Articles

Background: Adjacent segment disease (ASD) is a well‑recognised long‑term complication of lumbar spinal fusion, with the L5/S1 segment being particularly vulnerable when fusion terminates at L5. Data from resource‑constrained Nigerian centres on the incidence, features, and outcomes of L5/S1 ASD are scarce. This study evaluated the specific features, outcomes, and predictors of L5/S1 ASD following lumbar spine surgery at a Nigerian tertiary centre. Methods: A retrospective cohort study of 311 patients who underwent lumbar spine surgery with fixation terminating at L5 at the National Orthopaedic Hospital Dala, Kano, from January 2019 to June 2025 was conducted. Sixty‑three patients (20.3%) developed ASD over a minimum 1‑year follow‑up. Outcomes assessed included specific ASD features, management strategy (surgical vs conservative), patient satisfaction, and predictors of ASD and satisfaction. Results: The most common ASD features were disc degeneration (82.5%), facet joint arthropathy (68.3%), spinal stenosis (55.6%), and spondylolisthesis (36.5%). Twenty‑eight patients (44.4%) underwent surgical extension to S1, with 3 (4.8%) requiring additional S2AI screw fixation. The remaining 35 patients (55.6%) were managed conservatively. Surgical patients had significantly better pain relief (VAS 2.8±1.4 vs 4.6±1.8, p<0.001) and functional outcomes (ODI 28.4±12.6 vs 42.6±15.2, p<0.001). Patient satisfaction was reported by 48 patients (76.2%), with surgical management (OR 3.2, 95% CI: 1.4–7.3) and shorter symptom duration (OR 2.6, 95% CI: 1.1–6.1) being independent predictors of satisfaction. Predictors of ASD included: fusion length ≥3 levels (OR 3.4, 95% CI: 1.6–7.2), preoperative disc degeneration at L5/S1 (OR 2.8, 95% CI: 1.3–6.1), and age >55 years (OR 2.4, 95% CI: 1.1–5.2). Conclusions: L5/S1 ASD occurs in 20.3% of patients following lumbar fusion terminating at L5. Surgical extension to S1 with or without S2AI screws provides superior outcomes compared with conservative management. Fusion length, preoperative L5/S1 degeneration, and older age are significant predictors of ASD.

In this paper, we focus on human stature, which reflects both genetic inheritance and environmental influences, particularly nutrition. This study introduces a variable-order fractional Caputo model that integrates genetic contributions, nutritional dynamics, and demographic modifiers. By allowing the fractional order α(t) to vary with age, the model captures hereditary memory and delayed responses to environmental changes. Because analytical solutions for such models are rarely feasible, the predictor–corrector scheme was adopted. This method, combining an explicit Adams–Bashforth predictor with an implicit Adams–Moulton corrector, was chosen for its efficiency, stability, and adaptability to variable-order problems. Numerical simulations closely reproduce the WHO Child Growth Standards with minimal error, confirming the reliability of the approach. The study demonstrates that the strength of fractional modeling lies not only in its theoretical framework but also in the numerical method that makes it practical and applicable to pediatric endocrinology, nutrition policy, and family counseling.

Background: Type 2 diabetes requires sustained self-care, yet the relationship between specific self-care behaviors and quality of life may vary across populations and care contexts. Evidence focused on Filipino men remains limited. Objective: To describe dietary, exercise, medication, and glucose-monitoring adherence and examine their relationships with quality of life among Filipino men with type 2 diabetes in Manila, Philippines. Methods: This quantitative cross-sectional study analyzed questionnaire data from 31 adult Filipino men with type 2 diabetes. Seven adapted diabetes self-care items assessed diet, exercise, medication use, and home glucose monitoring. Quality of life was assessed with the World Health Organization Quality of Life-BREF. Descriptive statistics and two-tailed Pearson correlations were used. Results: Overall self-care adherence was moderate (M = 3.00). Dietary adherence (M = 3.11) and exercise adherence (M = 3.02) were moderate, whereas the combined medication and glucose-monitoring domain was low (M = 2.57). Mean quality of life was moderate (M = 3.11). Diet (r = -.002, p = .99), exercise (r = .31, p = .09), and medication/glucose-monitoring adherence (r = -.006, p = .97) were not significantly correlated with quality of life. Conclusion: The findings identify actionable gaps in structured exercise, medication-taking, and glucose monitoring but do not support a statistically significant relationship between measured self-care adherence and quality of life. Larger, analytically robust studies should examine clinical, psychological, social, and economic determinants alongside self-care.

