Introduction: Adolescent idiopathic scoliosis (AIS) is a three-dimensional congenital deformity of the spine. Current surgical treatment involves a multi-segmental posterior pedicle screw instrumentation and spinal fusion. Most reports focus on the surgical results in the coronal plane, but insufficient sagittal correction may lead to malalignment and accelerated distal segment degeneration. Currently, most surgeons contour rods based on experience during surgery without first determining the desired amount of thoracic kyphosis (TK) or measuring the angle created by the rod. In this study, we aim to determine if pre-bent patient-specific rods provide favorable sagittal alignment in AIS patients using normal reference thoracic kyphosis as our primary criteria. Objectives The main objective of this study was to assess whether the use of pre-bent patient-specific rods in AIS correction leads to improved sagittal alignment by achieving thoracic kyphosis angles that closely match surgically planned values. We sought to evaluate the degree of alignment across different subgroups classified by initial thoracic kyphosis and compare outcomes with normal reference kyphosis. Methods: The study included 67 total patients. Normal thoracic kyphosis reference range was established as between 20° and 40°. Patients were then separated into different subgroups based on their initial visit thoracic kyphosis compared to the referenced range, which included hypokyphosis, normal kyphosis, and hyperkyphosis. Thoracic kyphosis was assessed at three separate time points via plain radiography: initial visit, pre-operative, and most recent follow-up. Surgically planned target kyphosis was determined prior to surgery and used to correct patients to the reference kyphosis range. Paired T-tests were used to analyze thoracic kyphosis between the different subgroups. Results: Mean length to last follow-up was found to be 12.8 months. At the last follow-up, the mean increase in thoracic kyphosis was 13° for the group at large. The mean difference between kyphosis at last follow-up and target kyphosis in the subgroups was as follows: hypokyphosis was -4°, normal kyphosis was 0°, and hyperkyphosis group was +6°. Significant changes were found when comparing all subgroups’ preoperative thoracic kyphosis angles with their surgical plan, and no significant differences were found when comparing their postoperative thoracic kyphosis angle with their surgical plan. Conclusion: Prefabricated patient-specific rods achieved thoracic kyphosis angles close to surgically planned values, resulting in favorable sagittal plane alignment. The findings support the use of patient-specific rods to improve sagittal alignment and reduce the risk of malalignment and distal segment degeneration. Next steps for the study include following the cohort of patients over a longer period to assess the degree of degenerative conditions that develop in each subgroup and conducting a comparative analysis with traditional rods in all three anatomical planes.

Growth charts are commonly used for monitoring attained size at a specified age relative to a population average considered to represent expected growth. To evaluate the impact of the application of international growth charts for children under five on common growth metrics when compared to national reference charts. We conducted a systematic literature search across five electronic databases: CINAHL Complete (EBSCOhost), EMBASE (Ovid), MEDLINE (PubMed), Scopus, and Web of Science. Studies published in English between 2007 and 2023 that made comparisons between national reference charts and either INTERGROWTH-21st (IG-21st) or WHO Child Growth (WHO CGS) charts. Common growth metrics were compared using either z-scores or centiles. The prevalence of small- and large-for-gestational age, stunting, wasting, underweight, overweight, and obesity was compared when calculated using international standards versus national charts. We identified 1556 records, of which 314 were excluded as they were duplicates, 1069 after reading the title and abstract, 90 after reading the full texts, and 7 we could not retrieve the full texts. Z-score or centile values of local references were more often reported to be higher than values of WHO CGS when evaluating weight-, length-, or head circumference- for- age. Seven of 11 studies reported higher rates of small-for-gestational age, while four of five studies reported lower rates of large-for-gestational age using local references compared to IG-21st standards. Meaningful differences exist in growth assessment between national and international charts that have implications for identifying at-risk infants.

