Search Results (814)

Background: Plant-based protein supplementation in supporting muscle recovery following resistance exercise remains an area of growing interest, particularly among vegan athletes, as a potential alternative to animal-based proteins. This systematic review aimed to evaluate the effectiveness of plant-based proteins on recovery from resistance exercise-induced muscle damage in healthy young adults. Methods: A systematic and comprehensive search was administered in eight databases up to 1 May 2025, identifying 1407 articles. Following deduplication and screening, 24 studies met the eligibility criteria, including 22 randomized controlled trials and 2 non-randomized studies, with the majority from high income western countries. Results: Interventions primarily involved soy, pea, rice, hemp, potato, and blended plant protein sources, with doses ranging from 15 to 50 g, typically administered post resistance exercise. Outcomes assessed included muscle protein synthesis (MPS), delayed-onset muscle soreness (DOMS), inflammatory biomarkers, muscle function, and fatigue. The review findings reaffirm that single-source plant proteins generally offer limited benefits compared to animal proteins such as whey, particularly in acute recovery settings, a limitation well-documented consistently in the literature. However, our synthesis highlights that well-formulated plant protein blends (e.g., combinations of pea, rice, and canola) can stimulate MPS at levels comparable to whey when consumed at adequate doses (≥30 g with ~2.5 g leucine). Some studies also reported improvements in subjective recovery outcomes and reductions in muscle damage biomarkers with soy or pea protein. However, overall evidence remains limited by small sample sizes, moderate to high risk of bias, and heterogeneity in intervention protocols, protein formulations, and outcome measures. Risk of bias assessments revealed concerns related to detection and reporting bias in nearly half the studies. Due to clinical and methodological variability, a meta-analysis was not conducted. Conclusion: plant-based proteins particularly in the form of protein blends and when dosed appropriately, may support muscle recovery in resistance-trained individuals and offer a viable alternative to animal-based proteins. However, further high-quality, long-term trials in vegan populations are needed to establish definitive recommendations for plant protein use in sports nutrition. Full article

Enhancing farmers’ digital literacy is both an inevitable requirement for adapting to the digital age and an important measure for promoting the sustainable development of livestock and poultry manure resource utilization. This study surveyed and obtained data from 1047 farm households in Ningxia and Gansu, two provinces in China that have long implemented livestock manure resource utilization policies, from December 2023 to January 2024, and employed the binary probit model to analyze how digital literacy influences farmers’ willingness to adopt two livestock manure resource utilization modes, as well as to analyze the moderating role of three policy regulations. This paper also explores the heterogeneous results in different village forms and income groups. The results are as follows: (1) Digital literacy significantly and positively impacts farmers’ willingness to adopt both the “household collection” mode and the “livestock community” mode. For every one-unit increase in a farmer’s digital literacy, the probability of farmers’ willingness to adopt the “household collection” mode rises by 22 percentage points, and the probability of farmers’ willingness to adopt the “livestock community” mode rises by 19.8 percentage points. After endogeneity tests and robustness checks, the conclusion still holds. (2) Mechanism analysis results indicate that guiding policy and incentive policy have a positive moderation effect on the link between digital literacy and the willingness to adopt the “household collection” mode. Meanwhile, incentive policy also positively moderates the relationship between digital literacy and the willingness to adopt the “livestock community” mode. (3) Heterogeneity analysis results show that the positive effect of digital literacy on farmers’ willingness to adopt two livestock manure resource utilization modes is stronger in “tight-knit society” rural areas and in low-income households. (4) In further discussion, we find that digital literacy removes the information barriers for farmers, facilitating the conversion of willingness into behavior. The value of this study is as follows: this paper provides new insights for the promotion of livestock and poultry manure resource utilization policies in countries and regions similar to the development process of northwest China. Therefore, enhancing farmers’ digital literacy in a targeted way, strengthening the promotion of grassroots policies on livestock manure resource utilization, formulating diversified ecological compensation schemes, and establishing limited supervision and penalty rules can boost farmers’ willingness to adopt manure resource utilization models. Full article

