Previous research has documented associations between children's emotional understanding (EU) and social-cognitive abilities such as theory of mind (ToM) and executive function (EF); however, findings in preschool-aged children remain inconsistent. One potential explanation is that language ability, which develops rapidly during early childhood, has often not been examined concurrently with these abilities. The present study focused on individual differences in EU and examined how ToM, EF, and language ability relate to EU in Japanese preschool children, with particular attention to the mediating role of language. Participants were 90 children aged 3-6 years (M = 60.34 months, SD = 10.82). Children completed a false belief task, emotional understanding tasks, executive function tasks assessing cognitive flexibility and working memory, and a receptive vocabulary test. Correlational analyses, hierarchical multiple regression analyses, and bootstrapped mediation analyses were conducted. EU was positively associated with ToM, EF, and language ability. Language ability accounted for significant variance in EU beyond age and gender. When language ability was included in the model, the association between ToM and EU was no longer significant, whereas the association between EF and EU remained significant but was attenuated. Mediation analyses revealed significant indirect effects of both ToM and EF on EU through language ability, indicating that the association between ToM and EU was accounted for by language ability, whereas EF showed both direct and indirect associations with EU. These findings suggest that language ability plays a central role in linking social-cognitive abilities to emotional understanding in early childhood. Theory of mind was associated with emotional understanding primarily through language, whereas executive function showed both direct and indirect associations via language ability. By modeling multiple predictors simultaneously, this study provides an integrated account of individual differences in emotional understanding and elucidates the distinct pathways through which cognitive and social-cognitive skills are associated with emotional development.
Human mobility fundamentally shapes the spatial spread of infectious diseases, yet the level of detail required from mobility data to accurately inform epidemic models remains unclear. Mobile phone records offer unprecedented resolution on population movements, but little attention has been devoted however to determining (i) which aspects of mobility are epidemiologically relevant and (ii) what level of data resolution is necessary to capture spatial invasion dynamics. Using mobile phone records from 9.5 million users in Senegal (approximately 80% of the population), we systematically compare three approaches to aggregating mobility data for epidemic modeling. These approaches span a range of resolutions: high-resolution tracking of all individual displacements between consecutive visited locations (HR), medium-resolution accounting for time spent in all visited locations (MR), and low-resolution identification of the most-visited location (LR). We incorporate these mobility representations into a metapopulation epidemic model that explicitly accounts for transmission from residents, visitors, and returning travelers, and simulate diseases with varying transmissibility corresponding to controlled epidemic conditions, seasonal influenza-like transmission, and highly transmissible pathogens. We find that preserving all observed displacements in individual trajectories does not necessarily improve the epidemiological relevance of mobility in pathogens spatial transmission. Instead, displacement-based networks fragment long-range trips and underestimate key spatial connections relevant for disease spread. In contrast, approaches that capture where individuals spend most of their time (such as home, work, or school) more accurately reproduce spatial invasion patterns. Accounting for additional daily activities beyond these primary locations provides little additional epidemiological information. Our results suggest that lower-resolution mobility indicators capturing time spent at key locations are sufficient to inform predictive epidemic models. These findings have important implications for both epidemic modeling and data governance, indicating that mobile phone data can be aggregated to reduce privacy issues while still providing the essential information needed to model spatial disease transmission.
