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Attention Fragmentation in Digital Learning Environments: Micro-Procrastination, Cognitive Load, and Deep Work Across Educational Levels
No full textMaintaining sustained attention has become increasingly challenging in digitally saturated learning environments, where frequent notifications and habitual task switching are normalized. Although digital distraction has been widely examined, limited research has focused on digital micro-procrastination—brief, repetitive digital interruptions—and its cognitive consequences across educational levels. This study examined the relationships among Digital Micro-Procrastination (DMP), Perceived Cognitive Load (PCL), and Deep Work (DW) among junior high school, senior high school, and college students. Using a quantitative descriptive-comparative design, survey data were collected from 45 students equally distributed across three academic levels. All measures demonstrated acceptable internal consistency following reliability refinement. Data were analyzed using descriptive statistics, Spearman’s rank-order correlation, and Kruskal–Wallis tests. Results revealed a significant positive association between digital micro-procrastination and perceived cognitive load, indicating that frequent short digital interruptions are linked to heightened mental strain and attention fragmentation. Significant cross-level differences were observed, with college students reporting the highest levels of digital micro-procrastination and cognitive load. Findings related to deep work suggest a more nuanced relationship, wherein sustained focus may coexist with elevated cognitive effort rather than reduced task demands. Overall, the study underscores the cognitive implications of everyday digital practices and highlights the need for instructional and self-regulatory strategies that mitigate attention fragmentation in contemporary educational contexts
Mechanisms driving altitude- and latitude-dependent air quality variations from high-altitude NOx emissions
No full textAbstract The environmental impact of nitrogen oxide (NOx) emissions varies with emission altitude and latitude. NOx emissions from subsonic aviation (9-12 km) contribute to net global ozone formation, whereas those from supersonic aircraft (above 14 km) lead to net global ozone depletion. However, the effects of NOx emission altitude on surface air quality remain understudied. We evaluate how NOx emissions at different altitudes (8–22 km) and latitudes influence near-surface concentrations of two known air pollutants: ozone and fine particulate matter (PM2.5). Using the global chemical transport model GEOS-Chem, we find that NOx emissions of 1 Tg N yr−1 at 8–10 km (30–60°N) increase surface ozone (population-weighted) by 0.52 ppb and surface PM2.5 by 35 ng m−3, whereas emissions at 20–22 km reduce surface ozone by 1.73 ppb and increase surface PM2.5 by 310 ng m−3; this is nine times the PM2.5 increase per unit NOx from lower-altitude emissions. These effects stem from altitude-dependent mechanisms: at lower altitudes typical of subsonic aviation, NOx emissions increase upper tropospheric ozone which leads to enhanced surface ozone and nitrate aerosol. However, when emitted at higher altitudes NOx instead depletes ozone, permitting more ultraviolet light to reach the troposphere which boosts OH production and accelerates production of sulfate aerosol while destroying near-surface ozone. Our findings suggest that NOx emissions from high-altitude sources, including supersonic aircraft may not only contribute to stratospheric ozone depletion but also cause larger changes (albeit of mixed sign) in surface air quality than subsonic aviation per unit of NOx emitted
Anthropogenic warming projected to drive a decline in global tropical cyclone frequency in CMIP6 simulations
No full textAbstract Changes in tropical cyclone (TC) frequency in a warming climate remain highly uncertain, with model simulations often yielding conflicting results. Here, through an analysis of 26 CMIP6 models under the SSP5-8.5 scenario, we project a decline in global TC frequency of 2–10% by the late 21st century. This decline is driven by an El Niño-like warming pattern, marked by amplified warming in the equatorial central-eastern Pacific, equatorial Atlantic, and North Indian Ocean. These non-uniform sea surface temperature (SST) trends weaken zonal SST gradients, suppressing the Walker circulation, and inducing Gill-type atmospheric responses to localized heating, in addition to an equatorward shift in the Intertropical Convergence Zone. These changes reduce upward motion across most basins, suppressing TC genesis. Additionally, radiative forcing reduces interhemispheric temperature contrasts, dampening the cross-equatorial Hadley circulation and further decreasing TC frequency, most notably in the South Indian Ocean. Our findings highlight the critical role of spatially heterogeneous SST warming in modulating TC activity and stress the need to reduce uncertainties in future SST projections. These insights advance the physical understanding of climate-driven TC projections and provide essential guidance for adaptation planning in vulnerable regions