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality, with a disproportionate burden in low- and middle-income settings such as Bangladesh. This study assessed knowledge and attitude regarding hypertension prevention among pregnant women at a private hospital in Dhaka and their association with socio-demographic characteristics. Methods: A descriptive cross-sectional study was conducted among 122 pregnant women attending antenatal care at Ashulia Women and Children Hospital, Dhaka, using systematic random sampling. Data were collected via face-to-face interviews using a pre-tested, bilingual, structured questionnaire (10-item knowledge and 10-item attitude scales; Cronbach's alpha 0.814 and 0.795). Scores were dichotomized as low (≤50%) or high (>50%). Chi-square tests examined associations with socio-demographic variables (p<0.05). Results: Overall, 50.8% of women had high knowledge and 60.7% had a favorable attitude toward hypertension prevention; 63.9% had a high combined perception score. Knowledge was significantly associated with age (χ²=18.177, p<0.001), highest among women aged 20-29 years. Attitude was significantly associated with number of children (χ²=9.545, p=0.023), most favorable among women with two children. Education and occupation showed no significant association with either. Gaps persisted around dietary intervention, organic foods, and bed rest, despite high perceived importance of prevention (81.1%) and social media influence (81.1%). Conclusion: Knowledge and attitude toward hypertension prevention were moderate to favorable, with age and family size as the key socio-demographic correlates. Age-specific and family-inclusive education, potentially via social media, may be more effective than broadly targeted interventions.

Background: Hospital-acquired infections (HAIs) caused by multidrug resistant (MDR) bacteria are a major public health problem especially in resource-limited settings. Local data on antimicrobial resistance (AMR) are crucial to inform empirical therapy and infection prevention. Objectives: To identify bacterial pathogens causing HAIs, determine their AMR profiles and independent risk factors for MDR infections in a tertiary hospital in Erbil City, Iraq. Materials and Methods: A cross-sectional study was done at Hawler Teaching Hospital between January and June 2026. Standard microbiological methods were used to analyse 200 clinical specimens from patients with HAIs (≥48 hr after admission). Antimicrobial susceptibility testing was performed according to CLSI 2024 guidelines. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes. Multivariate logistic regression was used to assess independent risk factors. Results: Bacterial growth was obtained in 149 of 200 specimens (74.5%). The major pathogens were Escherichia coli (31.5%), Klebsiella pneumoniae (23.5%), Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (14.1%) and Acinetobacter baumannii (6.1%). In total, 69.1% of the isolates were MDR, with the highest rates in K. pneumoniae (80.0%) and A. baumannii (77.8%). Independent predictors of MDR infection were previous antibiotic use (AOR=4.45), ICU admission (AOR=3.92), and hospitalization >7 days (AOR=3.10). Conclusion: This study documented a significant burden of MDR-HAIs in Erbil City and determined modifiable clinical risk factors. The findings provide evidence to support antimicrobial stewardship, infection prevention and AMR surveillance in Iraqi healthcare settings.

