Search Results (1,202)

Temporary sidewalk disruptions caused by construction, maintenance, or other obstructions can significantly affect pedestrian mobility, particularly for those with mobility impairments. Although accessibility standards and universal design principles exist, temporary pedestrian detours do not always provide safe, continuous, and accessible routes, creating barriers to independent mobility. This study examines how municipalities plan, approve, and monitor sidewalk detours, focusing on accessibility. A qualitative descriptive approach was used, combining a review of guidance documents and grey literature with semi-structured interviews with seven professionals from five municipalities and one transportation organization in Québec, Canada (April–August 2024). Thematic analysis allowed the identification of four main themes concerning the detour design process, the criteria used, accessibility-related challenges, and the use of geospatial technology. The findings show that pedestrian safety and continuity of movement are central concerns, while accessibility is considered unevenly across organizations. Organizations in larger cities described more detailed accessibility-related criteria, such as width, slope, surface condition, curb ramps, and corridor delineation, but even this level of detail did not translate into consistent application. They indicated that applying these criteria is sometimes hindered by existing infrastructure, limited space, time constraints, variable guidance application, and a lack of decision-support tools. These findings provide an empirical basis for understanding current detour design practice and for developing geospatial decision-support tools for accessible detour planning. Full article

Background/Objectives: Dietary supplement (DS) use is a growing trend among university students, often influenced by non-institutional information. This study investigated the lifetime prevalence, behavioural correlates, and self-reported adverse effects of DS use according to EU regulatory definitions, evaluating how consumption frequency and product diversity relate to safety outcomes and student receptivity toward educational initiatives. Methods: A cross-sectional survey was conducted among 2001 students at the University of Catania. Multivariable logistic regression models were utilized to identify factors associated with lifetime DS use and favourability toward informative meetings. Results: The lifetime prevalence of DS use was 55.7%. The strongest correlate of use was self-rated knowledge, with comparable odds among moderately (OR = 4.02; 95% CI: 3.17–5.10) and well/completely informed participants (OR = 4.70; 95% CI: 3.44–6.42). Increased odds of consumption were also associated with information from health professionals (OR = 2.19; 95% CI: 1.59–3.02), friends (OR = 1.91; 95% CI: 1.37–2.65), and enrollment in scientific fields (OR = 1.70; 95% CI: 1.23–2.35). Overall, 34.6% of users reported at least one symptom temporally associated with supplement intake. Despite these reports, 74.3% of the sample welcomed institutional meetings, with favourability among users significantly associated with daily supplement intake (OR = 1.97; 95% CI: 1.23–3.14) and smoking status (OR = 1.77; 95% CI: 1.24–2.54). Conclusions: The results highlight a gap between high self-rated knowledge and the frequency of self-reported side effects. The strong student interest in formal guidance underscores the need for universities to integrate evidence-based nutritional and supplement-safety education into their curricula to ensure safe supplementation practices. Full article

Hypertension is the most common comorbidity in chronic kidney disease (CKD), affecting roughly 80–85% of patients overall and an even higher proportion in nondialysis CKD G3–G5. This narrative review examines whether, and under what clinical conditions, fruits, vegetables, and legumes can be used safely in adults with hypertensive CKD, especially nondialysis CKD G3–G5, as well as moderate to severe loss of kidney function, paying close attention to the gut microbiota, short-chain fatty acids, gut-derived uremic toxins, potassium bioavailability, and modifiable clinical risk factors. The clinical effect of plant foods on serum potassium cannot be predicted from total potassium content alone. The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines explicitly advise individualized potassium management and emphasize limiting foods rich in bioavailable potassium, especially processed foods, rather than reflexively restricting fruits and vegetables. Across CKD studies, the association between dietary potassium and serum potassium is weak or inconsistent, and the risk of hyperkalemia is modified by kidney function, bowel function, metabolic acidosis, diabetes and hyperglycemia, medications, food processing, and the food matrix itself. Potassium bioavailability varies substantially according to the food matrix, preparation method, portion size, and processing method; some minimally processed plant foods may provide less readily absorbable potassium than potassium-rich processed foods, juices, or potassium additives. Fruits, vegetables, and legumes also provide fiber, resistant starch, and polyphenols that can support saccharolytic fermentation, short-chain fatty acid production, bowel transit, and lower concentrations of some gut-derived uremic toxins. However, blood-pressure and kidney-outcome benefits in CKD are supported more strongly by observational and selected alkali-diet trials than by large microbiome-focused randomized studies. In hypertensive CKD, fruits, vegetables, and legumes should not be universally restricted simply because they contain potassium. A safer and more evidence-aligned strategy is individualized, food-source-aware prescribing that prioritizes minimally processed plant foods, accounts for preparation method and portion size, corrects constipation and acidosis, reviews potassium-raising medications and additives, and monitors serum potassium according to baseline risk. Full article

