Search Results (6,246)

Infections are an important cause of morbidity and mortality in renal transplant recipients. Among the viral pathogens encountered in this population, herpes simplex virus (HSV), a member of the Alphaherpesvirinae subfamily, has an important place. HSV type 2 infections in this immunosuppressed population are primarily due to viral reactivation. While HSV-2 frequently presents as genital herpes or remains asymptomatic, in rare cases, it can lead to severe neurological manifestations, such as encephalitis, particularly in the early post-transplant period with a reported mortality rate of up to 40%. We present the case of a 49-year-old male who, three years after kidney transplantation, developed acute neurological symptoms, including aphasia and disorientation. Polymerase chain reaction (PCR) analysis of cerebrospinal fluid (CSF) identified HSV-2 as the causative pathogen, enabling a swift and accurate diagnosis. The patient was promptly treated with intravenous acyclovir, adjusted for renal function, resulting in complete neurological recovery and subsequent negative follow-up CSF PCR results. This case emphasizes the vital role of PCR diagnostics as the gold standard for confirming viral encephalitis, particularly in immunosuppressed patients, where atypical presentations can complicate diagnosis. It also highlights the importance of considering HSV-2 encephalitis in the differential diagnosis even beyond the immediate post-transplant period. Early recognition and management, facilitated by the multidisciplinary approach, are critical for improving outcomes in this vulnerable patient population. Full article

Background/Objectives: The excessive consumption of free sugars adversely impacts health, contributing to systemic disorders and significantly increasing the risk of dental caries. Children are particularly vulnerable to dental caries due to their dietary habits and oral hygiene practices. This study aimed to examine the relationship between sugar intake and dental caries experience in a sample of children aged 6–12 years. Methods: Data were analyzed from the National Health and Nutrition Examination Survey (NHANES) covering the years 2011–2016. This cross-sectional study utilized nationally representative data from NHANES, which provides comprehensive health assessments on the U.S. population. This study focused on 3658 children aged 6–12 years. Free sugar intake and its association with dental caries were evaluated using the Decayed, Missing, and Filled Teeth (DMFT) index, a widely accepted measure for assessing cumulative caries experience in permanent teeth. Demographic and socioeconomic factors were also accounted for. The sample primarily consisted of generally healthy children, with mild to moderate health conditions included in the analysis. Results: The average Decayed, Missing, and Filled Teeth (DMFT) score was 1.69 (SD = 2.61). Untreated dental caries affected 19.1% of the sample, with disproportionately higher rates observed among Mexican American children (23.8%), children from lower socioeconomic backgrounds (24.2%), those with less-educated parents (25.1%), and overweight children (22.9%). Mean daily free sugar intake was 72.46 g (SD = 50.45), with significant variations across race/ethnicity, parental education, and gender. A statistically significant association was found between free sugar intake and dental caries in U.S. children (p < 0.001). Conclusions: Free sugar intake is strongly associated with an increased risk of dental caries. Disparities in caries prevalence were evident based on race/ethnicity, socioeconomic status, and parental education levels. Regulating sugar intake and promoting dietary education are effective strategies to reduce the risk of dental caries and improve oral health outcomes among children. Full article

Motorcyclists remain a disproportionately large group of vulnerable road users, with fatality rates significantly higher than that in other road groups. Additionally, fatal accidents involving motorcyclists have a more slowly decreasing trend in comparison to that of other road users, while the number of this kind of users is growing fast. For all these reasons, there is a need to understand what the key factors leading to fatal accidents are in order to identify the possible measures to minimize the accidents themselves or at least their consequences. This would permit, indeed, to positively impact the road traffic system, leading to the creation of the safest road traffic system possible, as it is the goal of the Sustainable Safety approach. The aim of this study is to dive into the mentioned problem, analyzing fatal motorcycle accidents in Slovenia over a decade, highlighting the key factors contributing to these incidents. By integrating data from four databases, the study evaluated accident trends, infrastructural elements, and rider behavior through a multi-stage analysis. Firstly, data were collected from four national, up-to-date databases that contain information about road accidents themselves, the road infrastructure, additional police data, and media descriptions. After merging this information into one comprehensive database, where each row represents all the data available for one accident, a general analysis of accidents’ trends over the considered 10-year period was developed, considering at first all fatal road accidents, then deepening it to accidents caused by a motorcyclist, and finally to single-vehicle accidents. A statistical analysis followed, aimed at identifying a statistical correlation between the accidents and the factors leading to them. The results of the first accident analysis indicated that excessive speed, incorrect driving direction, and overtaking maneuvers are the primary causes of fatal accidents, especially on non-urban roads preferred by motorcyclists. Single-vehicle accidents frequently involve collisions with roadside objects, including safety barriers and poles, underscoring the need for targeted infrastructural improvements. The following correlation analysis revealed that a total of seven factors were statistically significant: three human factors (age, gender, experience)—which were the ones with the strongest correlations—one infrastructural factor (pavement width), and three factors belonging to external conditions (accident type, cause, and location). Of these, four were positively correlated to the causer, while three, i.e., pavement width, causes, and road location, were negatively correlated. This study provides a foundation for future research on less severe accidents and proactive risk behavior analysis, aiming to improve motorcyclist safety comprehensively. Full article