Background: The rising prevalence of diabetes mellitus and its adverse effects on pregnancy outcomes have made pre-pregnancy care (PPC) a critical component of diabetes management among women of reproductive age. Diabetes poses significant risks during pregnancy, but PPC provides an opportunity to prevent complications. Despite these benefits, Nigerian women of childbearing-age living with diabetes still miss out on these advantages due to poorly defined and imperfect integration of PPC into the country’s healthcare system by Health Birth professionals (HBPs). Therefore, their understanding of PPC and the integration of PPC into routine diabetes management practices for childbearing women is essential. The study, therefore, aims to explore HBPs’ provision of PPC for women with pre-existing diabetes in Lagos, Nigeria. Methodology: A qualitative exploratory research design was conducted at two tertiary health institutions in Lagos. A total of 20 participants were purposively selected among doctors and nurse/midwives. The data collected through in-depth semi-structured interviews were transcribed verbatim and analyzed thematically. The trustworthiness of this study was established following the criteria of trustworthiness (credibility, dependability, transferability, and conformability), authenticity was added based on the research worldview. Result: Five themes and eleven subthemes emerged from the analysis. The main themes were clinical importance of PPC for women with diabetes, pregnancy-intention screening for diabetic women, PPC as standard care practice for women with diabetes, raising awareness of PPC, and the enablers of PPC provision. Conclusion: The study emphasized the clinical significance of PPC for women with diabetes; the need for pregnancy-intention screening among diabetic women; the need to make PPC a standard of care for women with diabetes; the importance of raising awareness; and the enablers of PPC. The study highlighted the significance of PPC and the factors that would facilitate its integration PPC into Nigeria's healthcare system. The provision of PPC for women of childbearing potential living with diabetes, as it is key to improving obstetric outcomes and reducing the risks associated with diabetes in pregnancy. It would also be beneficial for leaders at various levels of healthcare institutions to seek the necessary regulatory approvals from the Nigerian government to establish PPC.

Objectives: To evaluate the potential role of hysteroscopic subendometrial autologous platelet-rich plasma application in a patient with refractory thin endometrium after multiple high-quality embryo transfers. Methods: We report the case of a 45-year-old female with a 9-year history of infertility, 15 previous IVF cycles, 8 frozen embryo transfers with a persistently thin endometrium of <7mm. After the exclusion of intrauterine pathology via diagnostic hysteroscopy, leukocyte-poor PRP was activated with calcium gluconate and injected into the subendometrial region. A comparison of endometrial thickness, as well as uterine and subendometrial arterial blood flow before and after PRP application was made. Results: In the subsequent cycle, endometrial thickness increased to 8.2 mm, Doppler vascular parameters improved, and a euploid frozen embryo transfer resulted in a clinical pregnancy and live birth. This case supports further investigation of hysteroscopic subendometrial PRP in selected patients. Conclusion: The regenerative characteristics of PRP in optimizing blood flow should be considered crucial to improving the microcirculation of the endometrial basal layer and subsequent tissue remodeling.

Background: Antimicrobial resistance (AMR) is a major global public health threat that compromises the effectiveness of antimicrobial therapy. Nurses play a critical role in antimicrobial stewardship (AMS); however, evidence regarding their knowledge, attitudes, and practices (KAP) in the Philippine setting remains limited. Objective: To determine the knowledge, attitudes, and practices regarding antimicrobial stewardship among bedside nurses employed in selected tertiary hospitals in Baguio City, Philippines, and to examine the relationships between selected socio-demographic characteristics and AMS competencies. Methods: A quantitative descriptive cross-sectional correlational study was conducted among 119 bedside nurses from two tertiary hospitals in Baguio City. Data were collected using a modified, validated self-administered questionnaire. Descriptive statistics summarized respondents' characteristics and KAP scores. The Shapiro–Wilk test assessed normality. Univariate linear regression examined associations between socio-demographic characteristics and KAP outcomes. Statistical significance was set at p < 0.05. Results: Most respondents demonstrated moderate knowledge, highly positive attitudes, and favorable antimicrobial stewardship practices. Greater knowledge was significantly associated with better stewardship practices. Likewise, positive attitudes were positively associated with stewardship practices. Previous antimicrobial stewardship education and selected socio-demographic characteristics were associated with improved KAP outcomes. Conclusion: Bedside nurses demonstrated positive attitudes and favorable antimicrobial stewardship practices despite moderate knowledge levels. Strengthening competency-based antimicrobial stewardship education may enhance nurses' participation in stewardship initiatives and improve patient safety while contributing to national and global efforts to combat antimicrobial resistance.