This paper presents a hybrid decision support system that integrates a Belief Rule Base (BRB) model, a Machine Learning (ML) model, and Particle Swarm Optimization (PSO). The system predicts the credit rating of fintech clients based on data obtained through the Open Banking API. For a real-world dataset, the classification ML model Random Forest demonstrates high predictive accuracy. The BRB model is represented by a complete set of rules covering four attributes with three referential values for each attribute. By analyzing the distribution of the number of activated rules and their activation weights, the representativeness of the data was assessed. A group of rules with low activation weights was identified, corresponding to the referential value Middle for one of the attributes. PSO was applied to optimize BRB parameters, ensuring both interpretability of the results and the capability to model incomplete data. For model validation, data were synthesized using a Rule-Based Data Synthetic approach. The results show that BRB models maintain stable accuracy across real and validation datasets. In contrast, the accuracy of the ML model decreased on validation data by an average of 5% compared to the initial dataset. These findings highlight the advantages of the hybrid approach, which combines the accuracy of ML with the interpretability and robustness of BRB in data-limited environments

Shakespeare’s language has been studied and analysed for centuries, including monographs on the most disparate semantic fields –such as botany, geography, commerce, etc. In this regard, astronomical language is no exception. However, existing studies of Shakespeare’s astronomical language have either leaned towards the field of astrology and the symbolism of the occult or focused on glossing specific passages and terms, usually to disentangle the scientific value of astronomical references. Therefore, there is no systematic account of the semantics of these terms. Thus, the purpose of this study is to provide a holistic analysis of the three most common terms with a strictly astronomical meaning in Shakespeare’s lexicon, namely, ‘sun’, ‘moon’, and ‘star/s’. The analysis here maps the semantics of these terms by looking into the recurring meanings that they take. This, in turn, opens a new avenue of research into the stylistic utilization of astronomical bodies in ways that include character delineation, plot development, dramatic structure, gender characterization, and the role of figurative language at large.

Many patients with medullary thyroid cancer (MTC) experience recurrent or persistent disease after surgery due to its aggressive nature. However, the prognostic factors for progression-free survival (PFS) have been poorly investigated. This study aimed to explore prognostic factors associated with PFS in patients with MTC. Patients with MTC were enrolled from 15 medical centers in Shandong Province, China, between January 2010 and December 2021. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors for PFS in patients with MTC. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of the metastatic lymph node ratio (LNR) in predicting PFS. Patients with MTC from the Surveillance, Epidemiology, and End Results (SEER) database were used to test the predictive value of the LNR cutoff for overall survival (OS) and disease-specific survival (DSS). In the Shandong cohort, extrathyroidal extension (HR, 1.622; 95% CI 1.022-2.575, P = 0.040), LNR (HR, 2.806; 95% CI 1.121-7.025, P = 0.028), and T3 stage (HR, 2.060; 95% CI 1.074-3.952, P = 0.030) were independent risk factors for PFS in patients with MTC. The optimal cutoff value of the LNR for predicting PFS was 0.19. Compared to patients with LNR < 0.19, those with LNR ≥ 0.19 suffered worse PFS (Log-rank P < 0.0001) in the Shandong cohort, and worse OS (Log-rank P < 0.0001) and DSS (Log-rank P < 0.0001) in the SEER cohort. This study identified prognostic factors for PFS in patients with MTC. LNR ≥ 0.19 could be used as an adverse prognostic factor for patients with MTC.

In linguistically diverse and multilingual South African communities, it is common to use non-standard language varieties (NSLVs), often called mixed languages, as lingua franca. These NSLVs are primarily spoken in black townships throughout South Africa. Previous studies show that the discursive production of oral narratives impacts the development and use of higher-order language processing, as they require the knowledge, language skills and abilities to produce coherent discourse. The main focus of the existing literature in oral narrative is mostly on standard languages. In this study, we explore how speakers of Sepitori, a non-standard language variety (NSLV), produce an oral narrative compared to Sesotho, a standard language. The current study investigates the oral narrative production of a total number of 20 participants who are adult speakers of Sesotho and Sepitori (ten from each language). The Sesotho speakers were bilingual speakers of English and Sesotho. The Sepitori speakers were multilingual speakers of English, Sesotho, Zulu and other languages spoken in the Mamelodi township. This study used a mixed methodology of quantitative and qualitative analysis. Narratives were annotated for language complexity in the macro- and microstructure elements: the length and type of clause, pragmatic acts, referential lexical choices and code-switched words. Sepitori speakers produced narratives characterised by interactive clauses unrelated to the narrative level and with a greater range of lexical referents, showcasing more individual linguistic variation. Sesotho speakers produced a more sequential oral narrative in line with story schema with fewer interjections to the researcher. In an increasingly linguistically heterogeneous South Africa, more research is required to gain insights into how multilingual individuals develop and refine their narrative skills, emphasising the much-needed focus on NSLV from a psycholinguistic perspective, which may ultimately inform tools of assessment for multilingual children and adults in social, clinical and academic contexts.