Background/Objectives: Children now spend a substantial part of daily life in digital environments, and their digital, media, and information literacies shape their online safety, social-emotional development, and mental health, making these competencies a concern for child public health and preventive paediatric care. This study applies a Synthetic Knowledge Synthesis (SKS) to map how digital, media, and information literacies (hereafter digital literacies) among children have evolved, comparing neurotypical and neurodivergent children. SKS is a semi-automated approach that combines descriptive bibliometrics, keyword co-occurrence mapping, and qualitative content analysis to map an entire research field or topic. Methods: We treat digital literacies as relevant to children’s health, well-being, and safe online participation, and we analyse Scopus-indexed literature from 1996 to 2025 using descriptive bibliometrics, keyword co-occurrence mapping, and qualitative content analysis. Results: The mapping shows strong growth in general digital-literacy scholarship alongside a small but persistent body of work on a “double digital divide” affecting children with autism spectrum disorder (ASD), ADHD, and dyslexia. The two bodies of work differ in emphasis: the general literature foregrounds social integration and critical agency, while research on neurodivergent children foregrounds inclusive pedagogy, implicit learning, and multimodal expression. It also shifts from general digital-safety awareness toward protective mediations for vulnerabilities such as social-emotional decoding differences and impulsivity, which bear on children’s online safety and mental health. Because bibliometric mapping reveals where research is concentrated rather than what works in practice, the synthesis points to evidence gaps rather than proven methods. Conclusions: On this basis, we argue for an integrated public-health and socio-educational framework that complements universal literacy standards with adaptive, assistive safety nets, so that all children can take part in digital life safely and on equal terms. Full article

Objectives: The aim of this study was to evaluate the reliability, accuracy, and morbidity of dynamic sentinel lymph node biopsy (DSNB) in patients with intermediate- and high-risk penile cancer who had clinically negative lymph nodes, with a focus on long-term follow-up outcomes. Methods: Between January 2005 and January 2024, 287 patients with histologically confirmed penile cancer underwent radioisotope-guided DSNB at the Department of Urology, University of Pécs. Patients lost to follow-up within 24 months were excluded. Of the remaining patients, 211 underwent primary DSNB and 37 secondary DSNB. Thirty-nine patients in the primary DSNB group with Tis, T1a, or G1 tumours were additionally excluded, leaving 209 patients for analysis. Variables included tumour stage and grade, sentinel lymph node (SLN) yield and histology, complications, inguinal progression, false-negative rate, and radical lymphadenectomy findings. Results: A total of 573 SLNs were removed from 209 patients, with a median of 2.7 nodes per patient. SLN metastases were identified in 31 patients, involving 37 groins. Among 178 patients with negative SLNs, three developed inguinal metastases. Sensitivity was 91% per patient and 92.5% per groin, with false-negative rates of 8% and 7.5%, respectively. All false-negative cases occurred within two years, with no later inguinal recurrences. DSNB-related complications occurred in 24 patients (11.4%); most were mild or moderate and managed on an outpatient basis. Two patients required surgery and one required hospital readmission. Conclusions: In a high-volume centre, DSNB is a safe and reliable staging procedure with low morbidity in clinically node-negative intermediate- and high-risk penile cancer. Further studies should assess radiotracer injection sites and compare one-day versus two-day protocols. Full article

Sustainable finance increasingly treats green assets as instruments for climate-risk hedging; however, it remains unclear whether they protect investors during energy-market shocks and financial-market stress or merely transmit different transition, equity-market, and growth risks. This study asks whether green assets hedge better than brown assets, or whether the two asset classes hedge different risks across market states. Using daily data from 2010 to 2025 on exchange-traded clean-energy, fossil-fuel, green-bond, ESG, and market-risk instruments, we construct green and brown portfolios and analyze the green–brown return spread across normal conditions, high-volatility regimes, market-stress days, positive and negative oil-price shocks, the COVID-19 crisis, and the recent energy-crisis period. The empirical design combines performance and downside-risk metrics, rolling correlations and betas, Newey–West regressions, stress-state comparisons, quantile regressions, portfolio allocation tests, and supplementary machine-learning classification. The results reveal strong oil-shock asymmetry: brown assets outperform during positive oil-price shocks, while green assets perform relatively better when oil prices fall sharply. However, green assets do not function as broad safe havens during financial-market stress, reflecting persistent equity-market downside exposure and growth-factor repricing. Quantile regressions confirm nonlinear and state-dependent risk transmission, while portfolio tests show weak full-sample return-risk performance for clean-energy equity exposure alone. Shorter-sample suggests that green bonds and ESG assets display more defensive characteristics, whereas machine-learning models show limited short-horizon predictive power. Green assets are therefore not universal hedges but conditional transition-risk assets whose value depends on the shock source, market regime, and sustainable instrument. Full article