Background/Objectives: Cystic fibrosis (CF) is a rare autosomal recessive genetic disease that has a progressive and multisystemic course. The spectrum and frequency of mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) vary both in European countries and in other geographical regions. The aim of our retrospective study was to present the genetic variants identified in a group of 48 CF patients from the Moldova region (Romania), as well as to establish genotype–phenotype correlations. Methods: Genetic testing was initially performed for 38 CFTR mutations, and in heterozygous patients or those in whom no mutation was detected, CFTR gene sequencing (NGS) was performed. Results: The compound heterozygous genotype was identified in 26 (54.16%) of the patients (with one of the alleles being F508del), while 22 (45.83%) patients had the homozygous F508del genotype. The F508del variant was the most frequent (69.79%), followed by G542X (6.25%, 6/96). Several new variants were also identified that had not been reported in other studies from Romania (R1158X, K598*, R347H, c.2589_2599del, R496H, and CFTRdele2). Phenotypic manifestations in patients with CFTR class I, II, III and VII variants (homozygous and compound heterozygous) were more severe compared to those in patients with CFTR class IV, V and VI mutations, with the data obtained being consistent with those in the literature. Respiratory tract involvement was present in 77.08% of the patients, being more frequent in patients with the compound heterozygous genotype compared to the homozygous F508del genotype. Most patients had exocrine pancreatic insufficiency (EPI) (85.41%). Gastrointestinal manifestations included hepatocytolysis (66.66%) and biliary cirrhosis (0.41%). Meconium ileus was detected in 18.75% of patients, all with a compound heterozygous genotype. Conclusions: We compared the results obtained with data from the literature and correlated the detected CFTR variant (genotype) with the phenotypic manifestations, highlighting certain particularities present in some patients. Genetic testing allows for early diagnosis and adapted management, including personalized treatment for each patient. Identification of novel unclassified CFTR variants still remains a challenge for clinicians. NGS-based screening of heterozygous healthy carriers is important for both genetic counseling and prenatal diagnosis. Full article

Public service innovation research often focuses on the private or general public sectors, leaving the distinct challenges government entities face unexplored. An empirical study was carried out to bridge this gap using survey results from the United Arab Emirates (UAE) government entities. This study built on that research by further analyzing the relationships among these challenges through a social network approach, visualizing and analyzing the connections between them by utilizing betweenness centrality and eigenvector centrality as key metrics. Based on this analysis, the challenges were classified into different categories; 8 out of 22 challenges were identified as critical due to their high values in both metrics. Addressing these critical challenges is expected to create a cascading impact, helping to resolve many others. Targeted strategies are proposed, and leveraging open innovation is highlighted as an effective and versatile solution to address and mitigate these challenges. This study is one of the few to adopt a social network analysis perspective to visualize and analyze the relationships among challenges, enabling the identification of critical ones. This research offers novel and valuable insights that could assist decision-makers in UAE government entities and countries with similar contexts with actionable strategies to advance public service innovation. Full article

Wild ales represent a diverse category of spontaneously fermented beers, influenced by complex microbial populations and variable ingredients. This study employed an integrated metabolomic profiling approach combining proton nuclear magnetic resonance (¹H NMR) spectroscopy, liquid chromatography–mass spectrometry (LC-MS), and spectrophotometric assays (DPPH and FRAP) to characterize the molecular composition and antioxidant potential of 22 wild ales from six countries. A total of 53 compounds were identified and quantified using NMR, while 62 compounds were identified by using LC-MS. The compounds in question included organic acids, amino acids, sugars, alcohols, bitter acids, phenolic compounds, and others. Ingredient-based clustering revealed that the addition of dark fruits resulted in a significant increase in the polyphenolic content and antioxidant activity. Concurrently, herb-infused and light-fruit beers exhibited divergent phytochemical profiles. Prolonged aging (>18 months) has been demonstrated to be associated with increased levels of certain amino acids, fermentation-derived aldehydes, and phenolic degradation products. However, the influence of maturation duration on the antioxidant capacity was found to be less significant than that of the type of fruit. Country-specific metabolite trends were revealed, indicating the influence of regional brewing practices on beer composition. Correlation analysis was employed to identify the major contributors to antioxidant activity, with salicylic, dihydroxybenzoic, and 4-hydroxybenzoic acids being identified as the most significant. These findings underscore the biochemical intricacy of wild ales and exemplify metabolomics’ capacity to correlate compositional variation with functionality and authenticity in spontaneously fermented beverages. Full article