Background: Caregivers play a crucial role in the support and management of individuals experiencing mental health disorders; however, there is a paucity of research concerning the experiences of caregivers of deaf persons diagnosed with any form of mental disorder in Ghana. This study aims to explore the lived experiences of these caregivers, with a particular focus on their perceptions of mental health, available support systems, challenges encountered, and the consequent impact on familial relationships while supporting this underserved population. Method: This qualitative study engaged eleven family caregivers of deaf adults diagnosed with a mental health disorders made up of ten females and one male aged 45–68 years, recruited across four of the sixteen administrative regions in Ghana. Utilizing a semi-structured interview guide, face-to-face interviews were conducted to gather in-depth narratives from the participants. Results: Thematic analysis of the data revealed several key themes, including the awareness and understanding of mental health disorders, availability and accessibility of mental health support services and training, dynamics of psychosocial and familial relationships, and the multifaceted challenges faced in caregiving for individuals with mental health disorders. Conclusion: The findings underscored an urgent need for the development of a specialized caregiving manual tailored for caregivers of deaf individuals experiencing mental health disorders. This study advocates for policymakers to prioritize the creation of such resources to enhance care delivery and improve overall mental health outcomes for this vulnerable population. Full article

Aim: As the population is aging, falls by older people, in particular falls from four-wheeled walkers (“rollators”), are a growing problem. These falls must be examined by targeted research and interventions that incorporate gender differences. Therefore, this study examined the injury patterns of elderly patients admitted to a tertiary trauma centre in Switzerland after falls from rollators and focussed on gender differences. Methods: This was a retrospective single-centre study for the period from May 2012 to December 2019 which included elderly patients (≥65 years) who had suffered a fall from a rollator. Injury history, patient data, demographic information, and patient outcomes were compared between males and females, with the data sourced from the Ecare patient database, which contains all information related to patient visits and treatment procedures. Results: A total of 152 eligible patients were included in the analysis, with 56.6% hospitalised at our facility and 14.5% transferred to another hospital. The cohort comprised 50 (32.9%) males and 102 (67.1%) females. Males were more prevalent in the 75–84 age group, while females predominated in the 85 and older group, and this difference was statistically significant (p = 0.043). Osteoporosis was significantly more common in females (37.3% vs. 10%, p ≤ 0.001). Consequently, treatment with vitamin D and/or calcium was also significantly more prevalent among women (29.4% vs. 8%, p = 0.003). Most falls occurred at home (22.4%) or in nursing care facilities and rehabilitation centres (22.4%), without gender-based differences (p = 0.570). Men were six times more likely than women to sustain injuries when under the influence of alcohol (p = 0.002). Fractures to the lower extremities were the most common injuries, accounting for 34.2% of all injuries, with no statistically significant differences between groups (p = 0.063). Head injuries occurred in 34.9% of patients, with a trend towards more injuries in males (44% vs. 30.4%, p = 0.098). The cumulative rates of fractures to the pelvis, upper extremities, and lower extremities were significantly higher in females (59.8%) than in males (38%), p = 0.011. In-hospital mortality was significantly higher in men than in women (12.9% vs. 2.9%, p = 0.026). Operative procedures were significantly more common in women (33% vs. 16.3%; p < 0.001). Conclusion: Women were more frequently affected by falls related to rollators than men. Most falls occurred at home, in nursing care facilities, or rehabilitation centres, with no significant gender-based differences. There was a trend toward more head injuries in males, while the cumulative fracture rate of the pelvis, upper extremities, and lower extremities was significantly higher in females. In-hospital mortality was more than four times higher in men. These findings may guide the development of gender-specific interventions to reduce rollator-related injuries in the vulnerable elderly population. Full article

