Medication adherence is defined as the degree to which the medications taken reflect the prescribed intention and is influenced by various factors. Different factors, such as parental trauma or parenting style, may influence their child or children's medical treatment adherence. Authoritative, or "flexible," parenting is known to develop the most nurturing relationship between parent and child or children. The relationship between parental factors, such as parenting style and trauma level, and their influence on child medication adherence is being explored. This study examines the relationship between parental trauma, parenting style, and their child or children's adherence to medical recommendations. Participants were recruited through Amazon's Mechanical Turk, an online crowdsourcing platform. Participants were aged 18 years or older, a caregiver for at least 1 child younger than the age of 18 years, and had at least 1 child who was prescribed medication within the past 3 months. Parental trauma level was measured via the Adverse Childhood Experiences Questionnaire, and parenting style was measured via the Parental Authority Questionnaire-Revised. Descriptive statistics, including chi-square tests, 2-tailed t tests, and adjusted logistic regressions, were used to determine the association between parental trauma, parenting style, and their child or children's medical adherence. A total of 720 participant responses were analyzed. Children who were medically adherent were younger (P=.02). Caregivers' mean age was 36.8 (SD 7.97) years, and 35.4% (n=255) identified as male. An increase in caregivers' adverse childhood experiences score was marginally associated with an increased risk of medication nonadherence among their children (adjusted odds ratio 0.94; P=.07). Similar to other studies, this study showed that parents of children who adhere to medical treatment practice an authoritative parenting style. Uniquely, it also showed that an increased adverse childhood experiences score was only marginally associated with an increased risk of medical nonadherence.
Long short-term memory (LSTM) models were developed using rainfall and soil moisture data to predict soil moisture at various depths in an Asian pear orchard. Two types of rainfall inputs were tested: hourly rainfall data treated as individual values and event-based rainfall data, where cumulative rainfall was calculated by applying the minimum inter-event time threshold (12 h). Soil moisture was measured at depths of 20, 40, and 60 cm from the soil surface during 2023 and 2024 using frequency domain reflectometry. The models were trained to predict soil moisture at time horizons of 't + 1', 't + 3, 't + 6', and 't + 12' when 't' is present time. Short-term predictions more accurately followed the observed soil moisture trends than long-term predictions. During the collection period, rainfall varied from 0.5 mm to 48.5 mm per hour. Soil moisture contents increased immediately following the onset of rainfall. These results are consistent with existing knowledge. As soil depth increased, soil moisture contents tended to increase and respond more gradually to rainfall. During rainfall, in the topsoil (20 cm depth) moisture content fluctuated significantly, while the subsoil (60 cm depth) remained relatively stable for several hours after rainfall ended. The model performance was evaluated using mean absolute error, root mean square error (RMSE), and normalized RMSE values. In both models using hourly and event-based rainfall inputs, errors in soil moisture prediction tended to increase with longer forecast time horizons. However, these errors were significantly lower when using event-based rainfall data. These findings indicate that event-based rainfall is a more effective input for LSTM models in predicting soil moisture in an Asian pear orchard, and such models can support precision irrigation systems that optimize water use by delivering the right amount of water at the right time.
Plasma glial fibrillary acidic protein (GFAP), a marker of astrocyte reactivity, is elevated across multiple neurodegenerative conditions, including Alzheimer disease. However, its role in neurodegeneration and cognitive decline driven by cerebrovascular pathology, independent of β-amyloid (Aβ) copathology, remains poorly characterized. We investigated whether plasma GFAP is associated with medial temporal atrophy and cognition across a spectrum of cerebrovascular burden in Aβ-negative cognitively impaired individuals. In this cross-sectional multicenter study, Aβ PET-negative cognitively impaired participants were recruited from South Korean memory clinics. Plasma GFAP was measured using ultrasensitive Simoa assays. White matter hyperintensity burden was graded using the Fazekas scale and stratified into low (LVP: Fazekas 1) and high (HVP: Fazekas 2-3) cerebrovascular burden groups. Medial temporal gray matter density was assessed using voxel-based morphometry, and hippocampal and amygdalar volumes were derived from T1-weighted MRI adjusted for intracranial volume. Linear regression, interaction, and bootstrap mediation models were used to assess associations among GFAP, brain structure, and cognition. A total of 324 participants were included (LVP n = 203; HVP n = 121; median age 73 years [interquartile range 66-78]; 67.9% female). Compared with LVP, HVP participants were older (75 vs 71 years; p < 0.0001), had lower Mini-Mental State Examination (MMSE) scores (22.7 vs 24.5; p = 0.005), and higher plasma GFAP (136.7 vs 112.1 pg/mL; p = 0.001). Higher GFAP was associated with lower medial temporal gray matter density in HVP (β = -0.311; p = 0.001) but not LVP (β = -0.012; p = 0.858), with a significant GFAP-vascular burden interaction (β = -0.309; p = 0.008). In HVP, higher GFAP was associated with smaller hippocampal (β = -0.179; p = 0.044) and amygdalar volumes (β = -0.169; p = 0.049) and lower MMSE (β = -0.194; p = 0.039). Medial temporal atrophy statistically explained the GFAP-MMSE association (indirect β = -0.071, 95% CI -0.140 to -0.010; p = 0.016). Vascular comorbidities (diabetes, dyslipidemia, hypertension) did not modify the GFAP-cognition association. In Aβ-negative cognitively impaired individuals with high cerebrovascular burden, elevated plasma GFAP is associated with medial temporal atrophy and cognitive decline, suggesting GFAP may capture astrocyte-reactivity relevant to vascular cognitive impairment beyond amyloid pathology. These cross-sectional findings require confirmation in longitudinal and ethnically diverse cohorts.