This paper investigates how sustainable STEM education is being shaped within the pre-university systems of the 22 Arab countries. By categorizing these systems into four groups based on the Global Knowledge Index and two analytical tracks, this study examines in detail the factors that enable—or hinder—the development of long-term, sustainability-oriented competencies in science, technology, engineering, and mathematics. Beyond pedagogical dimensions, this study emphasizes STEM education as a strategic tool for achieving national sustainable development goals (SDGs), promoting workforce readiness, and informing education policy reform. The analysis highlights the policy efforts, systemic limitations, and the need for localized strategies to integrate sustainability into the STEM curricula and teacher training. It is structured in six sections: (1) an introduction to STEM and sustainability concepts, the Global Knowledge Index, and the Arab-region education landscape; (2) research questions, methodology, and data sources; (3) analysis of Groups 1 and 2, assessing their experiences in implementing sustainability-driven STEM initiatives; (4) analysis of Groups 3 and 4, evaluating their readiness for adopting sustainable STEM programs; (5) discussion of findings in light of sustainability policy frameworks; and (6) a concluding overview with actionable recommendations to align national education systems with global sustainability goals. Full article

Background and Objectives: Physical activity represents a cornerstone in the management of diabetes mellitus; however, the majority of persons with diabetes remain insufficiently active. Current guidelines emphasise the need to educate individuals with diabetes on physical activity at each clinical visit. The aim of the study was to develop an adequate instrument and test diabetologists’ knowledge on physical activity and related guidelines in diabetes, as well as investigate their prescribing habits. Materials and Methods: The instrument was developed with four diabetologists using Delphi and RAND appropriateness methods, then distributed to diabetologist societies in 12 Southeast European countries for anonymous completion by their members. Data were analysed using Mann–Whitney U test and Pearson ${ x}^2$ test. Results: Out of 302 analysed respondents, 123 (41%) worked at university hospitals, at average four days a week in outpatient departments, mean number of patients was 16 a day; 95 (32%) had a PhD, and 105 (35%) university teaching positions. Median overall knowledge was 15 (Q1–Q3, 13–17) out of 22 maximum points. 26% diabetologists knew recommended level of physical activity for people with diabetes. Physical activity goals were discussed during check-ups in 53.0% of cases; re-education and goal adjustments were provided in 33.4% when health status changed; and clear instructions were documented in 25.5% of medical records. Conclusions: Diabetologists’ overall knowledge of physical activity was found to be at least satisfactory in 90% of participants. Knowledge of the guidelines is insufficient in 75% of participants. The prescribing habits are inadequate in half of the participants. Full article

