Search Results (454)

To investigate the evolution of impermeability and pore structure in concrete under long-term service, systematic tests were conducted on submerged concrete from dam sections with over 75 years of service. Results show that the surface water permeation resistance index of concrete in the downstream section of the main dam is only 9.19 × 10⁻⁹, significantly lower than that of concrete from the upstream of the main dam (UMD), downstream of the main dam (DMD), upstream of the auxiliary dam (UAD), and upstream of the weir (UW). Moreover, its impermeability improves noticeably within the 0–100 mm depth range. Mercury intrusion porosimetry revealed that the median pore diameter, average pore diameter, pore content, and porosity in this region reach 306.7 nm, 55.4 nm, 35.64%, and 3.961 mm, respectively—all markedly higher than in other dam sections. Combined XRD and SEM/EDS analyses indicate that crystallization pressure from saline solutions in the coastal environment, together with long-term carbonation, leads to structural loosening and increased porosity in the downstream concrete of the main dam, ultimately degrading its impermeability performance. Full article

Background: Solid organ transplantation (SOT) is a life-saving treatment for patients with end-stage diseases and/or organ failure. However, access to healthy organs is often limited by challenges in organ preservation. Furthermore, upon transplantation, ischemia–reperfusion injury (IRI) can lead to increased organ rejection or graft failures. The work presented aims to address both challenges using an innovative nanomedicine platform for simultaneous drug and oxygen delivery. In recent studies, resveratrol (RSV), a natural antioxidant, anti-inflammatory, and reactive oxygen species (ROS) scavenging agent, has been reported to protect against IRI by inhibiting ferroptosis. Here, we report the design, development, and scalable manufacturing of the first-in-class dual-function perfluorocarbon-nanoemulsion (PFC-NE) perfusate for simultaneous oxygen and antioxidant delivery, equipped with a near-infrared fluorescence (NIRF) reporter, longitudinal, non-invasive NIRF imaging of perfusate flow through organs/tissues during machine perfusion. Methods: A Quality-by-Design (QbD)-guided optimization was used to formulate a triphasic PFC-NE with 30% w/v perfluorooctyl bromide (PFOB). Drug-free perfluorocarbon nanoemulsions (DF-NEs) and RSV-loaded nanoemulsions (RSV-NEs) were produced at 250–1000 mL scales using M110S, LM20, and M110P microfluidizers. Colloidal attributes, fluorescence stability, drug loading, and RSV release were evaluated using DLS, NIRF imaging, and HPLC, respectively. PFC-NE oxygen loading and release kinetics were evaluated during perfusion through the BMI OrganBank^® machine with the MEDOS HILITE^® oxygenator and by controlled flow of oxygen. The in vitro antioxidant activity of RSV-NE was measured using the oxygen radical scavenging antioxidant capacity (ORAC) assay. The cytotoxicity and ferroptosis inhibition of RSV-NE were evaluated in RAW 264.7 macrophages. Results: PFC-NE batches maintained a consistent droplet size (90–110 nm) and low polydispersity index (<0.3) across all scales, with high reproducibility and >80% PFOB loading. Both DF-NE and RSV-NE maintained colloidal and fluorescence stability under centrifugation, serum exposure at body temperature, filtration, 3-month storage, and oxygenation. Furthermore, RSV-NE showed high drug loading and sustained release (63.37 ± 2.48% at day 5) compared with the rapid release observed in free RSV solution. In perfusion studies, the oxygenation capacity of PFC-NE consistently exceeded that of University of Wisconsin (UW) solution and demonstrated stable, linear gas responsiveness across flow rates and FiO₂ (fraction of inspired oxygen) inputs. RSV-NE displayed strong antioxidant activity and concentration-dependent inhibition of free radicals. RSV-NE maintained higher cell viability and prevented RAS-selective lethal compound 3 (RSL3)-induced ferroptosis in murine macrophages (macrophage cell line RAW 264.7), compared to the free RSV solution. Morphological and functional protection against RSL3-induced ferroptosis was confirmed microscopically. Conclusions: This study establishes a robust and scalable PFC-NE platform integrating antioxidant and oxygen delivery, along with NIRF-based non-invasive live monitoring of organ perfusion during machine-supported preservation. These combined features position PFC-NE as a promising next-generation acellular perfusate for preventing IRI and improving graft viability during ex vivo machine perfusion. Full article