The primary aim of this study was to evaluate the diagnostic utility of the Structured Inventory of Malingered Symptomatology (SIMS) in detecting feigned cognitive impairment, specifically through self-reported cognitive and neurological symptoms, among older adults. The study was carried out at the University Hospital Kralovske Vinohrady in Prague, Czech Republic. The study included 172 participants: 56 patients with cognitive impairment (33 patients with MCI and 23 patients with dementia), 54 healthy elderly volunteers as a simulation group, and 62 healthy elderly honest responders. SIMS was used as the primary research tool. Cognitive performance was evaluated using the RBANS and the MoCA. Emotional status and functional abilities were measured using the GDS-15, BAI, and FAQ. Our results support the utility of SIMS in older adults, as the instrument significantly distinguished feigned symptoms from genuine cognitive impairment. At the proposed cutoff score of > 20, the SIMS Total Score yielded 100% sensitivity and specificity. For the AM scale, sensitivity reached 89% and specificity 98% (cutoff > 7), while the NI scale achieved 87% sensitivity and 96% specificity (cutoff > 6). AUC values for these scales exceeded .959. The primary contribution of this work is the introduction of revised cutoff scores specifically tailored for older adults (Total Score > 20, AM > 7, NI > 6, AF > 6, p > 2, and LI > 2). These adjusted criteria minimize the risk of false-positive results while extending the potential applications of SIMS within both clinical and forensic settings.
Older adults face a substantial burden of common mental disorders, yet they are less likely to seek professional help compared to younger adults. In Chinese contexts, collectivist values and stigma may further deter help-seeking. Social norms are central to the theory of planned behavior (TPB) and nudge theory, suggesting that norm-based messages, especially those that are visually engaging, could strengthen perceived social approval and subsequent help-seeking intentions. This study aims to evaluate the effectiveness of co-designed norm-based nudges, delivered in descriptive (descriptive norm nudge) or pictorial forms (pictorial norm nudge), in improving subjective norms and intentions to seek mental health help among older adults, compared to an information-only control. This 3-arm randomized controlled trial (1:1:1) recruits adults aged ≥60 years via community partners in Hong Kong. Participants receive daily texting for 14 days and are allocated to the pictorial norm nudge (descriptive text combined with pictorial cultural games that evoke social support), the descriptive norm nudge (descriptive text only), or the control (mental health service information) groups. Assessments are conducted at baseline (T0), after intervention (T1), and at a 3-month follow-up (T2). Primary outcomes are subjective norms and help-seeking intentions, measured using the Chinese version of the TPB questionnaire. Secondary outcomes include perceived behavioral control, help-seeking attitudes, perceived barriers, depression, anxiety, and loneliness. A 2-level linear mixed model will be used in intention-to-treat analyses to examine the intervention's effectiveness. The study grant was awarded in June 2023, with recruitment of participants to the randomized controlled trial starting in December 2024 and concluding in June 2026. As of June 30, 2026, a total of 532 eligible participants had completed the baseline assessment. Among them, 470 (88.34%) completed the postintervention, and 408 (76.69%) completed the 3-month follow-up assessment assessments. Data collection and follow-ups are ongoing. A full report of the findings is expected by October 2026, with publication anticipated in early 2027. This study will provide critical insights into the feasibility and effectiveness of brief, co-designed nudges for promoting mental health help-seeking intentions. If effective, this approach will offer a scalable, culturally adaptive, and low-intensity strategy to improve mental health service use among older adults.