Soft tissue sarcomas are rare mesenchymal tumors accounting for less than 1% of all cancers, originating intra-abdominally or retroperitoneally in 40% of cases.1 Leiomyosarcomas are among the most common retroperitoneal sarcomas (RPS), with surgery as primary treatment option whenever an R0 resection is feasible.2 Taken into account the concept of histology-guided surgery for RPS, surgery for leiomyosarcomas often does not require wide resections, allowing preservation of adjacent organs when not directly infiltrated.3 Nevertheless, high-grade leiomyosarcomas of abdominal major vessels may require extendend multi-organ resections and complex reconstructions, thus requiring a multidisciplinary surgical approach.4-8 All these factors highlight the need to manage such cases in referral centers.9 METHODS: We present the case of a 65-year-old patient with a locally advanced leiomyosarcoma of the right external iliac vein, infiltrating the ipsilateral external iliac artery, ureter and psoas major muscle. After multidisciplinary discussion, the patient underwent surgery with removal of the mass en bloc with infiltrated structures. The reconstructive phase was carried out with the assistance of vascular surgery and urology teams. The postoperative course was complicated by a ureterovesical anastomotic leak, treated conservatively. This video demonstrates the step-by-step radical removal of a locally advanced vascular leiomyosarcoma, highlighting the related critical aspects of vascular control and complex reconstructions, as well as the importance of management of these cases in referral centers and with a multidisciplinary surgical approach. Although surgical management of locally advanced vascular leiomyosarcomas is often challenging, a multidisciplinary approach and adequate surgical expertise can reduce surgery-related risks and lead to improved outcomes.
Test negative design studies allow for COVID-19 vaccine effectiveness (VE) estimation while minimizing selection bias from healthcare seeking and testing practices. However, failure to consider correlation between vaccination behaviors may result in biased COVID-19 VE estimates. Using different methods to account for potential correlation between COVID-19, influenza, and respiratory syncytial virus (RSV) vaccination status, we investigated variability in VE estimates of the 2023-2024 COVID-19 vaccine against COVID-19-associated emergency department and urgent care (ED/UC) encounters and hospitalizations during the 2023-2024 respiratory virus season. Data were leveraged from VISION, an electronic health record-based platform. VE estimates ≥7 days post vaccination did not increase by more than 5 percentage points against ED/UC encounters and 3 percentage points against hospitalizations when accounting for influenza and RSV vaccination status or excluding influenza and RSV positive controls. As the magnitude of this influence depends on season-specific factors, ongoing monitoring is warranted.
Despite well-documented poor health outcomes among homebound older adults with diabetes, little is known about how homebound status affects glycemic outcomes. This study examined the association between homebound status and glycemic control among community-dwelling older adults with diabetes and identified key factors associated with glycemic outcomes. We conducted a cross-sectional analysis using data from the 2017 National Health and Aging Trends Survey (NHATS). Participants included community-dwelling older adults aged 65 years and older with diabetes. Glycemic control was measured by hemoglobin A1c (HbA1c). Being homebound was defined as the inability to leave one's home independently. A fully adjusted linear regression model that accounted for predisposing, enabling, and need factors was used to assess the association between homebound status and HbA1c. All analyses accounted for the complex survey design. Homebound status was not independently associated with HbA1c in adjusted models. HbA1c was associated with age ≥ 85 years (β = -0.25, p = 0.01), number of comorbid conditions (β = -0.08, p = 0.005), depression (β =  + 0.62, p < .001), anxiety (β = -0.43, p = 0.003), and receipt of food assistance (β = -0.51, p = 0.004). These findings suggest that mental health needs and food access are important factors to consider alongside mobility in diabetes care. Collectively, the results highlight the potential value of a holistic, patient-centered approach to diabetes care among older adults that incorporates medical, psychosocial, and social domains.
