Search Results (2,295)

Background and Objectives: Despite critically low levels of chronic kidney disease (CKD) awareness worldwide, there is no psychometrically validated instrument to comprehensively assess CKD awareness across socioecological levels. This study aimed to develop, psychometrically evaluate and validate a multidimensional awareness scale grounded in socioecological theory for patients with stage 3–4 CKD. Materials and Methods: This methodological study enrolled 908 stage 3–4 CKD patients. Scale development proceeded through systematic stages: comprehensive literature review, qualitative interviews (n = 15), expert panel evaluation (n = 25), and pilot testing. The initial 72-item pool was refined to 41 items (Content Validity Index = 0.912). The sample was randomly split for exploratory factor analysis (EFA; n = 454) and confirmatory factor analysis (CFA; n = 454). Psychometric evaluation encompassed internal consistency (Cronbach’s α, McDonald’s ω), test–retest reliability (n = 30; 4-week interval), convergent validity (average variance extracted [AVE], composite reliability [CR]), discriminant validity (Fornell–Larcker criterion), and criterion validity (correlation with Turkish Health Literacy Scale-32 [TSOY-32]). Results: EFA revealed a seven-factor structure with an acceptable explained variance of 43.8%. Following iterative item elimination based on communalities (h² < 0.20) and factor loadings (λ < 0.30), CFA confirmed the final 34-item model with good fit (CFI = 0.972; RMSEA = 0.070 [90% CI: 0.067–0.074]). The factor structure captured awareness across core socioecological levels (Individual, Interpersonal/Institutional, Community, and Systemic), complemented by Treatment Adherence and Social Impact dimensions. Internal consistency coefficients were α = 0.884 and ω = 0.889 for the total scale. Test–retest reliability yielded an ICC of 0.954 (95% CI: 0.907–0.978). Convergent and discriminant validity were confirmed via composite reliability (CR: 0.740–0.953) and the Fornell–Larcker criterion. Criterion validity analysis revealed a significant correlation with TSOY-32 (r = 0.810, p < 0.001). Conclusions: The CKD Awareness Scale (CKD-AS-34) represents a novel, psychometrically validated, multidimensional awareness instrument for CKD. This scale enables clinicians to identify awareness deficits spanning individual to systemic levels, facilitating personalised patient education and targeted public health interventions. Full article

This study systematically evaluated the taxonomic relationship between Streptococcus taoyuanensis ST2^T and Streptococcus caecimuris CLAAV18^T. Comparative genomic analysis revealed a high 16S rRNA gene sequence similarity of 99.6%, with the two strains clustering closely in the 16S rRNA-based phylogenetic tree. The genetic relatedness was further validated by Multi-Locus Sequence Typing (MLST) analysis: assessments of seven conserved housekeeping genes (atpD, gapA, gyrB, GdhA, recA, dnaK, and sdhA) demonstrated complete concordance in target fragment lengths (ranging from 33 bp to 121 bp). No size polymorphisms, insertions, or deletions were detected, indicating a highly conserved core genome. At the whole-genome level, the Average Amino Acid Identity (AAI), Average Nucleotide Identity (ANI), and digital DNA-DNA hybridization (dDDH) values between the two strains were 96.8%, 95.7%, and 84.6%, respectively. These values significantly exceed the established thresholds for species delineation (AAI: 95.5%; ANI: 95%; dDDH: 70%), providing robust genomic evidence that both strains belong to the same species. Furthermore, phenotypic testing confirmed nearly identical physiological characteristics, with only minor biochemical variations. Based on the integration of phylogenetic, genomic, and phenotypic evidence, we formally propose Streptococcus taoyuanensis as a later heterotypic synonym of Streptococcus caecimuris. Full article