Knowledge work teams operating under variable demand face a class of delivery failure that single-layer governance models cannot prevent: structural overload injected at the commitment-formation boundary, invisible to execution-layer metrics, and amplified by cognitive fragmentation that standard workflow instruments do not register. This article examines the architectural conditions under which knowledge work control systems reduce cognitive load and improve delivery predictability. Through a grouped analytical review of empirical and theoretical literature on WIP-limit governance, team cognitive load, and observability-driven telemetry, the article identifies a shared structural limitation across all three bodies of research: none models the coupling between commitment formation, execution mode, and cognitive context as a single governed system. Drawing on control systems theory, queueing dynamics, and cognitive psychology, the article argues that delivery predictability degrades not from execution inefficiency but from the absence of cross-loop coupling rules that prevent obligation surplus, flow degradation, and cognitive fragmentation from reinforcing one another. The three-loop flow architecture comprising a Commit Loop with capacity-bounded intake, a Delivery Loop with explicit Normal, Overload, and Recovery operating modes, and a Cognition Loop enforcing context-capacity constraints through a Context Token Protocol is identified as a structural response to the documented failure modes of existing frameworks. The analytical contribution is a precise specification of the boundary conditions under which WIP-limit Kanban, team-topology design, and DORA-type telemetry each remain adequate, and the condition under which none of them does.

Background: Cystatin C (CysC) predicts adverse outcomes in heart failure (HF), yet its prognostic value relative to underlying renal function remains undefined. We aimed to determine the association between serum CysC and 1-year readmission risk in HF patients stratified by chronic kidney disease (CKD) status. Methods: This retrospective cohort study analyzed 2,008 hospitalized HF patients. Based on CKD status, patients were categorized into non-CKD and CKD groups. Serum CysC levels were analyzed as both continuous variable and in tertiles. The association with 1-year readmission was assessed using multivariable Cox proportional hazards models. Results: Overall, each 1 mg/L increase in CysC was independently associated with an 11% higher risk of re-admission (adjusted HR: 1.11, 95% CI: 1.01-1.23, p=0.003). A significant interaction with CKD status was found (p=0.003). In the non-CKD group, elevated CysC (>1.98 mg/L) was associated with a 51% increased risk (adjusted HR: 1.51, 95% CI: 1.18-1.92, p=0.001), with a non-linear threshold effect identified at 0.998 mg/L. Conversely, no significant association was observed in CKD patients (adjusted HR: 0.96, 95% CI: 0.82-1.12, p=0.576). Conclusions: Elevated serum CysC is a potent predictor of 1-year readmission in HF patients without CKD, but not in those with established CKD. Its prognostic utility is therefore highly dependent on renal context, highlighting its greatest value in patients without advanced renal dysfunction.

Objective: Kratom (Mitragyna speciosa) has emerged as a widely accessible nonprescription substance that is being utilized in the United States. Kratom is commonly used for self-management of pain, psychiatric symptoms, and opioid withdrawal. Veterans receiving care within the Veterans Health Administration (VHA) represent a high-risk population due to elevated rates of chronic pain, post-traumatic stress disorder (PTSD), and substance use disorders (SUDs). Despite increasing prevalence, kratom use remains underrecognized and is not routinely assessed in clinical practice. This narrative review studies the pharmacology, patterns of use, and clinical implications of kratom among Veterans and proposes a standardized screening framework for implementation within the VHA. This will help to align with the patient centered care delivered to our Veterans related to mental health conditions often concurrent with substance use, pain management, and opioid safety. Methods: A targeted narrative review of the literature was conducted using PubMed, Google Scholar, and relevant federal agency reports. Search terms included “kratom,” “Mitragyna speciosa,” “substance use disorder,” “opioid withdrawal,” and “Veterans.” Articles were selected based on relevance to pharmacology, epidemiology, adverse effects, and clinical implications. Findings were synthesized and interpreted using DSM-5-TR substance use disorder criteria. Results: Kratom exhibits partial agonist activity at μ-opioid receptors, producing dose-dependent stimulant and opioid-like effects. According to the National Institutes of Health's National Library of Medicine, mu-opioid receptors, found in the brain and spinal cord, are primarily responsible for pain relief and other opioid-like effects such as euphoria and respiratory depression. Veterans frequently use kratom to self-manage pain, mood symptoms, and opioid withdrawal (Garcia-Romeu et al., 2020; Grundmann, 2017). Kratom use is associated with dependence, withdrawal, and increased risk of polysubstance use (Post et al., 2019). Detection remains limited due to lack of standardized screening tools and the absence of detection in routine toxicology panels. Conclusions: Given the rising incidence of kratom use among Veterans and associated clinical risks, implementation of a standardized screening within the VHA is an appropriate intervention. Incorporating DSM-5-TR-informed criteria into structured assessments can help improve early identification, enhance patient safety, and support evidence-based treatment strategies.