Return to sport (RTS) is an important outcome after surgery for adolescent idiopathic scoliosis (AIS), yet postoperative clearance remains largely time-based and reported outcomes vary according to procedure, population, endpoint, and treating-center policy. This critical review integrates direct postoperative RTS cohorts with biomechanical, rehabilitation, psychological, safety, and clinical-guidance evidence. Most available data concern adolescents treated with posterior spinal fusion and rely on self-reported participation. Resumption of physical activity or sport is common within the first postoperative year, but return to the same discipline, previous competitive level, and objectively verified performance is less consistently demonstrated. Evidence for anterior fusion is sparse, whereas vertebral body tethering is supported by smaller, selected cohorts and should be interpreted separately. Associations between RTS and distal fusion level or construct characteristics remain inconsistent, and biomechanical studies suggest redistribution rather than normalization of movement. Reported sport-related complications are uncommon, but existing cohorts are too small and lack exposure denominators to quantify rare events. No universal safe date or validated AIS-specific readiness battery currently exists. The proposed Multidimensional Scoliosis Return-to-Sport Framework therefore uses elapsed time as safety context while integrating clinical recovery, physical and psychological readiness, graded sport-specific exposure, and distinct return outcomes. The framework is evidence-informed and requires prospective validation. Full article

Rare-event detection is a critical task in intelligent risk monitoring systems, where missed minority events may lead to financial loss, security threats, or operational failures. Existing imbalance-handling methods frequently apply one class-level correction and therefore ignore the heterogeneous geometric roles of minority observations. This study presents density–boundary graph reweighting (DBGR), a unified sample-level weighting framework that combines continuous minority sparsity and majority-boundary exposure and regularizes the resulting scores through a minority-only K-nearest-neighbor graph. Its methodological contribution lies in this joint pre-training formulation and in producing classifier-compatible weights, rather than in claiming novelty for density estimation, graph propagation, or weighting individually. Two variants are considered: DBGR-Safe for sparse and relatively safe minority prototypes and DBGR-Danger for sparse boundary observations. Experiments on financial fraud detection, industrial fault diagnosis, and network intrusion detection show recall-oriented gains with XGBoost and reduced variability for the tested LightGBM setting, while the benefit is limited for Random Forest. On Creditcard, DBGR-Danger improves Recall from 0.8223 to 0.8949 and F2 from 0.8410 to 0.8931. On NSL-KDD U2R, focal loss remains better in Recall, F2, and PR-AUC, whereas DBGR-Safe achieves the best F1. DBGR is therefore positioned as a complementary, classifier-compatible strategy rather than a universally superior imbalance-handling method. Full article

Standalone DC microgrids offer a promising solution for providing reliable and sustainable electricity to remote communities in developing countries. However, the intermittent nature of solar and wind resources, combined with continuously varying load demand, presents considerable operational challenges in maintaining real-time power balance, stable DC bus voltage, and ensuring reliable continuous supply. Therefore, there is dire need for user-friendly control solutions tailored to the specific needs of isolated communities. As such, this paper presents a coordinated control and power management strategy for an isolated hybrid solar–wind–battery integrated DC microgrid for rural electrification applications. A comprehensive mathematical model of the standalone DC microgrid incorporating photovoltaic generation, wind energy conversion, battery storage, bidirectional DC-DC conversion, and common DC bus dynamics is developed at the very first stage of the proposed coordinated control framework. The framework utilizes principal local device loops and a secondary dynamic power management strategy to ensure efficient renewable power extraction, dynamic source–storage–load coordination, stable DC bus voltage, and real-time energy management within the developed standalone DC microgrid. It is worthwhile to mention that, instead of using synthesized or online available wind speed and solar irradiance data, this research utilized real-time recorded metrological data obtained from the Mehran University Jamshoro, Pakistan. The obtained results establish a stable DC bus voltage regulation within acceptable operating limits, continuous power balance, seamless bidirectional battery operation, and safe battery state-of-charge (SoC) management to prevent deep discharging or overcharging, thus ensuring reliable operation. The overall performance confirms the technical robustness, operational flexibility, and practical suitability of the proposed standalone hybrid DC microgrid architecture for its resilient operation and rural electrification applications. Full article

