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Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is a major cause of neonatal mortality and morbidity worldwide. Its multifactorial etiology remains incompletely understood, and Cyprus reports among the highest PTB rates in Europe, highlighting the need for population-specific evidence. This study aimed to investigate the sociodemographic, behavioral, and obstetric history factors of PTB in Cyprus and to examine whether these factors differed according to the degree of prematurity. A matched case-control study was conducted at a tertiary referral hospital in Cyprus, designated as the national center for maternal and neonatal care. Eligible participants were women delivering between January 2019 and December 2022. Conditional logistic regression was conducted to determine the significant associations between sociodemographic, behavioral and obstetric history with PTB. Subgroup analysis of extreme to very (<32 weeks) vs moderate to late PTB (32 to <37 weeks) was also conducted. Participants were 978 women (489 cases <37 weeks, 489 controls &#x2265;37 weeks). Maternal age increased PTB odds (AOR=1.21; 95% CI: 1.06-1.38), as did previous gynecological surgeries (AOR=1.74; 95% CI: 1.30-2.34), cesarean section (AOR=1.87; 95% CI: 1.28-2.73), and miscarriage (AOR=1.44; 95% CI: 1.03-2.00). Primiparous women had reduced odds versus nulliparous (AOR=0.71; 95% CI: 0.52-0.98). In subgroup analysis, higher BMI (AOR=0.96; 95% CI: 0.92-0.99), prior cesarean (AOR=0.54; 95% CI: 0.30-0.99), and asylum seeker status (AOR=0.19; 95% CI: 0.05-0.67) were linked to lower odds of extreme PTB. Future prospective studies are needed to further investigate and confirm the observed associations between sociodemographic, behavioral, and obstetric factors with PTB and degree of prematurity.

Caspofungin is an echinocandin antifungal agent widely used for the treatment of invasive candidiasis because of its broad antifungal activity. Although ocular adverse events are listed among uncommon reactions in the Summary of Product Characteristics, detailed clinical descriptions of acute visual impairment temporally associated with caspofungin therapy are scarce. We report the case of a 21-year-old man who developed candidemia due to Candida guilliermondii following complex spinal surgery. Antifungal therapy with caspofungin was initiated in accordance with current clinical guidelines. Within 24&#x2009;hours of treatment initiation, the patient experienced a bilateral and symmetrical reduction in visual acuity, affecting both near and distance vision. Comprehensive ophthalmologic evaluation, including slit-lamp examination, fundoscopy, and optical coherence tomography, revealed no structural ocular abnormalities. Neurological assessment and neuroimaging were unremarkable. Visual symptoms persisted with fluctuating intensity during ongoing caspofungin administration and resolved completely within 48&#x2009;hours after drug discontinuation, following a switch to micafungin. No recurrence of visual impairment was observed during follow-up. Causality assessment using the Naranjo algorithm indicated a probable association between caspofungin and the adverse event. This case describes a transient and fully reversible visual disturbance temporally associated with caspofungin therapy, in the absence of identifiable ocular or neurological pathology. While a causal relationship cannot be established based on a single observation, this report contributes descriptive safety data relevant to real-world clinical practice. Clinicians should consider careful evaluation of new-onset visual symptoms occurring during antifungal therapy and ensure appropriate pharmacovigilance reporting to support the identification of rare or unexpected adverse drug reactions.

Isolated chondral fractures of the knee are rare injuries in pediatric patients and may be difficult to diagnose because of the absence of osseous attachment. We report an 11-year-old boy who sustained a right knee injury during soccer. Although radiographs and computed tomography showed no abnormalities, magnetic resonance imaging (MRI) revealed an isolated chondral fracture of the lateral femoral condyle. Fully automated 3-dimensional MRI visualized a full-thickness cartilage defect and enabled precise measurement of lesion morphology and area. The patient underwent anatomical reduction and fixation using bioabsorbable pins. Follow-up MRI at 5 months demonstrated complete cartilage healing, and the patient returned to competitive soccer 8 months postoperatively without symptoms. This case highlights the diagnostic and clinical utility of fully automated 3-dimensional MRI for preoperative assessment, surgical planning, and postoperative evaluation of isolated chondral fractures in pediatric patients, while demonstrating that timely fixation can achieve successful cartilage healing and return to sport.

