PLoS ONE最新文献

Background: Nutrition plays a crucial role in oral health, influencing the risk of caries, periodontal disease, erosion, and oral cancers. Dentists are key providers of dietary guidance, but require adequate knowledge to do this effectively. This study compared the impact of multimedia versus audio-based educational interventions on the knowledge and self-reported behavior of general dentists in Tehran regarding nutrition and oral health.

Methods: In this randomized controlled trial, 166 general dentists in Tehran were recruited in 2023 through professional online platforms and randomly allocated to either a multimedia-based or an audio-based educational intervention. Knowledge (11 items) and behavior (9 items) regarding the impact of nutrition on periodontal health, dental caries, oral cancer, and erosion were assessed using a validated questionnaire. The educational intervention was delivered over a one-month period. Within-group changes were assessed using paired t-tests, between-group differences using repeated-measures ANOVA, and the effect of demographic variables on post-intervention scores using ANCOVA, with baseline values as covariates (α = 0.05).

Results: Of the participants, 53.6% were women, and 37.9% worked in private practice. Both groups demonstrated significant improvements in knowledge and behavior scores following the intervention (p < 0.001), with greater gains observed in the multimedia group. Analysis of covariance indicated that baseline knowledge and behavior were not significantly associated with age, gender, dental school, years of professional experience, or practice setting.

Conclusion: Both multimedia- and audio-based educational interventions effectively improved dentists' knowledge and self-reported behaviors related to nutrition and oral health. Therefore, given dentists' busy work schedules, the use of these educational approaches may enhance their capacity to provide evidence-based counseling in the field of nutrition and oral health.

We present ScaffoldForge, a 3D conditional diffusion framework for the generative design of bone scaffolds. ScaffoldForge maps a set of standardized trabecular descriptors (bone volume fraction BV/TV, trabecular thickness Tb.Th, trabecular spacing Tb.Sp, trabecular number Tb.N, connectivity density Conn.D, structure model index SMI, degree of anisotropy DA, and permeability k) to a 3D scaffold architecture in a single forward pass. A multi-objective conditioning mechanism couples these descriptors through adaptive instance normalization, and a physics-constrained loss adds empirical penalties for stiffness, manufacturing feasibility, and perfusion, evaluated on the denoiser's reconstruction of the clean scaffold so that the penalties carry gradient. To address the scarcity of paired geometry-property data, we describe a procedural pipeline whose generated scaffolds reproduce the morphometric distributions of real micro-CT references. In an in silico evaluation on three benchmark datasets, ScaffoldForge attains an estimated 56.6 MPa compressive strength (8.2% over topology optimization; paired t-test, p = 0.043, n = 5 seeds) and reduces design-time cost from 8,400-12 seconds per design, a 700× speedup. Generated structures are diverse rather than memorized, and morphometric accuracy holds across all seven shape descriptors. Three analyses probe the reliability of these results given the small training corpus. Equivalence testing replaces the earlier argument from non-significant difference tests: the procedural and real descriptor distributions are equivalent at a medium margin of 0.5 standard deviations for all seven descriptors, but the 50 available real reference volumes cannot establish equivalence at a strict 0.3-standard-deviation margin for five of them. A classifier two-sample test shows that generated scaffolds retain a measurable but shrinking signature of the procedural generator. Enlarging the corpus from 250 to 2,050 scaffolds leaves in-distribution accuracy nearly unchanged while reducing the cross-dataset descriptor error on unseen anatomy from 0.079 to 0.058, which localizes the cost of the small corpus in generalization rather than in fit. We further illustrate a CT-to-scaffold pipeline for personalized generation. All results are computational; physical, biological, manufacturing, and regulatory validation remain future work.

Background: Patients with cancer experience substantial psychosocial challenges throughout the cancer journey. Psychosocial cancer care is crucial for addressing patients' psychological, emotional, social, spiritual needs, and for promoting well-being and quality of life. Despite its importance, psychosocial cancer care services remain insufficiently provided within routine cancer care services in many settings.

Aim of the study: To explore healthcare providers' perceptions of barriers to providing psychosocial cancer care services within routine care at a tertiary cancer hospital in Tanzania.