Bacterial infections and the lack of bioactivity of titanium implants and their alloys remain critical challenges for the long-term performance and clinical success of these devices. These issues arise from the undesirable combination of early microbial adhesion and the limited ability of metallic surfaces to form a bioactive interface capable of supporting osseointegration. To address these limitations simultaneously, this study employed electrical discharge machining (EDM), which enables surface topography modification and in situ incorporation of bioactive ions from the dielectric fluid. Ti-6Al-4V ELI surfaces were modified using two dielectric fluids, a fluorine/phosphorus-based solution (DF1-F) and a calcium/phosphorus-based solution (DF2-Ca), under positive and negative polarities. The recast layer was characterized by SEM and EDS, while bioactivity was evaluated through immersion in simulated body fluid (SBF) for up to 21 days. Antibacterial performance was assessed against Staphylococcus aureus at 6 h and 24 h of incubation. The results demonstrated that dielectric composition and polarity strongly influenced ionic incorporation and the structural stability of the modified layers. The DF2-Ca(+) condition exhibited the most favorable bioactive response, with Ca/P ratios closer to hydroxyapatite and surface morphologies typical of mineralized coatings. In antibacterial assays, Ca/P-containing surfaces significantly decreased S. aureus attachment (>80–90%). Overall, EDM with Ca/P-containing dielectrics enables the fabrication of Ti-6Al-4V surfaces with enhanced mineralization capacity and anti-adhesive effects against Gram-positive bacteria, reinforcing their potential for multifunctional biomedical applications. Full article

Urban Water Systems (UWS) are complex infrastructures that interact with energy, food, ecosystems and socio-political systems, and are under growing pressure from climate change and resource depletion. Planning circular interventions in this context requires system-level analysis to avoid fragmented, siloed decisions. This paper develops the Hydrosocial Resource Urban Nexus (HRUN) framework that integrates hydrosocial thinking with the Water–Energy–Food–Ecosystems (WEFE) nexus to guide UWS design. We conduct a structured literature review and analyse different configurations of circular interventions, mapping their synergies and trade-offs across socioeconomic and environmental functions of hydrosocial systems. The framework is operationalised through a typology of circular interventions based on their circularity purpose (water reuse, resource recovery and reuse, or water-cycle restoration) and management scale (from on-site to centralised), while greening degree (from grey to green infrastructure) and digitalisation (integration of sensors and control systems) are treated as transversal strategies that shape their operational profile. Building on this typology, we construct cause–effect matrices for each intervention type, linking recurring operational patterns to hydrosocial functionalities and revealing associated synergies and trade-offs. Overall, the study advances understanding of how circular interventions with different configurations can strengthen or weaken system resilience and sustainability outcomes. The framework provides a basis for integrated planning and for quantitative and participatory tools that can assess trade-offs and governance effects of different circular design choices, thereby supporting the transition to more resilient and just water systems. Full article

Academic engagement is a multidimensional construct encompassing students’ cognitive, emotional, and behavioral investment in learning. This study examines the levels and predictors of academic engagement among 390 students enrolled in the Master’s in Secondary Education Teacher Training at the National University of Distance Education (UNED, Spain). Using the Utrecht Work Engagement Scale-Student (UWES-S) and a quantitative, cross-sectional, and correlational design, the research explores associations between engagement and sociodemographic and motivational variables. Results indicate moderately high engagement levels, with dedication emerging as the most salient dimension, followed by absorption and vigor. Engagement correlated positively with age and was slightly higher among women, while vocational motivation stood out as the strongest differentiating factor. Prior teaching experience showed no significant influence. The findings highlight the importance of fostering purpose, professional meaning, and identity in initial teacher education—particularly in distance learning contexts—and suggest practical implications for designing supportive pedagogical environments that sustain students’ motivation and academic commitment. Full article