Ineffective uterine contractions contribute to labour dystocia and are a leading indication for primary caesarean delivery. Although oxytocin is the standard therapy for augmentation, prolonged exposure may result in receptor desensitisation and reduced effectiveness. Calcium is essential for myometrial contraction; however, systemic calcium homeostasis is tightly regulated, and it is unclear whether oral calcium supplementation can meaningfully influence uterine activity. This study aimed to evaluate the effect of oral calcium carbonate on uterine contractility. We conducted a single-centre randomised controlled pilot trial at a tertiary care teaching hospital (ClinicalTrials.gov: NCT07056062). Term patients with singleton foetus in cephalic presentation and an intrauterine pressure catheter in place were randomised 1:1 to receive a single 2,000 mg oral dose of calcium carbonate or no intervention. Uterine activity was measured using Montevideo units (MVUs) at baseline and at 30-minute intervals for two hours. Secondary outcomes included contraction frequency, peak contraction pressure, labour duration, mode of delivery, oxytocin dose, and postpartum haemorrhage. Oxytocin infusion rates were held constant during the observation period. Eighty-nine patients were analysed (45 control; 44 intervention) with similar baseline characteristics. No statistically significant difference in baseline MVUs was observed between groups (p = 0.1825). Although absolute MVUs were higher in the intervention group at 30 minutes (p = 0.0500), this difference was not sustained at subsequent time points and was absent in change-from-baseline analyses, suggesting no clinically meaningful treatment effect. No statistically significant differences were identified in secondary outcomes. Oral calcium carbonate did not result in a statistically significant improvement in uterine contractility or clinical outcomes. These findings likely reflect the limited physiologic effect of oral calcium on serum calcium levels. Oral calcium carbonate appears unlikely to be an effective intervention for labour augmentation; future research should focus on strategies with more controllable mechanisms. During labour, the uterus contracts to help the baby move through the birth canal. If contractions are too weak or poorly coordinated, labour may progress slowly, increasing the likelihood of caesarean delivery. Oxytocin is commonly used to strengthen contractions, but prolonged exposure may make the uterus less responsive over time. Calcium is an important mineral that helps muscle cells contract, including the muscles of the uterus. Because of this, we conducted a randomised clinical trial to determine whether providing calcium during labour could improve contractions. We found no meaningful differences in contraction strength or labour outcomes between patients who received calcium and those who did not. Although a difference in contraction strength was observed at one early time point, this was not sustained and did not translate into clinical benefit. These findings suggest that a single dose of oral calcium carbonate does not improve uterine contractions during labour.
To lower the operation temperature of solid oxide fuel cells, thin-film electrolytes have attracted considerable attention, but their chemical instability and mechanical defects hinder their performance. To address these issues, gadolinia-doped ceria (GDC)-yttria-stabilized zirconia (YSZ)-GDC trilayer (CZC) thin-film electrolytes have been developed, wherein the fuel-side GDC layer provides high ionic conductivity and densifies the YSZ, and the cathode-side GDC chemically protects the YSZ electrolyte from the lanthanum strontium cobaltite cathode. Electrochemical impedance spectroscopy shows that the measured ionic conductance of CZC electrolytes is 3-4 times higher than the simple sum of the single-layer conductance of YSZ and GDC in series. This enhancement does not depend on the growth temperature, as low-temperature-deposited then annealed films perform comparably to their high-temperature-grown counterparts. X-ray diffraction and electron microscopy reveal that the YSZ layer in the CZC electrolytes forms highly continuous columnar grains with a markedly decreased grain boundary density, minimizing lattice discontinuities along the ion transport pathways. Grain-orientation mapping confirms predominantly low-angle columnar boundaries rather than the highly misoriented interfaces that would impede ion transport. These observations suggest that the CZC trilayer conductance is enhanced by the single-crystal-like columnar growth of YSZ, facilitated by its crystallographic compatibility with the underlying GDC. Collectively, these findings establish the practicality of CZC trilayers as a high-performance thin-film electrolyte operable at lower temperatures, providing microstructural design guidelines for interface-engineered solid oxide ion conductors. This approach highlights how interface-guided microstructural engineering can unlock unexpected transport properties in such conductors, offering broad implications for next-generation energy devices.
The study aimed to assess the comparative efficacy of percutaneous vertebroplasty (PVP) combined with minimally invasive pedicle screw fixation versus PVP alone in elderly patients with osteoporotic vertebral compression fractures (OVCF). Ninety-four elderly patients with OVCF were randomly classified into the control (47 patients) and combined (47 patients) groups. The control group received PVP, while the combined group received PVP combined with minimally invasive pedicle screw fixation. Perioperative indicators such as intraoperative blood lose, operative time, and hospitalization time were recorded. Pain was assessed using the VAS before and at baseline and 1, 3, and 7 days postoperatively. At 1 and 3 days postoperatively, Serum CRP levels, WBC, and neutrophil counts were measured postoperatively. Radiographic outcomes (vertebral height ratio and Cobb angle), ADL scores, JOA scores, and ODI were evaluated preoperatively and at 3 months post-operation. Postoperative complications were documented. Baseline characteristics were comparable. The combined group showed superior pain relief, vertebral height restoration, Cobb angle correction, functional recovery, and reduced inflammatory markers (CRP, WBC, neutrophils) postoperatively (all P < 0.05). Blood loss and hospital stay were shorter in the combined group, though operative time was longer (P < 0.05). Complication rates did not differ significantly (P > 0.05). PVP combined with minimally invasive pedicle screw fixation yields better outcomes in elderly OVCF patients by enhancing pain control, vertebral height, and functional recovery without increasing perioperative risk.