Extended reality (XR) has seen increased usage in shoulder arthroplasty for both intraoperative guidance and surgical training, but its impact on technical accuracy and performance has not been quantified across studies. The objective of this analysis was to determine the impact of XR on educational efficiency and glenoid guidewire placement error. Two separate meta-analyses of randomized or quasi-experimental studies were performed. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses search guidelines, 24 studies were identified in XR-based shoulder surgery education. After applying inclusion, 3 studies involving 55 participants were meta-analyzed. Using the same Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 35 studies were identified in XR-guided shoulder arthroplasty. After applying inclusion criteria, 7 studies involving 349 guidewire placements were meta-analyzed. In the surgical education studies, XR-trained participants completed procedures faster than controls, but OSAT (Objective Structured Assessment of Technical Skills) scores did not significantly differ. Across the glenoid guidewire studies, XR guidance reduced version error and inclination error versus freehand, but entry point error was not significantly different between XR-guided procedures and freehand. XR-based tools appear to offer meaningful benefits for shoulder arthroplasty, but their impact may be domain-specific. XR education may substantially improve operative efficiency, while XR guidance may enhance the angular accuracy of glenoid guidewire placement without clearly changing entry point error.

Scars present repercussions beyond physical appearance, affecting emotional well-being and social interactions. Few studies have compared how different scar types, including keloids (K), hypertrophic scars (HS), and post-burn scars (BS), relate to psychosocial outcomes. Assess body appreciation and screening indicators of anxiety and depression in patients with scars of different etiologies. We conducted an exploratory cross-sectional study including 42 patients with scars allocated to three groups: K, HS, and BS. Body image perception was measured using the Body Appreciation Scale (BAS), and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Mean BAS and HADS scores were compared across groups, and associations with clinical features were explored. The combined prevalence of anxiety and depression symptoms increased descriptively from HS (0%) to K (5.9%) to BS (20%) (p&#x2009;=&#x2009;0.11). Higher odds of combined anxiety and depression symptoms were associated with facial involvement (p&#x2009;=&#x2009;0.017; OR&#x2009;=&#x2009;19.8, 95% CI 1.70-229.65), and functional impairment (p&#x2009;=&#x2009;0.039; OR&#x2009;=&#x2009;18.0, 95% CI 1.59-202.95) features more frequent among burn patients, although confidence intervals were wide. BAS scores did not differ significantly among groups (p&#x2009;=&#x2009;0.78), indicating moderate-to-high body appreciation across scar types (mean BAS: 3.68 burns, 3.77 hypertrophic, 3.85 keloids). Anxiety (p&#x2009;=&#x2009;0.57) and depression (p&#x2009;=&#x2009;0.43) scores were similar. Different scar types were associated with broadly similar psychosocial outcomes. Emotional vulnerability among patients with burn scars appears more closely related to scar-related features, such as facial location and functional impairment, than to scar etiology alone. Findings should be interpreted cautiously and regarded as hypothesis-generating. This study examined how different types of scars, including burns, hypertrophic scars, and keloids, may affect emotional well-being and body image. Adults with these scars completed questionnaires assessing body appreciation, anxiety, and depression. Overall, levels of body appreciation were similar across groups, suggesting that many people can adapt to visible or symptomatic scars over time.Participants with burn scars showed a tendency toward higher levels of anxiety and depressive symptoms. However, these emotional difficulties were more strongly associated with features such as facial involvement and functional limitations than with the type of scar itself. This highlights the importance of considering the broader clinical and social context in which scars occur.As this was an initial study with a relatively small number of participants, the findings should be interpreted as exploratory rather than definitive conclusions. Overall, the results suggest that while many people adapt well to scars, those accompanied by greater visibility or functional impact may be linked to emotional vulnerability. Comprehensive scar management should therefore address not only physical and psychological support but also promote recovery that considers the person as a whole.