The Heat-Affected Zone (HAZ) is one of the major parameters which determines the structural integrity in welded API 5L X52 pipelines, especially in a sour gas service containing Hydrogen Sulphide (H2S) [1]. This thorough review paper performed the analysis of different international standards including Det Norske Veritas Germanischer Lloyd DNVGL-ST-F101, American Petroleum Institute API 1104, National Association of Corrosion Engineers NACE MR0175 and American Society of Mechanical Engineers ASME B31.8. The researcher analysed the governing and regulation of Heat Affected Zone microstructure and associated properties including strength, hardness and toughness through the specifications like heat values, time between passes and Post Weld Heat Treatment (PWHT), welding specifications and qualification of welding procedures, welders and consumables [2]. By collecting and analysing the data from recent studies (2018-2025), the researchers found out that the standards focusing on prescribing strict recipes for welding and qualification procedures like DNVGL-ST-F101, including explicit heat input limits (typically 1.0-2.0 kJ/mm), obligatory post-weld heat treatment (PWHT), and rigorous consumable qualifications, perform well in Heat Affected Zone in sour gas service. The maximum hardness retirement i.e. 22 HRC (248 HV) obligated for sour media creates a critical limitation that forces optimization of welding procedures. The standards which focus on final quality or the end results rather than prescribing any specific method for producing the weld (Performance-based standards) like API 1104 remains less stringent which results in greater variation in properties around the weld i.e. the HAZ area impacting the service reliability in a worse manner during the sour media [3]. Contemporary world adopting new digital welding techniques for monitoring during weld production, prediction of the microstructural properties of HAZ based on machine learning and other advanced methods like hybrid welding processes which combines different precision welding techniques provide promising results for production of high quality and reliable welds which offer enhanced safety and reliability during sour service [4].

Background: The construction industry is one of the most hazardous sectors worldwide, with workers consistently exposed to risks from prolonged contact with hazardous materials. This study evaluates the effectiveness of wearable technologies in improving safety and health monitoring among construction workers in Nigeria. Methodology: A quantitative cross-sectional survey was conducted among 370 construction workers, site managers, and safety officers across Nigeria using an online questionnaire hosted on Google Forms. The study employed purposive sampling to ensure representation across job roles, experience levels, and project types. Data were collected on awareness, usage, benefits, challenges, and improvements associated with wearable technology. Data was analysed using SPSS version 28. Results: Findings showed that awareness of wearable technology was low (32.4%), and only 34.1% reported personal utilisation. Smart vests (32.7%), noise monitoring devices (32.4%), and smartwatches (32.4%) were the most common devices used. Benefits cited included reduced accident occurrences (28.4%) and enhanced well-being (24.6%), while barriers included cultural/language issues (32.7%) and technological limitations (22.4%). Overall, 48.6% reported improvement in safety and health monitoring. Logistic regression showed that wearable technology use significantly improved safety and health monitoring (AOR = 5.937, p < 0.001), with commercial project workers reporting higher odds of improvement (AOR = 7.495, p = 0.001). Conclusion: Wearable technology significantly enhances safety and health monitoring in Nigeria’s construction industry, particularly for experienced workers and commercial projects. Targeted interventions addressing awareness, training, and accessibility are crucial to overcoming barriers and maximizing its impact.

Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. Results: Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). Conclusions: Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.

Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. Results: A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. Conclusion: Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.