In this study, a thermally crosslinking clay-free weak gel water-based drilling fluid based on salt-responsive polymers and crosslinking agents was investigated as a promising and feasible strategy. Firstly, a salt-tolerant polymer was synthesized using N,N-dimethylacrylamide (DMAA), [2-(methacryloyloxy)ethyl]dimethyl-(3-sulfonopropyl)ammonium hydroxide (DMAPS), and acrylamide (AM). BPEI_10,000 was selected as the thermal crosslinking agent. The optimal crosslinking was achieved at 180 °C and 36% NaCl, with RMFL at 2.0% and BPEI_10,000 at 0.1%. Performance evaluation demonstrated that the crosslinking between RMFL and BPEI_10,000 could enhance the AV, PV, and YP of the RMFL(BPEI_10,000)/CF-WBDFs after aging at 180 °C for 16 h and reduce FL_API. The RMFL(BPEI_10,000)/CF-WBDFs exhibited appropriate shear-thinning behavior, viscoelasticity, thixotropy, and recoverable viscosity under high-temperature, high-salinity, and high-pressure conditions. Mechanism analysis revealed that RMFL and BPEI_10,000 could form a predominantly negatively charged, three-dimensional crosslinking weak gel at high temperatures. The crosslinking weak gel could form dense filter cakes, improving rheological properties and reducing filtration loss of CFWBDFs in high-temperature, high-salinity environments. This paper proposed a novel method to address the technical challenge of rheological performance failure of CFWBDFs, offering valuable insights for subsequent investigations. Full article

Milbemycin D is a promising 16-membered macrolide insecticide with reported superior efficacy, but its commercial development has been hindered by extremely low natural yields. This study aimed to construct a high-yielding microbial platform for milbemycin D production using combinatorial biosynthesis and advanced genome editing. An optimized CRISPR/Cas9-AcrIIA4 system was employed to seamlessly replace the aveA3 polyketide synthase (PKS) gene in the ivermectin B1b-producing strain Streptomyces avermitilis HU501 with the heterologous milA3 PKS from S. bingchenggensis. The engineered strain was validated genetically and metabolically, followed by high-throughput screening and fermentation optimization in various media. The biosynthesized compound was structurally confirmed by spectroscopy. Bioactivity was evaluated against Bursaphelenchus xylophilus, Hyphantria cunea, and Plutella xylostella. The engineered strain S. avermitilis HU501-M successfully shifted its major product to milbemycin D, reaching a final titer of 679.03 mg/L. Bioassays revealed that milbemycin D exhibited significantly enhanced potency, with LC₅₀ values 8–24% lower than those of milbemycin A3/A4. This work demonstrates an efficient CRISPR/Cas9-mediated PKS replacement strategy to achieve the high-yield production of milbemycin D, offering a promising microbial source and a generalizable framework for engineering complex polyketide pathways. This proof-of-concept establishes a foundation for future process development toward potential commercial application. Full article

Autonomous vehicle technology has rapidly advanced in recent years. Such technology is increasingly viewed not merely as a technical innovation but also as a social and behavioural transformation shaped by how these systems are interpreted, trusted, and integrated into everyday life. There are mounting expectations regarding its potential to improve traffic safety, enhance energy efficiency, reduce congestion, and support sustainable mobility; however, key questions remain about how different groups and communities experience autonomous mobility. This review synthesizes equity, governance, and sustainability dimensions as they appear within the existing corpus of AV user acceptance research. A structured review of research on autonomous vehicles (AVs) and user acceptance was conducted using an initial database search followed by iterative literature refinement and structured thematic coding. Using this approach, the review identifies key thematic patterns, highlights structural research gaps, and explores regional differences, offering a framework that supports subsequent comparative analysis. AVs have the potential to shape accessibility, social relations, and sustainable lifestyles. By integrating technological advancement with local governance, community practices, and social equity considerations, automated public transit may serve as a catalyst for sustainable and inclusive urban transformation. Full article