Drought events have become increasingly common in Central Asia, increasing the risk of vegetation degradation. In this study, the resilience of vegetation to drought and its drivers was investigated across different seasons. The findings revealed that western Central Asia faced a notably high incidence of spring droughts, characterized by longer durations and greater severity than droughts in other seasons. In contrast, the Aral Sea Basin experienced fewer droughts in summer and autumn, although these droughts were more severe and intense and had longer durations. Croplands, particularly those in northern Kazakhstan, generally demonstrated relatively low resistance but relatively strong resilience. In contrast, sparsely vegetated areas in regions such as southern Xinjiang and areas downstream of the Aral Sea Basin presented high drought resistance but relatively low resilience. Precipitation and vapour pressure deficit (VPD) had the most significant impact on drought resilience in Central Asia, with a combined contribution of 55.18%, particularly in the northern and eastern regions of the area. The vegetation in spring was characterized by the highest resistance and resilience levels (40.67% and 40.65%, respectively) in Central Asia, followed by those in summer. In terms of vegetation loss, vegetation in spring accounted for the greatest proportion (44.03%), followed by that in summer, at 31.07%. The main characteristics of drought (duration and intensity) were the major factors influencing the loss of vegetation, especially in grasslands and sparsely vegetated areas. During prolonged summer droughts (>40 months), grasslands and sparse vegetation suffered substantial declines in gross primary productivity (GPP). In contrast, forests exhibited more severe GPP reduction at a drought peak of around 2 and intensity above 1.5. Quantifying the resilience and loss of vegetation to drought across different seasons can aid in the formulation of effective strategies to prevent and manage vegetation degradation in Central Asia.
Acinetobacter baumannii, particularly multidrug-resistant strains, is a high-burden nosocomial pathogen with limited therapeutic options. Eravacycline is increasingly used off-label despite limited supporting clinical evidence. This meta-analysis aimed to evaluate the effectiveness and safety of eravacycline versus non - eravacycline-based regimens in adults with resistant A. baumannii infections. MEDLINE, Embase, and Cochrane Central were searched for studies evaluating eravacycline regimens in hospitalized adults with A. baumannii infection. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Data were analyzed using R statistical software. Fifteen studies encompassing 462 patients were included. Populations consisted predominantly of older adults, with respiratory tract infections representing the most common source of infection (77.6%). Carbapenem-resistant A. baumannii accounted for 84.4% of evaluable cases. No statistically significant differences were observed between eravacycline and non - eravacycline-based regimens in all-cause mortality (RR 1.06; 95% CI 0.46-2.47), clinical cure (RR 0.90; 95% CI 0.77-1.07), or microbiological eradication (RR 0.88; 95% CI 0.56-1.37). Complementary single-arm pooled estimates among eravacycline-treated cohorts were favorable. This meta-analysis strengthens the evidence base for eravacycline effectiveness in resistant A. baumannii infections and supports its consideration when preferred regimens are not feasible; adequately powered randomized trials are needed to define optimal positioning.
Rotavirus (RV) is a leading cause of diarrhea-related morbidity and mortality among children under 5 y globally, accounting for approximately one-third of childhood diarrhea cases in China. Vaccination is the most effective strategy for RV prevention. Rotarix, a liquid RV vaccine with a 2-dose schedule, has been modified to exclude porcine circovirus (PCV) components. This study evaluated the immunogenicity and safety of Rotarix PCV-free vs Rotarix in healthy Chinese infants. In this Phase III, observer-blinded, randomized, multicenter study, infants aged 6-16 weeks were randomized to receive two oral doses of either vaccine (Rotarix PCV-free or Rotarix) 1-month apart. Primary endpoints were seroconversion rates (SCRs) and geometric mean concentrations (GMCs) of serum anti-RV IgA antibodies 1-month post-Dose 2. Non-inferiority was defined as a 95% CI lower limit (LL) for both SCR ≥ -10% and GMC ratio ≥ 0.67. Safety was assessed by monitoring solicited adverse events (AEs) within 14 d post-vaccination, unsolicited AEs within 31 d, and serious AEs (SAEs) throughout the study. Of 2000 randomized participants, 96.8% (Rotarix PCV-free) and 96.6% (Rotarix) received both doses. SCR: 84.9% (Rotarix PCV‑free) vs 88.7% (Rotarix); difference -3.73% (95% CI - 6.93, -0.55; p = .0317), met non‑inferiority ≥-10%. GMC ratio did not meet non‑inferiority: ratio 0.71 (95% CI 0.60-0.84; p < .0001), 95% CI LL < prespecified 0.67. The most common systemic AE was cough/runny nose (Rotarix PCV-free 30.6% vs Rotarix 25.4%); SAEs occurred in 26.1% and 25.2% of participants, respectively, with none deemed vaccine-related. Rotarix PCV-free demonstrated non-inferior SCRs vs Rotarix. Both vaccines showed comparable safety profiles.ChinaDrugTrials.org registration: CTR2023189.EudraCT: 2020-000972-38.