Materials and methods: This study adopted an explorative qualitative design. This study was conducted at Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Purposeful sampling was used to recruit 18 healthcare providers until information saturation was reached. Data were collected through face-to-face interviews using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analysed using a thematic analysis approach to identify key patterns and themes.

Results: Three themes emerged that describe health care providers' perceptions of barriers to the provision of psychosocial cancer care. These barriers include inadequately trained healthcare providers, an unsupportive organizational structure and environment for psychosocial care services, and challenges in establishing a trusting therapeutic relationship between patients and providers.

Conclusion: Despite its recognized importance in promoting quality of life, the provision of psychosocial cancer care remains insufficiently provided in cancer settings. Findings from this study indicate that psychosocial care provision is limited by inadequate and incompetent staff, a lack of coordination, and an unsupportive organizational structure, and that building effective patient-provider therapeutic relationships was reported to hinder the provision of psychosocial care. To address these barriers, training, the establishment of coordinating units, and the development of protocols to guide the multidisciplinary team are essential. Integrating psychosocial care competencies into healthcare professionals' training curriculum is also essential to bridge the gap.

Managing large carnivores benefits from understanding their vital rates, including survival. For cougars (Puma concolor), the hazards relevant to survival across the landscape are poorly understood. The risks that landscape features present can change temporally, increasing survival in one season while creating mortality risk in another. Between 2016 and 2021, 80 cougars were radio-collared and tracked in west central Alberta, Canada, for a total of 1082 cougar months with a mean monitoring time of 13.5 months/individual. We documented 37 deaths, determined causes of mortality, generated survival estimates using Kaplan-Meier models by sex and age class annually and for two seasons (i.e., warm and cold), and investigated factors affecting survival using Cox proportional hazard models. Humans were responsible for 29 of the 37 documented mortalities, including harvest, removal of problem individuals, landowner removals, incidental trapping, and vehicle collisions, with harvest representing the largest single source of mortality (16/37 deaths) for both sexes. However, we were unable to detect a difference in survival estimates between sexes or age classes and found no evidence of a male-biased harvest. Mean annual survival was 0.60 (95% CI: 0.50-0.72) and varied seasonally with lower survival in the cold season (0.62, 95% CI: 0.52-0.74) than the warm season (0.96, 95% CI: 0.92-1.00). Using Cox proportional hazards models (Andersen-Gill), model selection identified a best-supported mixed model combining biological, environmental, and anthropogenic features: season, proximity to residences, proximity to secondary roads, linear-feature crossing rate, and step length.

Wild edible plants grow in natural environments with little direct human management; consequently, their productivity and quality frequently exhibit pronounced spatiotemporal variability, making stable supply difficult. This variability represents a major constraint on the exploitation of wild edible plants as local food resources, and overcoming it requires an ecological understanding of the factors affecting variation in both productivity and quality. Here, we examined the effects of human harvesting and environmental factors on the taste characteristics of young culms of Sasa kurilensis. No statistically significant differences were detected between harvested and control plots in any major taste index, including umami, bitter aftertaste, astringency, umami richness, and sweetness (measured as Brix values). In contrast, taste characteristics showed substantial variation among study plots, suggesting a strong association with local environmental conditions. Elevation and slope angle were significantly correlated with bitter aftertaste, umami, and sweetness; plots at higher elevations and on steeper slopes tended to produce plants with a less bitter aftertaste, and higher sweetness and umami. Principal component analysis integrating multiple taste indices revealed that the major axis of taste variation was significantly associated with elevation, and that harvesting treatment had no detectable effect. These results suggest that the taste characteristics of young culms in the study area are governed primarily by topographic gradients rather than by human harvesting. Although wild edible plants are important food resources in boreal and temperate forests worldwide, many are poorly managed. By quantitatively establishing relationships between taste characteristics and environmental factors in young culms, this study provides a scientific basis for determining the optimal timing, location, and selection criteria for wild edible plant harvesting, thereby contributing to the development of sustainable use strategies.