Background: Apocynum venetum L., a saline–alkali-tolerant plant, is a valuable resource for forage, textile, and medicinal purposes. This study aimed to identify the AQP gene family in A. venetum genome-wide and explore their potential functions under abiotic stress. Methods: Gene identification, phylogenetic relationships, structural features, and evolutionary patterns were analyzed, along with gene expression patterns and correlations with physiological traits. Results: Phylogenetic analysis classified the 25 candidate AvAQP genes into five distinct subgroups, with members exhibiting conserved gene structures, motifs, and phosphorylation patterns. Subcellular localization predictions indicate targeting primarily to the plasma membrane or the vacuole, with one isoform (AvTIP5;1) predicted to localize to both. Synteny analysis revealed three intraspecific and multiple interspecific gene pairs (26 with Arabidopsis thaliana and 34 with Medicago truncatula). In silico promoter analysis identified 49 cis-regulatory elements associated with phytohormone response, stress signaling, and development, providing preliminary clues for their possible involvement in diverse biological processes. qPCR profiling under abiotic stress demonstrated tissue-specific expression patterns among AvAQP members under different stress conditions. Correlation analyses between gene expression and physiological indicators (growth- and water-related traits) were predominantly positive, with only a few negative correlations under stress conditions, suggesting that AvAQP expression may be associated with plant physiological status. Conclusions: This study presents a comprehensive analysis of the AQP family in A. venetum providing a foundation for further functional characterization of these genes in response to abiotic stress. Full article

This study examines how digital governance (DG) contributes to public value (PV) in a large, service-intensive public organization and tests whether digitally enabled human resource management practices (DHRM) transmit this effect. Using a cross-sectional survey of employees in Egypt Post (n = 278), items were measured on a five-point Likert scale and analyzed with reliability diagnostics, validity assessments (CFA, CR, AVE, HTMT), and regression-based mediation with 5000 bootstrap resamples. All scales showed strong internal consistency (Cronbach’s alpha: DG = 0.903, DHRM = 0.948, PV = 0.923) and convergent validity (AVE greater than 0.50). Discriminant validity was confirmed via HTMT (less than 0.85). The study finds that DG was positively associated with PV (beta = 0.773, p less than 0.001) and with DHRM (beta = 0.818, p less than 0.001). DHRM was also positively associated with PV when controlling for DG (beta = 0.332, p less than 0.001). Bootstrapping confirmed a significant indirect effect of DG on PV through DHRM (a times b = 0.281; 95% CI [0.156, 0.424]), indicating partial mediation. This study advances public value scholarship by specifying DHRM as a micro-foundation linking governance capacity to value outcomes, demonstrating the partial mediation mechanism in an under-researched Middle Eastern public-sector context, and providing empirical evidence that digital transformation yields higher public value when governance arrangements are translated into workforce routines and capabilities via digital HRM. Implications: The findings suggest that public managers should treat HR digitalization as a core implementation mechanism alongside governance reforms. Full article

Emergency Departments (EDs) are the primary hospital interface during disasters and mass-casualty incidents, yet surge capacity assessments predominantly emphasize workforce and logistics while overlooking measurable spatial determinants. Observations from five tertiary hospitals in India indicate that circulation bottlenecks, incompatible functional adjacencies, and contamination risks can compromise safety and operational performance. This study develops and validates the Spatial Surge Capacity Assessment Framework (SSCAF) to operationalize spatial resilience as a quantifiable dimension of healthcare infrastructure preparedness. A sequential mixed-methods design was applied across five tertiary hospitals using structured spatial walkthroughs; architectural and disaster-planning document review; and focus group discussions involving 81 clinicians, administrators, and facility planners. The outcome of this thematic analysis produced 42 spatial indicators, refined through three Delphi rounds with a multidisciplinary expert panel. Consensus retained 30 key performance indicators (median ≥ 4/5; IQR ≤ 1; Kendall’s W = 0.855; χ² = 297.42; p < 0.001). Content validity was strong (I-CVI 0.75–1.00; S-CVI/Ave = 0.93), and reliability was high (ICC 0.82–0.91), structured into eight operational domains. The resulting weighted scoring matrix standardizes the measurement of spatial surge preparedness. The SSCAF provides an evidence-based audit and planning tool supporting resilient hospital infrastructure. It aligns with the Sendai Framework, enabling governance audits, guiding ED retrofitting, and supporting performance-based evaluation for planners and architects. Full article

