and counter-directional, consistent with a dual role in early containment and late collateral damage within the model. The current evidence supports a minimum-range organizational account of severe dengue vascular decompensation centered on the NS1-barrier-myeloid unit. This account is best interpreted as a competing-constraint model: viral/NS1 pressure, endothelial/glycocalyx barrier preservation, repair capacity, and myeloid effector control can become difficult to maintain within the same physiological window during progression toward vascular leakage. The ABM provides C2-level in silico support for logical sufficiency by showing that these review-supported components can generate a connected endothelial-barrier failure analog under explicit assumptions. It does not establish causal mechanistic validation, molecular equivalence, or patient-level prediction. Claim escalation now requires longitudinal cohorts measuring NS1/viraemia, endothelial barrier injury markers such as SDC1 or Ang-2, and myeloid effector proxies such as sTREM-1 or CXCL10, together with orthogonal functional perturbation assays reporting CI-bearing outcomes.
In 2022, the Swedish Women's Elite Ice Hockey League (SDHL) became the first women's league to introduce bodychecking. Using insurance data, this study examined injury incidence before and after the implementation of this rule. Since 2019, the SDHL has comprised 10 teams with 20-25 players on each. All players in SDHL have license insurance to take care of ice hockey injuries. All injuries that lead to contact with the insurance company are registered in a database. The insurance covers accidental injuries occurring during matches, organized team practices, hockey school sessions, and direct travel to and from these activities. Injury data from all seasons between 2019-2020 and 2024-2025 were analyzed. Injury rates (IR) per 1,000 player-game hours were calculated and compared across seasons and between pre-implementation (2019-2022) and post-implementation (2022-2025) periods. A total of 120 injuries were recorded among 92 players. IR per 1,000 player-game hours increased from 6.6 (95% CI 3.8-10.7) in season 2021-2022 to 16.7 (11.6-23.2) in 2022-2023, with moderately elevated rates remaining in subsequent seasons. When grouped by period before and after body checking implementation, IR increased from 6.0 (4.4-8.1) pre-implementation to 11.0 (8.6-13.7) post-implementation (p < 0.05). The injury incidence was highest during the first season with body checking and declined in subsequent seasons compared with this initial post-implementation peak. The introduction of body checking in the SDHL was associated with a significant increase in injuries recorded through the insurance system, indicating that this rule change may lead to a higher injury burden. More research on this topic is needed if body checking is to be widely incorporated into women's ice hockey.
In child physical abuse cases, a clinical forensic medical examination (CFME) is performed to document medical evidence, such as lesions and scars. In Denmark, however, not all cases are referred by the police to a CFME, and we aimed to study the key characteristics of police reported cases of child physical abuse (N = 136, ages 4-17 years) - case context, the child's disclosure and sociodemographic factors - that could influence the police's selection process. Associations between case characteristics and CFME referrals were studied using univariate and multivariate logistic regression models, which were supported by age- and sex-matched conditional logistic regression models. CFME referrals were found to be less common for cases with children from a low socioeconomic status family or with previously reported concerns (such as a report to the social services), and more common when the violence endured by children involved punching/striking of limbs or left visible marks. Moreover, the number of victims in a sibship seemed to be associated with CFME referrals. Referrals were not influenced by parents' origin or the suspect-child relationship. A biased referral process may lead to unequal case handling and undermine the rule of law. By identifying the characteristics relevant to this process, we aimed to contribute to a systematic and consistent approach to case management. Future qualitative interview studies with police officers and prosecutors and studies focused on larger populations can offer further valuable insights into the selection process.
Urinalysis is commonly used to diagnose urinary tract infections (UTIs), but its accuracy is reduced in children undergoing clean intermittent catheterization (CIC) because of asymptomatic pyuria. This study aimed to determine the optimal urinary leukocyte cutoff value for diagnosing UTIs using a hemocytometer. This retrospective observational study included children (<16 years) on CIC at a tertiary children's hospital between April 2020 and March 2025. Quantitative urinalysis was performed using a UF-1500 hemocytometer. UTI was defined as bacteriuria ≥104 CFU/mL accompanied by antimicrobial treatment. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff for urinary white blood cell (WBC) count. Among 134 patients (2871 specimens), 101 specimens were classified as infection cases (3.5%). Median urinary WBC counts were markedly higher during infection (1514.6/mm3) than during non-infectious periods (21.2/mm3; p < 0.001). ROC analysis yielded an area under the curve of 0.950 (95% CI, 0.935-0.964). The optimal cutoff value was 220.8/mm3, corresponding to 94.1% sensitivity, 84.7% specificity, and 99.7% negative predictive value. WBC counts did not significantly differ among infections caused by different uropathogens. Hemocytometer-based quantification of pyuria provided high diagnostic accuracy and may be particularly useful as a rule-out test for UTIs in children undergoing CIC.