Background/Objectives: Inclusion body myositis (IBM) causes progressive, quadriceps-predominant weakness that impairs mobility and increases fall risk, yet outcomes most relevant to independence remain unsynthesized for IBM. This review compiles direct IBM evidence across five domains (A1–A5): natural history, motor performance, falls and balance, sensory/peripheral-nerve function, and interventions. Methods: Eight databases and two trial registers were searched without date or language limits. Eligible studies enrolled adults with IBM based on recognized criteria reporting lower-limb strength or function, gait, transitional tasks, balance, falls, or intervention outcomes; mixed-myopathy cohorts required extractable IBM-specific data. Two reviewers independently screened, extracted, and appraised risk of bias, following PRISMA 2020. Results: Sixty-four studies were included; per-domain totals (A1: 16, A2: 9, A3: 6, A4: 2, and A5: 38) exceed 64 because studies may span domains. Quadriceps strength was the most sensitive progression marker, detected earlier by quantitative testing. Falls were near-universal and insufficiently managed. No drug showed convincing functional benefit in controlled trials, whereas exercise and orthotic/robotic assistance appeared to be safe in small studies. Sensory and peripheral-nerve dysfunction were common, but proprioceptive acuity and postural balance were unmeasured. Conclusions: IBM progression is best measured by quantitative quadriceps strength and function. Intervention evidence derives largely from small, uncontrolled and neutral trials. Primary myopathy is likely the principal driver of decline, but its downstream consequences—for balance, proprioception, and falls—remain underexplored and are the priority for future study. Full article

Background: Sarcopenia, the age-related loss of muscle mass and strength, affects over 20% of older adults in Taiwan and contributes to frailty and functional decline. Nutritional supplementation offers a promising strategy for those unable to engage in structured exercise, yet multi-ingredient MCT–leucine–creatine-based interventions remain understudied in clinically defined sarcopenic populations. Methods: We conducted an 8-week randomized, double-blind, placebo-controlled trial at National Taiwan University Hospital (ClinicalTrials.gov NCT06376266). Seventy-three older adults (mean age 77.3 ± 7.7 years) meeting AWGS 2019 sarcopenia criteria were randomized to TLN-01 (a multi-ingredient supplement containing whey protein, branched-chain amino acids, medium-chain triglycerides, creatine, resveratrol, and vitamin D₃, n = 34) or isocaloric placebo (n = 39). Primary outcomes were changes in appendicular skeletal muscle mass (ASM) assessed by DXA and handgrip strength. Targeted plasma amino acid metabolomics (LC-MS) was performed as an exploratory endpoint. Results: ASM increased significantly in the TLN-01 group (+0.42 kg, +3.2%; p < 0.001) but remained unchanged in controls (p = 0.785), with a significant between-group difference (ANCOVA p < 0.01); this absolute change was below the commonly cited minimal clinically important difference. Handgrip strength did not differ significantly between groups (p = 0.32); within-group analysis showed a significant decline in the placebo group (−7.0%; p < 0.001) that was not observed in the intervention group (p = 0.537). Metabolomic analysis revealed reductions in plasma taurine and 1-methylhistidine and an increase in kynurenine; given the absence of clear separation on PCA/PLS-DA, these findings are considered exploratory and hypothesis-generating rather than confirmatory evidence of altered amino acid utilization or proteolysis. No clinically significant adverse metabolic or renal events occurred. Conclusions: Eight weeks of this multi-ingredient MCT–leucine–creatine-based supplement induced a modest increase in muscle mass and attenuated the decline in handgrip strength observed in the placebo group among sarcopenic older adults without a structured exercise program, supporting further investigation as a safe and practical nutritional adjunct in geriatric care. Full article

Sodium-ion batteries are emerging as credible complements to lithium-ion technology for sustainable, safe, and cost-effective energy storage. This critical review links molecular-scale electrolyte solvation and interphase chemistry to electrode compatibility, full-cell engineering, manufacturing constraints, and commercial viability. Organic liquid, aqueous, ionic-liquid, concentrated, inorganic solid, polymer, and composite electrolytes are compared using transport, stability, processing, and interface criteria. The principal cathode and anode families are then evaluated in terms of practical voltage, reversible capacity, cycling stability, raw-material exposure, manufacturability, and end-of-life implications. A distinctive contribution of this work is the explicit separation of thermodynamic predictions, laboratory measurements, prototype demonstrations, and company-reported targets, together with design rules that connect electrolyte chemistry to cell-level performance. Sodium-ion batteries are unlikely to replace lithium-ion batteries universally, but they can occupy a strategic role where cost, safety, abundance, supply-chain resilience, and circularity outweigh maximum energy density. Full article