Background and Aims: Hypothermic oxygenated machine perfusion (HOPE) improves outcomes in orthotopic liver transplantation (OLT), but reliance on University of Wisconsin machine perfusion solution (UW-MPS) increases costs and logistical burden. Histidine-tryptophan-ketoglutarate (HTK) has potential as a single-solution alternative for HOPE. This study evaluated the safety and efficacy of HTK versus UW-MPS during HOPE. Methods: A retrospective, propensity score-matched cohort study including 46 patients who received donation after brain death (DBD) grafts that were preserved with HOPE at the Medical University of Vienna between May 2018 and October 2024 was conducted. A total of 23 patients received grafts perfused with HTK; another 23 patients transplanted with organs perfused with UW-MPS were matched based on recipient age and sodium model of end-stage liver disease score, donor age and sex, cold ischemia time, and perfusion time. Postoperative outcomes, perfusion parameters, and cost differences were assessed. Results: The HTK and UW-MPS cohorts demonstrated comparable perfusion dynamics and vascular resistance. While arterial pressure and flow were higher in the UW-MPS group, clinical outcomes—including early allograft dysfunction (47.8% each), ICU stay, and comprehensive complication index—were statistically similar. A trend toward fewer biliary complications (13.0% vs. 30.4%) and reduced hemodialysis requirement (17.4% vs. 30.4%) was observed in the HTK group. Use of HTK reduced perfusion-related costs by approximately EUR 560 per procedure. Conclusion: HTK is a viable alternative to UW-MPS during HOPE in OLT of DBD grafts, offering comparable short-term outcomes and relevant cost savings. Prospective studies are warranted to validate these findings and explore broader applications of single-solution perfusion strategies. Full article

Static cold storage remains the most widely used method for organ preservation in transplantation. Over time, preservation solutions have undergone continuous optimization. Ecosol is a novel extracellular-type, colloid-based preservation solution. In this study, we evaluated the safety and efficacy of Ecosol in comparison to the gold standard University of Wisconsin (UW) solution using both allogeneic and syngeneic rat orthotopic liver transplantation models. Liver function parameters were assessed and compared to baseline values of the respective rat strains. In the syngeneic setting, alanine transaminase (ALT) levels were significantly higher in the UW group than in the Ecosol group on day 1 post-transplantation (p < 0.05). Lactate dehydrogenase (LDH) levels were significantly elevated in the UW group compared to Ecosol in both allogeneic and syngeneic models on day 1 (p < 0.001). Gamma-glutamyl transferase (GGT) and total bilirubin were also significantly higher in the UW syngeneic group on day 1 (p < 0.05). In the allogeneic setting, aspartate aminotransferase (AST) and ALT levels were significantly elevated in both the UW (p < 0.0001) and Ecosol (p < 0.0001 and p < 0.001, respectively) groups on day 1 compared to the baseline values of Brown Norway (BN) rats. On day 7, these elevations persisted in the UW group, whereas no significant differences were observed in the Ecosol group compared to the baseline BN values (UW vs. Ecosol: p < 0.0001). In syngeneic transplants, AST and ALT levels were significantly elevated in both groups on day 1 compared to the baseline values of Lewis rats (p < 0.0001). By day 7, AST levels remained significantly elevated in the UW group, while Ecosol showed no significant difference from baseline (p < 0.0001). Organ viability, assessed via non-invasive imaging after 8 h of cold storage, was improved with Ecosol. Overall, Ecosol demonstrated biological safety and non-inferiority to the UW solution for liver preservation in a rat orthotopic liver transplantation model. Full article