This study examined temporal trends in co-infection associated with sexually transmitted and blood-borne infections (STBBIs) in Ontario and assessed associations with behavioural, social, and structural determinants within a syndemic framework. A retrospective, population-based approach was used to analyse 269,814 positive test records for chlamydia, gonorrhea, syphilis, and HIV from Ontario's public health notifiable diseases database across seven Public Health Units (PHUs) between 2013 and 2023. Co-infection was defined as ≥ 2 STBBIs diagnosed within 14 days. Descriptive statistics, Chi-square, and multivariable logistic regression were used to identify behavioural, social, and structural predictors of co-infection. Area-level marginalization was assessed using ON-Marg indices. STBBI rates steadily increased across all PHUs over the study period, with Toronto, Northwestern, and Thunder Bay District showing the highest burden. Co-infections accounted for 5.71% of infection episodes and increased significantly over time, with a 10.20% annual increase estimated using negative binomial regression (p = 0.010). Male and transgender individuals had higher odds ratios of co-infection compared to females. Behavioural factors (anonymous sex, multiple partners, condomless sex, substance use) and social vulnerabilities (underhoused/homeless, survival sex, sex work) were associated with co-infection. ON-Marg dimensions in housing, material resources, and racialized populations were also associated with higher co-infection rates while age/labour force marginalization showed an inverse relationship. The findings provide evidence consistent with syndemic patterns among STBBIs in Ontario, shaped by behavioural, social, and structural inequities. Integrated, equity-focused interventions and improved integration of co-infection data within disease surveillance systems may support more effective prevention strategies as co-infection rates rise. RéSUMé: OBJECTIFS: L’étude porte sur les tendances temporelles de co-infection associées aux infections transmissibles sexuellement et par le sang (ITSS) en Ontario et évalue les associations avec les déterminants comportementaux, sociaux et structurels dans un cadre syndémique. MéTHODES: À l’aide d’une approche populationnelle rétrospective, nous avons analysé 269814 dossiers de tests positifs pour la chlamydia, la gonorrhée, la syphilis et le VIH dans la base de données ontarienne des maladies à notification obligatoire dans sept bureaux de santé publique (BSP) entre 2013 et 2023. La co-infection était définie comme étant ≥ 2 ITSS diagnostiquées sur une période de 14 jours. La statistique descriptive, le khi-carré et la régression logistique multivariée ont servi à identifier les prédicteurs comportementaux, sociaux et structurels de la co infection. La marginalisation régionale a été évaluée à l’aide de l’indice de marginalisation ontarien (ON-Marg). RéSULTATS: Les taux d’ITSS ont régulièrement augmenté dans tous les BSP sur la période de l’étude, les charges de morbidité les plus élevées étant observées à Toronto, dans le Nord-Ouest et dans le district de Thunder Bay. Les co-infections représentaient 5,71% des épisodes d’infection et ont augmenté de façon significative avec le temps, avec une augmentation annuelle de 10,20% estimée par régression binomiale négative (p = 0,010). Les hommes et les personnes transgenres présentaient des rapport de cotes de co-infection plus élevés que les femmes. Les facteurs comportementaux (relations sexuelles anonymes, partenaires multiples, relations sexuelles sans condom, usage de substances) et de vulnérabilité sociale (logement précaire/itinérance, sexe de survie, travail du sexe) étaient associés à la co-infection. Les dimensions du logement, des ressources matérielles et des populations racialisées de l’indice ON-Marg étaient aussi associées à des taux de co-infection plus élevés; pour la dimension de l’âge/la population active, la relation était inverse. CONCLUSION: Ces constats confirment le caractère syndémique des ITSS en Ontario, qui sont influencées par les iniquités comportementales, sociales et structurelles. Des interventions intégrées, axées sur l’équité, et une meilleure intégration des données de co-infection dans les systèmes de surveillance des maladies pourraient favoriser des stratégies de prévention plus efficaces face à l’augmentation des taux de co-infection.