Depression carries the highest burden of mental health-related disability in the United States. Approximately 13% of military veterans report elevated rates of depression. Despite the availability of evidence-based treatments for depression, nearly 50% of veterans in need of mental health care remain untreated. Internet-based interventions show promise in reducing this gap; however, there are currently no standard self-guided internet-based interventions for depressive symptoms in veterans. Deprexis is one such intervention that leverages cognitive behavioral therapy to target depressive symptoms. This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of Deprexis, a fully self-guided internet-based intervention for depression, in US military veterans with mild to severe depressive symptoms. This open-label pilot trial recruited 19 veterans with mild to severe depression (mean age 55.5, SD 8.2 y; baseline Quick Inventory of Depressive Symptomatology-Self-Report [QIDS-SR]: mean 16.2, SD 4.1) for an 8-week course of Deprexis, with self-report assessments at baseline, posttreatment (8 wk), and follow-up (16 wk). Primary outcomes included depressive symptoms (QIDS-SR), functional disability (World Health Organization Disability Assessment Schedule 2.0), and symptom-related disability (Sheehan Disability Scale). Feasibility was assessed through recruitment and retention rates, and acceptability was measured using validated questionnaires (Credibility and Expectancy Questionnaire and Client Satisfaction Questionnaire). Multilevel models examined change over time, with effect sizes calculated using pooled SDs from unconditional models. Recruitment and retention targets were met, with 15 out of 19 (79%) participants meeting the adherence criteria (ie, ≥60 min of active program use). Of these, 14 participants completed posttreatment questionnaires and were included in the completer analyses. The program received a positive acceptability rating: of the 18 participants who completed follow-up assessments, 78% (n=14) rated services as good or excellent and 72% (n=13) were satisfied with the amount of help received. No safety concerns were reported. Among completers (n=14), QIDS-SR scores decreased from baseline to posttreatment (estimate -2.22, SE 1.44; P=.14; d=-0.54, 95% CI -1.07 to 0.13) and follow-up (estimate -2.85, SE 1.19; P=.02; d=-0.70, 95% CI -1.21 to -0.08) with moderate-to-large effect sizes. Effect sizes were similar in the total sample. Functioning (World Health Organization Disability Assessment Schedule 2.0) improved among completers at follow-up (estimate -8.09, SE 3.80; P=.045; d=-0.41, 95% CI -0.96 to -0.05). Disability (Sheehan Disability Scale) did not significantly improve from baseline to posttreatment or follow-up. This pilot trial demonstrates that Deprexis is feasible and acceptable for veterans with mild to severe depression, with preliminary evidence of effectiveness for depressive symptoms. The delayed emergence of functional improvements and sustained gains at follow-up support the potential of this scalable intervention. The results provide a strong foundation for the ongoing randomized controlled trial.
Generating innovative and valuable ideas is essential for organizational competitiveness, and structured ideation formats are widely used to support creativity and idea generation of individuals, teams, and organizations. One such format is nominal brainstorming, in which participants generate ideas independently rather than through group interactions. Previous research has produced mixed results regarding the impact of anonymity in such individual idea-generation settings. Anonymous formats may reduce evaluation apprehension but can also lead to free riding, while non-anonymous formats promote accountability yet might increase the fear of negative evaluation. To clarify these conflicting findings, this study examines a novel mixed-anonymity approach in which participants generate ideas independently and anonymously, but the identities of those with the highest-rated ideas are subsequently revealed. We investigate the effects of mixed-anonymity on individually generated brainstorming outputs in two field experiments. The first adopts a between-subject design (N = 216), randomly assigning participants to anonymous, non-anonymous, or mixed-anonymity conditions. The second follows a within-subject design (N = 192), exposing each participant to all three conditions. In both studies, participants engaged in nominal brainstorming tasks. Ideation outcomes were measured by quantity, novelty, and user value. Additionally, we assessed evaluation apprehension and free riding as potential mediators. Our between-subject experiment did not demonstrate significant differences in idea quantity, novelty, or user value among the three anonymity conditions. Conversely, the within-subject experiment revealed significantly higher idea novelty under mixed-anonymity conditions compared to anonymous and non-anonymous conditions, but no significant effects on idea quantity or user value. Contrary to initial hypotheses, the proposed mediators, evaluation apprehension and free riding, did not explain these results. These findings refine the current understanding of anonymity in nominal brainstorming by showing that mixed-anonymity does not yield consistent effects across experimental settings. Overall, this study indicates that the role of mixed-anonymity in individual idea generation is contingent, not as straightforward as existing theorizing based on evaluation apprehension and free riding would suggest.
