Search Results (21,180)

Introduction: Gastrointestinal dysfunction is common in critically ill patients and is associated with increased morbidity and mortality. Plasma citrulline, a non-proteinogenic amino acid synthesized by enterocytes, has been proposed as a biomarker of intestinal function and enterocyte mass. However, the available evidence regarding its clinical significance in critically ill patients remains heterogeneous. This structured narrative review aimed to evaluate the current evidence on plasma citrulline in critical illness, focusing on its association with gastrointestinal dysfunction, disease severity, and clinical outcomes. Methods: A structured narrative review based on a structured literature search was conducted using PubMed and Scopus. Reference lists of included studies and relevant reviews were also screened. Studies evaluating circulating citrulline in adult critically ill patients and reporting gastrointestinal dysfunction, intestinal injury, disease severity, or other relevant clinical outcomes were included. Study selection was performed by two reviewers, and data were analyzed descriptively. Results: Eleven studies met the inclusion criteria, the majority being prospective observational studies. The timing of citrulline measurement, patient populations, analytical methods, and evaluated outcomes varied considerably across studies. Lower circulating citrulline concentrations were frequently associated with gastrointestinal dysfunction or markers of intestinal impairment; however, associations with disease severity, mortality, and other clinical outcomes were inconsistent. Several factors, including renal function, systemic inflammation, and methodological variability, may influence the interpretation of circulating citrulline concentrations. Conclusions: Plasma citrulline may provide complementary information regarding enterocyte function and gastrointestinal dysfunction in critically ill patients. However, current evidence does not support its use as a standalone diagnostic or prognostic biomarker. Further prospective studies using standardized measurement protocols and serial assessment are needed to determine its potential role alongside clinical evaluation and complementary biomarkers. Full article

Dairy products, particularly cheese from selenium-enriched milk, provide an effective vehicle for Se supplementation in the human diet. This study examined how coagulant type and ripening affect total Se (Se_tot), free selenomethionine (SeMet) formation, and in vitro Se bioaccessibility in Edam-type cheeses produced from biofortified milk (73 µg L⁻¹ Se). Cheeses were manufactured in a single batch using either animal (calf) or microbial (Rhizomucor miehei) rennet and ripened for six weeks under controlled laboratory conditions. Although Se_tot declined in both cheeses, microbial-rennet cheese exhibited a rapid 13.5% loss in week 1, whereas animal-rennet cheese showed a more gradual decrease. After six weeks, both cheeses retained about 40 µg Se per 100 g. A robust 20 mmol L⁻¹ ammonium acetate extraction coupled with LC-ICP-MS enabled detection of free SeMet at concentrations as low as 0.0003 µg g⁻¹ Se and revealed a linear increase throughout ripening in both cheeses. In vitro Se bioaccessibility reached 64% of Se_tot for animal-rennet cheese and approached complete release in microbial-rennet cheese. These findings suggest that the choice of coagulant may influence not only Se retention, but also the gastrointestinal accessibility of protein-bound Se in Edam-type cheese. Full article

Background/Objectives: Saliva may provide a non-invasive alternative to blood sampling for therapeutic drug monitoring (TDM) of mycophenolic acid (MPA) in children. This study assessed MPA and, secondarily, mycophenolic acid glucuronide (MPAG) in non-centrifuged Salivette^® devices to determine an acceptable interval between saliva collection and laboratory processing. Methods: Phosphate-buffered saline (PBS), artificial saliva, and saliva from five healthy adult volunteers were externally spiked with MPA and MPAG at 5 and 500 ng/mL and applied to Salivette^® cotton swabs. Samples were stored for 12, 24, and 48 h at 22 °C and 6 °C and analyzed by liquid chromatography-tandem mass spectrometry. Percentage deviations from nominal concentration within ±15% were considered acceptable. Results: In PBS, both analytes met the acceptance criterion for up to 24 h under both conditions. In artificial saliva, both met the criterion for at least 24 h and, under some conditions, for 48 h. In human saliva, all volunteer-level MPA results met the criterion after 12 h at both temperatures, whereas MPAG did not consistently meet it. Mean MPA deviations across volunteers ranged from −10.8 to 1.9% at 22 °C and from −12.3 to 2.4% at 6 °C. Conclusions: MPA met the acceptance criterion after 12-h in non-centrifuged Salivette^® devices, supporting the feasibility of a 12-h pre-centrifugation interval under comparable conditions. Prompt centrifugation and processing are advisable when MPAG determination is required. Confirmation using incurred post-dose saliva from pediatric patients receiving mycophenolate mofetil is required. Full article