This article evaluates how artificial intelligence (AI) and educational technology (EdTech) support inclusive learning in Russia and Kazakhstan, two Eurasian countries that share post-Soviet educational legacies but differ in their levels of digital infrastructure and teacher preparedness. Using an asymmetric mixed-methods design, the study draws on a primary survey of N = 2570 educators and staff in four Russian cities (Moscow, Saint Petersburg, Yekaterinburg, Novosibirsk; October–December 2024; response rate 59.8%) and secondary policy/indicator analysis for Kazakhstan. Russia exhibits higher broadband access, AI/EdTech platform adoption, and teacher digital skill levels compared with Kazakhstan. Structural equation modeling (SEM; SmartPLS 4.1) tested four latent constructs—learning environment (LE), general digital competencies (HCg), specialized AI skills (HCs), and inclusion (I)—with satisfactory validity (AVE > 0.5; HTMT ≤ 0.85). A three-stage Measurement Invariance of Composite Models (MICOM) procedure confirmed configural, compositional, and full mean/variance invariance across Russian city subgroups, enabling pooled path analysis. Kazakhstan indicators from secondary sources are discussed as a descriptive benchmark. Semi-structured interviews with 24 stakeholders (12 Russia, 12 Kazakhstan; March 2025; analyzed with NVivo 14) revealed four themes: policy coherence, teacher readiness, infrastructure access, and ethical AI governance. Key SEM paths were LE → HCg (β = 0.278), HCg → HCs (β = 0.652), and HCs → I (β = 0.188), all p < 0.001. A formal mediation analysis confirmed a significant indirect effect across the full LE → HCg → HCs → I chain. The findings indicate that infrastructure is necessary but insufficient: the key to inclusion lies in sustained development of both basic and specialized digital skills, supported by coherent policies and continuous professional development. China and India are discussed as secondary international benchmarks drawn from published reports, not as sites of primary data collection. Full article

Background/Objectives: We investigated whether ingestion of caffeine (~1 h before) was beneficial to subsequent morning (07:30 h), mood, strength and cognitive measures. Methods: Fourteen recreationally active males were recruited and completed six sessions: (i) one repetition maximum (1RM) for bench press and back squat; (ii) two familiarization sessions of strength measures; (iv) three experimental conditions administered in a double-blinded, randomized counterbalanced design order, either caffeine (Caffeine [CAFF], 300 mg or 2.8–4.3 mg/kg body weight), placebo (Placebo [PLAC]) ingested at 06:30 h, or no-pill control (No Pill [NoPill]). For each experimental session, on arrival at the laboratory, rectal and skin temperature were measured as well as a battery of cognitive performance through a battery of tests (trail-making test, Rey’s auditory verbal learning test, and Stroop word–colour interference test). Thereafter, maximum voluntary contraction on an isometric chair (MVC) without and with stimulation was conducted, and three repetitions were performed at 40, 60 and 80% of 1RM for bench press and back squat. Average power (AP), average velocity (AV), peak velocity (PV), mean propulsive velocity (MPV), average acceleration (RDV), displacement (D) and time-to-peak velocity (tPV) were recorded using MuscleLab linear encoders. Rating of perceived exertion and effort was asked after each set (RPE). The data was analysed using a general linear model with repeated measures. Results: MVC peak-force values with and without stimulation showed a significant increase in the CAFF condition compared to values for NoPill and with stimulation PLAC conditions (stim: Δ9.0 and 8.7%; no stim: 8.3%; p < 0.05; η²_p = 0.33 and 0.42). Greater muscle % activation was achieved for the CAFF than the other conditions (~6%, p ≤ 0.042; η²_p = 0.33). In the non-stimulated MVC, RPE was perceived as easier (4.8%, p = 0.04). AV and MPV values were higher in both bench press (Δ3.3 and 4.6%) and back squat (Δ7.7 and 9.2%) in CAFF than the PLAC condition (p = 0.031; η²_p = 0.24 and 0.23 and 0.24 and 0.32). CAFF improved auditory total recall compared to NoPill (9.5%, p = 0.040; η²_p = 0.22). Conclusions: Early morning ingestion of caffeine improved MVC to levels observed by others in the evening, as well as some aspects of bench press, back squat and recall performance. Caffeine ingestion had no effect on core temperature, mood, tiredness, alertness or other measures of cognitive performance. Full article