Background/Objectives: Nursing professionals were among the most affected groups during the COVID-19 pandemic, exposed to simultaneous physical demands and emotional strain. This study examined the interplay between work engagement, compassion fatigue, and musculoskeletal symptoms among frontline nurses in a Brazilian public hospital. Methods: A cross-sectional study (n = 77) was conducted between February and April 2022 using validated instruments (Work Stress Scale, ProQoL-BR, Nordic Musculoskeletal Questionnaire, and UWES-9). Descriptive and inferential analyses were performed (p ≤ 0.05). Results: Most participants did not report occupational stress (84.4%). No profiles of compassion fatigue were identified, although notable rates of burnout (26.0%) and secondary traumatic stress (23.4%) were observed. Engagement scores were very high in vigor and dedication. Musculoskeletal symptoms were prevalent, especially in the lumbar region (chronic: 60.0%). Female sex, statutory employment, and lack of physical activity were associated with a higher prevalence of symptoms and sick leave. Work engagement (vigor and overall score) showed negative correlations with absenteeism. Conclusions: The coexistence of high engagement and emotional vulnerability, in the absence of compassion fatigue, suggests that higher levels of engagement may be associated with lower occupational stress. These findings highlight the importance of integrated strategies, including ergonomic interventions, health promotion, and organizational support, to preserve the physical and mental health of frontline nursing professionals. This study provides new evidence of engagement as a potential protective factor that may mitigate physical and emotional burden among nurses in resource-limited settings. Full article

Social media is an essential part of people’s lives worldwide. This study aimed to analyze the predictive capacity of social media addiction on academic engagement among students enrolled in the Faculty of Health Sciences at the National University of Chimborazo during the first academic period of 2023. The Social Media Addiction Questionnaire (ARS) and the Utrecht Work Engagement Scale (UWES-S-17) were applied to 1200 participants during an analytical study. According to the simple linear regression model, 11.2% of the variance in academic engagement levels was explained by social media addiction, with statistical significance (p < 0.05). The multiple linear regression model was significant, although it showed a low capacity to explain and predict the level of academic engagement, considering the dimensions of the level of addiction to social media (obsession, lack of control, and excessive use). The ROC curve parameters showed statistical significance, showing a moderate ability to discriminate insufficient academic commitment. The results serve as a basis for future studies and as a diagnostic basis for establishing policies and strategies in the institution where the research was conducted to increase academic engagement and reduce social media addiction. Full article

Background/Objectives: The present study seeks to address an important empirical gap by examining the associations of workplace gaslighting with symptoms of anxiety and depression, quiet quitting, and work engagement among a sample of Greek employees. Methods: An online cross-sectional study was conducted in Greece in December 2024, with 291 employees, aged 18 years or older, who reported at least one year of work experience. The validated Greek versions of already published tools were used to measure workplace gaslighting (GWS), anxiety and depression (PHQ-4), quiet quitting (QQS) and work Engagement (UWES-3). Associations between gaslighting and mental health and occupational outcomes were tested using multivariable linear regression, adjusting for demographic and occupational covariates. Results: Higher workplace gaslighting scores were significantly predictive of anxiety (b = 0.565, p < 0.001) and depression (b = 0.571, p < 0.001). Gaslighting was also a significant predictor of both quiet quitting (b = 0.368, p < 0.001) and work engagement (b = −0.373, p < 0.001). Conclusions: These results highlight the negative consequences of gaslighting on the mental health and work engagement of employees. Employees should be encouraged to report instances of supervisory gaslighting, while senior leadership and organizational governance structures ought to implement and enforce a zero-tolerance policy toward such behaviors. Full article