Background: Attention Deficit Hyperactivity Disorder (ADHD) is associated with impairments in executive functions, particularly cognitive flexibility, which may negatively affect academic performance, behavioral regulation, and daily adaptation in children. Physical activity has emerged as a promising non-pharmacological strategy to support executive functioning; however, evidence regarding the effects of different exercise modalities on cognitive flexibility remains heterogeneous. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was retrospectively registered in the PROSPERO database (CRD420261399699) before manuscript submission. Searches were conducted in PubMed, Scopus, MEDLINE, Web of Science, PsycInfo, and SPORTDiscus. Studies examining the effects of physical activity interventions on cognitive flexibility in Primary Education students with ADHD were included. Seventeen studies involving 634 participants aged 6–12 years met the eligibility criteria. Methodological quality was assessed using design-appropriate critical appraisal tools. Results: Overall, the included studies reported potentially beneficial effects of physical activity on cognitive flexibility, although findings varied according to study design, intervention characteristics, and outcome measures. Across the available studies, multi-session interventions tended to report more consistent improvements across cognitive flexibility outcomes than single-session protocols. Structured sports and interventions combining physical and cognitive demands, including football, table tennis, EXCIR, and BARAN, also reported improvements in several cognitive flexibility outcomes. However, substantial methodological heterogeneity and the absence of direct comparisons between intervention types or durations preclude conclusions regarding the superiority or comparative effectiveness of specific approaches. Conclusions: Physical activity may represent a promising complementary strategy for supporting cognitive flexibility in children with ADHD. The available evidence suggests potentially favorable findings for multi-session and cognitively engaging interventions; however, these patterns should be interpreted cautiously because of the heterogeneity of study designs, intervention protocols, and cognitive flexibility measures. Further well-designed studies directly comparing intervention characteristics and exercise modalities are needed before specific recommendations regarding optimal type or duration can be established. Full article

Heritage education has undergone substantial conceptual, pedagogical, and technological transformations over the last decade, driven by the expansion of digital technologies, participatory pedagogies, and arts-based approaches to learning. Although research in this field has grown considerably, existing studies remain fragmented across educational contexts, disciplinary traditions, and methodological perspectives. This systematic review aims to synthesise international research published between 2015 and 2026 on the relationships among heritage education, arts-based learning, museum education, digital transformation, sustainability, and teacher education. The review followed the PRISMA 2020 Statement and the PRISMA-S reporting recommendations. Searches conducted in the Web of Science Core Collection and Scopus identified 525 records, of which 53 studies met the predefined eligibility criteria and were included in the qualitative synthesis. The findings reveal a marked expansion of museum-based and digitally mediated heritage learning, the growing adoption of arts-based pedagogies, and an increasing emphasis on teacher education and community participation. While digital technologies have become firmly established within heritage education, artificial intelligence remains an emerging area of inquiry with limited empirical evidence. The review also identifies persistent challenges, including the underrepresentation of rural and non-Western perspectives, limited longitudinal research, and the need for more robust methodological designs. Building on the synthesis of the reviewed literature, the article proposes the Arts-Based Heritage Learning Ecosystem as an integrative framework for understanding the interplay among cultural memory, artistic mediation, museum participation, digital innovation, sustainability, and teacher education. The study contributes to current debates by providing an updated synthesis of international research and by offering a conceptual basis to inform future research, curriculum development, and educational practice. Full article

