Search Results (11,367)

Introduction: Three-dimensional (3D) printing technology has rapidly evolved across various fields of medicine and dentistry, particularly in orthodontics. One key application in orthodontics is the fabrication of dental models. Numerous parameters throughout the dental cast fabrication workflow can influence the accuracy of 3D-printed models. This review aims to evaluate the influence of post-processing procedures, specifically post-curing and post-rinsing, on the dimensional accuracy of 3D-printed dental casts. Materials and Methods: An initial data search was conducted using specific keywords across four databases (PubMed, Scopus, Web of Science, and Google Scholar). A secondary search of references and citations was also performed. This systematic review ultimately identified five studies that met the inclusion criteria (in vitro studies and studies referred to post-processing only of 3D-printed models) for further evaluation and analysis, whereas reviews, opinion studies, and papers in languages other than English were excluded. Based on the QUIN tool, all studies were assessed for their risk of bias. Because of the studies’ heterogeneity, a qualitative descriptive synthesis was conducted. Results: All five included studies were in vitro investigations. One study examined the influence of the post-curing process on dimensional accuracy, while the remaining four explored the impact of post-rinsing procedures on both dimensional accuracy and other surface characteristics of 3D-printed dental casts. Conclusions: According to the findings of the included studies, both post-curing and post-rinsing procedures had statistically significant effects on the dimensional accuracy of 3D-printed dental models. Nevertheless, all five studies concluded that the observed deviations remained within clinically acceptable limits, rendering the casts suitable for diagnostic orthodontic purposes or device fabrication. However, further research is needed to reinforce current findings and to enhance our understanding of the optimal post-processing protocols of additively manufactured dental casts. Full article

Sports, and especially competitions, can be a stressful experience for athletes, who often struggle to find and apply strategies to cope with stress. Thus, this study analyzes how different coping strategies anticipated to be employed in an important competition are explained by psychological (i.e., cognitive appraisal and emotions) and person and sports-related factors (i.e., gender, type of sport). Specifically, athletes were asked to complete a protocol 24–48 h prior to an important competition to assess their adaptation to stress related to high performance. The study included 383 athletes (60% male, M_age = 22.9 ± 5.3 years), from individual (swimming and running, n = 157; 41%) and team sports (handball, volleyball, n = 226; 59%) competing in major national leagues. Hierarchical linear regression analyses (enter method) were performed to examine the extent to which coping strategies and coping efficacy were explained by psychological, personal and sport-related variables. Results indicated (a) higher control perception and excitement were related with higher intention to use active coping; (b) being a female athlete, practicing individual sports, and excitement (higher intensity and facilitative value) were associated with a higher intention to use emotional support; (c) being a female athlete, lower coping perception, higher anger intensity, and higher facilitative value of happiness were associated with a higher anticipated use of humor; and (d) being a male athlete, higher anxiety, anger, and happiness intensity, and lower facilitative value of dejection and excitement were associated with higher anticipated use of denial. In sum, the explanation of each coping strategy is distinct and should be analyzed separately. Full article

In this paper, we have proposed a two-party authenticated key establishment (AKE), and authenticated key transport protocols based on lattice-based cryptography, aiming to provide security against quantum attacks for secure communication. This protocol enables two parties, who may share long-term public keys, to securely establish a shared session key, and transportation of the session key from the server while achieving mutual authentication. Our construction leverages the hardness of lattice problems Ring Learning With Errors (Ring-LWE), ensuring robustness against quantum and classical adversaries. Unlike traditional schemes whose security depends upon number-theoretic assumptions being vulnerable to quantum attacks, our protocol ensures security in the post-quantum era. The proposed protocol ensures forward secrecy, and provides security even if the long-term key is compromised. This protocol also provides essential property key freshness and resistance against man-in-the-middle attacks, impersonation attacks, replay attacks, and key mismatch attacks. On the other hand, the proposed key transport protocol provides essential property key freshness, anonymity, and resistance against man-in-the-middle attacks, impersonation attacks, replay attacks, and key mismatch attacks. A two-party key transport protocol is a cryptographic protocol in which one party (typically a trusted key distribution center or sender) securely generates and sends a session key to another party. Unlike key exchange protocols (where both parties contribute to key generation), key transport protocols rely on one party to generate the key and deliver it securely. The protocol possesses a minimum number of exchanged messages and can reduce the number of communication rounds to help minimize the communication overhead. Full article