Ecological risk assessments estimate chemical exposures in wildlife from contaminant concentrations within their surrounding environment. This approach precludes a detailed understanding of interactions between biota and contaminant sources. It also overlooks how the uneven and irregular use of space by animals influences variability in exposure. Here, we conducted a meta-analysis to examine whether site-specific variability in lead exposure was associated with the home range size and movement-related traits of terrestrial bird species. We constructed a series of linear models to test the effect of ecological and environmental predictors on variability in lead exposure, which we quantified using the coefficient of variation for site-specific feather lead concentrations. Accounting for variance across study, site, species, and phylogeny, we show that birds with larger home ranges exhibited more variable levels of lead exposure than those with more restricted movement patterns. This relationship was moderated by foraging niche and was significant in ground foraging birds but non-significant in generalists and arboreal-aerial foragers, which may relate to differences in dietary lead sources and niche complexity. Site-specific variability in feather lead concentrations was further structured by feather type, with contour feathers exhibiting lower variability than wing, tail, or mixed feather samples. Our findings highlight how the use of space at varying scales might influence divergent patterns of chemical exposure in terrestrial birds. We discuss how incorporating movement-related traits into wildlife risk assessments can reduce uncertainties associated with spatial variability in exposure and improve the ecological relevance of monitoring outcomes.
Hydrogen atom abstraction (HAA) reactions by ṄH2 radicals from fuel molecules are critical in ammonia combustion chemistry, particularly in the co-combustion of ammonia with high reactivity fuels, as these C-N cross-reactions play a pivotal role in the development of ammonia blend fuel mechanisms. This study explored the influence of multi-structural effects on the kinetics and thermodynamics of HAA reactions from a range of representative alkanes (n-butane, iso-butane, n-pentane, iso-pentane, n-heptane, and iso-octane) and oxygenated species (butanol, methyl propyl ether and ethyl ethanoate). Rate constants were determined using on-the-fly canonical variational transition-state theory with small-curvature tunneling and multi-structural torsional anharmonicity. The calculated kinetics data were compared with previously reported results obtained from traditional transition state theory with unsymmetrical Eckart tunneling and 1-D hindered rotor treatment. Additionally, this study investigated the effects of recrossing corrections and small-curvature tunneling, revealing the differences between different tunneling treatment and the influence of recrossing on reaction kinetics. These findings provide critical insights into reaction mechanisms and offer alternative kinetic data for advancing ammonia-hybrid combustion models. This work emphasizes the necessity of accounting for anharmonicity and multi-structural effects in rate constants and thermochemistry calculations, particularly for relatively larger molecules with multiple conformers.
To assess attachment patterns and stress coping strategies in patients with NIH and non-NIH phenotypes of PCOS. Additionally, to explore the correlations between attachment and stress coping, as well as the correlations between BMI, hirsutism, and psychological variables. 62 patients with NIH phenotypes and 32 patients with non-NIH phenotypes were enrolled into the study. Each patient underwent gynecological and endocrinological diagnostics. Attachment Styles Questionnaire was used to assess attachment, and Mini-Cope Inventory was applied to assess stress coping. The anxious-ambivalent attachment pattern was more pronounced in patients with "classic" NIH phenotypes. Patients with NIH phenotypes were less likely to use active coping, planning, and acceptance as coping mechanisms for stress. Furthermore, we observed a statistical trend in the differences in the following avoidance coping strategies: denial (p = 0.066), behavioral disengagement (p = 0.084), and self-blame (p = 0.066). In both phenotypes secure attachment correlated positively with seeking emotional support, whereas anxious-avoidant correlated negatively with this mechanism. In turn, anxious-ambivalent attachment in both phenotypes correlated negatively with acceptance and positively with behavioral disengagement and self-blame. Attachment patterns did not correlate with either BMI or the severity of hirsutism. Patients with different PCOS phenotypes differ in their attachment patterns and stress coping strategies. Attachment styles are correlated with specific coping mechanisms for stress. Personalized approach that takes into account the clinical variability of PCOS and differences in psychological functioning should be applied.