In cervical dystonia (CD), balance and gait impairments can compromise daily activities and negatively affect quality of life. However, interventions addressing these deficits remain poorly investigated. A 54-year-old woman with CD, presenting balance and gait difficulties that interfered with work-related motor tasks, underwent a four-month training program. Sessions (40 min, three times per week) combined lower-limb strengthening, proprioceptive and balance exercises, and integrated motor–cognitive tasks. Pre- and post-intervention assessments included gait speed (GS), stride length (SL), and stance time (ST) under usual (UW), fast (FW), and dual-task (DT) walking conditions, measured with an inertial sensor (BTS G-Walk). DT cost was calculated for GS and SL. Balance was evaluated with the Mini-BEST and Four-Square Step Test (FSST), while fear of falling was measured with the Falls Efficacy Scale-International (FES-I). Of note, both assessment sessions were conducted in the absence of botulinum toxin effects, whereas the training was performed, at least in part, under its influence. After training, increase were observed in GS and SL, with reductions in ST across all gait conditions. DT cost decreased for both GS and SL. Balance performance increased, and fear of falling was reduced. Importantly, the patient reported a marked improvement in work-related performance. This case suggests that a specific training program may effectively ameliorate balance and gait in CD, with positive effects on functional mobility. Further studies on larger samples are warranted to confirm efficacy. Full article

Static cold storage (SCS) remains the most widely used method of liver graft preservation due to its simplicity, accessibility, and reduced cost in transplantation practice. Since the invention of the University of Wisconsin (UW) solution, several alternative preservation solutions—including histidine–tryptophan–ketoglutarate (HTK), Celsior, and more recently IGL-1 and IGL-2—have been formulated to optimize cellular and vascular protection during cold ischemia. More recently, the introduction of dynamic perfusion techniques, such as hypothermic oxygenated perfusion (HOPE) and normothermic machine perfusion (NMP), approximately fifteen years ago, has further enhanced transplantation protocols, being applied either alone or in combination with traditional SCS to ensure optimal graft preservation prior to implantation. Despite these technological advances, achieving fully effective dynamic perfusion remains a key challenge for improving outcomes in vulnerable grafts, particularly steatotic or marginal livers. This review details how Polyethylene Glycol 35 (PEG35)-based solutions activate multiple cytoprotective pathways during SCS, including AMP-activated protein kinase (AMPK), nitric oxide (NO) production, and the antioxidant transcription factor Nrf2. We propose that these molecular mechanisms serve as a form of preconditioning that is synergistically leveraged by HOPE to preserve mitochondrial function, endothelial glycocalyx integrity, and microvascular homeostasis. Furthermore, the oncotic and rheological properties of PEG35 reduce perfusate viscosity, mitigating shear stress and microcirculatory damage during dynamic perfusion—effects that are further enhanced by NO- and AMPK-mediated protection initiated during the SCS phase. This integrated approach provides a strong rationale for combining PEG35-mediated SCS with HOPE, particularly for grafts with high susceptibility to ischemia–reperfusion injury, such as fatty livers. Finally, we highlight emerging avenues in graft preservation, including the design of unified perfusion solutions that optimize endothelial, mitochondrial, and redox protection, with the potential to improve post-transplant outcomes and extend applicability to other solid organ grafts. Full article

Background: Recently, patients have been using large language models (LLMs) such as ChatGPT, Gemini, and Claude to address their concerns. However, it remains unclear whether the readability, understandability, actionability, and empathy meet the standard guidelines. In this study, we aim to address these concerns and compare the outcomes of the LLMS to those of professional resources. Methods: We conducted a comparative cross-sectional study by following the relevant items of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies and using 14 patient-style questions. These questions were collected from the professional platforms to represent each domain. We derived the 14 domains from validated quality-of-life instruments (EORTC QLQ-H&N35, UW-QOL, and FACT-H&N). Fourteen Responses were obtained from three LLMs (ChatGPT-4o, Gemini 2.5 Pro, and Claude Sonnet 4) and two professional sources (Macmillan Cancer Support and CURE Today). All responses were evaluated using the Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, and the Empathic Communication Coding System (ECCS). Readability was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level metrics. Statistical analysis included one-way ANOVA and Tukey’s HSD test for group comparisons. Results: No differences were found in quality (DISCERN), understandability, actionability (PEMAT), and empathy (ECCS) between LLMS and professional resources. However, professional resources outperform the LLMs in readability. Conclusions: In our study, we found that LLMs (ChatGPT, Gemini, Claude) can produce patient information that is comparable to professional resources in terms of quality, understandability, actionability, and empathy. However, readability remains a key limitation, as LLM-generated responses often require simplification to align with recommended health-literacy standards. Full article