This study examines the association between book-tax differences (BTDs), sales decline, and earnings persistence among non-financial listed firms in Vietnam. Adopting a conditional perspective, the study treats BTDs as observable signals of accounting-tax divergence, reporting environments, and transitory earnings components, while sales decline is conceptualized as an adverse operating state that may weaken the association between current and future earnings. Using a balanced panel of 325 firms from 2013 to 2023, comprising 3,575 firm-year observations, earnings persistence is measured through the association between current and one-year-ahead pre-tax book income. Earnings are further decomposed into operating cash flows and accruals to examine component-level persistence. The empirical analysis uses OLS regressions with industry and year fixed effects and firm-clustered standard errors. Additional analyses control for earnings management and tax avoidance and test the robustness of the findings using a continuous measure of sales decline, a sample excluding the COVID-19 period, and an alternative annual-decile classification of large BTDs. The results show that pre-tax book income is persistent, but its persistence is significantly lower during periods of sales decline. The evidence for BTDs is asymmetric: large positive BTDs are more consistently associated with lower earnings persistence, whereas the evidence for large negative BTDs varies across model specifications and earnings components. The three-way interactions among sales decline, BTD classifications, and current earnings are not statistically significant in the main analyses, indicating that the evidence does not support a broad BTD-specific amplification mechanism. Overall, the findings suggest that earnings persistence is shaped by earnings components, accounting-tax reporting signals, and operating conditions. The study highlights the importance of interpreting BTDs jointly with sales trends and earnings components in the Vietnamese institutional setting.

Female breast cancer presents high incidence and mortality rates and is considered a significant public health problem. The timeliness of oncological treatment is a fundamental factor in the prognosis and survival of patients. The objective of this study was to analyze the spatial distribution pattern of the percentage of women who initiated breast cancer treatment within 60 days and its association with socioeconomic indicators and the availability of health services in Brazil. An ecological study was conducted using 133 Intermediate Regions of Urban Articulation (IRUA), based on records from the period 2013-2019. Data on the percentage of treatment initiation within 60 days were obtained from the Hospital Cancer Registry Integrator (IHCR). Socioeconomic variables were collected from the Atlas of Human Development in Brazil and the Institute for Applied Economic Research (IPEA). Data on the availability and density of health professionals and services were obtained from the National Registry of Health Establishments (NRHE) and the Hospital Information System (HIS). The Global Moran's Index and the Local Indicator of Spatial Association (LISA) were used to verify the existence of territorial clusters. Multivariate analysis employed models with global spatial effects. The percentage of breast cancer cases that initiated treatment within 60 days was 48.9% (95% CI: 48.6% - 49.1%), with the highest adherence observed in the IRUA of Cascavel (85%) and the lowest in the IRUA of Rio de Janeiro (16.6%). In the final Spatial Lag Model, positive associations were observed with the density of Family and Community Physicians (β = 0.35; p = 0.007) and the proportion of surgical procedures (β = 0.30; p = 0.001). The analysis indicates that compliance with the 60-day law is related to the structure and organization of health services, highlighting the importance of primary health care as the coordinator of care and the role of surgical capacity in the spatial distribution pattern.

Objectives: Although molecular detection of Cyclospora cayetanensis is increasingly incorporated into multiplex gastrointestinal diagnostic workflows, dedicated external quality assessment (EQA) programmes for Cyclospora remain limited. We performed a nationwide interlaboratory comparison to evaluate routine molecular detection of C. cayetanensis across decentralized ISO15189-accredited laboratories in the Netherlands.

Methods: An anonymized 11-sample panel containing unpreserved stool specimens and eNAT-preserved stool suspensions was distributed to laboratories in the Netherlands (n = 8) and Curaçao (n = 1). Laboratories analysed samples using their routine diagnostic workflows. Workflow characteristics, DNA extraction procedures, molecular platforms, and interpretation criteria were collected by a structured questionnaire. Because detection of Cryptosporidium spp. is usually performed within the same workflow and present similar extraction challenges, Cryptosporidium-positive samples were included as internal workflow controls. Aggregated retrospective laboratory data were collected to explore surveillance feasibility and to gain insight in seasonality of C. cayetanensis and Cryptosporidium spp.