We assessed whole hippocampal and subfield volumes, in association with memory ability, in a sample including cognitively unimpaired (CU) older adults and those in early syndromic stages of pathological aging, here subjective cognitive decline (SCD) and mild cognitive impairment (MCI). Participants completed a battery of neuropsychological tests and a 3T magnetic resonance imaging brain study that included high-resolution T2-weighted images of hippocampus and its subfields: subiculum; cornu ammonis 1, 2, and 3 (CA1, CA2, CA3); and dentate gyrus (DG). Significant differences were found in the left whole hippocampus, left subiculum, CA1, and DG volumes in the MCI group compared to the CU or SCD groups. Least absolute shrinkage and selection operator regression techniques revealed that left subiculum and left CA1 volume significantly predicted memory ability above and beyond whole hippocampal and other subfield volumes. We found clinical differences in memory ability in older adults were associated with focal differences in specific hippocampal subfield volumes.

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder mediated by autoantibodies directed against acetylcholine receptors (anti-AChRs), in which thymic pathology plays a central pathogenic role. While thymomas predominantly arise in the anterior mediastinum, ectopic locations represent a rare and clinically distinct entity. Among these, preaortic ectopic thymomas are exceedingly rare, and their association with refractory MG has not previously been described. We report a 48-year-old woman with generalized MG with bulbar predominance, presenting with an eight-month history, confirmed by markedly elevated anti-AChR antibodies (91.1 nmol/L), a positive neostigmine test, and a pathological decrement exceeding 10% on repetitive nerve stimulation across three nerve-muscle pairs. The patient experienced a life-threatening myasthenic crisis requiring ICU admission and failed to achieve sustained remission despite corticosteroids, pyridostigmine, intravenous immunoglobulins (IVIg), and two cycles of rituximab (1000 mg at day 1 and day 15, followed by 1000 mg at six months), fulfilling criteria for refractory MG. After repeated immunotherapy failures and a normal chest X-ray, a prior external CT, initially interpreted as normal or possibly representing ectopic thyroid tissue, was followed by a dedicated thoracic CT at our institution, which identified a left-lateralized anterior mediastinal soft-tissue mass in close preaortic contact with the ascending aorta (42 &#xd7; 28 &#xd7; 41 mm). Complete surgical resection via median sternotomy was performed. Histopathological investigation confirmed a WHO type B2 thymoma (2021 WHO classification), with identification of Hassall's corpuscles confirming the thymic origin of the mass. The patient achieved complete clinical remission (Besinger score 100/100; MGC score 0/50) following postoperative IVIg and was subsequently tapered off corticosteroids. This case highlights the necessity of systematic thoracic CT in all refractory MG regardless of plain radiograph findings and prior imaging reports&#xa0;and underscores the potential importance of complete surgical excision of preaortic ectopic thymic tissue in achieving disease control. Following a systematic search of PubMed, Scopus, and Google Scholar, we did not identify any previously reported case of a WHO type B2 preaortic ectopic thymoma described as the underlying cause of refractory generalized MG.

Based on the Theory of Unpleasant Symptoms (TOUS), this study aimed to examine the relationship between premenstrual syndrome (PMS) and test anxiety among nursing college students, and to explore the serial mediating roles of bedtime procrastination and attention in this association. A multicenter cross-sectional survey was conducted among 791 female nursing students from eight medical and health vocational colleges in China. Participants completed the General Information Questionnaire, Premenstrual Syndrome Scale (PSS), Bedtime Procrastination Scale (BPS), Multi-Dimensional Attention Rating Scale (MARS), and Test Anxiety Scale (TAS). Pearson correlation analysis, multiple linear regression, and structural equation modeling with 5,000 bootstrap resamples were performed. Mean scores of PSS, BPS, MARS, and TAS were 6.26&#xb1;4.85, 27.38 &#xb1; 6.022, 35.91&#xb1;4.47, and 18.42&#xb1;7.96, respectively. PMS was positively associated with bedtime procrastination and test anxiety and negatively associated with attention (all P<0.001). Multiple linear regression identified bottled drink intake frequency, menstrual cycle, thinking/feeling personality type, only-child status, PMS, bedtime procrastination, and attention as significant predictors of test anxiety (P<0.05). Structural equation modeling showed that PMS had a significant direct effect on test anxiety (&#x3b2;=0.20, 95% CI: 0.12-0.28). Bedtime procrastination and attention significantly mediated this association, including a serial mediation pathway (&#x3b2;=0.03, 95% CI: 0.01-0.06). The total indirect effect accounted for 50% of the total effect. PMS was associated with test anxiety among nursing students, both directly and indirectly through the serial mediating roles of bedtime procrastination and attention. Within the TOUS framework, these findings advance understanding of the physiological-behavioral-cognitive pathway underlying test anxiety and suggest potential intervention targets for improving mental health among nursing students.