Background/Objectives: Despite its well-established health benefits, adherence to the Mediterranean lifestyle (MedLife) has declined globally, including in its region of origin, alongside a significant shift toward ultra-processed food consumption. Understanding the factors associated with MedLife adherence is essential for developing targeted interventions and tailored policy recommendations. As part of the MEDIET4ALL PRIMA project, this cross-sectional study aimed to comprehensively examine geo-demographic, socio-economic, psychological, behavioral, and barrier-related factors associated with and potentially contributing to MedLife adherence. Methods: Data were collected from 4010 participants aged 18 years and above across ten Mediterranean and neighboring countries using the multinational MEDIET4ALL e-survey, which included the validated MedLife index, along with various other questionnaires. Results: Results indicate that only 22% of respondents demonstrated high adherence to the Mediterranean lifestyle (MedLife), with significant variability observed across countries, age groups, education levels, and health statuses. Spain had the highest proportion of participants with high adherence (38%). Factors associated with significantly higher adherence rates include older age, living in the Mediterranean region, higher education levels, a greater awareness of MedLife principles, lower perceived barriers, normal BMI, better health status, and stable economic and marital conditions (p-values ranging from 0.04 to <0.001). Additionally, individuals with high MedLife adherence exhibited more socially and physically active lifestyles and experienced less psychological strain (p < 0.001). Regression analyses identified MedLife awareness as the strongest positive predictor of adherence (β = 0.206), followed by social participation (β = 0.194) and physical activity (β = 0.096). Additional positive contributors include life satisfaction, sleep quality, living in the Mediterranean region, age, and education (β ranging from 0.049 to 0.093). Conversely, factors that are negatively associated with adherence include sedentary behavior, living environment, and barriers such as low motivation, taste dislike, price unaffordability, limited availability, and the time-consuming nature of preparing Mediterranean food (MedFood; β ranging from −0.036 to −0.067). Conclusions: These findings indicate that fewer than one in four adults across Mediterranean and neighboring countries demonstrate high adherence to MedLife, supporting prior evidence of suboptimal adherence even within Mediterranean regions. This study identified a range of behavioral, socio-demographic, and environmental factors—both positive and negative predictors—that can help guide the design of targeted, culturally adapted interventions to promote MedLife behavior. Future research should incorporate objective measurements and longitudinal monitoring to better understand underlying mechanisms, establish causality, and develop sustainable strategies for enhancing MedLife adherence in diverse populations. Full article

Background/Objectives: Systemic sclerosis (SSc) is a multisystemic chronic autoimmune disease, which leads to disability and possibly early retirement. The objective of our study was to explore the associations between employment status (ES) and demographic, clinical and functional features in a single-center EUSTAR cohort. Methods: Consecutive patients with SSc examined between November 2011 and June 2023, who were under the age of retirement in our country (62 years for women, 65 for men at the time), were included. All patients underwent a comprehensive clinical assessment and filled in a work assessment questionnaire as well as two validated health-related questionnaires: the Scleroderma Health Assessment Questionnaire (SHAQ) and the Duruoz Hand Index (DHI). Associations between ES and potential predictors (education level, disease characteristics, work conditions, SHAQ and DHI) were tested using logistic regression adjusted for age and gender. Results: Ninety-one patients (mean ± SD age 53.7 ± 11.8 years, twenty-two with diffuse skin involvement, fifty-six with a history of digital of digital ulcers (DUs)), were included. Only 22 patients were still employed, while 69 were retired, of which 38 retired because of SSc. Among the employed, nine performed manual labor, nine spent many hours standing and three had to work in a cold environment. When potential predictors were tested separately, adjusted for age and sex, patients with higher education (OR (95% CI) 11.36 (2.03–63.36), p = 0.006) and no history of digital ulcers had higher odds of being employed. The presence of joint contractures and weightlifting as a work demand were associated with unemployment. In a multivariable model, higher education (OR 5.91, 95% CI 0.97–36.09, p = 0.054 and younger age (OR 0.90, 95% CI 0.85–0.96, p = 0.001) were independently associated with continued employment. High school education did not show a significant effect (OR 0.089, 95% CI 0.015–0.530, p = 0.008). Patients with a history of digital ulcers had the lowest employment rates compared to those with no digital ulcer history. No significant associations were found between employment status and SHAQ or DHI scores. Conclusions: SSc is associated with significant work disability and early retirement. Higher education, the lack of Dus and younger age were highly associated with staying employed. Given the rarity of SSc, we consider that our good sample size (n = 91) reflects disease prevalence, but results should be tested in other studies and the single center should be considered when interpreting generalizability. Full article