Understanding the biological determinants of stroke outcome is essential to improve treatment strategies. Cellular senescence may contribute to vascular dysfunction with age and has been linked to poor outcomes across a range of diseases. However, the role of senescence on stroke outcome in patients is not well defined. We sought to investigate the relationship between enriched senescence-associated gene signature expression and functional outcome after stroke. Acute ischemic stroke patients and control participants were recruited from University of Alberta Hospital. Control (non-stroke) participants had stroke risk factors and were of similar age and sex to the stroke patients. Whole-blood gene expression was measured by microarray. Senescence signature expression was evaluated to quantify senescence enrichment by gene set enrichment analysis. Outcome was determined using the modified Rankin Scale (mRS) at 90 days after stroke onset. The relationship between senescence, age, risk factors, and stroke outcome was analyzed through ordinal logistic regression. We included 129 acute ischemic stroke patients ≥60 years old, with a mean age of 77.3 ± 9.9 years and 41.9% female, and 41 control participants, with a mean age of 76.5 ± 7.9 years and 56.1% female. Patients with poor outcome (mRS > 2) had enriched senescence gene expression compared with those with good outcome (mRS ≤ 2); control participants also showed significant differences in senescence enrichment compared with the stroke outcome groups. High senescence was associated with a shift toward worse mRS scores (OR: 2.32; 95% CI 1.05-5.97) adjusted for age, sex, stroke severity, and type 2 diabetes mellitus. Senescence increased with age with variability across different ages. Among the senescence-associated genes, most differentially expressed between outcome groups were the epidermal growth factor receptor (EGFR) ligands amphiregulin and epiregulin, and the C-C motif chemokine ligand 16. Increased senescence was associated with worse stroke outcome. These findings suggest that blood cell senescence may contribute to vascular aging and worse stroke outcome, likely by altering epidermal growth factor receptor signaling, increasing inflammation and blood-brain barrier disruption. This study provides translational evidence that measuring senescence may reflect a biological aging process that influences functional outcome after stroke.
Histopathologic staging of Alzheimer disease has led to validation of imaging techniques that guide diagnosis and treatment. We previously constructed preliminary phases of the sequential progression of TDP-43 and tau to guide similar efforts in behavioral-variant frontotemporal dementia (bvFTD). In this article, we expand this work using digital pathology and longitudinal clinical data to more comprehensively model the relationship between clinical progression and the distribution and severity of postmortem frontotemporal lobar degeneration (FTLD) pathology. In this retrospective cohort study, 101 patients (42% female, median age at symptom onset = 63 years) were selected from the Penn Integrated Neurodegenerative Disease Database and had both longitudinal assessments and primary neuropathologic diagnosis of FTLD-Tau or FTLD-TDP. We used validated methods to quantify the burden of primary pathology from up to 6 cortical regions across hemispheres. FTLD-TDP pathologic phase was constructed from diagnostic pathology data based on published criteria. We tested the association between pathologic metrics and (1) disease duration or (2) the rate of clinic progression measured by 2 independent global measures (Clinical Dementia Rating Scale-Sum of Boxes [CDR-SB] and Mini-Mental State Examination [MMSE]). Linear regression and linear mixed-effects models were adjusted for hemisphere sampled, sex, age at onset, pathogenic variant status, and pathologic subtype. Disease duration did not associate with pathologic burden in multiple regression (FTLD-TDP β = 0.01 [-0.06, 0.09]; p = 0.7; FTLD-Tau β = 0.1 [-0.4, 0.7]; p = 0.7). By contrast, mean TDP-43 burden, but not FTLD-Tau burden, was associated with both worse relative CDR-SB (β = 0.1 [0.06, 0.2]; p = 0.0001) and MMSE (β = -0.1 [-0.2, -0.03]; p = 0.009) among all FTLD-TDP patients. TDP-43 phase also associated with worse CDR-SB (β = 0.07 [0.02, 0.1]; p = 0.005) and MMSE (β = -0.2 [-0.3, -0.1]; p = 0.000005). TDP-43 burden (CDR-SB (β = 0.1 [0.03, 0.2]; p = 0.005 and MMSE (β = -0.2 [-0.4, -0.05]; p = 0.009)), but not phase (CDR-SB (β = 0.02 [-0.03, 0.08]; p = 0.4 and MMSE (β = -0.04 [-1, 0.07]; p = 0.5)), associated with relative decline in sensitivity analyses limited to bvFTD. Greater TDP-43 burden was most closely associated with antemortem clinical decline rather than cumulative aggregation through the disease course. These human data suggest that the temporal dynamics of protein aggregation may differ among FTLD proteinopathies, with implications for the interpretation of FTLD-Tau and FTLD-TDP‑specific biomarkers as these are developed.