Background/Objectives: The use of antidepressants and anxiolytics has increased worldwide, raising concerns about treatment patterns, medication safety, and rational use. This study aimed to characterize the frequency, utilization patterns, and safety-related aspects of antidepressant and anxiolytic use among healthcare students and university staff at a Brazilian public university. Methods: A cross-sectional study was conducted between September 2024 and June 2025 using an online questionnaire administered to students and staff at the University of São Paulo, Brazil. Descriptive statistics and multivariable logistic regression were applied to characterize medication utilization patterns and evaluate factors associated with antidepressant and/or anxiolytic use. Results: Among the 300 participants, 167 (55.7%) reported antidepressant and/or anxiolytic use during the previous six months. Most users reported treatment for more than one year (59.9%), anxiety as the primary indication (68.3%), and prescription by a healthcare professional (93.4%). A total of 203 medications were reported, with selective serotonin reuptake inhibitors being the most common pharmacological class (42.4%). Among users, 99 (59.3%) reported at least one self-reported adverse effect, most commonly excessive drowsiness, reduced libido/sexual dysfunction, dry mouth, headache, and nausea. No statistically significant independent associations were identified between antidepressant and/or anxiolytic use and the evaluated sociodemographic characteristics. Conclusions: Antidepressant and anxiolytic use was frequently reported and was characterized by predominantly long-term, professionally prescribed treatment and frequent self-reported adverse effects. These findings may inform institutional strategies to improve access to mental healthcare while promoting the rational and safe use of psychotropic medications within university settings. Full article

This study devised a blasting experiment to establish a dynamic quantified relationship between blasting and movement, failure, and ejection of rock masses. The experiment was conducted using the 3D digital image correlation method (3D-DIC), which provided high-speed images capturing the process of shallow-buried tunnel blasting. The study analyzed the mechanical behavior of full-section rock mass under blasting action through cross-scale image processing. Yield and elastic points were distinguished based on the time–displacement curve. Then, the spatial vector method was employed to deduce flying rock trajectory and throwing distance, enabling the subdivision of underground space based on risk assessment. The results show that the rock in the cut zone starts moving within 3 ms after initiation, ultimately exhibiting a maximum visible off-plane displacement of 215 mm. Displacements are related to delay time and distance. Different zones show distinct dominant directions of rock mass displacement. The rock mass becomes flying rocks separated from the cross-section. The initial velocity of the flying rocks ranges from 11.8 m·s⁻¹ to 29.9 m·s⁻¹. Around 85% of the flying rocks fall within the range of 0 to 40.8 m. Only 5% of the flying rocks fall outside 64.3 m. Appropriate protective measures should be taken for equipment during experiments. Full article

Background and Objectives: Following the removal of the uterus, due to prolapse or other indications, disruption of the apical support structures may result in descent of the vaginal apex. As the condition progresses, the cystocele, rectocele, and/or enterocele are formed, finally creating a complex vaginal eversion that generally requires surgical multi-compartmental repair. This review aimed to provide a comprehensive overview of cur-rent surgical modalities for post-hysterectomy vaginal vault prolapse, which could sup-port personalized treatment. Materials and Methods: MEDLINE, Scopus and Google Scholar databases were searched to retrieve freely available manuscripts published in English language since the year 2000. Results: Surgical correction remains the basis of management for symptomatic post-hysterectomy vaginal vault prolapse. The primary objective of treatment is restoration of robust apical support, normalization of vaginal axis, preservation of sexual and urinary function along with minimization of operative complications and recurrence. Several reconstructive approaches have been established as safe and comparatively reliable. They are classified into native tissue vaginal repairs (sacrospinous ligament fixation, uterosacral ligament suspension), abdominal or minimally invasive sacro-colpopexy, mesh-augmented techniques, and obliterative procedures. No single surgical approach appears universally superior across anatomical, functional, and safety outcomes, and procedure selection should therefore be individualized according to patient characteristics, treatment priorities, and surgeon expertise. Consequently, procedure selection should be individualized according to patient characteristics and surgeon expertise. Conclusions: Post-hysterectomy vaginal vault prolapse remains a complex and clinically significant condition. Current evidence supports the central importance of apical suspension during all hysterectomies. Optimal treatment outcomes are achieved through patient-centered decision-making that balances durability, safety, functional recovery, and individual expectations. Full article