The extraction, processing and transport of crude oil in the Niger Delta region of Nigeria has long been associated with collateral environmental damage to the largest mangrove ecosystem in Africa. Oil pollution is impacting not only one of the planet’s most ecologically diverse regions but also the health, livelihoods, and social cohesion of the Delta region inhabitants. Quantifying and directly associating localised oil pollution events to specific petrochemical infrastructure is complicated by the difficulty of monitoring such vast and complex terrain, with documented concerns regarding the thoroughness and impartiality of reported oil pollution events. Earth Observation (EO) offers a means to deliver such a monitoring and assessment capability using Normalised Difference Vegetation Index (NDVI) measurements as a proxy for mangrove biomass health. However, the utility of EO can be impacted by persistent cloud cover in such regions. To overcome such challenges here, we present a workflow that leverages EO-derived high-resolution (10 m) synthetic aperture radar data from the Sentinel-1 satellite constellation combined with machine learning to conduct observations of the spatial land cover changes associated with oil pollution-induced mangrove mortality proximal to pipeline networks in a 9000 km² region of Rivers State located near Port Harcourt. Our analysis identified significant deforestation from 2016–2024, with an estimated mangrove mortality rate of 5644 hectares/year. Using our empirically derived Pipeline Impact Indicator (PII), we mapped the oil pipeline network to 1 km resolution, highlighting specific pipeline locations in need of immediate intervention and restoration, and identified several new pipeline sites showing evidence of significant oil spill damage that have yet to be formally reported. Our findings emphasise the critical need for the continuous and comprehensive monitoring of oil extractive regions using satellite remote sensing to support decision-making and policies to mitigate environmental and societal damage from pipeline oil spills, particularly in ecologically vulnerable regions such as the Niger Delta. Full article

The rapid urbanization and pursuit of sustainability have elevated shared mobility as a cornerstone of smart cities. Among its modalities, scooter-sharing has gained popularity for its convenience and eco-friendliness, yet it faces significant adoption barriers. This study investigates the challenges to scooter-sharing systems within smart cities, focusing on the Silesian region of Poland as a case study. It aims to identify region-specific barriers and opportunities for scooter-sharing adoption in Central and Eastern Europe and to provide insights into its long-term development trends and potential challenges. Using comprehensive statistical methods, including factor analysis and regression models, this study identifies key barriers such as insufficient bike paths, poor path conditions, inadequate signage, fleet maintenance issues, and complex rental processes. External factors like adverse weather and heavy traffic, coupled with health and safety concerns, further hinder adoption, particularly among vulnerable populations. Additionally, the study explores future trends in scooter-sharing, emphasizing the role of advanced technologies, adaptive urban planning, and sustainable fleet management in ensuring long-term feasibility. Drawing on global case studies, it underscores the need for tailored infrastructural investments, advanced fleet management, and user-centric policies to align scooter-sharing systems with smart city goals of sustainability, accessibility, and improved mobility. These findings offer actionable insights for policymakers and service providers striving to integrate scooter-sharing into the evolving landscape of urban mobility. Full article

Nutritional support in critically ill patients has been acknowledged as a pillar of ICU care, playing a pivotal role in preserving muscle mass, supporting immune function, and promoting recovery during and after critical illness. Providing effective nutritional support requires adapting it to the patient’s diagnosis, unique characteristics, and metabolic state to minimize the risks of overfeeding or underfeeding while mitigating muscle loss. This level of care requires a comprehensive nutritional assessment and the establishment of a nutrition-focused protocol. Regular, consistent and detailed nutritional evaluation can influence both therapeutic decisions and clinical interventions, thus ensuring that the specific needs of critically ill patients are met from the acute phase through their entire recovery process. Bioelectrical impedance analysis (BIA) is increasingly recognized as a valuable tool for enhancing nutritional care in critically ill patients. By delivering precise, real-time insights into key aspects of body composition, BIA is thought to provide clinicians with a more comprehensive understanding of the complex physiological changes that occur during critical illness. This narrative review highlights the potential of BIA in offering these precise assessments, facilitating the development of more accurate and personalized nutritional strategies for critically ill patients. If BIA can reliably assess dynamic shifts in hydration and tissue integrity, it holds the promise of further advancing individualized care and optimizing clinical outcomes in this vulnerable population. Full article