A highly sensitive intensity-interrogation refractive index (RI) sensor with a light-emitting diode (LED) was experimentally implemented via spectrally asymmetric resonance of a high-contrast grating (HCG). Our novel design concept realizes high sensitivity to RI variations by leveraging the asymmetry of the HCG's resonant spectrum to control its overlap with the light-source spectrum; in contrast, most conventional designs only focus on shifting the resonant spectrum. Electromagnetic field numerical simulations clarified that an optimized HCG exhibited spectrally asymmetric resonant reflection. The measured reflection spectra showed good agreement with the calculation results, and the reflected light intensity from the sample varied dramatically with a minuscule RI variation under 490 nm LED illumination owing to a significant change in the overlap. An RI sensitivity of 481% per refractive index unit (RIU) and an RI limit of detection of 9.98 × 10-4 RIU were experimentally achieved. Our sensor can be used in a wide range of applications owing to its high RI sensitivity and simple LED-based system without complex equipment, such as a spectrometer or angle-resolved setup.
To evaluate the inhibitory role of 0.01% atropine combined with 2% carteolol hydrochloride on myopia progression in children aged 3-8 years in western China. A total of 78 myopic children (spherical equivalent refraction from -2.00D to -8.00D) were initially assigned based on parental willingness to a control group (artificial tears (Hialid®) once nightly) or a treatment group. The treatment group was then randomly divided into an atropine group (0.01% atropine + artificial tears) and a combination group (0.01% atropine +2% carteolol hydrochloride). Spherical equivalent (SE), axial length (AL), and intraocular pressure (IOP) were measured at baseline and 3, 6 months. Chi-square and Kruskal-Wallis tests, adjusted by multivariate regression and standardized mean differences (SMD), were applied. Analysis of Covariance (ANCOVA) addressed minor baseline variations. Repeated-measures analysis of variance evaluated ocular parameters across the three groups to assess the effect of IOP-lowering drugs on delaying myopia progression. Both treatment groups showed significantly reduced SE and AL progression at 3 and 6 months (all p < 0.001). At 6 months, the combination group exhibited significantly smaller AL increase (0.09 ± 0.10 mm) and SE progression (-0.09 ± 0.12 D) than the atropine group (AL: 0.47 ± 0.18 mm; SE: -0.51 ± 0.18 D) and control group (AL: 0.99 ± 0.16 mm; SE: -1.03 ± 0.15 D; all p < 0.001). IOP decreased in the combination group (-1.75 ± 4.24 mmHg) but increased in the other groups. Adverse reaction rates were comparable between groups (p > 0.05). 0.01% atropine combined with 2% carteolol hydrochloride safely and effectively inhibits myopia progression in children with early-onset myopia.
Deficiency of pyridoxal-5'-phosphate, the clinically measured and active form of pyridoxine (vitamin B6), is prevalent among those with alcohol use disorder. However, unlike thiamine, pyridoxal-5'-phosphate is not routinely repleted. Evidence is presented that its repletion would improve outcomes of alcohol withdrawal syndrome and promote long-term abstinence. Excessive excitatory glutamatergic signaling and inadequate inhibitory GABAergic signaling are central to the pathophysiology of alcohol withdrawal syndrome. Pyridoxal-5'-phosphate is an essential cofactor for the rate-limiting enzyme in the conversion of glutamate to GABA, glutamic acid decarboxylase. Therefore, pyridoxal-5'-phosphate deficiency would be expected to exacerbate the signaling imbalance that underlies alcohol withdrawal syndrome, worsening symptoms and treatment response. This is supported by the finding that pyridoxal-5'-phosphate deficiency-whether in animal models or other clinical conditions, including nutritional pyridoxine insufficiency, isoniazid toxicity, and certain inborn errors of metabolism-can create a glutamatergic/GABAergic imbalance severe enough to cause anticonvulsant-refractory status epilepticus. Pyridoxal-5'-phosphate deficiency in alcohol use disorder occurs in part because alcohol is oxidized by alcohol dehydrogenase to acetaldehyde, which displaces pyridoxal-5'-phosphate from binding proteins, exposing it to hydrolysis by phosphatases. Hepatic disease promotes deficiency through increased phosphatase activity. Other mechanisms, including poor nutritional intake, likely contribute. In a small study of individuals with alcohol use disorder, pyridoxine deficiency was more prevalent in those who had an alcohol withdrawal seizure than in those who had not. More notably, among patients treated for alcohol withdrawal with the phenothiazine promazine-an obsolete treatment now known to lower the seizure threshold in alcohol withdrawal-supplementation with pyridoxine 120 mg/day resulted in fewer seizures than pyridoxine 20 mg/day (P = 0.02). These findings are consistent with animal models in which pyridoxal-5'-phosphate deficiency lowers the seizure threshold. In another study, of patients who suffered alcohol withdrawal seizures, those who progressed to delirium tremens