The deterministic simplification of parking maneuvers in traditional traffic models presents a critical challenge for the safe integration of Autonomous Vehicles (AVs). This study establishes a stochastic human baseline to provide a naturalistic ground truth dataset essential for calibrating perception and prediction sensors in mixed traffic scenarios. Through the analysis of 1038 maneuvers observed in a university shared space in Catania, Generalized Linear Models and Kaplan–Meier estimators were applied to quantify the impact of geometric constraints on 0°, 45°, and 90° configurations. Results identify 45° angled parking as the Pareto-optimal solution regarding stability and speed, achieving an average maneuver time of 7.54 s. Furthermore, a vertical parking paradox emerges: in the presence of narrow aisles, entry times increase drastically, generating bottlenecks with an 85th percentile exceeding 50 s. Finally, a structural functional asymmetry reveals that exit maneuvers require approximately 54% of the time needed for entry. These findings provide empirical metrics essential for validating human behavior models and fine-tuning decision-making and timeout logic in autonomous driving systems. Full article

Background: Early diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) remains challenging. Although ECG and morphological abnormalities at diagnosis are well-described, their temporal evolution has not been systematically evaluated. This study characterized the prevalence and longitudinal progression of electrical and structural cardiac abnormalities preceding ATTR-CM diagnosis. Methods: We retrospectively analyzed patients with confirmed ATTR-CM evaluated at a specialist amyloidosis center between 2006 and 2023. Diagnosis was established by grade 2–3 myocardial uptake on 99mTc-DPD scintigraphy. Standard 12-lead ECGs and transthoracic echocardiograms were reviewed at diagnosis and at baseline, 3–5 years earlier. Results: Sixty-three patients (79% men; mean age 77 ± 8 years) were studied, including 33 (52%) with hereditary ATTR (ATTRv) and 30 (48%) with wild-type ATTR (ATTRwt). Overall, 95% had a NAC score ≤ 2, consistent with less advanced disease at diagnosis. During the prediagnostic phase, 79% of patients exhibited pathological ECGs. Non-specific ST–T abnormalities (40%), prolonged QTc (38%), left-axis deviation (35%), first-degree AV block (33%) and anterior infarction pattern (33%) were each observed in at least one-third of patients. From baseline to diagnosis, significant prolongation was observed in the PR interval (+26 ms), QRS duration (+11 ms), and QTc interval (+22 ms) (p < 0.001 for all), and a leftward shift observed in the electrical axis (−12.03°, p = 0.011). Low voltage was uncommon at both time points. Although interventricular septal thickness increased significantly (+3.42 mm; p < 0.001), left ventricular ejection fraction and dimensions were relatively stable. Conclusions: In this proof-of-concept study, electrical remodeling precedes functional changes and outperforms low voltages to raise clinical suspicion of ATTR-CM. Full article

Background: Sustainable dietary transitions are increasingly emphasized in public health policy; however, validated psychometric instruments assessing knowledge, attitudes, and practices (KAP) in Asian contexts remain limited. Objectives: This study aimed to develop and evaluate a KAP questionnaire on sustainable diets and examine sociodemographic variations and behavioral correlates among Taiwanese adults. Methods: A two-phase mixed-methods design was used, including expert validation and a cross-sectional online survey (n = 587). Construct validity was examined using exploratory factor analysis, and reliability was evaluated through internal consistency and test–retest assessments. Multivariable logistic regression models were fitted to identify factors associated with low adherence to a low-carbon diet. Model diagnostics included variance inflation factors (VIF), Hosmer–Lemeshow tests, Nagelkerke pseudo-R², and ROC analysis. Results: Content validity was high (S-CVI/Ave = 0.95–0.98). The attitude and practice domains demonstrated satisfactory internal consistency, whereas the knowledge domain showed comparatively lower reliability. In multivariable logistic regression analyses, higher attitude scores were independently associated with lower odds of low adherence to a low-carbon diet. Eating-out frequency and clear awareness of sustainability in Taiwan’s Dietary Guidelines were also significantly associated with adherence. The fully adjusted model demonstrated adequate calibration and excellent discrimination (AUC = 0.778). Conclusions: The instrument provides preliminary psychometric evidence supporting the assessment of sustainable diet-related KAP among Taiwanese adults. Attitudes appear more strongly associated with dietary practices than knowledge alone. The questionnaire may support future monitoring and research. Full article