Operating LiNixCoyMn1-x-yO2 (NCM, x ≥ 0.92) cathodes at high temperature/voltages (≥4.3 V or 45°C) to achieve high capacity inevitably leads to accelerated capacity fade. Despite extensive research into cycling behaviour under various cut-off voltage and phase degradations, the fundamental mechanisms governing internal phase transformations, lattice deformations, and internal stress generation remain poorly understood. By using HAADF-STEM characterization with DFT and MD simulations, we disclose a new chemo-mechanical degradation rule: lattice bending leads to the formation of O1/LiNi2O4 (Fd-3m) and unstable intermediate transition phase Ni3O4 (Cmmm), the bending and distortion of the lattice are the direct causes of internal stress. Unlike previous findings, both RS, Ni3O4/LiNi2O4 and O1 phases were detected in various crack regions. Stress concentration from bending-induced O1-LiNi2O4 and LiNi2O4-Ni3O4-RS (Fm-3m) phase transformations leads to intracrystalline cracking, impairing capacity retention. Lattice deformation can lead to the emergence of stress and the formation of micro-cracks, even during the O3-O1 phase transition. This work confirmed the relationship between phase transformation and stress in the in cracked areas and stress. Meanwhile, this research provides new insights into the degradation mechanism for lithium-ion batteries, specifically paving the way for the design and optimization of high-energy-density.
The 13C NMR chemical shielding of cyclic ketones presents a long-standing spectroscopic paradox: cyclopentanone (5-CK) exhibits the most deshielded carbonyl resonance, breaking the monotonic trend predicted by classical hybridization models, ring strain theories, and partial atomic charges. While high-resolution FTIR spectra (fundamental, 1st, and 2nd overtones), force constant analysis, and experimental CO bond dissociation energies confirm a monotonic weakening of the CO bond as ring size increases, the 13C NMR chemical shift follows a non-linear trend. Through a combination of spectroscopy and Natural Chemical Shielding (NCS) analysis, we reconciled this dichotomy. It was demonstrated that the 'cyclopentanone anomaly' is not a direct result of ground-state bond strain or %s-character redistribution (Bent's Rule) but is instead driven by a maximal paramagnetic orbital contribution. Specifically, the σ33 principal component of the shielding tensor, oriented perpendicular to the σ-bond of CO is identified as the primary contributor to deshielding. It reaches a maximum in the five-membered ring due to optimized magnetic-field-induced mixing of the oxygen lone pairs and the π* orbitals. This study provides a definitive resolution to a decades-old puzzle, shifting the conceptual framework for interpreting NMR shifts in strained systems from simple ground-state models to a rigorous analysis of paramagnetic shielding tensors.
This exploratory study investigates the association between smoking and premature ovarian insufficiency (POI) to inform smoking cessation strategies and support women's reproductive health. Using literature data mining and association rule analysis, we constructed a protein-protein interaction (PPI) network to identify potential core targets associated with POI. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore biological functions and signaling pathways potentially involved in POI pathophysiology. In a parallel clinical study, we measured urinary cotinine levels in Chinese patients presenting with infrequent menstruation (May 2020-May 2025). Participants were categorized according to established clinical criteria for the presence or absence of POI, and statistical analyses were conducted to evaluate the association between cotinine exposure and POI risk. Data mining identified six cigarette smoke components associated with POI-related ovarian dysfunction: nicotine, benzo[a]pyrene (BaP), nicotine-derived nitrosamine ketone (NNK), acrolein, 1, 3-butadiene, and cotinine. Topological network analysis suggested a potential central role for these compounds in tobacco-related POI mechanisms. However, degree, betweenness, and closeness centrality only reflect topological position within the constructed network and do not confirm dominant biological function. Moreover, more extensively studied compounds tend to have more documented molecular targets in public databases, which may artificially inflate their network centrality. GO enrichment indicated that these compounds may interfere with granulosa cell proliferation by modulating the cell cycle, while KEGG analysis linked them to pathways involved in progesterone-mediated oocyte maturation, cell cycle regulation, and oocyte meiosis. In the clinical cohort, higher urinary cotinine levels were associated with increased POI prevalence (quartile analysis) and a nonlinearly elevated odds risk (restricted cubic spline), particularly above the median. Urinary cotinine demonstrated weak positive associations with follicle-stimulating hormone (FSH) and luteinizing hormone (LH), but no significant initial association with anti-Müllerian hormone (AMH). Logistic regression suggested a moderate predictive value for POI, which persisted after multivariable adjustment and subgroup analyses. Notably, cotinine exhibited a nonlinear association with AMH (minimal change below the median, followed by a sharper increase above it), while maintaining linear relationships with FSH and LH. Multivariable linear regression indicated consistent positive associations between cotinine and all three hormonal markers. These findings suggest that smoking may be associated with POI through plausible biological pathways identified via network pharmacology, and that urinary cotinine levels correlate with both POI risk and key ovarian reserve markers. Given the observational and exploratory nature of this study, the results raise hypotheses regarding smoke-associated ovarian dysfunction rather than establishing definitive causality, and they support further prospective research alongside targeted clinical and public health interventions.