The current clinical test for ketosis in dairy cows, which is based on measuring blood β-hydroxybutyrate (BHB) concentrations, is an invasive procedure that impacts herd welfare. Alternative biomarkers, especially non-invasive ones, are urgently needed for subclinical ketosis (SCK) diagnosis. To address this, we examined the milk lipidomic profiles of healthy and SCK cows from a research dairy farm over two consecutive years. A total of 125 polar lipid species were quantified in milk samples using a targeted liquid chromatography–mass spectrometry (LC-MS) approach. Chemometric analysis identified four potential biomarkers (PC 28:0, PC 29:0, PC 30:1 and PC 31:0), which met the thresholds for p value (<0.0004) and fold change (FC > 2). Global fatty acid (FA) profiling by gas chromatography–flame ionization detection (GC-FID) after transesterification of all lipids revealed that the levels of C8:0, C10:0, C12:0, C14:0, C15:0 and C18:1t11 were significantly suppressed in the SCK group (15–52% lower compared to the control group, p < 0.01), and C15:0 and C18:1t11 were the most promising markers for SCK in dairy cows at the FA level (43–50% reduction compared to the control group, p < 0.0001). Tandem LC-MS and FA data generated by GC demonstrated that SCK also caused significant changes in regio-isomer and double bond isomer composition of a model phospholipid molecule (PC 34:1) and a model triglyceride molecule TAG 52:2; these fine-structural alterations could also be explored for discovering novel SCK biomarkers in dairy cows. The PLS-DA predictive model built from lipidomic data showed excellent accuracy (>95%) in predicting cows with SCK. All of the promising biomarkers identified and the predictive model built in this study need further validation using larger SCK cohorts from different herds. Full article

Background: Communication competence is essential for nurse managers because it facilitates team coordination, organizational alignment, shared decision-making, and the quality and safety of care. Despite its acknowledged importance, the key traits of this competence have not been systematically summarized. Objective: We aimed to identify and describe the traits of communication competence among nurse managers in healthcare settings, determine the most frequently reported traits, and explore the contextual, behavioral, and organizational factors associated with its expression. Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420261356065). Searches were performed in Web of Science, Scopus, PubMed, and CINAHL, covering 1 January 2016 to 1 February 2026. Peer-reviewed studies using quantitative, qualitative, or mixed methods that addressed communication competence from the perspective of nurse managers were included. Data analysis involved a structured narrative synthesis that combined frequency analysis of identified traits with contextual analysis of communication competence. Results: Fifteen studies met the inclusion criteria. After comparison, grouping, and conceptual refinement, 23 communication traits were identified. The most frequently reported traits were Active Listening and Verification of Understanding, along with Strategic and Multi-Channel Communication Planning (each 10.14%), followed by Building Trust-Based Professional Relationships (9.18%), Open and Transparent Communication (8.21%), and Clear, Consistent, and Effective Message Design (7.73%). The results also indicated that communication competence is context-dependent and linked to organizational factors such as structural empowerment, shared decision-making, and managerial visibility. Empowering communication behaviors correlated with psychological empowerment, team cohesion, staff retention, and perceived improvements in quality of care. Conversely, limiting behaviors were associated with declines in trust, dignity, and professional functioning. Conclusions: Communication competence among nurse managers is not merely a peripheral interpersonal trait but a core managerial skill with a well-defined foundation. Its key elements suggest that this competence is built on responsiveness, strategic intentionality, and relational credibility. Therefore, communication competence should be viewed as an organizationally significant capability that directly affects team performance, workforce sustainability, psychological safety, and the quality of care. Implications for Nursing Management: Recognizing a core set of communication traits provides a useful basis for leadership training, simulation exercises, and managerial evaluations. Improving this skill could strengthen team unity, boost staff involvement, and enhance the quality of care as healthcare settings become more complex. Full article