Comparison of the prevalence of metabolic syndrome between individuals with spinal cord injury and the general population based on the cutoff values of abdominal obesity

Mastitis, an inflammation of the udder primarily caused by an IMI, is one of the most common diseases in dairy cattle. Somatic cell count has been widely used as an indicator of udder inflammation, assisting in the detection of subclinical mastitis. More recently, differential SCC (DSCC), which represents the combined proportion of lymphocytes and polymorphonuclear leukocytes, has become available for routine dairy milk screening, although it was not yet widely studied. Therefore, the objective of this study was to assess and compare the usefulness of quarter-level SCS or DSCC to predict the probability of subclinical mastitis. Additionally, our goals included estimating the sensitivity (Se) and specificity (Sp) of SCS and DSCC across all potential cut-off values. The current study was an observational study conducted on commercial dairy farms. Five dairy herds were selected using a convenience sampling. A Gaussian finite mixture model (GFMM) was applied to investigate the latent quarter subclinical mastitis status with either measurement, SCS or DSCC. Posterior values for SCS and DSCC obtained from the GFMM were used for predictive estimation of the parameters. The estimated SCS distribution for healthy quarters had a mean (SD) of 1.4 (1.3), and, for quarters with subclinical mastitis, it was 4.5 (2.4). For DSCC, the estimated mean was 55.6% (15.2) for healthy quarters, whereas it was 80.4% (6.4) for quarters with subclinical mastitis. The most discriminant cut-off for SCS, as indicated by the Youden index, was 3.0, corresponding to exactly 100,000 cells/mL. At this threshold, the Se and Sp of SCS were 0.73 (95% Bayesian credible interval [BCI]: 0.70-0.77) and 0.90 (95% BCI: 0.89-0.91), respectively. The most discriminant cut-off point for DSCC was 70.0%, with corresponding Se and Sp values of 0.95 (0.93, 0.96) and 0.83 (0.81, 0.85), respectively. For the SCS analysis, we obtained predictive probabilities of subclinical mastitis approaching 0 and 100%, with only a narrow range of SCS results yielding intermediate probabilities. On the other hand, predictive probabilities ranging from 0 to 90% were obtained for DSCC analysis, with a large range of DSCC results presenting intermediate probabilities. Thus, SCS seemed to surpass DSCC for predicting subclinical mastitis. These findings provided a foundation for future studies to further explore and validate the efficacy of GFMM for diagnostic tests yielding quantitative results.

Abstract BACKGROUNDThe kinetic study of boron extraction from Salt Lake brine is the essence and mechanism of solvent extraction process. A thorough understanding of the kinetic competition between desired Ionic liquid (IL)‐isooctyl alcohol (2‐EH) extraction processes and any detrimental diffusion resistance is required to achieve high extraction efficiency of boron in Salt Lake brine.RESULTSThe extraction experiments of boron from Salt Lake brine with highly extraction efficiency (93.6%) in 3‐dodecyl‐1‐methylimidazolium hydrogen sulfate ([C12mim][HSO4])‐2‐EH extraction system was performed in a constant interfacial area stirred Lewis cell. The work uniquely employs a laminar constant interface surface cell as the research object, offering a more precise measurement of the extraction kinetics compared to traditional methods. Furthermore, the impacts of key parameters such as extraction temperature, stirring speed, phase interface area, and the initial concentrations of boron [C12mim][HSO4] and 2‐EH were thoroughly examined, revealing their significant influence on extraction efficiency.CONCLUSIONThe results showed that the extraction process mainly occurred in the two‐phase interfacial region and was controlled by aqueous diffusion reaction. The activation energy was determined to be about 23.90 kJ·mol−1. Meanwhile, thermodynamic parameters (ΔH, ΔS, and ΔG) revealed that the extraction of boron was an endothermic and non‐spontaneous process. According to data analysis, boron extraction is approximately first‐order, and a novel rate equation and extraction mechanism are proposed. The results will provide referential values for the development of more efficient separation processes. © 2025 Society of Chemical Industry (SCI).