Insomnia affects health, well-being, and productivity. Despite recommendations favoring Cognitive Behavioral Therapy for Insomnia (CBT-I) as first-line treatment, hypnotic medications remain widely used. To examine the frequency and types of sleep medications used by individuals with insomnia symptoms seeking psychological treatment, as well as factors associated with hypnotic use. The present cross-sectional study included 1,158 adults with insomnia symptoms recruited from a specialized service between 2021 and 2022. Participants completed online questionnaires assessing sociodemographic characteristics, medication use, and standardized measures of insomnia severity (Insomnia Severity Index), anxiety, and depression (Hospital Anxiety and Depression Scale). Descriptive analyses and multivariate logistic regression were performed. From the total (n&#x2009;=&#x2009;1,158), 60% of participants reported current use of sleep medication. The most frequently used classes were Z-drugs and benzodiazepines, followed by sedative antidepressants. Greater insomnia severity was the primary factor associated with hypnotic use (odds ratio&#x2009;=&#x2009;1.14; p &#x2009;<&#x2009;0.001). White participants were also more likely to use hypnotics, regardless of insomnia severity. Pharmacological treatment remains predominant among individuals with insomnia symptoms, despite recommendations for CBT-I as the first-line treatment. These findings highlight the importance of expanding access to behavioral interventions and promoting the rational use of sleep medications in Brazil.

Neonatal mortality remains one of the most pressing global health challenges, disproportionately affecting low- and middle-income countries. In Ethiopia, complex interrelated factors contribute to high neonatal mortality rates, creating a multifaceted public health concern that demands comprehensive investigation. Despite the magnitude of this challenge, there exists a notable lack of longitudinal studies that examine the temporal patterns of neonatal deaths, survival, and associated risk factors throughout the complete neonatal period. This study addresses this gap by evaluating survival outcomes and identifying determinants of mortality among neonates admitted to the neonatal intensive care unit at Zewditu Memorial Hospital, a referral facility serving a high-burden urban population in Addis Ababa, Ethiopia. A retrospective cohort study of 1,014 neonates admitted to the neonatal intensive care unit from September 11, 2020 to September 10, 2023 was conducted. Systematic random sampling was used to select patients. An electronic data collection method was used, and the data were exported to STATA version 17.0 for cleaning and analysis. Bi-variable and multivariable Cox proportional hazard regression models were employed to identify mortality risk predictors. Kaplan-Meier survival estimates and log-rank tests were used to compare survival probabilities. Model adequacy was assessed using the Cox-Snell residual test. Over 7,945 neonate-days, the mortality incidence rate was 13.72 deaths per 1,000 neonate-days (95% confidence interval (CI) [11.37-16.55]), with most deaths occurring within the first week. Significant predictors of mortality risk were extremely low birth-weight (<1,000 g; Adjusted Hazard Ratio (AHR) = 18.94, 95% CI [7.89-45.23]), very low birth weight (1,000-1,499 g; AHR = 5.09, 95% CI [2.75-9.43]), perinatal asphyxia (AHR = 3.52, 95% CI [2.25-5.49]), neonatal sepsis (AHR = 2.47, 95% CI [1.28-4.77]), respiratory distress syndrome (AHR = 1.65, 95% CI [1.01-2.68]), and meconium aspiration syndrome (AHR = 2.35, 95% CI [1.20-4.57]). This study found associations between elevated neonatal mortality rates and birth weight and specific perinatal complications as key factors linked to survival. The predominance of deaths within the first week, particularly among neonates with low birth weight, perinatal asphyxia, sepsis, respiratory distress syndrome, and meconium aspiration syndrome, necessitates the implementation of risk-stratified care and intensive early monitoring. These findings provide evidence for targeted interventions that could substantially reduce neonatal mortality in resource-constrained healthcare settings.