Background/Objectives: Urinary angiotensin-converting enzyme (uACE) activity has long been regarded as a promising biomarker for kidney and cardiovascular diseases; however, its clinical applicability has been limited by the presence of endogenous urinary inhibitors and technically demanding assay protocols. We aimed to establish a fast and reproducible method for measuring uACE activity to identify the inhibitory compounds responsible for previous assay failures and to define practical preanalytical conditions suitable for routine laboratory implementation. Methods: A fluorescence-based kinetic assay was optimized for urine samples. Endogenous inhibitors were isolated by membrane filtration and chemically characterized, while the effect of sample dilution was evaluated as a simplified alternative for eliminating inhibitory interference. We assessed the stability of ACE activity under various storage conditions to support reliable measurement. Results: Urea (IC₅₀ = 1.18 M), uric acid (IC₅₀ = 3.61 × 10⁻³ M), and urobilinogen (IC₅₀ = 2.98 × 10⁻⁴ M) were identified as the principal reversible inhibitors, jointly accounting for up to 90% suppression of uACE activity. Their inhibitory effect was effectively eliminated by a 128-fold dilution. ACE activity remained stable for 24 h at 25 °C but was completely lost after freezing. A strong positive correlation between uACE activity and creatinine concentration (r = 0.76, p < 0.0001) justified normalization. ACE activity-to-creatinine ratio turned out to be significantly lower in ACE inhibitor-treated patients than in untreated controls (6.49 vs. 36.69 U/mol, p < 0.0001). Conclusions: Our findings demonstrate that accurate measurement of uACE activity is feasible using a rapid dilution-based protocol. The normalized ACE activity can serve as a practical biomarker for detecting pharmacological ACE inhibition and monitoring therapy adherence in cardiovascular care and may also provide insight into renal pathophysiology such as tubular injury or local RAAS-related processes. Full article

Industrial safety in high-risk sectors such as mining, construction, oil and gas, petrochemicals, and offshore fishing remains a strategic global challenge due to the high incidence of occupational accidents and their human, financial, and legal consequences. Despite international standards and advancements in safety strategies, significant barriers persist in the effective implementation of a Zero Accident culture. This scoping review, conducted under PRISMA-ScR guidelines, analyzed 11 studies selected from 232 records, focusing on documented practices in both multinational corporations from developed economies and local companies in emerging markets. The methodological synthesis validated theoretical models, practical interventions, and regulatory frameworks across diverse industrial settings. The findings led to the construction of a five-pillar model that provides the structural foundation for a comprehensive safety strategy: (1) strategic safety planning, defining long-term vision, mission, and objectives with systematic risk analysis; (2) executive leadership and commitment, expressed through decision-making, resource allocation, and on-site engagement; (3) people and competencies, emphasizing continuous training, communities of practice, and the development of safe behaviors; (4) process risk management, using validated protocols, structured methodologies, and early warning systems; and (5) performance measurement and auditing, combining reactive and proactive indicators within continuous improvement cycles. The results demonstrate that only a holistic approach, one that aligns strategy, culture, and performance, can sustain a robust safety culture. While notable reductions in incident rates were observed when these pillars were applied, the current literature is dominated by theoretical contributions and model replication from developed countries, with limited empirical evaluation in emerging contexts. This study provides a comparative, practice-oriented framework to guide the implementation and refinement of safety systems in high-risk organizations. This review was registered in Open Science Framework (OSF): 10.17605/OSF.IO/XFDPR. Full article

The zygomaticus major and minor (ZMa/ZMi) are key determinants of smile dynamics and midface contour, yet they exhibit substantial morphological variability—including bifid or multibellied bellies, accessory slips, and atypical insertions. Such variants can alter force vectors, fat-compartment boundaries, and SMAS planes, increasing the risk of asymmetry, contour irregularities, or “joker smile” following facelifts, fillers, thread lifts, and smile reconstruction. To our knowledge, this is the first review to integrate the Landfald classification of ZMa/ZMi variants with a standardized dynamic imaging-based workflow for aesthetic and reconstructive midface procedures. We conducted a narrative literature synthesis of anatomical and imaging studies. Bifid or multibellied variants have been reported in up to 35% of cadaveric specimens. We synthesize anatomical, biomechanical, and imaging evidence (MRI, dynamic US, 3D analysis) to propose a practical protocol: (1) focused history and dynamic examination, (2) US/EMG mapping of contraction vectors, (3) optional high-resolution MRI for complex cases, and (4) individualized adjustment of surgical vectors, injection planes, and dosing. Procedure-specific adaptations are outlined for deep-plane releases, thread-lift trajectories, filler depth selection, and muscle-transfer orientation. We emphasize that standardizing preoperative dynamic mapping and adopting a “patient-specific mimetic profile” can enhance safety, predictability, and preservation of authentic expression, ultimately improving patient satisfaction across diverse midface interventions. Full article