Background: Peritoneal surface malignancies (PSM) are aggressive cancers with limited treatment access in low- and middle-income countries (LMICs). While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved survival outcomes globally, their feasibility in LMICs remains underexplored. This first multicenter study in North Africa evaluates the implementation and outcomes of CRS with or without HIPEC in resource-limited settings. Methods: A retrospective cohort study of 391 patients with PSM (colorectal cancer, pseudomyxoma peritonei, ovarian cancer, gastric cancer, or mesothelioma) treated with CRS ± HIPEC between 2014 and 2020 at four tertiary centers in Morocco, Tunisia, and Algeria. Primary outcomes included overall survival (OS), disease-free survival (DFS), and severe postoperative morbidity (Clavien-Dindo ≥ IIIa). Cox regression was used to identify independent prognostic factors. Results: Among 391 patients, complete cytoreduction (CC-0/1) was achieved in 88%, and HIPEC was performed in 39%. Severe morbidity occurred in 22%, with HIPEC, spleno-pancreatectomy, and incomplete cytoreduction (CC-2) identified as significant risk factors. The median OS was 68 months, with 1- and 5-year survival rates of 97% and 56%, respectively. Patients undergoing CRS + HIPEC had significantly longer OS than CRS alone (70 vs. 64 months, p = 0.016), though DFS was not significantly different between groups. Independent predictors of improved OS included HIPEC, CC score, PCI, and primary tumor type. Conclusions: This first North African multicenter study establishes the feasibility and efficacy of CRS and HIPEC in LMICs, achieving survival outcomes comparable to high-income settings. The findings support expanding advanced PSM treatment programs in resource-limited settings, emphasizing structured training and multidisciplinary collaboration to improve access and outcomes. Full article

Driven by the demands of climate change mitigation, many countries have begun large-scale electricity production from variable renewables, such as solar PV and wind power. Electricity production from wind turbines, in particular, strongly depends on local weather conditions and their changes caused by climate change. Thus, for many countries with a high share of wind power generation, such as Germany, two essential questions arise: how will climate change affect electricity production, and how strong will be this impact for different RCPs? To better assess the impact on existing onshore wind turbines, spatially and temporally resolved data on their power generation are required. In order to create such disaggregated data, this study uses a physical simulation model and climate data modified for the RCP 2.6, RCP 4.5, and RCP 8.5 scenarios. To investigate the effects on a significant region with very high wind power generation in Germany, the numerical simulations were carried out on an ensemble of 22 onshore wind turbines with an installed capacity of 65.5 MW in the German Bight. After model validation, the power generation from this turbine ensemble was simulated for the high-wind year 2008 and the low-wind year 2010. The simulation results are presented with a high temporal resolution, and the observed changes are discussed for the applied RCPs. In summary, the resulting wind power generation of the entire plant ensemble decreases with increasing RCP to values of up to nearly 3 GWh for both years. Full article

Crop water use (ET_c) is typically estimated as the product of crop evapotranspiration (ET_o) and a crop coefficient (K_c). However, the estimation of ET_o requires various meteorological data, which are often unavailable or of poor quality, particularly in countries such as Guinea-Bissau, where the maintenance of weather stations is frequently inadequate. The present study aimed to assess alternative approaches, as outlined in the revised FAO56 guidelines, for estimating ET_o when only temperature data is available. These included the use of various predictors for the missing climatic variables, referred to as the Penman–Monteith temperature (PMT) approach. New approaches were developed, with a particular focus on optimizing the predictors at the cluster level. Furthermore, different gridded weather datasets (AgERA5 and MERRA-2 reanalysis) were evaluated for ET_o estimation to overcome the lack of ground-truth data and upscale ET_o estimates from point to regional and national levels, thereby supporting water management decision-making. The results demonstrate that the PMT is generally accurate, with RMSE not exceeding 26% of the average daily ET_o. With regard to shortwave radiation, using the temperature difference as a predictor in combination with cluster-focused multiple linear regression equations for estimating the radiation adjustment coefficient (k_Rs) yielded accurate results. ET_o estimates derived using raw (uncorrected) reanalysis data exhibit considerable bias and high RMSE (1.07–1.57 mm d⁻¹), indicating the need for bias correction. Various correction methods were tested, with the simple bias correction delivering the best overall performance, reducing RMSE to 0.99 mm d⁻¹ and 1.05 mm d⁻¹ for AgERA5 and MERRA-2, respectively, and achieving a normalized RMSE of about 22%. After implementing bias correction, the AgERA5 was found to be superior to the MERRA-2 for all the studied sites. Furthermore, the PMT outperformed the bias-corrected reanalysis in estimating ET_o. It was concluded that PMT-ET_o can be recommended for further application in countries with limited access to ground-truth meteorological data, as it requires only basic technical skills. It can also be used alongside reanalysis data, which demands more advanced expertise, particularly for data retrieval and processing. Full article