Robot-assisted retrohepatic inferior vena cava (IVC) thrombectomy (RA-IVCT) is a high-risk procedure. We previously proposed caudate lobectomy for complex retrohepatic tumor thrombus, demonstrating safety and feasibility. Nonetheless, RA-IVCT for patients with tumor thrombus around the hepatic vein and involving the IVC wall (T3c disease) represents the most challenging scenario with a high complication rate. To develop the stepwise and reproducible 3C technique, and to evaluate its feasibility and safety. We conducted a comparative study of 12 patients who underwent RA-IVCT using the 3C technique, with 12 patients as controls who underwent the previously reported RA-IVCT technique. The 3C technique is indicated for thrombus around the hepatic vein, suspected IVC wall invasion, and well-developed collateral circulation. First, suprahepatic IVC control was established. Second, a caudate lobectomy was performed via parenchymal transection between the paracaval portion and the Spiegel's lobe. Third, tumor-bearing IVC cavectomy was performed through caudal-to-cephalic stapling. Baseline data, perioperative outcomes, and short-term survival rates were analyzed. All 3C procedures were completed robotically, whereas four controls required open conversion. The 3C group had a shorter liver mobilization time (126&#xa0;min vs 182&#xa0;min, p&#xa0;=&#xa0;0.015), less blood loss (850 ml vs 2450 ml, p&#xa0;=&#xa0;0.002), lower transfusion volume (p&#xa0;=&#xa0;0.005), and fewer complications (p&#xa0;=&#xa0;0.031). Organ function and survival rates were comparable. Limitations included small sample size, single-center experience, and nonrandomized design. The 3C technique is a safe, stepwise, and reproducible robotic approach for retrohepatic tumor thrombus with IVC wall invasion.

Late failure of early-generation AFX endografts (Endologix Inc) remains a relevant challenge, sometimes presenting as combined type IA/IIIA endoleak many years after apparently successful endovascular aneurysm repair. We report an 85-year-old man who developed rapid sac enlargement 13 years after AFX-Strata implantation (Endologix Inc) due to modular disconnection and proximal cuff migration. He was treated with relining using a custom-made semi-inner branch endograft, with adjunctive proximal thoracic extension to seal a residual endoleak. Completion angiography and follow-up computed tomography angiography confirmed complete exclusion and branch patency, with uneventful recovery. This case highlights the need for lifelong surveillance after AFX implantation and supports semi-inner branch relining for high-risk patients.

Tobacco use is a major preventable cause of morbidity and mortality, and Cognitive Behavioral Therapy (CBT) may address the cognitive, behavioral, and relapse-related mechanisms that sustain smoking. This review evaluated the efficacy of CBT for smoking cessation by synthesizing controlled studies reporting smoking abstinence and smoking reduction outcomes. Within this systematic review and meta-analysis, a search was performed in PubMed, Web of Science, Scopus, ScienceDirect, SpringerLink, ACM Digital Library, IEEE Xplore, and Google Scholar for studies published from 1 January 2000 to 15 January 2026. Eligible studies were randomized controlled trials or controlled quasi-experimental studies of people who smoked and compared CBT, delivered face-to-face or remotely, with a non-CBT control condition. Outcome data were extracted for smoking abstinence and smoking reduction. Risk-of-bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized controlled studies. Odds Ratios (ORs) were pooled using DerSimonian and Laird random-effects models, with fixed-effect estimates used only as sensitivity analyses. Fourteen studies were included. Eleven studies contributed to the smoking abstinence meta-analysis, and five contributed to the smoking reduction meta-analysis. For smoking abstinence, the random-effects pooled OR was 1.60 (95% CI: 0.95-2.70; z=1.76; p=0.078; I2=83.70%). For smoking reduction, the random-effects pooled OR was 1.96 (95% CI: 0.66-5.81; z=1.21; p=0.226; I2=83.64%). Risk-of-bias assessments indicated low-risk, some-concerns, or moderate-risk ratings across included studies; no included study was judged to have a critical risk-of-bias. CBT showed a favorable direction of effect for smoking abstinence, but the random-effects estimate was imprecise, and heterogeneity was substantial. Evidence for smoking reduction was also not statistically conclusive. The findings should therefore be interpreted cautiously, and future trials should clarify treatment moderators, standardize outcome definitions, and refine CBT protocols for different cessation goals.