Magnetic fields (MFs), including static (SMFs) and extremely low-frequency electromagnetic fields (ELF-EMFs), have recently emerged as potential modulators of anticancer drug responses. Evidence indicates that MFs can influence membrane transport, oxidative stress, DNA damage, apoptosis, and cell cycle regulation, thereby altering the efficacy of chemotherapeutics and targeted agents. These effects are strongly dependent on MFs’ parameters and biological context, leading to synergistic, antagonistic and no-effect outcomes. However, inconsistent exposure protocols, limited reproducibility, and scarce clinical validation remain major obstacles. This review highlights current experimental findings, proposes mechanistic links between MFs and drug action, and outlines key challenges for advancing MF-based adjuvant strategies in oncology. Full article

This study examines the challenges of implementing educational technologies for sustainability education in diverse, real-world settings. While such tools are often designed for universal applications, a multitude of contextual factors, particularly in low-resource scenarios, can impede their full implementation. Through a series of in situ experiments conducted across three educational settings in Greece, Romania, and Italy, the research revealed that field deployment yields critical insights into organisational and technical limitations that are not evident in controlled experiments. The key findings underscore the importance of incorporating a broad range of socio-technical factors into design research protocols. The research also reveals a significant trade-off between the readiness of a tool and the need for its contextualisation, underscoring that effective implementation requires iterative adaptation and tailored training. Ultimately, the work concludes that real-world deployment blurs the distinction between a prototype and a product, necessitating a flexible approach to ensure equitable and prosperous adoption. Full article

Wayfinding with minimal effort is essential for reducing cognitive load and emotional stress in unfamiliar environments. This exploratory quasi-experimental study investigated wayfinding challenges in a university building housing three spatially dispersed counseling centers and three academic departments that share the building entrances, lobby, and hallways. Using mobile eye tracking with concurrent think-aloud protocols and schematic mapping, we examined visual attention patterns during predefined navigation tasks performed by 24 first-time visitors. Findings revealed frequent fixations on non-informative structural features, while existing wayfinding cues were often overlooked. High rates of null gazes indicated unsuccessful visual searching. Thematic analysis of verbal data identified eight key issues, including spatial confusion, aesthetic monotony, and inadequate signage. Participants frequently described the environment as disorienting and emotionally taxing, comparing it to institutional settings such as hospitals. In response, we developed wayfinding design proposals informed by our research findings, stakeholder needs, and contextual priorities. We used an experiential digital twin that prioritized perceptual fidelity to analyze the current wayfinding challenges, develop experimental protocols, and discuss design options and costs. This study offers a transferable methodological framework for identifying wayfinding challenges through convergent analysis of gaze patterns and verbal protocols, demonstrating how empirical findings can inform targeted wayfinding design interventions. Full article

Objectives: To explore sport physiotherapists’ perspectives and experiences on the management of anterior cruciate ligament (ACL) injuries in Saudi Arabia and to understand the key challenges that influence rehabilitation practice. Methods: A qualitative semi-structured interviews were conducted with sport physiotherapists recruited from different regions and clinical settings (Public, private and sport clubs) in Saudi Arabia. Eligibility criteria included ≥2 years’ post-qualification experience in ACL injuries management. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. A total of twenty-six sport physiotherapists (18 males; mean age 31 years, range 26–39) participated, including 13 working primarily as clinicians and 13 with combined clinical and research roles. Results: Five themes were identified: (1) disruptions of ACL injury in daily life and sport; (2) managing fear of re-injury and uncertainty in surgical vs. conservative care; (3) guiding rehabilitation through challenges of workload, progression, adherence and supportive tools; (4) variability in protocols, assessment tools, and available resources; and (5) returning to sport is more than just passing a test. These themes demonstrate that ACL injuries rehabilitation in Saudi Arabia is shaped by physical and psychological readiness, cultural expectations, and disparities in resources. Conclusions: Physiotherapists described ACL rehabilitation as a long-term process that needs an integration of physical, psychological, and contextual factors. This study’s findings highlight the need for resource-sensitive, standardized guidelines and the inclusion of psychological readiness assessments within rehabilitation processes. This study provides context-specific evidence that can be used to inform the development of culturally responsive, evidence-based approaches to strengthen ACL rehabilitation in Saudi Arabia. Full article

