Search Results (400)

Background/Objectives: This study aims to present a structured clinical workflow for offline adaptive Biology-guided Radiotherapy (BgRT) using the RefleXion X1 PET-linac system, addressing challenges introduced by inter-treatment anatomical and biological changes. Methods: We propose a decision tree offline adaptation framework based on real-time assessments of Activity Concentration (AC), Normalized Target Signal (NTS), and bounded dose-volume histogram (bDVH%) metrics. Three offline strategies were developed: (1) preemptive adaptation for minor changes, (2) partial re-simulation for moderate changes, and (3) full re-simulation for major anatomical or metabolic alterations. Two clinical cases demonstrating strategies 1 and 2 are presented. Results: The preemptive adaptation strategy was applied in a case with early tumor shrinkage, maintaining delivery parameters within acceptable limits while updating contours and dose distribution. In the partial re-Simulation case, significant changes in PET signal necessitated a same-day PET functional modeling session and plan re-optimization, effectively restoring safe deliverability. Both cases showed reduced target volumes and improved OAR sparing without additional patient visits or tracer injections. Conclusions: Offline adaptive workflows for BgRT provide practical solutions to address inter-fractional changes in tumor structure and function. These strategies can help maintain the safety and accuracy of BgRT delivery and support clinical adoption of PET-guided radiotherapy, paving the way for future online adaptive capabilities. Full article

Background: Left atrial appendage occlusion (LAAO) is a valuable alternative to long-term anticoagulation in patients with atrial fibrillation (AF) and a high bleeding risk. However, effective vascular closure following large-bore venous access remains a clinical challenge, particularly in patients with multiple comorbidities. This study compares two venous closure techniques—Z-sutures and the suture-mediated ProGlide™ device—regarding their safety and efficacy in patients undergoing LAAO. Methods: We conducted a single-center observational study including 163 patients treated with LAAO between 2021 and 2024. Closure was achieved via a Z-suture (n = 126) or the ProGlide™ (n = 37) based on operator preference. The primary endpoint was clinically relevant bleeding (BARC ≥ 2). The secondary endpoints included 30-day mortality and hospital stay duration. Results: The Z-suture group included older and more comorbid patients. Despite these differences, the bleeding rates were comparable between groups. Clinically relevant bleeding was infrequent (Z-suture: 12.6%; ProGlide™: 13.5%). No 30-day deaths occurred in either group, and their hospital stay durations were similar. Conclusions: Both the Z-suture and ProGlide™ techniques demonstrated comparable safety and efficacy. Due to their simplicity and potential cost advantage, Z-sutures may be a practical alternative in routine care for high-risk patients. Full article

Background/Objectives: Diabetic foot (DF) is among the leading causes of diabetes-related disability. It is important to maintain regular follow-up and patient education in the prevention and treatment of DF ulcers. In extraordinary situations such as a pandemic, there are disruptions in regular clinical follow-up and patient education, and the effects of this disruption need to be investigated. The aim of this study was to investigate the impact of the pandemic on the clinical condition of patients hospitalised for DF. Methods: Patients were divided into two groups according to the date of admission to the clinic: the pre-pandemic (1 January 2019–11 March 2020) and the pandemic period (12 March 2020–1 June 2021). Comparisons were made between the two groups in terms of DF data and clinical parameters. Data were analysed with SPSS using chi-square, Student’s t-test and Mann–Whitney U analysis. Results: As a result of the screening, data from 125 DF patients (45 pre-pandemic and 80 pandemic) were collected. The DF stage, according to the Wagner classification, was significantly more advanced in patients during the pandemic period (p = 0.015). However, the time between the onset of symptoms and hospitalisation was longer for patients during the pandemic period (p = 0.035). When analysing treatment outcomes, the rate of wound healing was found to be lower (62.2% vs. 30%), and the rate of transtibial amputation was higher (11.2% vs. 20%) during the pandemic period (p = 0.002). Conclusions: This study found that the number of patients hospitalised for DF increased during the pandemic period, as did the severity of the wound, length of admission and radical treatment interventions. Full article