This work presents a compact dual-band millimeter wave (mmWave) antenna that operates at 17-27 GHz and 36-43 GHz, with resonance frequencies centred at 21.1 GHz and 38.3 GHz, respectively. The multiple embedded arc-shaped mmWave antenna geometry provides compact, effective dual-band operation. The concentric arcs of the antenna structure are effectively optimized to produce a dual band of operation with good impedance matching. The resulting antenna has gain of 4.8 dBi at 26 GHz and 6.1 dBi at 37 GHz frequencies. The developed antenna is intended for widespread usage in satellite and 5G networks. Despite providing significant bandwidth for 5G and other next-generation communication systems, mmWave frequencies are susceptible to path loss, particularly in congested urban areas. This study further investigates the performance of the designed dual-band mmWave antennas in various urban environments. Both Line-of-Sight (LOS) and Non-Line-of-Sight (NLOS) scenarios are considered to capture realistic deployment conditions. To accurately model propagation behaviour, the analysis incorporates the ABG and CI path-loss models, which comprehensively account for environmental factors such as shadowing, diffraction, and precipitation.
Several studies investigating injury burden have used "standard" formulae for injury rates when calculating their 95% confidence intervals. However, this may have led to artificially narrow confidence intervals because the authors' calculations did not account for violations of important underlying assumptions such as (1) clustering (e.g. when some athletes have multiple injuries), and (2) other assumptions unrelated to clustering. Although previous authors have recommended appropriate methods such as bootstrapping to solve these challenges, there is little guidance for sport medicine researchers on how to implement bootstrapping given the complexity of data in our field. The purposes of this article are (1) to illustrate when the "standard" formulae for injury rate confidence intervals can be used in sport medicine research, (2) why the standard formulae for injury rate confidence intervals are inappropriate when estimating injury burden and (3) provide more detailed instructions on how to use bootstrapping for confidence intervals in the context of any sport medicine study that includes repeated measures.
Despite sustained elimination efforts, leprosy transmission persists in Uganda. The World Health Organization's Towards Zero Leprosy strategy targets zero infections and Grade 2 Disability (G2D) by 2030. Uganda's National TB and Leprosy Strategic Plan aims to reduce child cases to <3% and G2D to <5%. We assessed temporal trends and spatial distribution of leprosy in Uganda from 2020-2024 to evaluate progress toward these targets. We conducted a descriptive analysis using national surveillance data from the District Health Information System 2 (DHIS2). Newly diagnosed leprosy cases reported between 2020 and 2024 were analyzed by age, sex, clinical type, and disability grade. Incidence was calculated using annual mid-year population estimates from the Uganda Bureau of Statistics. Temporal trends were assessed using the Mann-Kendall test and Sen's slope estimator. Spatial distribution of incidence, child cases, and G2D proportions was examined using QGIS at the regional and district levels. Between 2020 and 2024, Uganda reported 1,935 new leprosy cases, with an overall incidence of 8.8 per 1,000,000 population. Multibacillary disease accounted for 86% of cases, and 21% presented with Grade 2 Disability (G2D). Children aged ≤15 years comprised 14% of cases, consistently exceeding the national elimination target of 3%. No significant monotonic trend was observed in overall incidence (p = 0.89), child proportion (p = 0.069), or G2D proportion (p = 0.14). Spatial analysis demonstrated persistent concentration of high incidence in the West Nile region, with 9 of 13 districts bearing the highest disease burden. Elevated G2D proportions were observed intermittently in the Teso and Ankole regions. Leprosy incidence in Uganda remained relatively stable from 2020 to 2024; however, persistently high proportions of multibacillary disease, child cases, and G2D indicate ongoing transmission and delayed diagnosis in specific regions. Targeted interventions, including strengthened contact tracing and active case detection in high-burden areas, are essential to accelerate progress toward national elimination goals.