This study analyzes the relational architecture of Brazilian traceable beef exports using a tripartite network model that connects certified meatpacking plants, AgriTrace sustainability protocols, and importing countries. By leveraging export authorization data from the Brazilian Ministry of Agriculture, it is shown that certification protocols function not merely as compliance tools but as relational governance infrastructures, mediating legitimacy, market access, and coordination within global value chains. Bipartite projections allowed the deriving and analyzing of two secondary networks: one mapping connections between meatpacking plants that share certifications, and the other linking consumer nations through common supply channels. The meatpacking plant network displays high modularity, featuring two dominant clusters alongside several smaller, regionally coherent clusters. This structure reflects diverse governance capabilities and strategic certification adoptions. Conversely, the consumer nation network shows lower modularity but identifies central hubs that organize international demand and signal regulatory alignment. These patterns reveal underlying dynamics of coopetition, where actors collaborate through shared standards yet compete through innovation. By integrating the Inner Development Goals (IDG) framework, it is revealed internal capacities, such as trust, complexity awareness, and shared purpose, underpinning the efficacy of traceability systems as ethical and adaptive infrastructures. This values-based lens provides a novel perspective on how technical systems can foster resilient, inclusive, and sustainable trade, thereby contributing to planetary health and human-centered development in global livestock governance. Full article

Background: Ovarian cancer remains a major contributor to cancer-related morbidity and mortality worldwide. Primary cytoreductive surgery is the cornerstone of treatment, and accurate preoperative assessment of tumor resectability is critical to guiding optimal therapeutic strategies in patients with advanced tubo-ovarian cancer. Methods: A narrative review about the role of ultrasound for assessing tumor spread and prediction of tumor resectability was performed. Results: The ISAAC study represents the largest prospective multicenter trial to date comparing the diagnostic performance of ultrasound (US), computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in predicting non-resectability, using surgical and histopathological findings as the reference standard. Key strengths of the study include the use of standardized imaging and intraoperative reporting protocols across ESGO-accredited high-volume oncologic centers. All three imaging modalities were performed within four weeks prior to surgery by independent, blinded expert operators. US demonstrated diagnostic accuracy comparable to that of CT and WB-DWI/MRI. The study also defined modality-specific thresholds for the Peritoneal Cancer Index (PCI) and Predictive Index Value (PIV), offering quantitative tools to support surgical decision-making. A noteworthy secondary finding was patient preference: in a cohort of 144 participants who underwent all three imaging modalities, nearly half preferred US, while WB-DWI/MRI was the least favored due to discomfort and examination duration. Conclusions: The ISAAC study represents a significant advancement in imaging-based prediction of surgical non-resectability in tubo-ovarian cancer. Its findings suggest that, in expert hands, ultrasound can match or even surpass cross-sectional imaging for preoperative staging, supporting its integration into routine clinical practice, particularly in resource-constrained settings. Full article

Background: Pediatric odontogenic infections pose significant diagnostic challenges, particularly in distinguishing between cellulitis and abscess. Accurate differentiation is crucial for guiding appropriate management—antibiotics alone for cellulitis versus surgical incision and drainage (I&D) for an abscess—but can be difficult without specialized expertise or advanced imaging. Objective: We aimed to evaluate the diagnostic accuracy of handheld point-of-care ultrasound (POCUS; Philips Lumify), utilized by non-specialist clinicians, in differentiating cellulitis from abscess in pediatric odontogenic infections. A secondary objective was to assess its impact on reducing hospital admissions and emergency department (ED) burden. Methods: This prospective cohort study involved 111 pediatric patients (aged 1–17 years) presenting with maxillofacial odontogenic infections to a tertiary care academic medical center. Following clinical evaluations, handheld POCUS assessments were performed by trained non-specialist clinicians. Findings from I&D or clinical resolution with antibiotics served as the reference standard. Ninety cases were included in the final diagnostic accuracy analysis after 21 exclusions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy with 95% confidence intervals (CIs) were calculated. Hospital admission trends were compared before (2017–2021) and after POCUS implementation (January 2022–April 2025). Interpretation should consider potential verification bias from the asymmetric reference standard (I&D for abscess vs. clinical resolution for cellulitis). Results: Handheld POCUS exhibited a sensitivity of 72.97% (95% CI: 57.02–84.60%), specificity of 73.58% (95% CI: 60.42–83.56%), PPV of 65.85% (95% CI: 50.55–78.44%), NPV of 79.59% (95% CI: 66.36–88.52%), and overall accuracy of 73.33% (95% CI: 63.38–81.38%). Following POCUS implementation, the annualized hospital admission rate for pediatric facial odontogenic infections decreased from 60.0 to 19.5 admissions/year; rate ratio (RR) = 0.33 (95% CI: 0.25–0.42), p < 0.001 (Poisson regression with log-offset for period length). Conclusions: Handheld POCUS, operated by non-specialist clinicians after a defined training protocol, was associated with a lower annualized admission rate and demonstrated moderate diagnostic accuracy. Its adoption was associated with a notable reduction in hospitalizations, suggesting its potential for alleviating ED overcrowding, reducing healthcare costs, and minimizing pediatric stress. Wider adoption, supported by standardized training, could enhance healthcare efficiency and quality in managing this common pediatric condition. Full article