Results: Seven laboratories performed molecular detection of C. cayetanensis, while all nine performed detection of Cryptosporidium spp. Complete qualitative agreement was observed for Cryptosporidium spp. detection. For C. cayetanensis, overall qualitative agreement was high, although one false-positive and three false-negative results occurred among core samples. Detection of a low-positive educational sample varied substantially between laboratories, indicating reduced reproducibility near assay-specific limits of detection. This study shows that eNAT-preserved stool suspensions remained stable under ambient transport conditions. Retrospective laboratory data showed low-level year-round C. cayetanensis detection and a seasonal increase in Cryptosporidium spp. positivity during late summer and autumn.

Conclusions: Routine molecular detection of C. cayetanensis demonstrated good overall interlaboratory agreement across decentralized diagnostic laboratories. However, reproducibility decreased for low-positive samples, highlighting the importance of assay validation, external quality assessment, and cautious interpretation of weak positive C. cayetanensis PCR results.

Prior research on NIH R01 grants peer review found that selection of proposals for panel discussion constituted the decision point with the largest contribution to Black-white NIH funding disparities. We use a causal decomposition framework to understand what factors causally contribute to reducing Black-white disparities in selection into discussion, and to assess how recent procedural changes may affect Black-white disparities in selection into discussion. We first use causal decomposition methodology to explore whether hypothetical interventions eliminating Black-white disparities and/or differences in attributes would reduce Black-white disparities in selection of proposals for panel discussion. The attributes we consider include those associated with applicants (degree, career stage, their institution's funding bin) and their submitted proposals (application type, amended status, Preliminary Overall Impact Score, and NIH assigned Administering Organization and Integrated Review Group). Under reasonable assumptions, we find that among the attributes considered, Preliminary Overall Impact Score was the only one that, after equalizing, could dissolve Black-white disparities in selection into discussion. In addition, we conduct a thought experiment to explore potential impacts of the NIH's move to binary scoring for the Investigator and Environment criteria in the new Simplified Peer Review Framework on Black-white disparities in selection into discussion. Analyses from our thought experiment suggest that changing to binary scoring of the Investigator-and-Environment factor may not have any effect on disparities in selection into discussion. Overall, under the assumptions of the causal decomposition framework, these results suggest that efforts aimed at reducing disparities in selection into discussion should focus on identifying upstream, policy-relevant, and practically feasible interventions for eliminating racial disparities in Preliminary Overall Impact Scores. In contrast, the transition to the Simplified Peer Review Framework is unlikely to substantially reduce disparities in selection into discussion.

The development of aluminium matrix composites with improved structural and tribological performance has attracted considerable interest for lightweight engineering applications. This work investigates the microstructural, mechanical, tribological, and hot-deformation response of an AA8011 aluminium composite containing 5 wt.% TiB2, fabricated by ultrasonic-assisted stir casting and subsequently processed by equal-channel angular pressing (ECAP). The effect of accumulated severe plastic deformation was evaluated in the as-cast condition and after 2, 4, 6, 8, and 10 ECAP passes. Phase constitution and elemental characteristics were examined using X-ray diffraction and energy-dispersive spectroscopy, while microstructural evolution was characterized using optical microscopy, scanning electron microscopy, electron backscatter diffraction, and transmission electron microscopy. Repeated ECAP progressively refined the aluminium matrix, improved the spatial distribution of TiB2 particles, and reduced pronounced casting-related structural discontinuities. The EBSD-measured grain size decreased from 12.45 μm in the as-cast condition to 0.54 μm after 10 passes. The resulting microstructural refinement and densification were accompanied by increases in hardness, tensile strength, compressive strength, flexural strength, impact energy, and elongation. The ultimate tensile strength increased from 182 to 266 MPa after 10 passes. Dry-sliding tests performed at loads of 10-50 N and a sliding distance of 5000 m showed reductions in wear rate of approximately 55-58% and in coefficient of friction of approximately 62-75% relative to the as-cast condition. Processing-map analysis further indicated an expansion of the stable deformation region with increasing ECAP passes. The combined results demonstrate that ultrasonic-assisted stir casting followed by multi-pass ECAP provides an effective route for tailoring the microstructure and mechanical, tribological, and hot-deformation response of AA8011-5 wt.% TiB2 composites within the investigated processing conditions.