Environmental exposures, such as railway noise and vibration, might be unequally distributed across communities. This study investigates how area-level socioeconomic conditions and migration density vary with the distribution of railway noise and vibration in Southwest Sweden. We employed linear regression and spatial autoregressive models to analyse data from the EpiVib study, which included 7,280 individuals living within 1 km of a trafficked railway in four regions of Southwest Sweden. The study assessed the relationships between exposure levels and area-level socioeconomic conditions and migration density using Statistics Sweden's small-area division system (i.e., DeSO). Areas with lower socioeconomic conditions and higher migration density are exposed to higher levels of railway noise and vibration. Spatial autocorrelation analysis revealed that noise levels were higher in areas with more than 20% of inhabitants having a foreign background. The impact of area-level indicators on noise exposure varied with urbanicity, with higher exposure levels in rural and suburban areas compared to urban areas. Vibration exposure was more pronounced in areas with fair socioeconomic conditions and higher migration density. The study shows inequalities in railway noise and vibration exposure, according to area-level socioeconomic conditions and migration density. Areas with better socioeconomic conditions are consistently less exposed to both railway noise and vibration. Furthermore, the impact of area-level indicators on noise exposure depends on urbanicity levels. Future research, interventions and policies that account for area-level socioeconomic factors as well as urbanicity are advised to ensure environmental equity and justice regarding rail traffic exposures.
Accurate CO2 emission data are essential for monitoring, reporting, and verification (MRV) in energy-intensive sectors such as cement production. In China's carbon market, emission regulation in the cement sector still relies primarily on material balance-based accounting with low temporal resolution, which constrains real-time supervision and data quality assessment. To improve data timeliness and reliability, online monitoring approaches are increasingly applied. However, individual methods exhibit distinct systematic uncertainties and operational limitations. This study proposes an integrated online monitoring framework that combines three complementary approaches for cement production: second-level material-based monitoring, second-level flue gas-based monitoring, and daily 3D inventory-based monitoring. Using operational data from a 5,000 t/d clinker production line in southern China, the performance, limitations, and applicability of each method for carbon market MRV were assessed. Results show that material-based monitoring is sensitive to material metering points. Flue gas-based monitoring directly measures CO2 emissions but is strongly affected by stack flow-field heterogeneity and production load variations, underscoring the importance of appropriate flow measurement configuration. Although the 3D inventory-based method has a lower temporal resolution, it provides an independent and stable reference for cross-validation of high-frequency emission estimates. Further analysis indicates that material-based and flue gas-based emissions do not scale proportionally when production load adjusts, reflecting flow-field changes. By integrating high-frequency data reconstruction with SAITS and cross-validation against daily 3D inventory estimates, the proposed framework enhances consistency and reliability across monitoring methods. The findings demonstrate that the combined use of multiple online monitoring approaches can effectively mitigate individual method limitations and support high-integrity MRV in China's cement sector.