The stability and reliability of power supply are crucial for driving economic growth and ensuring sustainable development. Among the factors threatening engineering equipment safety, metal corrosion is particularly significant, with iron (Fe), aluminum (Al), and their alloys being the most vulnerable to degradation. This review provides a systematic overview of the corrosion mechanisms, protection strategies, and monitoring technologies for Fe and Al metals and their alloys. The discussion begins with an analysis of the primary corrosion forms affecting these materials, emphasizing the role of environmental and material-specific factors. Advances in corrosion protection methods, including surface treatments, protective coatings, and the utilization of corrosion products to enhance material durability, are examined in detail. Furthermore, the application of real-time and unmanned platform technologies for corrosion monitoring is highlighted, with a focus on their potential to improve monitoring efficiency, accuracy, and safety evaluations. These technologies provide robust data and technical support for the development of targeted corrosion-resistant solutions. This review aims to offer insights into the current challenges and future directions in the study of Fe and Al corrosion resistance, serving as a reference for both researchers and practitioners in the field of engineering. Full article

Today, the development of the Internet of Things has grown, and the number of related IoT devices has reached the order of tens of billions. Most IoT devices are vulnerable to attacks, especially DdoS (Distributed Denial of Service attack) attacks. DDoS attacks can easily cause damage to IoT devices, and LDDoS is an attack launched against hardware resources through a small string of very slow traffic. Compared with traditional large-scale DDoS, their attacks require less bandwidth and generate traffic similar to that of normal users, making them difficult to distinguish when identifying them. This article uses the CICIoT2023 dataset combined with behavioral features and stacking mechanisms to extract information from the attack behavior of low-rate attacks as features and uses the stacking mechanism to improve the recognition effect. A method of behavioral characteristics and stacking mechanism is proposed to detect DDoS attacks. This method can accurately detect LDDoS. Experimental results show that the recognition rate of low-rate attacks of this scheme reaches 0.99, and other indicators such as accuracy, recall, and F1 score are all better than other LDDoS detection methods. Thus, the method model proposed in this paper can effectively detect LDDoS attacks. At present, DDoS attacks are relatively mature, and there are many related results, but there is less research on LDDoS detection alone. This paper focuses on the investigation and analysis of LDDoS attacks in DDoS attacks and deduces feasible LDDoS detection methods. Full article

Pragmatics is key to communicating effectively, and its assessment in vulnerable populations is of paramount importance. Although tools exist for this purpose, they are often effortful and time-consuming, with complex scoring procedures, which hampers their inclusion in clinical practice. To address these issues, we present the Brief Assessment of Pragmatic Abilities and Cognitive Substrates (APACS Brief), a rapid (10 min), easy-to-use and freely distributed tool for evaluating pragmatics in Italian, inspired by the existing APACS test and already validated in the remote version (APACS Brief Remote). The APACS Brief test measures–with a simplified scale–the domains of discourse production and figurative language understanding and is developed in two parallel forms, each including novel items differing from APACS. Psychometric properties, cut-off scores, and thresholds for change were computed on 287 adults. The analysis revealed satisfactory internal consistency, good test–retest reliability, and strong concurrent and construct validity. Moreover, APACS Brief showed excellent discriminant validity on a sample of 56 patients with schizophrenia, who were also cross-classified consistently by APACS Brief and APACS cut-off values. Overall, APACS Brief is a reliable tool for evaluating pragmatic skills and their breakdown, with brief administration time and simple scoring making it well-suited for screening in at-risk populations. Full article

Wavelet coherence analysis (WCA) examines the dynamic interactions between economic policy uncertainty (EPU) in Brazil, Chile, Colombia, and Mexico and key external variables, using monthly data from 2010 to 2022. The findings reveal the following: (i) medium-term co-movements (4–16 months) between EPU and global financial indicators, including the Chicago Board Options Exchange (CBOE) Market Volatility Index (RVIX), Merrill Lynch Option Volatility Estimate Index (RMOVE), and Global EPU Index (RGEPU), emphasizing the sustained influence of financial volatility on domestic policy environments, particularly during global turbulence; (ii) significant interactions between EPU and the Climate Policy Uncertainty Index (RCPU) in resource-dependent economies like Brazil and Colombia, with pronounced effects in medium- and long-term horizons; (iii) bidirectional relationships between Brent crude oil prices (RBRENT) and EPU in Brazil, Colombia, and Mexico, where oil price fluctuations shape policy uncertainty, especially during global market disruptions; and (iv) notable co-movements between EPU and the Dow Jones Sustainability World Index (RW1SGI) in Brazil, Chile, and Mexico, highlighting sensitivity to shifts in sustainability-driven markets. These results underscore the need for economic diversification, strengthened financial safeguards, and integrated climate risk management to mitigate external shocks. By exploring the time–frequency dynamics of global uncertainties and domestic policy environments, this study provides actionable insights for fostering resilience and stability in Latin America’s interconnected economies while addressing vulnerabilities to global market volatility and sustainability transitions. Full article