Amid growing environmental concerns and an increasing push for sustainable development, countries in the Middle East and North Africa (MENA) region have taken proactive steps toward green growth, energy transition, and technological innovation. As a result, this study examines the effects of green growth, energy transition, technological innovation, financial inclusion, and urbanization on environmental sustainability in the Middle East and North Africa (MENA) region. Moreover, this study breaks new ground by exposing the hidden environmental costs of financial inclusion, urbanization, and technological innovation in the MENA region’s development trajectory, thereby providing compelling evidence for rethinking sustainability through an integrated approach that aligns economic ambition with ecological responsibility. Data for the studied variables were sourced from the World Bank database covering the period 1990 to 2021. The results show that green growth and energy transition significantly reduce CO₂ emissions, supporting the idea that economic expansion aligned with environmental priorities can contribute to ecological improvement. However, the impact of technological innovation is statistically insignificant, indicating that innovation in the region has not yet translated into meaningful environmental gains, possibly due to the dominance of non-green or industrial-focused innovation. Financial inclusion is found to increase CO₂ emissions, likely by facilitating greater access to credit and financial services that fuel energy-intensive consumption and production activities. Similarly, urbanization also contributes to rising emissions, reflecting the unsustainable nature of urban growth in many MENA region. Based on this study, we advocate for a coordinated regional approach to climate and energy policy, underpinned by shared governance and collective action. Full article

Cockroaches, particularly the German cockroach (Blattella germanica Linnaeus, Blattodea: Ectobiidae) and the American cockroach (Periplaneta americana (Linnaeus), Blattodea: Blattidae), are major public health pests due to their ability to transmit pathogens and develop resistance to chemical insecticides, including synthetic pyrethroids, which are widely used worldwide. Given the increasing resistance, entomopathogenic nematodes (EPNs) have emerged as a potential biological control alternative. This study evaluates the efficacy of three EPN species, Steinernema carpocapsae (Weiser), S. feltiae (Filipjev), and Heterorhabditis bacteriophora Poinar, against B. germanica and P. americana collected from different regions of Antalya, Türkiye. Laboratory bioassays were conducted under controlled conditions, testing five EPN concentrations (100, 250, 500, 750, and 1000 IJs/mL). The results showed that S. carpocapsae was the most effective, causing mortality rates of 46.7% to 100% in adult German cockroaches and 20% to 66.7% in nymphs, while S. feltiae and H. bacteriophora exhibited lower efficacy. American cockroaches showed higher resistance, with S. carpocapsae achieving a maximum mortality of 33.3% at the highest concentration, whereas S. feltiae and H. bacteriophora had no significant lethal effect. These findings suggest that S. carpocapsae could be a promising biological control agent for B. germanica, particularly in pyrethroid-resistant populations. Full article

Trimethylamine N-oxide (TMAO), a gut microbiome metabolite linked to cardiovascular health, can be influenced by dietary factors like choline intake and diet quality. This study compared the effects of mixed tree nuts (MTNs) and pretzels, as part of a 12-week hypocaloric weight loss diet, on TMAO levels and identified dietary predictors. Methods: Plasma samples from 95 overweight individuals consuming either 1.5 oz. of mixed tree nuts (MTNs, n = 56) or isocaloric pretzels (n = 39) daily for 12 weeks were analyzed. Nutritional data were collected at baseline and week 12 through dietary recall using the Automated Self-Administered 24 h Dietary Assessment Tool (ASA24), and the overall diet quality was assessed via the Healthy Eating Index (HEI) score. TMAO levels were determined and analyzed using linear mixed-effect models, adjusting for covariates. Wilcoxon signed-rank tests compared baseline and week 12 TMAO and weight. Multiple linear regression identified baseline predictors of TMAO. Results: Baseline demographics, anthropometric measures, HEI scores, and dietary choline intake were similar between the MTN and pretzel groups. A significant positive association was observed between baseline dietary choline and plasma TMAO levels (p = 0.012). The 12-week hypocaloric diet led to significant weight reduction in both groups (p < 0.01), but the magnitude of weight loss did not differ significantly between the MTN (−3.47 lbs) and pretzel (−4.25 lbs) groups (p = 0.18). Plasma TMAO levels decreased significantly in both groups (p < 0.01), but the between-group difference in reduction was not significant. (MTNs: −0.34 vs. pretzels: −0.37; p = 0.43). HEI scores and dietary choline intake remained unchanged, with no significant time–intervention interaction. Participants with low baseline HEI scores (≤53.72) had a more pronounced reduction in TMAO levels in the MTN group compared to the pretzel group (MTN: −0.54 vs. pretzel: −0.23; p = 0.045) over 12 weeks, despite similar weight loss. This difference was not observed in participants with higher HEI scores. Conclusions: The 12-week hypocaloric diet reduced body weight and plasma TMAO levels similarly in both MTN and pretzel groups. Participants with lower dietary quality saw a greater reduction in TMAO levels in the MTN group, suggesting MTNs may better modulate TMAO levels, especially for those with poorer baseline diets. Full article