Patients with chronic kidney disease (CKD) in maintenance hemodialysis are vulnerable to adverse hospital-based outcomes. The present study aimed to describe the association between clinical variables and hospital admission and mortality in patients ascribed to an outpatient hemodialysis unit in northeastern Mexico. We conducted a retrospective analytical study with data recorded during the period of January to June 2025. 215 adult patients with maintenance hemodialysis were included. Associations between clinical data and hospitalizations, readmissions, and in-hospital mortality were analyzed. In the present study, 32.8% of patients had CKD related to diabetes mellitus and hypertension. 53% of patients received two hemodialysis sessions per week. The median number of comorbidities was two and hypertension was the most frequent comorbidity. 37% of patients required at least one hospital admission; the most common cause of hospitalization was volume overload followed by infections. 12% of hospitalized patients died. Hospital admission was associated with cancer, erythropoietin use, fewer hemodialysis sessions and uncontrolled hypertension. Mortality was associated with peripheral artery disease, erythropoietin use and male gender. In multivariable analyses, no independent predictors of in-hospital mortality were identified. We observed a tendency towards an association between diuretic use and hospital readmissions. Comorbidity burden, pharmacologic treatment and hemodialysis prescription should be taken into account in patients with maintenance hemodialysis to lower hospital-based adverse outcomes. Diagnostic and therapeutic strategies aimed at diminishing volume overload may have a significant impact reducing hospitalizations in outpatient hemodialysis patients.
Lumbar arthrodesis is commonly required for a number of spinal pathologies. The increasing use of cannabis and its legalization in many countries has the potential to impact spine surgical outcomes. There is a scarcity of research on the association between cannabis use and the need for revision surgery after lumbar fusion. The purpose of this study is to evaluate the relationship between cannabis use and the need for revision surgery after lumbar arthrodesis. A systematic review, utilizing a comprehensive search strategy, was implemented to identify relevant studies, focusing specifically on the association between cannabis use and the incidence of revision surgery following lumbar fusion procedures. The primary outcome was the need for revision surgery. A subsequent meta-analysis was then performed. Data were synthesized using odds ratios (ORs) and the Mantel-Haenszel method, with a random-effects model to account for between-study variability. In addition, heterogeneity was assessed using I² statistics, sensitivity analyses were conducted to evaluate the robustness of the findings, and potential publication bias was examined using funnel plots. Five studies with a total of 9983 patients were included in the meta-analysis. Our analysis showed a significantly increased risk of revision surgery in patients with cannabis use compared with nonusers [OR: 2.27 (95% CI: 1.27-4.05)]. The high heterogeneity (I²=95%) suggests differeces in patient populations, definitions of cannabis use, and follow-up durations across the included studies. Cannabis use is associated with a significantly increased risk of revision surgery after lumbar fusion. These findings highlight the importance of targeted preoperative counseling and postoperative monitoring.
This narrative review synthesises advances in multimodal neuroimaging that, over the past five years, have substantially refined models of schizophrenia pathophysiology. Converging evidence from structural, diffusion, functional, molecular, and computational studies challenges static, regionally focal, or single-neurotransmitter accounts of the disorder. Instead, contemporary findings support a framework in which schizophrenia reflects heterogeneous, developmentally anchored deviations in distributed neural circuits that manifest as large-scale network instability. Structural and diffusion imaging reveal individually variable patterns of cortical, white matter, and thalamic subnuclei alterations. Functional MRI demonstrates impaired regulation across salience, default mode, executive, and thalamocortical systems, while positron emission tomography and magnetic resonance spectroscopy implicate subregion-specific dopaminergic and glutamatergic abnormalities. Computational modelling further indicates that these multilevel disturbances may converge on altered synaptic gain and excitation-inhibition imbalance within cortical microcircuits, providing a mechanistic substrate for systems-level dysconnectivity. Importantly, heterogeneity is not incidental but central: normative modelling and biologically informed subgrouping demonstrate that while group-level effects are robust, the anatomical and neurochemical loci of deviation vary substantially across individuals. We propose that shared network instability may arise from diverse developmental perturbations across cortico-striato-thalamo-cortical circuits. Future progress will depend on longitudinal, harmonised, and multimodal study designs capable of modelling individual trajectories across risk stages and treatment exposure. Conceptualising schizophrenia as a dynamically evolving circuit disorder therefore offers an integrative framework that bridges molecular dysfunction and clinical expression and provides a roadmap for mechanism-informed stratification, while clinical translation remains a longer-term objective.