Despite the high global prevalence of depressive and anxiety disorders, access to early clinical assessment remains limited for many. Although this field has grown rapidly, existing reviews have focused primarily on technical performance, with limited systematic attention to whether current models meet the prerequisites for clinical implementation. This scoping review mapped methodological approaches across this domain and evaluated clinical readiness using five predefined indicators: sample size adequacy, external validation, prospective data collection, real-world evaluation, and model explainability. Searches of PubMed, Web of Science, and IEEE Xplore (March 2026) identified 2463 records; 34 studies (37 dataset evaluations) were included. The majority of studies (91%) were published from 2022 onwards. Depression was the primary target in 91% of studies, while only one study addressed anxiety. Hand-crafted acoustic features were the most frequent (57%), while classical machine learning was the most common model type (32%). External validation was conducted in only 32% of evaluations and real-world testing in 8%. Clinical readiness was classified as Low in 24%, Moderate in 65%, and High in 11% of evaluations. No evaluation met all five indicators simultaneously. These findings apply primarily to voice-based depression screening; 36 of 37 evaluations targeted depression, and the evidence base for anxiety disorders is limited to a single evaluation, precluding comparable characterisation for that condition. The principal challenges to clinical implementation are insufficient external validation, reliance on laboratory conditions, narrow linguistic coverage, and inconsistent metric reporting. The framework applied in this scoping review provides a replicable structure for assessing the clinical validity of AI-driven psychiatric screening tools. Full article

Urban canal-edge spaces are increasingly recognised as important blue–green infrastructure for mitigating urban heat; however, the mechanisms governing pedestrian thermal comfort in these environments remain insufficiently understood. This study employed a validated ENVI-met model to investigate the effects of canal orientation, canal width, water bodies and riparian tree configuration on pedestrian thermal comfort under summer heatwave conditions in Manchester, UK. A total of 32 scenarios were simulated to quantify the individual and combined effects of these design factors. Canal water alone provided only moderate daytime cooling, with its effectiveness depending strongly on canal orientation and local ventilation conditions. In contrast, riparian trees substantially improved thermal comfort through reductions in mean radiant temperature associated with canopy shading. Furthermore, the study identified that thermal performance was influenced not simply by the presence of blue and green infrastructure, but by their interaction. Rather than acting as the dominant cooling source, canal water enhanced the cooling effectiveness of adjacent vegetation, while continuous canopy shading emerged as the principal mechanism controlling pedestrian thermal comfort. These findings provide new insights into the mechanisms of canal-edge cooling and offer quantitative evidence to support climate-responsive design of thermally comfortable and resilient urban waterfronts. Full article

Fresh cheeses are highly perishable dairy products due to their high moisture content, pH, and other intrinsic characteristics that support microbial growth. This scoping review synthesized the available evidence on spoilage-associated bacteria in fresh cow cheeses, the physicochemical and sensory changes associated with spoilage, and the methods for their identification and quantification. The review was conducted in accordance with the PRISMA-ScR guidelines and registered in the Open Science Framework (OSF). Literature searches were performed in PubMed/MEDLINE, Scopus, SciELO, and Google Scholar through 2 April 2026. Of 7379 records identified, 30 studies met the inclusion criteria. Across the reviewed studies, Pseudomonas spp. emerged as the predominant spoilage-associated bacteria, followed by members of the Enterobacteriaceae, lactic acid bacteria (LAB), and spore-forming bacteria. Total viable count was the microbiological indicator most frequently used to monitor spoilage progression. Microbial spoilage was consistently associated with acidification, proteolysis, lipolysis, discoloration, gas production, texture deterioration, and reduced sensory acceptability. These findings highlight the central role of psychrotrophic bacteria in the spoilage of fresh cow cheeses and emphasize the importance of microbiological monitoring and spoilage-control strategies throughout production and storage. Full article