Health care epidemiology, characteristics, and regional variation of chiropractic care in Switzerland: a descriptive study using insurance claims data
No full textAbstract Background Musculoskeletal disorders are a leading cause of disability and major driver of health care costs in Switzerland. Since chiropractors are musculoskeletal health care providers in this setting, we aimed to describe the health care epidemiology, characteristics, and regional variation of chiropractic care in Switzerland. Method We conducted a retrospective descriptive study using administrative health insurance claims data of all ages from Helsana. Chiropractic care incidence cases were persons with first occurrence of chiropractic care in two study index years, 2018 and 2019. Chiropractic care prevalence cases had any chiropractic care over a 24-month prevalence period. We estimated (i) crude, (ii) sex-, age-, and region- standardised 12-month cumulative incidence, and (iii) 24-month prevalence of chiropractic care per 100,000 population. We characterised four mutually exclusive chiropractic care incidence subgroups based on additional health care use eight weeks before or after the index visit. Regional variation was visualised with choropleth maps. Results Among 1,137,904 and 1,196,760 persons with Helsana health insurance in 2018 and 2019, 17,148 (mean age 48.7 [SD, 18.4] years; 9,717 [56.7%] women) and 18,261 (mean age 48.2 [SD, 18.2] years; 10,421 [57.0%] women) persons had a chiropractic care incidence visit, respectively. The crude 12-month chiropractic care incidence was estimated at 1,507 (95% CI, 1,485 to 1,530) and 1,526 (1,504 to 1,548) cases per 100,000 in 2018 and 2019, respectively. Sex-, age-, and region-standardised incidence estimates were comparable to crude estimates. The 24-month prevalence of chiropractic care was estimated at 3,135 (3,105 to 3,166) per 100,000 population. The chiropractic case subgroup with the highest health care use had more comprehensive insurance models with lower deductibles. Incidence of chiropractic care varied across regions with the lowest incidence observed in Ticino and the highest in Espace Mittelland and Zurich. Conclusions The incidence and prevalence of chiropractic care utilisation in Switzerland in 2018 and 2019 were markedly low. Chiropractic care subgroups differed in their characteristics, and incidence estimates varied across major regions. Further studies on the predictors and causes of chiropractic care underutilisation are warranted to inform accessible and equitable musculoskeletal and rehabilitation health services in Switzerland
Global, regional, and national burden of lymphoma from 1990 to 2021: a comprehensive analysis based on the global burden of disease study 1990–2021
No full textAbstract Purpose Based on the global burden of disease (GBD) data from 1990 to 2021, to systematically evaluate the spatiotemporal variation characteristics of the incidence, mortality, and disability-adjusted life years (DALYs) of lymphoma and its main subtypes (Hodgkin’s lymphoma [HL], non-Hodgkin’s lymphoma [NHL], and their subtypes). And explore the influence of the sociodemographic index (SDI) on the disease burden of lymphoma. Methods Using the GBD 2021 data covering 204 countries/regions worldwide, the age-standardized incidence rate (ASIR), mortality rate (ASDR), DALYs, and average annual percentage change rate (EAPC) were analyzed. The influence of socio-economic factors on the burden of lymphoma was revealed through SDI stratification, regional comparison, and gender-age analysis. Results The results showed that the incidence and mortality rates of HL and NHL in areas with high SDI were relatively high and on the rise, which might be related to the improvement of medical diagnosis levels. The burden of NHL in medium- and low-SDI regions is relatively low but gradually increasing. The incidence of Burkitt lymphoma (BL) and DALYs significantly increased in areas with high SDI, while the changes were relatively small in areas with medium and low SDI. The incidence and mortality rates of most subtypes in men are higher than those in women, and the burden varies significantly among different age groups. Conclusion The socioeconomic level is closely related to the disease burden of lymphoma. It is necessary to strengthen global medical collaboration and resource allocation, especially to enhance the diagnosis and treatment capabilities in areas with low SDI. In the future, it is necessary to explore the interaction between environmental and genetic factors on lymphoma and formulate precise regional prevention and control strategies in order to reduce the disease burden and promote health equity
A novel mechanistic insight: BYHWD glycosides promote vascular endothelial repair via EPCs