This article considers the study of the grinding and homogeneity of a feed mixture in a device that combines the processes of grinding and mixing. It was found that it is important to improve the working elements with the elimination of passive zones. In this regard, the purpose of this study is to improve the working elements of the feed preparation device with an assessment of the quality of the grinding and homogeneity of the feed mixture. For the efficiency of grinding, serrated surfaces have been developed along four planes of the hammer, which maximizes the use of the working surfaces of the hammer and eliminates passive zones. The design parameters of the serrated surfaces are the step between the tops of adjacent serrations (t, mm), the height of the serrations (h, mm), the angle of inclination (α, °) and the sharpness of the serrations (o_z, °). It was found that it is necessary to strive to reduce the step between the tops of adjacent serrations t. The results of the experiments with four-sided serrated hammers showed that a significant portion of the crushed grain waste particles was smaller than 1 mm (25.36–34.34%); the particle size was over 1 mm and less than 2 mm (35.09–44.22%); the particle size was over 2 mm and less than 3.55 mm (27.59–28.73%), and an insignificant portion of particles was larger than 3.55 mm (0.99–2.98%). The experiments yielded the following results on the homogeneity of the mixing of grain waste and the control component: 86.6% (after 2 min), 87.2% (after 4 min) and 87.6% (after 6 min). The feed preparation device with the developed four-sided serrated hammers and impact-mixing mechanisms can produce sufficiently crushed and uniformly mixed feed mass. Full article

This study presents a hybrid computational investigation into the radiation shielding behavior of Fe-enriched Al-based alloys (Al-Fe-Mo-Si-Zr) for potential use in nuclear applications. Four alloy compositions with varying Fe contents (7.21, 6.35, 5.47, and 4.58 wt%) were analyzed using a combination of Monte Carlo simulations, machine learning (ML) predictions based on multilayer perceptrons (MLPs), EpiXS, and SRIM-based charged particle transport modeling. Key photon interaction parameters—including mass attenuation coefficient (MAC), half-value layer (HVL), buildup factors, and effective atomic number (Z_eff)—were calculated across a wide energy range (0.015–15 MeV). Results showed that the 7.21Fe alloy exhibited a maximum MAC of 12 cm²/g at low energies and an HVL of 0.19 cm at 0.02 MeV, indicating improved gamma attenuation with increasing Fe content. The ML model accurately predicted MAC values in agreement with Monte Carlo and XCOM data, validating the applicability of AI-assisted modeling in material evaluation. SRIM calculations demonstrated enhanced charged particle shielding: the projected range of 10 MeV protons decreased from ~55 µm (low Fe) to ~50 µm (high Fe), while alpha particle penetration reduced accordingly. In terms of fast neutron attenuation, the 7.21Fe alloy reached a maximum removal cross-section (Σ_R) of 0.08164 cm⁻¹, showing performance comparable to conventional materials like concrete. Overall, the results confirm that Fe-rich Al-based alloys offer a desirable balance of lightweight design, structural stability, and dual-function radiation shielding, making them strong candidates for next-generation protective systems in high-radiation environments. Full article