had lower pyridoxal-5'-phosphate concentrations than those who did not (P = 0.011). Finally, anxiety and confusion are manifestations of both alcohol withdrawal and pyridoxal-5'-phosphate deficiency, presumably in part due to the signaling imbalance common to both. Therefore, these symptoms may be compounded when alcohol withdrawal is superimposed on pyridoxal-5'-phosphate deficiency. The established effectiveness and safety of intravenous pyridoxine in treating seizures and other symptoms resulting from pyridoxal-5'-phosphate deficiency caused by nutritional pyridoxine insufficiency, isoniazid toxicity, and inborn errors of metabolism provide proof of concept that pyridoxine supplementation may safely reduce the severity of alcohol withdrawal syndrome and enhance the response to treatment of those who are deficient. Indeed, seizures resulting from these other causes of pyridoxal-5'-phosphate deficiency remain refractory to benzodiazepines and phenobarbital until administration of pyridoxine, suggesting that some patients with treatment-refractory alcohol withdrawal syndrome would become treatment-responsive after pyridoxine treatment. In addition to causing a glutamate/GABA imbalance, pyridoxal-5'-phosphate deficiency may decrease CNS serotonin through inhibition of aromatic L-amino acid decarboxylase. Both effects can cause anxiety, stress sensitivity, and dysphoria, contributing to craving. Repletion may attenuate these symptoms and, thereby, reduce craving. Pyridoxal-5'-phosphate deficiency produces an excitatory/inhibitory imbalance by impairing the conversion of glutamate to GABA-an imbalance that in other clinical contexts can manifest as anticonvulsant-refractory seizures. It is therefore unlikely that pyridoxal-5'-phosphate deficiency always remains clinically silent during alcohol withdrawal. Moreover, during non-withdrawal abstinence, pyridoxal-5'-phosphate deficiency may cause a glutamate/GABA imbalance and low serotonin, possibly triggering anxiety, stress sensitivity, and dysphoria, thereby increasing craving. Pyridoxal-5'-phosphate repletion in alcohol use disorder warrants investigation.
This study aims to investigate sex differences in knee biomechanics during unexpected cutting and their correlation with sensorimotor function. Sixteen male and 16 female athletes were recruited. Participants were asked to complete six unexpected cutting tasks on their dominant side. Peak muscle force, position sense, and force sense of the dominant knee were measured using a CON-TREX isokinetic dynamometer. Results suggested that female athletes demonstrated a higher knee valgus angle at initial contact (p = 0.004) and peak knee valgus angle (p = 0.027) than males. Females also had a lower peak knee flexion angle (p = 0.001) and knee flexion moment (p = 0.002) than males. Quadriceps force sense errors were correlated with peak knee valgus angle in female (r = 0.558, p = 0.025) and male (r = 0.550, p = 0.027) athletes. In addition, in female athletes, higher quadriceps strength was related to a greater peak knee flexion angle (r = 0.525, p = 0.037). In summary, female athletes exhibit knee biomechanical characteristics associated with a higher risk of anterior cruciate ligament injury compared with male athletes. Insufficient quadriceps strength and larger force sense error are associated with the knee biomechanical characteristics.
Purpose: To compare the efficacy of the original and augmented Fink techniques in the surgical correction of V-pattern strabismus associated with primary inferior oblique overaction. Methods: We conducted a retrospective chart review of patients who underwent concurrent horizontal strabismus surgery (recess - resect procedure) and bilateral symmetric inferior oblique recession using either the standard Fink technique (corresponding to an 8-mm recession) or augmented variants (9, 10, or 11-mm recession). The primary outcome assessed was reduction in V-pattern strabismus, measured in prism diopters (PD) using prism and alternate cover testing in primary position,upgaze, and downgaze. Results:  Twenty-nine patients were studied. Ten underwent the standard Fink procedure with bilateral 8-mm recessions. The remaining patients received augmented recessions: 8 patients with 1 mm (9 mm total), 2 patients with 2 mm (10 mm total), and 9 patients with 3 mm (11 mm total) beyond Fink's original point. Greater inferior oblique recession correlated with larger postoperative reduction of V-pattern strabismus. The 11-mm group achieved the greatest correction, significantly more than the 8-mm (p = .002) and 9-mm groups (p = .018). The 9-mm group showed more variability in outcomes, while the 10-mm group had intermediate corrections but limited by a small sample size (n = 2). Conclusions: Augmenting the Fink technique by placing the inferior oblique insertion more inferiorly enhances correction of V-pattern strabismus, especially with 11-mm recessions, without causing significant anteriorization. These findings indicate that progressive augmentations can be customized based on the severity of the V-pattern. Larger, prospective studies are needed to validate these findings and refine surgical protocols.