Background/Objectives: For low- and middle- income country (LMIC) settings, a global nutrition transition is rapidly emerging as diets shift, resulting in a dual burden of malnutrition. High quality dietary intake data for these populations is essential to understand dietary patterns contributing to these nutrition issues. New technology is emerging to address dietary assessment challenges; however, it is unknown how researchers conducting studies with LMIC populations or under-served groups in high-income countries adopt technology-assisted methods. This study aimed to describe the features of the dietary assessment methods used in these settings. Methods: A cross-sectional survey of members of an online international nutrition network was conducted. Participants completed an online questionnaire collecting data on dietary assessment method use, populations studied, and factors influencing method selection. Results: Of 45 participants (ranging from 27 to 60 years) who completed the questionnaire, 67% conducted dietary assessments in children aged 1–5 years, 60% in pregnant women and 60% in female adults. Dietary assessment was conducted predominantly in countries classified as LMIC (n = 50), compared to the assessment of vulnerable groups in high-income countries (n = 3). All participants reported using 24-h recalls, 80% used food frequency questionnaires, while 22% used image-based and 22% used image-assisted methods. Predominant modes were interviewer-administered, paper questionnaires and manual analysis; however, digital survey platforms were used by nearly half of participants. Conclusions: Although traditional dietary assessment methods continue to dominate in LMICs, evidence of technological-assisted method use is emerging. Technology-assisted methods, tailored to address challenges in collecting quality dietary intake data in LMICs, are becoming more accessible. Full article

Background/Objectives: This study aimed to evaluate the clinical characteristics and identify the prognostic factors affecting visual outcomes, retinal detachment, and recurrence in cytomegalovirus retinitis (CMVR) patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: A retrospective analysis of 54 CMVR patients (84 eyes) who underwent allo-HSCT between 2015 and 2024 was conducted. Ophthalmologic and systemic evaluations were performed. The visual outcomes were classified as improvement, stabilization, and deterioration. Logistic regression and LASSO regression models were used to identify the prognostic factors. Results: Improved or stabilized visual outcomes were found in 22 eyes, while 62 eyes suffered from deterioration. Larger lesion areas were independently associated with poorer visual outcomes (OR 0.989, p = 0.002). Eight (9.5%) eyes had rhegmatogenous retinal detachment and thirteen (15.5%) eyes suffered from recurrence. Retinal detachment was significantly predicted by higher baseline aqueous CMV DNA load (OR 5.087, p = 0.026). Macula involvement (OR 5.322, p = 0.032) and more intravitreal injections (IVs) (OR 1.263, p = 0.008) were independent risk factors for recurrence. No systemic factors were found to be associated with the clinical outcome of eyes with CMVR. Conclusions: Ocular characteristics, rather than systemic factors, were more useful to predict the clinical outcome of eyes with CMVR. Routine ophthalmic screening and early intervention are essential to improving outcomes in this vulnerable population. Full article

Background/Objectives: Carotid artery stenosis (CAS) is one of the main causes of stroke, and the vulnerability of plaque has been proved to be a determinant. A joint analysis of shear wave elastography, a radiofrequency echo-based wall tracking technique for arterial stiffness evaluation, and of autonomic and baroreflex function is proposed to noninvasively, preoperatively assess plaque vulnerability in asymptomatic CAS patients scheduled for carotid endarterectomy. Methods: Elastographic markers of arterial stiffness were derived preoperatively in 78 CAS patients (age: 74.2 + 7.7 years, 27 females). Autonomic and baroreflex markers were also assessed by means of an analysis of the beat-to-beat fluctuations in heart period and systolic arterial pressure, derived at rest in supine position (REST) and during active standing. Postoperative analysis identified 36 patients with vulnerable plaque (VULN) and 42 with stable plaque (STABLE). Results: Baroreflex sensitivity (BRS) at a respiratory rate decreased during STAND only in VULN patients, being much higher at REST compared to STABLE levels. Autonomic indexes were not helpful in separating experimental conditions and/or populations. The Young’s modulus (YM) of the plaque was lower in the VULN group than in the STABLE one. Cardiovascular control and elastographic markers were significantly correlated only in VULN patients. A multivariate logistic regression model built combining YM and BRS at the respiratory rate improved the prediction of plaque vulnerability, reporting an area under the ROC curve of 0.694. Conclusions: Noninvasive techniques assessing shear wave elastography and baroreflex control could contribute to the early detection of plaque vulnerability in patients with asymptomatic CAS. Full article