Audience analysis is a cornerstone of effective non-profit advocacy, ensuring that communication strategies are relevant, inclusive, and persuasive. This article explores how demographic, interest-based, and needs-oriented data can inform tailored communication approaches. It highlights practical strategies for addressing barriers such as low literacy, language diversity, and cultural differences, while demonstrating the value of visual aids, simplified language, and local references. Case studies from health, education, and environmental initiatives illustrate how understanding audience composition enhances engagement, fosters trust, and motivates action. By embedding audience analysis into advocacy planning, non-profits can optimize outreach, strengthen stakeholder relationships, and achieve sustainable social impact.

Background: The suspension has the role of transmitting and carrying the forces and moments between the wheels and the frame and controlling the wheel runout, thus providing the car with good comfort and operational stability. Objective: Through the analysis of the current situation of suspension research, we summarize the research line and specific technical solutions of suspension, and finally, we provide an outlook on the future development direction of suspension, which in turn can provide some reference value for readers. Methods: The existing suspensions are classified into passive suspensions, semi-active suspensions, and active suspensions, and their improvement methods are described to compare the advantages and disadvantages of different improvement methods. Results: By comparing the results of suspension studies, semi-active suspension can effectively improve the smoothness and handling stability of the vehicle. Semi-active suspension has the advantages of low energy consumption, simple control, lower cost, easy implementation, and high reliability, while the effect of vibration control can be close to active suspension to some extent and far better than passive suspension. Conclusion: This paper introduces passive suspension, semi-active suspension, and active suspension in three categories and describes the working principle, functions, problem-solving advantages, and shortcomings of the three suspensions, respectively. Semi-active suspension is more suitable for the future development trend of suspension.

Tirabrutinib is an orally effective, approved, and highly selective second-generation Bruton's tyrosine kinase (BTK) inhibitor for the treatment of recurrent or refractory primary central nervous system lymphoma (PCNSL). This study aimed to develop an ultra-high performance liquid chromatography- tandem mass spectrometry (UPLC-MS/MS) method for the determination of tirabrutinib concentration in rat plasma, where zanubrutinib was used as an internal standard (IS). This method was also applied to study whether tirabrutinib would interact with voriconazole, itraconazole, and fluconazole in rats, providing a reference value for clinical medication guidance. In the current study, the organic solvent protein precipitation method was used to treat plasma samples, which is simple and reproducible. Tirabrutinib (m/z 455.32 → 320.21) and zanubrutinib (m/z 472.13 → 455.04) were separated on a Waters Acquity BEH C18 column (2.1 × 50 mm, 1.7 μm) and detected by multiple reaction monitoring (MRM) in positive ionization mode. The method showed good linearity in the range of 5-3000 ng/mL for tirabrutinib with the lower limit of quantification (LLOQ) of 5 ng/mL. The recovery and matrix effects were 85.7-91.0% and 102.0-113.3%, respectively. The accuracy, precision, stability, and carry-over effect were also acceptable. The method could also be used for determining the pharmacokinetic interaction of tirabrutinib in rats. The results showed AUC0→∞ of tirabrutinib to be increased by 139.3% and 83.9% in the presence of voriconazole and fluconazole, respectively, while itraconazole had little effect. It is necessary to monitor the concentration of tirabrutinib in patients when it is combined with voriconazole and fluconazole to achieve a better therapeutic effect and reduce the risk of adverse reaction. Further research should be conducted in the future.

Background:: Mountain areas, in a normal ecosystemic context as the analyzed region from the European Romanian Carpathians, offer healthier solutions through different agronomical practices and solutions designed for the production of functional food. The paper approaches a chain formed by mountain functional food – agronomic practices – mountain products commerce, the purpose being the development of the entire mountain products value chain from an area focusing on the matrix "from the farm to the fork". The paper analyzes highly consumed mountain products with functional food roles Allium cepa, Allium sativum, Cucumis sativus, Capsicum, and Solanum lycopersicum. Objective: The research highlights the importance of vegetable mountain products as a functional food in the current hunger and environment contexts, in a more and more polluted world Methods:: The experimental, clinical, and agronomical research, together with the production territorial profile, show that mountain products present high qualitative valences comparatively with low-land areas or with reference values given by USDA. Results:: According to macro-nutritional and micro-nutritional analysis – lipids-fats, saturated fatty acids, protein, cyanocobalamin (B12), ergocalciferol (D2 ), cholecalciferol (D3 ), iron and calcium – Allium sativum dominates the mountain product's top with a functional food role. Instead of this, mountain producers prefer to cultivate mountain products with a higher income horizon. Conclusion:: Functional food represents an imperative in a more polluted world. Being less polluted than other ecosystems, the mountain area offers healthier agricultural products and requires notable investments, together with more involved agronomy.