Background: The sacroiliac joint (SIJ) plays a crucial role in transmitting axial loads and maintaining pelvic stability. Sacroiliac joint arthropathy (SIJA) accounts for 10%–30% of low back pain cases but remains underrecognized due to overlapping pain referral patterns and nonspecific imaging findings. Diagnosis relies primarily on characteristic pain distribution and provocative maneuvers, with image-guided intra-articular block serving as the diagnostic gold standard. This study aimed to characterize the clinical profile of block-confirmed SIJA, emphasizing referral pain distribution, triggering position, and provocative test responses. Methods: A cross-sectional study was conducted on 98 patients with diagnostic block–confirmed SIJA at Siloam Hospital Lippo Village, Indonesia. Demographic data, referral pain sites, sitting duration, and results of FABER, compression, and distraction tests were analyzed descriptively. Results: The mean age was 52.07 ± 14.17 years, with 72.4% females. Referral pain most frequently involved the lower back (28.6%) and thigh (28.6%), with occasional extension to the groin (8.2%) or calf (4.1%). Over half of patients (55.1%) reported sitting more than six hours daily. Pain was predominantly triggered during sit-to-stand transitions (85.7%) and while sitting (74.5%). SIJ tenderness (98.0%) and FABER positivity (75.5%) were most consistent. Conclusion: The dominant referral pain in SIJA involves the lower back and posterior thigh. Sit-to-stand transition is the most frequent triggering position, while FABER testing demonstrates the highest diagnostic yield among provocative maneuvers. These consistent patterns may serve as practical clinical indicators to improve diagnostic accuracy in suspected SIJ-related pain.

Introduction: Stroke remains one of the leading causes of death and disability worldwide, with ischemic stroke accounting for most cases. Structural vascular factors such as carotid artery tortuosity have gained attention as potential markers of vascular aging and cerebrovascular risk. The carotid tortuosity index (CTI), defined as the ratio of actual vessel length to the straight-line distance between two fixed points, provides a quantitative measure of arterial curvature. A CTI value of ≥1.2 indicates pathological tortuosity. Although noninvasive modalities such as CTA and MRA are frequently used, digital subtraction angiography (DSA) remains the gold standard for evaluating vessel geometry due to its higher spatial precision. This study aimed to determine the association of age, sex, and hypertension with CTI measured by DSA. Methods: A cross-sectional study was conducted from November to December 2025 at the Neurointervention Clinic, RS Pelni Jakarta, Indonesia, involving 61 adult patients who underwent carotid DSA. CTI was measured bilaterally using digital imaging software and classified as <1.2 (non-tortuous) or ≥1.2 (tortuous). Clinical data, including age, sex, and hypertension status, were collected from medical records and analyzed using bivariate tests. Results: Older age (≥65 years), female sex, and hypertension were significantly associated with higher CTI values on both carotid sides. Tortuosity was more common among hypertensive patients and elderly females, indicating the influence of vascular remodeling and chronic hemodynamic stress. Conclusion: Carotid tortuosity increases with age, hypertension, and female sex. DSA-based CTI measurement provides a reliable and precise approach for evaluating vascular changes associated with cerebrovascular risk.

Background: Sleep deprivation is increasingly prevalent among young adults due to academic, occupational, and social demands, making them susceptible to circadian disruption. Executive functioning—encompassing working memory, inhibitory control, and cognitive flexibility is essential for academic and professional success. This meta-analysis quantifies the effect of sleep deprivation on executive functioning in healthy young adults. Practical Implications: These findings highlight the need for evidence-based interventions such as university-level sleep education programs, flexible academic scheduling, and workplace policies promoting adequate sleep to optimize cognitive performance and productivity among young adults. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, PsycINFO, and Web of Science were searched (January 2000–March 2024) for studies assessing acute (<6 hours sleep or ≥24 hours total deprivation) or chronic (<6 hours/night over multiple days) sleep deprivation in young adults. Outcomes included validated executive function tests (e.g., Stroop, N-Back). Random-effects meta-analysis (Hedges’ g) was conducted using R (version 4.3.2) with metafor/meta packages. Heterogeneity (I², Q-test), sensitivity (leave-one-out), and publication bias (funnel plot, Egger’s test) were evaluated. Results: Out of 2,478 screened studies, 39 met inclusion criteria (n=4,578). Sleep deprivation had a moderate-to-large detrimental effect on executive functioning (Hedges’ g = -0.62, 95% CI [-0.78, -0.45], p<0.001). Subdomain analysis revealed greatest impairment in working memory (g = -0.71), followed by inhibitory control (g = -0.59) and cognitive flexibility (g = -0.49) (all p<0.001). Moderate heterogeneity was present (I² = 58%), with results robust to sensitivity analysis. Egger’s test indicated no significant publication bias (p=0.22). Interpretation: Sleep deprivation significantly impairs executive functioning in young adults, especially working memory. Interventions improve sleep may enhance cognitive performance and should be integrated into public health strategies and educational policies. Future research should assess chronic restriction and individual vulnerability factors.