Heavy metal contamination of agricultural soils and urban green spaces has become a major environmental concern, threatening ecosystem functioning, food safety, and sustainable land management. Silicon-based growing media have emerged as an environmentally friendly approach for reducing metal mobility while enhancing plant establishment in contaminated environments. Despite growing research interest, a comprehensive evaluation of the mechanisms, effectiveness, and practical applications of silicon-amended growing media across diverse plant systems remains lacking. This systematic review addresses this gap by synthesizing current evidence following the PRISMA 2020 framework. A systematic search of Web of Science, Scopus, PubMed, ResearchGate and Google Scholar identified 247 publications published between 2010 and 2025, of which 32 peer-reviewed studies met the predefined inclusion criteria for qualitative analysis. The reviewed literature demonstrates that silicon incorporation into growing media improves substrate functionality by modifying physicochemical properties, immobilizing heavy metals, regulating metal transport within plants, strengthening antioxidant and osmo-protective defense systems, preserving photosynthetic activity, and improving nutrient acquisition and water-use efficiency. Furthermore, silicon influences molecular signaling pathways and promotes beneficial rhizosphere interactions that collectively enhance plant resilience under metal stress. Among the evaluated materials, silicon nanoparticles consistently exhibited greater remediation efficiency than conventional silicon sources because of their higher surface reactivity and improved bioavailability. Overall, silicon-based substrate engineering represents a multifunctional and sustainable strategy for mitigating heavy metal contamination while improving the performance of agricultural crops and urban vegetation. Future research should focus on validating these findings under long-term field conditions, optimizing silicon formulations for different substrate types and contamination scenarios, evaluating environmental safety, and integrating silicon-based technologies into climate-resilient agricultural practices and urban green infrastructure. Full article

Over the years, metabolic syndrome (MetS) has emerged as one of the most significant public health challenges, driven by the global increase in obesity, physical inactivity, unhealthy dietary patterns, and population aging. Ellagitannins are a class of hydrolysable tannins that have emerged as promising natural bioactive compounds, owing to their broad spectrum of biological activities. Increasing evidence suggests that some ellagitannins and their metabolites modulate several pathogenic mechanisms underlying metabolic syndrome, including oxidative stress, chronic inflammation, insulin resistance, endothelial dysfunction, and dysregulated lipid metabolism. This work reviews the pharmacological activities and therapeutic prospects of ellagitannins in the management of metabolic syndrome-related disorders. It further provides a critical and comparative analysis of the pharmacological profiles of reported ellagitannins, offering insights into their therapeutic efficacy and potential synergistic applications in the management of MetS-related disorders. Overall, Punicalagin and Geraniin currently possess the strongest preclinical evidence, supported by multiple independent studies employing both cellular and animal models that consistently demonstrate beneficial effects across several components of MetS. Chebulagic acid, Corilagin, Chebulinic acid, and Punicalin also show considerable promise but require further validation in diverse experimental systems. Potential synergistic interactions among ellagitannins when administered in combination should be investigated for enhanced therapeutic efficacy and broader multifaceted pharmacological effects. Full article

Idesia polycarpa is a woody oil tree threatened by stem canker caused by Botryosphaeria dothidea, yet the organization and infection-responsive behavior of its phenylalanine ammonia-lyase (PAL) gene family remain poorly understood. Here, we identified five IpPAL genes and characterized their phylogenetic relationships, conserved features, duplication patterns, promoter cis-elements, and infection-associated expression profiles. Segmental and tandem duplication contributed to IpPAL family evolution, and all duplicated pairs showed Ka/Ks ratios below 1, consistent with purifying selection. RNA sequencing (RNA-seq) of contrasting Chengdu and Zhangjiajie provenances revealed distinct temporal responses. In Chengdu, IpPAL2–IpPAL4 were significantly upregulated at 24 h after inoculation, whereas all five genes were upregulated at 96 h. In Zhangjiajie, all five IpPAL genes were significantly upregulated at 24 h, while IpPAL2–IpPAL5 remained upregulated at 96 h. No IpPAL gene met the differential-expression criteria between provenances under mock conditions or at 24 h; at 96 h, IpPAL1 and IpPAL3 were lower and IpPAL5 was higher in Zhangjiajie than in Chengdu. Scanning electron microscopy (SEM) provided complementary qualitative evidence of provenance-associated tissue responses. These findings demonstrate time- and gene-specific IpPAL responses to B. dothidea and identify candidate genes for further functional analysis. Full article