Objective: A study examined the relationship between somatic cell count (SCC) and milk yield Theoretical Framework: The sustainable development of dairy farms will be key to stopping the growing agricultural frontier. In comparison to breeds from temperate regions, tropical bovine production is low in terms of milk kilos, composition, or udder health. Method: We enrolled one hundred fifty cows (Primiparous, PM, 75 and Multiparous, MP 75) in early lactation (days in milk, PM =134 ± 3; MP = 136 ± 5), milk production (9,88 kg/d, on average) of the creole breed Gyr lechers. Prior to the assignment to each treatment, the SCC values were lower than 220,000 cells/mL, on average. All cows were maintained to graze daily on Megathyrsus maximus and supplemented with Morus alba ad libitum, being hand-milking at 0700 daily. Before analysis, the SCC was logarithmically trans-formed (log10). Then, PROC Mixed from SAS version 9.4 was used to evaluate all measurements. Results and Discussion: The MP had higher milk yields than PM cows (10.83 vs. 9.18 ± 0.38 kg/d; P = 0.003). Similar results were observed for fat-corrected milk (8.26 vs. 6.80 ± 0.34; P = 0.002), although the fat values did not differ between both groups (P = 0.86) being lower than referential values for these breeds (2.46 ± 0.16, on average). Additionally, no differences were observed in the other milk components (P = 0.65 to 0.85). Despite that, the somatic cell count (SCC) values indicated a statistical tendency in PM than in MP (1.89 vs. 2.13 ± 0.05; P = 0.07). Research Implications: Low-fat contents were observed in both groups, possibly due to the low quality of foods used in ruminant feeding. Correspondingly, the parity and advanced lactation conditioned the SCC contents. Therefore, further studies may be relevant in order to identify complementary factors that possibly could be more determinants. Originality/Value: The relevance and value of this research are very importance due to the main activity in this zone is livestock cattle.

Rationale: The use of race-specific reference values to evaluate pulmonary function has long been embedded into clinical practice; however, there is a growing consensus that this practice may be inappropriate and that the use of race-neutral equations should be adopted to improve access to health care. Objectives: To evaluate whether the use of race-neutral equations to assess percent predicted forced vital capacity (FVC%pred) impacts eligibility for clinical trials, antifibrotic therapy, and referral for lung transplantation in Black, Hispanic/Latino, and White patients with interstitial lung disease (ILD). Methods: FVC%pred values for patients from the Pulmonary Fibrosis Foundation Patient Registry were calculated using race-specific (Hankinson and colleagues, 1999), race-agnostic (Global Lung Function Initiative [GLI]-2012), and race-neutral (GLI-2022 or GLI-Global) equations. Eligibility for ILD clinical trials (FVC%pred >45% and <90%), antifibrotic therapy (FVC%pred >55% and <82%), and lung transplantation referral (FVC%pred <70%) based on GLI-2022 and GLI-2012 equations were compared with those based on the Hankinson 1999 equation. Results: Baseline characteristics were available for 1,882 patients (Black, n = 104; Hispanic/Latino, n = 103; White, n = 1,675), and outcomes were evaluated in 1,531 patients with FVC%pred within ±90 days of registry enrollment (Black, n = 78; Hispanic/Latino, n = 72; White, n = 1,381). Black patients were younger at the time of consent and more likely to be female compared with Hispanic/Latino or White patients. Compared with GLI-2022, the Hankinson 1999 equation misclassified 22% of Black patients, 14% of Hispanic/Latino patients, and 12% of White patients for ILD clinical trial eligibility; 21% of Black patients, 17% of Hispanic/Latino patients, and 19% of White patients for antifibrotic therapy eligibility; and 6% of Black patients, 14% of Hispanic/Latino patients, and 12% of White patients for lung transplantation referral. Similar trends were observed when comparing the GLI-2012 and Hankinson 1999 equations. Conclusions: Misclassification of patients for critical interventions is highly prevalent when using the Hankinson 1999 equation and highlights the need to consider adopting the race-neutral GLI-2022 equation for enhanced accuracy and more equitable representation in pulmonary health care. Our results make a compelling case for reevaluating the use of race as a physiological variable and emphasize the pressing need for continuous innovation to ensure equal and optimal care for all patients regardless of their race or ethnicity. Clinical trial registered with www.clinicaltrials.gov (NCT02758808).