Background: Building Information Modelling (BIM) improves safety planning in construction by enabling visualization and simulation to identify and reduce risks. However, its adoption in Nigeria is limited. This study examines the application of BIM in enhancing safety and environmental performance on construction sites in Nigeria. Methodology: A quantitative cross-sectional survey was conducted using a structured online questionnaire distributed to professionals in Nigeria’s construction industry. A purposive sampling method was employed to target respondents with relevant BIM experience. Data were analysed using SPSS version 28, applying descriptive statistics, chi-square tests, and logistic regression at a 5% significance level. Result: Findings show that BIM was fully adopted by 7.0% of organizations, with only 19.8% of respondents using it to identify safety hazards during planning. While 76.8% reported no notable safety benefit, 19.5% identified improved risk management as the key benefit. Most respondents (80.2%) reported no noticeable environmental benefits. Among those who did, improved energy efficiency was the most cited benefit (16.4%). Respondents with 10 or more years of experience were significantly more likely to report enhanced safety and environmental outcomes (AOR = 4.555; p = 0.003) and adequate BIM utilization (AOR = 3.255; p = 0.023). Those with intermediate BIM experience were also more likely to report high enhancement (AOR = 2.857; p = 0.039) and effective tool use (AOR = 2.881; p = 0.050). Conclusion: This study revealed that BIM has the potential to improve construction outcomes in Nigeria if supported by training, experience, and structured implementation.

Background: Resting-state functional MRI (rsfMRI) provides insights into large-scale brain network organization associated with cognitive control, emotion regulation, and attentional processes. The ventral attention network (VAN) is a key salience-driven network that supports attentional re-orienting to behaviorally relevant stimuli. However, little is known about how VAN resting state functional connectivity varies by demographic, socioeconomic, psychosocial, and behavioral factors during early adolescence. Objective: To examine associations between VAN rsfMRI connectivity and multiple demographic, socioeconomic, psychosocial, and behavioral characteristics. Methods: Data came from the baseline and early follow-up waves of the Adolescent Brain Cognitive Development (ABCD) Study. The analytic sample included youth with high-quality baseline rsfMRI data and complete socioeconomic and psychosocial measures. The primary outcome was mean resting-state functional connectivity within the VAN across subcortical and cortical regions of interest (ROIs). Bivariate correlations were computed between VAN connectivity and demographic (age, sex, puberty, race/ethnicity), socioeconomic (income, parental education, marital status, neighborhood income), psychosocial (trauma, discrimination, financial difficulty), trait (impulsivity), and behavioral variables (body mass index, depression, suicide, prodromal symptoms, and substance use). Unadjusted bivariate correlations and adjusted logistic regressions were used for data analysis. Results: VAN connectivity showed small but significant correlations with multiple contextual factors. Higher household income, parental education, and neighborhood affluence were associated with greater connectivity, whereas Black race and Hispanic ethnicity were related to lower connectivity. Youth reporting higher discrimination and financial difficulty exhibited weaker VAN connectivity. Greater VAN connectivity was negatively associated with impulsive reward-driven trait (drive), prodromal symptoms, BMI, and marijuana and alcohol use. Associations between VAN connectivity and suicide, depression, marijuana use, and alcohol use remained significant in age and sex adjusted models. Conclusions: VAN connectivity reflects subtle neural correlates of socioeconomic and psychosocial context in early adolescence. Our results underscore the importance of integrating structural and contextual factors in interpreting brain-behavior associations across diverse populations. These findings are suggestive of stable socioeconomic and psychosocial correlates of network efficiency.