Background/Objectives: Isthmin-1 (ISM1) is a secreted protein involved in immune regulation, inflammation, and angiogenesis. Although ISM1 has been implicated in chronic inflammatory conditions, its clinical relevance in rheumatoid arthritis (RA) remains unknown. This study aimed to evaluate serum ISM1 levels in RA patients and assess their associations with disease activity, autoantibody status, and inflammatory markers. Methods: This cross-sectional study included 90 RA patients fulfilling the 2010 ACR/EULAR criteria and 30 age- and sex-matched healthy controls. Serum ISM1 concentrations were measured using ELISA. Disease activity was assessed using DAS28-CRP and DAS28-ESR. Statistical analyses included group comparisons, correlation testing, multivariate linear regression, and ROC curve analysis to evaluate the predictive performance of ISM1 for remission or low disease activity. Results: Serum ISM1 levels were significantly lower in RA patients than in controls (454 ± 378 vs. 972 ± 809 ng/L, p < 0.001). ISM1 concentrations were inversely correlated with CRP, ESR, and both DAS28 indices. Multivariate regression confirmed independent associations between lower ISM1 concentrations and higher disease activity. ISM1 levels were significantly reduced in RF- and anti-CCP-positive patients, as well as in treatment-naïve early RA. ROC analysis identified a cut-off value of 673.73 ng/L for predicting remission or low disease activity, with an AUC of 0.713 (95% CI: 0.596–0.820), 100% specificity, and 38.9% sensitivity. Conclusions: This study is the first to demonstrate that serum ISM1 is independently associated with disease activity and autoantibody positivity in RA. High ISM1 levels may serve as a specific indicator of clinical remission or low disease activity, supporting its potential as a non-invasive biomarker for disease monitoring. Full article

Robots designed for children with Autism Spectrum Disorder (ASD) have demonstrated potential in promoting social engagement and emotional learning. This study presents the design and preliminary evaluation of JARI, a social robot developed to support emotional recognition and interaction in children with ASD aged 6 to 8 years. The robot integrates mechanical, electronic, and software components within a modular architecture and is operated via a web-based Wizard of Oz interface. Aesthetic decisions, including a deliberately ambiguous zoomorphic appearance to avoid triggering the recognition of specific animal forms and the use of sensory accessories, were made to increase acceptance and reduce overstimulation. JARI was tested in the following two scenarios: individual interaction at a special education center in Peru, and group interaction at an inclusive school in Spain. Results show that most children were able to identify the robot’s emotional expressions and responded positively to its color cues. Behavioral analysis revealed significant engagement through physical gestures, sustained visual attention, and emotional mirroring. These findings suggest that JARI is effective in capturing attention and eliciting meaningful interaction from children with ASD. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition often associated with bisphosphonate use, leading to impaired bone healing and difficult clinical management. Given the lack of predictable therapeutic options, this study investigated the effects of systemic ozone therapy on MRONJ healing. This study aimed to analyze the effects of systemic ozone therapy on oral hard and soft tissue healing in senescent rats with medication-related osteonecrosis of the jaw (MRONJ) induced by antiresorptive therapy. Methods: Twenty-eight senescent Wistar rats, aged eighteen months and weighing ~350 g, were used for this study. The animals were divided into four groups. The negative control (SAL) group received saline applications, while the control-treated (SAL+OZ) group received saline applications and ozone therapy (0.7 mg/kg). The MRONJ (ZOL) group received Zoledronate, an intravenous antiresorptive drug (100 μg/kg), and the MRONJ-treated (ZOL+OZ) group received zoledronate application and was treated with systemic ozone therapy (0.7 mg/kg). All rats underwent molar extraction in the third week of the experiment and were euthanized in the seventh week of the experiment. The mandibles were resected, reduced, and prepared for microtomographic analysis, histopathological/histometric analysis, and immunohistochemistry. Results: The ZOL group presented characteristics of vitreous, non-vital, and dense bone, poor vascularization, and high values of inflammation markers compatible with MRONJ. In contrast, the ZOL+OZ group exhibited improvement in alveolar bone and soft tissue healing, a decrease in nonvital bone area, and modulation of local inflammation. Conclusions: It can be concluded that Ozone therapy improved oral hard and soft tissue healing of MRONJ in senescent female rats subjected to antiresorptive drugs and might be considered for future clinical applications. Full article

This study evaluates the seismic fragility and code compliance of reinforced concrete buildings in Turkey following the 6 February 2023 Kahramanmaraş earthquake. Sixty representative buildings were modeled in SAP2000, consisting of thirty structures designed according to TEC-1975 and thirty according to TEC-1998. These models were subjected to three-dimensional nonlinear time history analyses using ground motions scaled to match the seismic characteristics of the earthquake. Structural performance was assessed by comparing calculated displacement demands with capacity thresholds defined by modern code provisions. The results show that buildings designed under TEC-1998 generally performed better than those constructed according to TEC-1975, particularly in terms of deformation capacity and collapse resistance. Fragility curves and exceedance probabilities were developed to quantify damage likelihoods across different performance levels. When compared with post-earthquake field observations, the analytical models produced lower collapse rates, which may suggest the presence of widespread code noncompliance in the actual building stock. These findings highlight the critical importance of ensuring adherence to seismic design regulations to improve the resilience of existing structures. Full article