Systematic analyses that examine uncertainty in models are essential for assessing their credibility. In this study, we implemented an uncertainty analysis that quantifies the effect of parameter uncertainty on a set of ecological indicators in outputs of the marine ecosystem OSMOSE model applied to the northern Peru Current ecosystem (NPCE OSMOSE). We worked under simple uncertainty assumptions corresponding to ranges of 10, 20, and 30% variability around the reference values of the parameters describing the dynamics of the species modelled in NPCE OSMOSE. The results based on nearly 1.5 million simulations help to identify the main sources of uncertainty that could be of use to focus future research and point to the most reliable indicators in the face of uncertainty. First, uncertainty in the parameters of some species, in particular a key zooplankton species and Humboldt squid, have far-reaching impacts on the modelled biomass of other key species. Second, a set of ecological indicators appear to be relatively insensitive to input uncertainty and may therefore be useful in supporting ecosystem-based management. Furthermore, our findings underline the need for better species representation in terms of data quality but also bottom-up and top-down processes in trophic models. We highlight the difficulties of studying uncertainty in complex models while presenting an approach that can serve as a template for addressing uncertainty analysis in other ecosystem models. Finally, although this approach focuses on parameter uncertainty, it could also serve as a guide to address structural, initial conditions and model forcing uncertainties.

A novel game-based belief rule base

Abstract: To reduce the risk of insufficient nutrient intake, nutrient reference values for humans are set at the average nutrient need level without a safety margin. The vast majority of nations and areas in the globe set nutritional intake guidelines for their citizens. Currently, no harmonized nutrient reference value has been published, as well as the development of standards cannot be achieved through the use of formalized frameworks or terminology. The study's objective was to create recommendations for appropriate and secure micronutrient intake ranges that could be used to inform dietary advice. As relevant to the study, we examined micronutrient data from food intake surveys from representative nations. The comparison of national standards illustrates that the level of reference values for nutrient for individual countries is dependent on variables such as methodology, data sources, physical activity exemptions, standard body weights, and age range. In the current study, iron, calcium, magnesium, vitamin A, B12, D and folate were identified as the most commonly under-consumed micronutrients. In this article, the level of six countries' standards are compared to the current reference values for nutrients. Further, numerous words for different dietary standards components are discussed, and a final set of harmonized reference nutrient intake for the dietary advice is provided.

Determinants of prolonged length of hospital stay in patients undergoing surgery due to extremity fractures: a retrospective cohort study

Abstract Toxic metal ion‐selective electrodes (TM‐ISEs) with simultaneously multiple high‐response properties (MHRPs) are urgently needed for continuous monitoring of contaminated water environment. Still, scarce reports exist from research in which electrodes developed possess those properties. To overcome this challenge, we previously proposed an IECQ index method for obtaining a few of Pb2+‐ISEs with MHRPs and a universal approach for selecting referable values of response characteristic ([RC]refer) for normalization. This research aims to select electrodes with MHRPs from 391 collected electrodes for five kinds of TM (Cd, Cu, Hg, Ag or Zn)‐ISEs (TM‐ISEs) reported in the literature, through the IECQ,i indices and the study of the IECQ screening capacity, that is, the magnitude of IECQ coverage. The higher coverages, from 63.60% to 100%, of four categories IECQ,i (IECQ,2B, IECQ,3C, etc.) to electrodes with high performance are observed, indicating their good screening abilities. For eight diverse needs, the 21 screened electrodes have MHRPs, and their excellent performances are comparable with those used in real‐time monitoring. The reliability of the monitored results would be improved if they were applied to the actual detection of TM ions.