No full textAbstract Objective To explore the mechanism of glycosides from BYHWD promote EPCs repairing damaged vascular endothelium. Methods A model of vascular intimal damage in rats and an aging model in EPCs were established. HE staining was carried out to examine the blood vessel intima; Elisa assays were employed to assess the levels of TC, TG, HDL-C, LDL-C, Col-1, MMP-9, and TIMP-1; frozen sections were utilized to detect the homing status of EPCs in vivo; western blot was used to detect the contents of eNOS, ITGβ3, ITGβ6, FAK, P-FAK, ERK1/2 and P-ERK1/2; the CCK-8 assay was used to evaluate the proliferation rate; the cell migration test was used to evaluate cell migration capabilities; and the tube formation test was used to determine the tube formation ability. Results BYHWD, glycosides, and EPCs are capable of ameliorating intimal thickening. They can increase the levels of eNOS, raise HDL levels, and reduce TG, TC, and LDL levels. Moreover, glycosides can promote the function of EPCs following vascular intimal damage. BYHWD and glycosides can decrease the rate of EPCs cell aging and increase the cell proliferation rate, migration ability, and tube-forming function in the aging model. BYHWD and glycosides can down regulate P-FAK, P-ERK, ITGβ3, ITGβ6, Col-1, and MMP-9, while up regulate TIMP-1 levels in the aging model. Additionally, glycosides can promote EPCs to change the levels of these proteins. Conclusion Glycosides promote EPC-mediated repair of damaged vascular endothelium through inhibiting the integrin/ECM via FAK/ERK pathway. Graphical Abstrac
Neutrophils and NETosis in polycystic ovary syndrome: unraveling the immuno-metabolic thromboinflammatory axis
No full textAbstract Polycystic ovary syndrome (PCOS), traditionally defined by its endocrine and reproductive hallmarks—hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology—is increasingly viewed as a complex disorder associated with chronic low-grade immuno-metabolic inflammation. Emerging evidence suggests that neutrophils, the most abundant innate immune cells, may play a contributory role in linking metabolic stress, inflammatory signaling, and vascular dysfunction in PCOS. In women with PCOS, hyperandrogenism, insulin resistance, and adipose-derived inflammatory cues have been associated with altered neutrophil activation profiles, including increased oxidative stress, degranulation, and markers suggestive of neutrophil extracellular trap (NET) formation. While direct evidence for NET-driven pathology in PCOS remains limited, mechanistic insights from related inflammatory and metabolic diseases indicate that NET-associated pathways can amplify thrombo-inflammatory signaling, endothelial dysfunction, and tissue injury. This review synthesizes available PCOS-specific data on neutrophil activation alongside mechanistic frameworks inferred from other disease contexts, emphasizing cytokine- and adipokine-mediated priming, neutrophil heterogeneity, and potential NET-associated effects on reproductive, metabolic, and cardiovascular outcomes. We also highlight critical knowledge gaps, including the need for longitudinal studies, standardized NET biomarker assessment, and single-cell immune profiling to define neutrophil subsets and functional states in PCOS. Finally, we discuss translational perspectives, proposing neutrophil- and NET-focused strategies as potential adjuncts to existing hormone-centric management, rather than established therapeutic targets. By reframing PCOS through an immuno-metabolic lens centered on innate immune dysregulation, this review provides a cautious yet integrative conceptual framework to guide future mechanistic and clinical investigations. Graphical Abstrac
Evaluation of serum HMGB1 levels in assessing the severity of pediatric sepsis and analysis of the therapeutic efficacy of blood purification modalities
No full textAbstract Background High Mobility Group Box 1 protein (HMGB1) plays a critical role in the pathogenesis of sepsis. However, its value in assessing disease severity and its relationship with blood purification therapy in pediatric sepsis remains underexplored. Objective This study aims to investigate the value of serum HMGB1 in evaluating the severity of pediatric sepsis and its association with blood purification treatment. Methods A retrospective observational cohort study was conducted. This study included 90 pediatric patients with sepsis and 21 healthy controls admitted from March 2022 to December 2023. Patients were stratified into a mild-severity group (n = 44) and a severe-severity group (n = 46) based on clinical criteria. Among the severe patients, 21 received continuous renal replacement therapy (CRRT). Of these, 6 were treated with a single-mode (CHDF) and 15 with a mixed-mode (CHDF + PE) blood purification strategy. Serum HMGB1 levels were measured using enzyme-linked immunosorbent assay (ELISA). Results Serum HMGB1 levels were significantly higher in the sepsis group compared to the healthy control group (P < 0.001). Within the sepsis cohort, HMGB1 levels were significantly elevated in the severe group versus the mild group (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that HMGB1 had an area under the curve (AUC) of 0.921 for diagnosing severe sepsis, demonstrating superior performance compared to other inflammatory markers. CRRT treatment was associated with a significant reduction in HMGB1 and other inflammatory markers (P < 0.001). The survival rate in the mixed-mode treatment group was significantly higher than that in the single-mode group (86.7% vs. 16.7%, P = 0.006). Conclusion Serum HMGB1 levels are significantly associated with the severity of pediatric sepsis and show promising diagnostic value. Blood purification treatment is associated with a reduction in HMGB1 levels; however, the underlying mechanisms require further investigation