Background/Objectives: The transition from pediatric to adult care in inborn errors of metabolism (IEM) is considered important to ensure continuity of care, adherence to treatment, and long-term metabolic control. However, transition processes are often delayed, and standardized protocols are lacking, which can negatively impact patient outcomes. This study aimed to evaluate the impact of structured transition consultations on adult care engagement, nutritional management, and follow-up adherence in patients with IEM. Methods: This retrospective study included 160 patients (59.4% women) diagnosed with IEM and with a mean age of 36.2 ± 11.6 years. Patients were divided into two groups: those who underwent a structured transition consultation (n = 41) and those who did not (n = 119). Data on demographic and clinical characteristics, dietary management, and follow-up adherence were collected. Results: Patients who underwent structured transition consultations were significantly younger at diagnosis (1 [IQR 131] months vs. 66 [IQR 359] months, p = 0.001) and at their first adult visit (24.4 ± 9.5 vs. 32.3 ± 10.6 years, p < 0.001) compared to those who did not. Neonatal screening (45% of the overall cohort) was more common among these patients (65.9% vs. 37.8%, p = 0.007) suggesting a trend toward smoother integration into adult care. The absence of dietary records was considerably more frequent in the non-transition group (43.7% vs. 17.1%), with a significant crude association (p = 0.007) that was attenuated after age adjustment (p = 0.064). Overall follow-up adherence was high (88.1%) and comparable between groups. Conclusions: Structured transition consultations in patients with IEM were associated with earlier participation in adult care, better maintenance of dietary records, and high overall follow-up adherence, even among younger patients typically at higher risk of disengagement. Full article

Generation of state-of-the-art highly productive cabbage genotypes (Brassica oleracea convar. capitata (L.) Alef.) with improved agronomic traits is attainable using modern biotechnological approaches. However, capitata cabbage is relatively recalcitrant to de novo shoot organogenesis from callus tissue, especially with loss of somatic cell totipotency during genetic transformation. An effective and rapid protocol for in vitro indirect shoot organogenesis from hypocotyl and cotyledon explants derived from 6-day-old aseptic donor seedlings of Russian cabbage genotypes (the DH line as well as cvs. Podarok and Parus) has been developed. In order to obtain standardized donor explants, aseptic cabbage seeds were germinated under dim light conditions (30–40 µmol m⁻² s⁻¹) with a 16 h light/8 h dark photoperiod. Multiple indirect shoot organogenesis (1.47–4.93 shoots per explant) from both cotyledonary leaves and hypocotyl segments with a frequency of 55.2–89.1% was achieved through 45 days of culture on the 0.7% agar-solidified (w/v) Murashige and Skoog (MS) basal medium containing 2 mg/L 6-benzylaminopurine (6-BAP), 0.02 mg/L 1-naphthalene acetic acid (NAA), and 5 mg/L AgNO₃. The regenerants were successfully rooted on an MS basal medium (69.2%) without plant growth regulators (PGRs), as well as supplemented with 0.5 mg/L NAA (86.8%). Subsequently, in vitro rooted cabbage plantlets were adapted to soil conditions with an efficiency of 85%. This rapid protocol, allowing for the performance of a full cycle from in vitro seed germination to growing adapted plantlets under ex vitro conditions over 95 days, can be successfully applied to induce an indirect shoot formation in various cabbage genotypes, and it is recommended to produce transgenic plants with improved quality traits and productivity. Full article