Background/Objective: Diabetes mellitus type 2 (T2DM) is a significant global public health concern. This analytical cross-sectional study aimed to evaluate the impact of T2DM on the severity of dental caries and salivary properties. Methods: A total of 182 participants (n = 91 per group) were recruited into the T2DM and non-diabetes (ND) groups. Unstimulated whole saliva (UWS) and blood samples for HbA1c were collected. Clinical assessments included plaque index, SoproLIFE, ICDAS, and severity index for root caries. Results: A total of 92 male and 89 female participants were recruited in this study. The results showed that the mean of UWS pH was slightly lower in the T2DM (6.65 ± 1.12) than the ND group (6.88 ± 0.49), however the difference was statistically insignificant (p = 0.065). The mean saliva buffer capacity was almost identical between the two groups, with values of 7.38 ± 3.2 in T2DM and 7.37 ± 2.83 in the ND groups (p = 0.973), indicating an insignificant difference. The mean saliva spinnbarkeit was slightly high and insignificant in the T2DM (4.57 ± 4.34) compared to the ND group (3.69 ± 3.6) (p = 0.141). The T2DM group had a significantly high proportion of participants with very low saliva flow rate (<0.1 mL/min) in comparison to ND (20.9% vs. 5.5%) (p = 0.004). ICDAS scores were significantly higher in T2DM (0.67 ± 0.32) when compared to the ND group (0.57 ± 0.24) (p = 0.014). ICDAS scores 3 and 6 were significantly higher in T2DM (2.76 ± 2.66; 0.86 ± 2.61) in comparison to ND (2.10 ± 2.00, 0.26 ± 0.96). Conclusions: Within the limitations of this analytical cross-sectional study, participants with T2DM demonstrated a higher risk of developing severe carious lesions and exhibited low salivary pH and flow rate when compared with non-diabetic individuals, supporting a possible association between glycemic status, salivary alterations, and caries severity. Full article

Frailty among older adults heightens their risk of negative health outcomes, and medication use plays a major role in this increased vulnerability. Various aspects of medication use elevate the risk of poor outcomes in individuals with frailty. The current scoping review was designed to explore medication use in older adults with frailty in primary care, focusing on the prevalence of potentially inappropriate medications (PIMs), polypharmacy, medication adherence, and their role in contributing to adverse drug events. This scoping review was conducted using the Arksey and O’Malley, supplemented by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR) guidelines. A search of the literature was conducted from inception to November 2023 in Ovid EMBASE, PubMed (MEDLINE), Scopus, EBSCOhost CINAHL, and Ovid International Pharmaceutical Abstracts. Studies which met the eligibility criteria included older adults with frailty (≥65 years) living at home, defined frailty criteria, and assessment of medication use. Out of the 4726 studies screened, 223 were included, conducted across 39 countries. Frailty prevalence varied widely from 0.9% to 89.2%. Polypharmacy (5–9 medications) and hyper-polypharmacy (≥10 medications) were notably more common among individuals with frailty, with polypharmacy rates ranging from 1.3% to 96.4%. Twelve studies reported PIM prevalence among individuals with varying levels of frailty, ranging from 2.4% to 95.9%. This scoping review highlights the challenges and complexities involved in understanding the relationship between medication use and frailty in older adults. Full article