Accelerometer-based detection of circadian rhythm disruption in sheep following shearing
No full textAbstract Background . Circadian rhythms regulate physiological and behavioral processes in livestock, influencing welfare, productivity, and adaptation to environmental changes. In sheep, locomotor activity (LA) is a reliable marker of circadian organization and can be continuously monitored using accelerometers. Shearing represents an abrupt management event that alters body insulation and may disturb thermal balance and stress responses, but its effects on circadian rhythmicity have not been quantified. This study aimed to evaluate whether shearing disrupts circadian LA in ewe lambs using continuous accelerometer-based monitoring. Results . Eleven Rasa Aragonesa ewe lambs were monitored continuously from 48 h before to 72 h after shearing. Circadian parameters were quantified using cosinor analysis, including mesor, amplitude, and acrophase, together with indices of rhythm robustness (Circadianity Index, CI) and day–night differentiation (Diurnality Index, DI). Before shearing (− 48 h and − 24 h), sheep displayed robust circadian rhythms, with mesor values of 0.032–0.033 g, high amplitudes (0.011–0.014 g), acrophases clustered around midday (1237–1318 h), elevated CI values (0.19), and pronounced day–night contrasts reflected by high DI values (0.43). At 24 h post-shearing, LA increased significantly, while amplitude (0.009) and CI decreased compared with pre-shearing values (P < 0.01), and acrophase was significantly delayed to the evening (1849 h; P < 0.01). Day–night differentiation was also significantly reduced (P < 0.001). At 48 h post-shearing, amplitude and CI declined further (0.005; P < 0.001), indicating a marked weakening of rhythm robustness, with acrophase delayed to approximately 2008 h. By 72 h post-shearing, circadian organization was severely disrupted, with minimal amplitude (0.001), near-zero CI, markedly reduced DI, and a significantly advanced acrophase to early morning hours (0407 h). Conclusions . Accelerometer-based biotelemetry revealed that shearing strongly alters the circadian organization of LA in sheep. The procedure induces acute behavioral activation followed by dampened rhythmic strength and altered phase expression, likely reflecting combined stress and thermal effects. These findings highlight the sensitivity of circadian monitoring through accelerometry for detecting management-induced disturbances in livestock behavior. Incorporating chronobiological approaches into routine welfare assessment could improve understanding of physiological adaptation and support more welfare-friendly management practices in animal production systems
Competency of novice anesthesia residents in performing trans thoracic echocardiography following a structured problem-based hands-on course using a trans thoracic echocardiography simulator versus video-based training: a randomized controlled assessor-blinded trial
No full textAbstract Background Trans-thoracic echocardiography (TTE) improves the diagnostic skills of anesthesia trainees during the perioperative period. We compared performance between two educational intervention, simulation-based hands-on training and video-based training as measured by a novel TTE Competency Score (TCS). Methods Fifty novice anesthesia residents were randomized into an intervention group-I (received simulation-based training) and a control group-C (received video-based training). Both groups underwent evaluations of their knowledge and skills on live volunteers or ICU patients using TCS right after the training and again six months thereafter. An independent sample t-test was employed to compare TCS between the groups, while a paired t-test was used to assess intragroup TCS at the baseline, after training, and six months post-training. Results The two groups had no significant difference in the pre-test assessment scores. Immediately following the training session, Group I exhibited a significantly higher TCS compared to Group C (25.2 ± 2.7 and 22.4 ± 2.5, p = 0.01). Compared to the I-group, the C-group made more attempts to achieve competence. Group I exhibited higher confidence levels both immediately and six months later. After a six-month follow-up, the TCS scores in both groups were lower than the scores recorded immediately. Conclusion This study demonstrates that a structured, problem-based simulator course improved immediate TCS and 6-month confidence compared with video-based training. However, a decline in TCS in both groups over time highlights the need for periodic refreshers within six months to improve retention. Trial registration CTRI [CTRI/2021/07/034684]
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