The planthopper Pentastiridius leporinus, commonly called reed glass-winged cicada, transmits the pathogens “Candidatus Arsenophonus phytopathogenicus” and “Candidatus Phytoplasma solani”, which are infesting sugar beet and, most recently, also potato in the Upper Rhine valley area of Germany. They cause the “Syndrome Basses Richesses” associated with reduced yield and sugar content in sugar beet, leading to substantial monetary losses to farmers in the region. No effective solutions exist currently. This study uses statistical models to understand to what extent the abundance of cicadas depends on climate regions during the vegetation period (April–October). We further investigated what influence temperature and precipitation have on the abundance of the cicadas in sugar beet fields. Furthermore, we investigated the possible impacts of future climate on cicada abundance. Also, 22 °C and 8 mm/day were found to be the optimal temperature and precipitation conditions for peak male cicada flight activity, while 28 °C and 8 mm/day were the optimum for females. By the end of the 21st century, daily male cicada abundance is projected to increase significantly under the worst-case high greenhouse gas emission scenario RCP8.5 (RCP-Representative Concentration Pathways), with confidence intervals suggesting a possible 5–15-fold increase compared to current levels. In contrast, under the low-emission scenario RCP2.6, male cicada populations are projected to be 60–70% lower than RCP8.5. An understanding of the influence of changing temperature and precipitation conditions is crucial for predicting the spread of this pest to different regions of Germany and other European countries. Full article

Health hazards caused by indoor air pollution (IAP) remain a global concern, especially in developing countries. IAP has complex mechanisms related to outdoor air pollution (OAP) and various other factors, and their relationship needs to be clarified to examine effective policies. We conducted an indoor and outdoor air monitoring survey in urban, peri-urban, and rural areas in Bangladesh, one of the countries with the most severe air pollution. The results show that IAP is more severe in urban households than in rural households, with a five-fold difference in daily indoor ${\mathrm{P}\mathrm{M}}_{2.5}$ concentration between 117 $\mathsf{\mu }\mathrm{g}/{\mathrm{m}}^3$ and 22 $\mathsf{\mu }\mathrm{g}/{\mathrm{m}}^3$, respectively. Regression analysis reveals that IAP is strongly associated with OAP and is hardly affected by solid fuels used in well-ventilated outside kitchens. Our findings support the view that the mitigation of IAP in developing countries can be achieved not only through a transition to clean fuels, which often entails substantial costs, but also through more practical and accessible alternatives, such as the use of outdoor kitchens, electric fans, and careful management of behaviors such as indoor smoking and mosquito coil use. Full article

(1) Background: Invasive aspergillosis is a life-threatening fungal infection, particularly in patients with hematologic malignancies. Isavuconazole, a broad-spectrum triazole, has emerged as a key treatment option, but real-world data in high-risk populations from middle-income countries remain limited. (2) Methods: We conducted a multicenter, retrospective study to evaluate the clinical response rate and tolerability of isavuconazole in patients with hematologic malignancies and probable or proven invasive aspergillosis across four medical centers in Brazil. (3) Results: We enrolled 50 patients aged 18 to 82 years (64% male) with proven or probable invasive aspergillosis, diagnosed in the context of complex hematologic conditions. Among them, 60% had active or refractory malignancies, and 22% had a prior COVID-19 infection. Isavuconazole was used as a first-line therapy in 64% of cases. No patients discontinued treatment due to toxicity. The 6-week overall survival was 60%. Prior COVID-19 infection was associated with a lower survival rate (44% vs. 69% in patients without COVID-19, p = 0.04). (4) Conclusions: This study provides real-world evidence supporting the efficacy and tolerability of isavuconazole in a high-risk population. The findings reinforce its role as a key antifungal therapy, particularly in patients with complex underlying conditions. Full article