Background and Objectives: Delayed cerebral ischemia (DCI) is a major determinant of poor outcome after aneurysmal subarachnoid hemorrhage (aSAH), yet early risk prediction remains difficult, particularly in sedated or ventilated intensive care patients. We evaluated whether a large language model (LLM) could predict DCI from phase-based dynamic clinical data, compared with intensive care specialists. Materials and Methods: In this single-center, retrospective study, 216 consecutive patients with aSAH were assessed at three predefined phases of accumulating clinical data (day 1; days 1 + 3; days 1 + 3 + 5). For each patient–phase, an LLM (ChatGPT, GPT-5.5 Thinking) and two blinded intensive care specialists predicted DCI risk using only the data available up to that time point. DCI was adjudicated by a blinded three-member panel. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC), with non-inferiority defined a priori as Δ = 0.10. Calibration, decision-curve analysis, and reproducibility were also assessed. Results: Of 216 patients, 60 (27.8%) were DCI-positive and 15 were indeterminate; the primary sample comprised 201 patients. In the prespecified primary analysis, the LLM met the non-inferiority criterion relative to both specialists across all three phases (LLM AUC 0.703–0.747; specialists 0.712–0.764); however, in an equal-granularity sensitivity analysis, non-inferiority remained supported only in Phases 2 and 3 and was not demonstrated in Phase 1. Discrimination increased numerically as data accumulated (Phase 1 vs. 3, p = 0.072), an increase that was attenuated in a landmark-restricted analysis accounting for DCI-onset timing. The LLM showed the lowest false-reassurance rate (3.3–11.7%), reflecting a more cautious threshold rather than better discrimination. Confidence did not reliably indicate accuracy (~25% of high-confidence predictions were wrong); outputs were highly reproducible (Fleiss κ 0.887; intraclass correlation coefficient (ICC) 0.968). Conclusions: An LLM achieved DCI discrimination that was non-inferior to—but not better than—that of experienced specialists; its unreliable confidence scores support clinician-supervised rather than autonomous use. Full article

Background: Sustaining progress toward polio eradication requires not only effective vaccination but also a resilient laboratory network capable of timely poliovirus detection, confirmation, and genetic characterization. In the WHO African region, the African polio laboratory network provides essential virological support for eradication efforts; however, persistent circulating Vaccine-derived Polioviruses (cVDPVs) outbreaks and increasing demands of genomic surveillance continue to challenge laboratory capacity. Despite its critical role, evidence describing the operational performance, adaptive capacity, and evolution of regional polio laboratory network remains limited. This study evaluates the performance and operational experience of the African polio laboratory network in 2025, highlighting contributions to poliovirus detection, genomic surveillance, quality assurance, and outbreak response, while sharing lessons to inform regional public health systems. Methods: A retrospective secondary data analysis was conducted using laboratory surveillance and outbreak databases, supplemented by reviews of programmatic reports. Data were cleaned and harmonized prior to analysis. Descriptive analyses were performed to assess laboratory workload, timeliness indicators, genomic capacity, quality assurance performance, and operational challenges. Qualitative review of programmatic documents was conducted to identify contextual factors influencing performance. Results: In 2025, 77,230 Acute Flaccid Paralysis (AFP) specimens were analyzed across 16 laboratories. Ninety-two percent of specimens met the timeliness target for virus isolation, and 94% met the target for PCR-ITD. Genomic sequencing confirmed 20 cVDPV outbreaks in 10 countries. The establishment of new sequencing laboratories in Uganda and Nigeria reduced turnaround times, and a 2025 expansion plan aimed to build sequencing capacity in 12 additional countries. All laboratories assessed in 2024 for virus isolation, PCR-ITD, and environmental surveillance exceeded quality assurance accreditation thresholds and were rated “Pass”. The pilot implementation of Direct Detection Nanopore Sequencing (DDNS) techniques is expected to further strengthen genomic surveillance. Challenges remain, including stock out of essential supplies, uneven workloads, and infrastructure gaps. Conclusions: The African polio laboratory network has demonstrated sustained capacity, adaptability, and innovation in supporting polio eradication activities in the WHO African region. This study provides evidence on the importance of strengthening laboratory systems, expanding genomic capacity, and maintaining quality assurance mechanisms to support the final phase of polio eradication and broader public health surveillance. Full article