Myogenic contractures are a common consequence of stroke, yet their prevalence and severity remain unclear. This multicentred, retrospective, cross-sectional study assessed severity and prevalence of myogenic contractures in selected, clinically targeted upper- and lower-limb muscles using registry data and tested associations with spasticity severity, age, and disease duration. Data from 159 patients from specialised spasticity centres were analysed using first recorded muscle assessments at various time points post-stroke. Maximal passive muscle extensibility and spasticity were measured using the Tardieu Scale. Shoulder extensors, adductors, and thumb and finger flexors in the upper limb (22.0-35.7% shortening) and gastrocnemius, soleus, gluteus maximus, hamstrings, and rectus femoris in the lower limb (16.6-20.1%) were most affected. Mean contracture prevalence within selected, clinically targeted muscles was 90.9% within one year, with high proportions also observed at 1-10 years. Age and spasticity severity significantly correlated with contracture severity, while disease duration did not. This study provides clinic-based data on post-stroke myogenic contractures in selected, clinically targeted upper- and lower-limb muscles, highlighting high prevalence in these muscles. Shoulder extensors and adductors, along with plantar flexors, were most affected. The study emphasises the need for standardised contracture definition and measurement. Post-stroke myogenic contractures are common in clinically relevant upper- and lower-limb muscles associated with functional impairment.Shoulder extensors and adductors, along with plantar flexors, were identified as the most affected muscles.Early prevention and treatment of contractures through long-term, progressive static stretching postures and/or orthoses are important considerations in clinical management.Standardised definitions and measurement methods for contractures are of utmost importance for accurate assessment.
Adolescent suicidal ideation is a critical public health issue, with limited support options in low-resource settings. This study aimed to evaluate the acceptability, usability, and preliminary effects of Emo-Safe, an Android-based application designed to enhance emotional regulation and reduce suicidal ideation among adolescents. This study utilized a sequential, explanatory mixed-methods approach, consisting of quantitative followed by qualitative methods. Sixty students, aged 15-18, participated in the study, divided into an intervention group (n = 30) and a control group (n = 30) for 4 weeks. Core app features included daily mood tracking, reflective journaling with AI-assisted reframing guided by cognitive-behavioral therapy (CBT) principles, breathing exercises, personalized insights, and an AI "friend" for encouragement. Outcomes measured were the Indonesian Depression Anxiety Stress Scales for Youth (IDASS-Y) and the Suicidal Ideation Scale (SIS). Results indicated that the intervention group had significantly lower post-test IDASS-Y scores (28.43 vs. 33.17; p = 0.037) and reduced stress levels (8.83 vs. 12.37; p = 0.001). The SIS also favored the intervention group (14.83 vs. 21.70; p < 0.001). Acceptability was high (mean rating 4.24/5) with positive feedback on material clarity and facilitator effectiveness, along with suggestions for improvements. Findings demonstrate the acceptability and usability of Emo-Safe, alongside promising short-term reductions in stress and suicidal ideation. However, further systematic evaluation of broader feasibility indicators, such as recruitment and long-term engagement, is needed in future trials.
To evaluate the clinical feasibility of using the non-zero-calcification-risk Multi-Ethnic Study of Atherosclerosis (nzcr-MESA) score, a simplified risk calculator that includes only age, sex, and ethnicity, for predicting the extent of coronary artery calcification (CAC) as measured by computed tomography (CT). In this retrospective study, 241 Caucasian patients underwent coronary CT angiography (CCTA) for the assessment of coronary artery disease. The objective extent of coronary calcification was quantified using Agatston scores. The nzcr-MESA score was calculated based on patient demographics and compared to the extent of calcification. Statistical analysis involved Spearman correlation coefficients and regression models to determine the relationship between nzcr-MESA and CAC. Significance was set at P < 0.05. A positive correlation was found between nzcr-MESA scores and the degree of CAC (P < 0.0001, females R = 0.56, males R = 0.39) as well as to disease severity according to the coronary artery disease-reporting and data system (CAD-RADS) scores (P < 0.0001, females R = 0.45, males R = 0.42), suggesting that the simplified score is a predictor of calcification and coronary disease. The optimal nzcr-MESA cutoff values for preselecting patients with severe coronary artery calcification (Agatston Score ≥ 400) were 90 % for females and 95 % for males. The nzcr-MESA score offers a clinically feasible, simplified method for estimating CAC extent, with significant implications for CT coronary imaging. Given its ease of use and its capability to correctly predict severe CAC, nzcr-MESA can be useful to preselect suitable diagnostic protocols. Integrating nzcr-MESA into clinical routine may help to streamline diagnostic workflows.