Commonly used methods in User-Centered Design (UCD) can face challenges in incorporating user feedback during early design stages, often resulting in extended iteration cycles. To address this, we explore the following question: “How can generative artificial intelligence (AI) be utilized to enable prototyping within user studies to facilitate immediate user feedback integration and validation?” We introduce a conceptual framework for live-prototyping, where designers modify AI-generated components of a prototype in real time through a separate control interface during user testing. This approach invites more immediate interaction between feedback and design decisions. To explore our concept, we engaged in a case study with experienced prototyping practitioners, examining how real-time prototyping might shape design processes. Participants highlighted the framework’s potential to support spontaneous insight generation and enhance collaborative dynamics. However, they also highlighted important considerations, including the need for a certain level of AI knowledge and challenges around planning and reliability. By integrating generative AI into the UCD process, our conceptual framework contributes to ongoing conversations around evolving user-centered methodologies. Full article

Given the relevance of sustainability, this study analyzed the impacts on water consumption in the production chain of ornamental stone pieces (marble and granite) and quartz-based composites. The goal was to compare the water demand throughout the process, from extraction to manufacturing, using 1 m³ blocks as the unit of analysis. This study was conducted in Bahia, a state with significant ornamental stone production, located in a semi-arid region with limited water availability. The methodology included data collection from participating companies, combined with sectorial information and the Ecoinvent version 3.3 database, modeled using the SimaPro 8.0 software. The impact assessment was carried out using the AWaRE (Water Scarcity Footprint) and ReCiPe Endpoint methods, following the guidelines of Life Cycle Assessment (LCA), as per ABNT NBR ISO 14040 standards. The results showed that marble and granite have lower water demand and environmental impact in the categories of particulate matter, human toxicity, ecotoxicity, eutrophication, and acidification when compared to quartz composites. The highest environmental impact occurred during the processing stage, which requires a large amount of water and generates effluents, losses, and particulate matter. The results indicate that marble and granite demand less water and exhibit lower environmental impacts—across categories like particulate matter, human toxicity, ecotoxicity, eutrophication, and acidification—than quartz composites. Notably, the processing stage incurred the highest environmental burden due to its intensive water use and consequent generation of effluents, losses, and particulate matter. These findings highlight the necessity of efficient water management and the adoption of circular economy principles—including water reuse and waste valorization—to promote long-term sustainability in the ornamental stone industry. Full article

Background and Objectives: Patients with heart failure (HF) are at risk of increased morbidity and mortality related to pneumococcal pneumonia, and routine vaccination with a conjugated pneumococcal vaccine (PCV) for HF patients is strongly endorsed by all major international guidelines. Despite this, data on the factors associated with vaccine uptake remain scarce. The aim of this study was to understand the demographic and clinical factors associated with vaccine uptake in patients with HF and analyze the all-cause mortality in the vaccinated and unvaccinated cohorts. Materials and Methods: Four hundred and fifty patients with HF and a reduced ejection fraction followed up at a single center were enrolled. Patients were followed up for a median of 164.0 (148.0–181.0) days. Results: In total, 193 of the 450 patients (42.9%) were vaccinated with PCV-13 at enrollment. Vaccinated patients were more likely to have an implantable device, namely an implantable cardioverter/defibrillator (ICD), cardiac resynchronization treatment (CRT) or left ventricular assist device (LVAD), and less likely to have a past medical history of hypertension and chronic obstructive pulmonary disease (COPD) at baseline. After multivariable adjustment, the presence of an ICD (OR: 3.17, 95% CI: 1.98–5.08), CRT (OR: 2.75, 95% CI: 1.45–5.20) and COPD (OR: 0.42, 95% CI: 0.19–0.94) remained as determinants of vaccination. All-cause mortality was not different across vaccinated or unvaccinated patients either in the unmatched (log-rank p = 0.67) or matched (log-rank p = 0.52) cohorts. Conclusions: The presence of implantable devices and coexisting COPD was associated with a higher and lower likelihood of vaccination with PCV-13, respectively. No difference in mortality across cohorts was observed in this observational analysis. Full article