Background Family medicine plays a central role in strengthening primary healthcare systems and addressing evolving population health needs, particularly in regions undergoing rapid healthcare transformation. Over the past 15 years, the Emirates Health Services (EHS) Family Medicine Residency Program in the United Arab Emirates (UAE) has aimed to develop a competent family medicine workforce capable of delivering comprehensive, community-oriented, and patient-centered care. Methods This sequential mixed-methods study evaluated the evolution and perceived educational outcomes of the EHS Family Medicine Residency Program between 2009 and 2025. Quantitative data were collected using a structured survey administered to program alumni and current fourth-year residents (R4), while qualitative data were obtained through focus group discussions with residents, alumni, and faculty members. Quantitative analyses included descriptive statistics, non-parametric subgroup comparisons, and Spearman correlation analyses. Qualitative data were analyzed using inductive thematic analysis. Findings were integrated during interpretation. Results Of 71 eligible participants, 64 completed the survey (response rate: 90.1%), including 56 alumni and eight current R4 residents. Overall satisfaction with the residency program was high, with a median satisfaction score of 4.55/5.00. Faculty teaching, supervision, and academic day activities received the highest ratings, whereas hospital-based training and work-life balance demonstrated comparatively greater variability. Median perceived competency and preparedness scores were 4.36/5.00 and 4.37/5.00, respectively. Satisfaction demonstrated moderate positive correlations with perceived competency (Spearman &#x3c1; = 0.60, p < 0.0001) and preparedness for independent practice (&#x3c1; = 0.64, p < 0.0001). Outcome scores differed across post-residency duration groups, with alumni more than 10 years post-residency reporting the highest satisfaction, perceived competency, and preparedness scores. Qualitative findings suggested substantial program evolution toward a more structured, learner-centered, and competency-oriented training model, with strengths in academic-clinical integration, supervision, assessment systems, ambulatory learning, and resident professional development. Persistent challenges included workload pressures, administrative burden, and variability in hospital-based supervision. Conclusion Over the past 15 years, the EHS Family Medicine Residency Program has undergone substantial development toward a more structured and competency-oriented training model. Participants generally perceived the program positively in relation to supervision, educational experiences, preparedness for independent practice, and professional development. Ongoing operational and workload-related challenges warrant continued program refinement and longitudinal evaluation.

Chronic obstructive pulmonary disease (COPD) represents the third leading cause of death globally, affecting 213.39 million people, yet approximately 70% of cases remain undiagnosed due to insufficient spirometry utilization in primary care settings. We developed machine learning-based COPD classification models using nationally representative data from 8061 participants aged &#x2265;40 years in the National Health and Nutrition Examination Survey 2007-2012. Least Absolute Shrinkage and Selection Operator (LASSO) regression with repeated ten-fold cross-validation systematically selected sixteen features from 33 candidate variables. We compared twelve machine learning algorithms. SHapley Additive exPlanations (SHAP) analysis provided model interpretability. CatBoost demonstrated optimal performance on the validation set with an area under the receiver operating characteristic curve (AUC) of 0.788, a sensitivity of 0.706, and a specificity of 0.728. SHAP analysis identified age and smoking duration as dominant risk factors, revealing non-linear relationships, including body mass index's U-shaped association with COPD risk and synergistic age-smoking interactions. Decision Curve Analysis confirmed net clinical benefit across risk thresholds of 0.1 to 0.6. This study establishes a machine learning framework combining systematic feature selection, comprehensive algorithm evaluation, and explainable artificial intelligence for COPD risk classification using readily available clinical data. The model achieved a clinically appropriate sensitivity-specificity balance through threshold optimization, demonstrating potential for risk-stratified spirometry referral in primary care settings. External validation in independent populations represents the essential next step before clinical implementation.