Background/Objectives: Functional foods are widely discussed in nutrition research, yet their consumption is rarely quantified using a standardized, food-based metric. We developed the Functional Food Consumption Index (FunFoCI) and conducted an initial evaluation of its performance in adults. Methods: In this cross-sectional study, 500 adults (≥18 years, 286 women, 214 men) were assessed using a 210-item quantitative food frequency questionnaire (FFQ) and a 3 day food record (FR). Candidate index foods were evaluated by five experts, using a 4-point Likert scale to establish content validity, and the finalized FunFoCI comprised 100 foods across nine groups: fruits; vegetables; whole grains; legumes; nuts and oilseeds; fermented foods and products; animal-based foods; functional oils; and spices, herbal teas, and functional beverages. FunFoCI scoring used a sample distribution-based percentile approach, including modifications for zero-inflated or sparsely consumed items, followed by group-level normalization (0–1), equal weighting across nine groups, and rescaling to 0–100. FR data were used to examine the between-method feasibility of the scoring approach. The convergent validity was assessed via correlation analyses, with the Diet Quality Index-International (DQI-I) and Healthy Eating Index-2015 (HEI-2015) derived from both FFQ and FR data, and additional correlation analyses and robustness checks were conducted to examine associations among key study variables. Known group patterns were examined across sociodemographic, lifestyle, and anthropometric characteristics. Results: Content evaluation supported index coverage (S-CVI/Ave = 0.912; S-CVI/UA = 0.877; mean modified kappa = 0.899). The mean FunFoCI total scores were 32.68 ± 11.92 (FFQ) and 13.29 ± 4.65 (FR). Participants were classified into low (32.8%, n = 164), moderate (33.0%, n = 165), and high (34.2%, n = 171) FunFoCI categories. FunFoCI correlated with FFQ-derived DQI-I and HEI-2015 (r = 0.367 and r = 0.368; both p < 0.001), and both indices increased across ascending FunFoCI total scores (p < 0.001). The FFQ-derived FunFoCI total score was correlated with the FR-derived FunFoCI score (r = 0.294; p < 0.001). FunFoCI scores showed differences across participant sociodemographic, lifestyle and anthropometric characteristics. Conclusions: FunFoCI is a newly developed, expert-reviewed, food-based index with transparent, sample distribution-based scoring and normalized aggregation. Its initial evaluation supports its use for the standardized quantification of relative functional food consumption in adults, while further studies should assess the reliability and external validation criteria in other populations and study designs. Full article

Background: Gefitinib (Gef) is a first-line epidermal growth factor receptor (EGFR) inhibitor for NSCLC, but its clinical application is limited by poor aqueous solubility and low oral bioavailability. Methods: A self-assembled gefitinib nanosuspension (GG-NS) incorporating genistein (Gen) was rapidly developed and optimized via hammer acoustic resonance (HAR) technology. Systematic optimization was conducted using a high-throughput HAR-based process, with particle size, PDI, and zeta potential as key evaluation parameters. Structural and morphological characteristics were analyzed using powder X-ray diffraction (PXRD), thermal analysis, transmission electron microscopy (TEM), and Fourier-transform infrared (FT-IR) spectroscopy. In vitro dissolution behavior and cytotoxicity against A549 lung cancer cells were evaluated. Results: Optimal GG-NS with Z-Ave = 223.50 ± 1.53 nm, PDI = 0.239 ± 0.031 and zeta potential = −24.10 ± 0.47 mV was successfully prepared. The nanosuspension remained physically stable for up to five months at both 4 °C and 25 °C. Compared with the raw drugs, GG-NS enhanced the dissolution of gefitinib and genistein in water by 3.76-fold and 13-fold, respectively. In addition, GG-NS showed significantly enhanced cytotoxicity against A549 cells, with a 33.8% higher inhibition rate than the physical mixture after 72 h. Conclusions: This study demonstrates, for the first time, that HAR technology enables the rapid fabrication of a self-assembled GG-NS with improved dissolution performance, physicochemical stability, and in vitro anticancer activity, highlighting its promise as an efficient and scalable formulation strategy for poorly soluble anticancer drugs. Full article