Accurate seismic resilience assessment is critical for engineering structure design and risk management. Traditional seismic resilience assessment methods widely adopt simplified bounding assumptions for the dependencies between component failure events, most commonly presuming either complete correlation or full uncorrelation of component failures. These over-simplifications inevitably introduce substantial systematic bias, leading to pronounced overestimation or underestimation of the actual seismic performance and resilience of structural systems. To address this, this paper proposes a system-level analytical framework using Copula functions to model complex dependencies between component failure events.&#x2022;The proposed method delivers a more accurate, high-probability resilience estimate within traditional theoretical bounds.&#x2022;It quantifies true system resilience by capturing correlation structures overlooked by conventional methods.&#x2022;This framework provides a reliable basis for performance-based seismic design and risk decision-making.

Leclercia adecarboxylata is a rare opportunistic Gram-negative organism that has increasingly been recognized as a pathogen in immunocompromised patients. In pediatric populations, infections are uncommon and rarely reported, particularly in Thailand.Case presentation: We report a 3-year-old Thai boy with acute myeloid leukemia in the induction phase who presented with febrile neutropenia and right knee cellulitis following minor trauma. Pus culture grew L. adecarboxylata, which was confirmed by MALDI-TOF mass spectrometry, while blood culture remained negative. Despite profound neutropenia, the infection remained localized without bacteremia. The patient was treated with intravenous ceftazidime and amikacin, followed by oral amoxicillin-clavulanic acid, for a total of 14 days, with complete clinical recovery. This case highlights L. adecarboxylata as a potential pathogen in immunocompromised children with skin and soft tissue infections, particularly following environmental exposure. Clinicians should be aware that L. adecarboxylata may cause clinically significant skin and soft tissue infections and, in high-risk patients, has also been associated with invasive infections, including bacteremia.

Selective serotonin reuptake inhibitors (SSRIs) are widely used as first-line treatments for major depressive disorder (MDD) and anxiety disorders, with common adverse effects, including sexual dysfunction, anxiety, insomnia, and appetite changes, although seizures have also been reported, particularly in the presence of risk factors such as older age, family history of epilepsy, neurological comorbidities, and high antidepressant dosages. We describe two patients who developed generalized tonic-clonic seizures associated with SSRI therapy. The first case is a man with SSRI-resistant MDD and multiple medical comorbidities who experienced five generalized tonic-clonic seizures while receiving various antidepressants. The second case is a woman with generalized anxiety disorder (GAD) who developed two generalized tonic-clonic seizures temporally related to paroxetine use. In both cases, extensive investigations, including laboratory tests, electroencephalogram (EEG), CT, and MRI, yielded normal results, suggesting a potential drug-associated etiology. Both patients were subsequently switched to the atypical antidepressant agomelatine, which was followed by a complete cessation of seizures and marked improvement in mood and anxiety symptoms. These observations underscore the need to consider seizures as a potential adverse event of SSRIs and suggest that agomelatine could be considered an alternative pharmacological option for patients at risk of antidepressant-associated seizures.

Infection prevention and control (IPC) behaviors among healthcare workers are influenced by multiple components and complex features of the work system. Complexity refers to the multicomponent, non-linear, and context-dependent characteristics of system elements, and is increasingly recognized as a key feature of healthcare delivery. However, evidence on the role of IPC complexity in these relationships remains limited. A cross-sectional survey was conducted in 3 branch hospitals of a tertiary hospital in Wuhan, China. A total of 833&#xa0;healthcare workers completed a structured questionnaire assessing IPC person, organization, tools and technology, tasks, internal environment, external environment, IPC complexity, and IPC behaviors based on Systems Engineering Initiative for Patient Safety (SEIPS) model. Structural equation modeling and bias-corrected bootstrap analyses were used to evaluate direct and indirect associations. IPC complexity (&#x3b2;= 0.106, P=0.048) positively associated with IPC behaviors. IPC tasks (&#x3b2;= 0.172, P=0.003) and internal environment (&#x3b2;= 0.221, P<0.001) directly associated with IPC behaviors; IPC person (95% CI:0.001-0.033, P=0.015), internal environment (95% CI:0.009-0.088, P=0.015) and external environment (95% CI:0.007-0.075, P=0.018) indirectly associated with IPC behaviors through the complexity. IPC behaviors were linked to multiple work system factors, with complexity serving as an important intermediate correlate. Efforts to improve IPC practice should address task demands, environmental support, and perceived work complexity rather than focusing on individual behaviors alone.