Search Results (3,367)

(1) Background: Frailty is a major geriatric syndrome associated with adverse health outcomes, while direct assessment of cardiorespiratory fitness (CRF) is often impractical in routine clinical settings. This study investigated the association between estimated cardiorespiratory fitness (eCRF) and incident frailty in middle-aged and older adults from three nationally representative aging cohorts. (2) Methods: We analyzed longitudinal data from the Health and Retirement Study (HRS; 2006–2020) in the United States, the English Longitudinal Study of Ageing (ELSA; 2004–2018) in England, and the China Health and Retirement Longitudinal Study (CHARLS; 2011–2018) in China. Participants aged 50 years or older were included. eCRF was calculated using validated sex-specific non-exercise algorithms. Frailty was assessed using a 30-item Frailty Index (FI), and incident frailty was defined as FI ≥ 0.25. Cox proportional hazards models were used to evaluate the association between baseline eCRF and incident frailty. (3) Results: A total of 8152 participants (3982 women and 4170 men) were included in the longitudinal analysis. Each 1-SD increase in eCRF was associated with a lower risk of incident frailty in HRS (HR = 0.60, 95% CI: 0.54–0.68), ELSA (HR = 0.54, 95% CI: 0.46–0.64), and CHARLS (HR = 0.74, 95% CI: 0.63–0.87). Compared with the low-eCRF group, the moderate- and high-eCRF groups had progressively lower risks of incident frailty across all three cohorts, indicating a graded inverse dose–response relationship. Findings were generally consistent across subgroup and sensitivity analyses. (4) Conclusions: Higher eCRF was associated with a lower risk of incident frailty among middle-aged and older adults across three nationally representative cohorts. As an accessible, non-invasive metric, eCRF may be useful for identifying individuals at elevated risk of incident frailty. Full article

Cross-linking is a therapy that strengthens the cornea and helps slow the progression of keratoconus. This therapeutic surgery has evolved from a single standardized protocol to a diverse array of techniques tailored to improve safety, efficacy, patient comfort, and accessibility. It represents a transformative advancement in keratoconus treatment. Its ability to biomechanically reinforce the cornea and halt disease progression has revolutionized patient care, reducing the burden of advanced keratoconus and improving long-term visual outcomes. Ongoing refinements in technique continue to enhance its efficacy, safety, and patient comfort, securing its role as a cornerstone of modern ophthalmic practice. This process involves creating new covalent bonds between corneal fibers using a photosensitising substance called riboflavin. The effectiveness of cross-linking can be assessed by introducing the severity index, which provides a quantitative measure of the therapeutic outcome. This index allows for a more objective evaluation for both prognostic and therapeutic purposes. Full article

Background/Objective: Patients with peripheral artery disease (PAD) are known to have poor awareness and understanding of the diagnosis. The role of generative AI chatbots in improving PAD patient education is unknown. Our goal is to compare a generative AI chatbot customized for PAD patient education to publicly available AI chatbots. Methods: This is a cross-sectional comparative evaluation of the responses of four AI chatbots to ten prompts that are commonly asked questions about PAD. The three publicly available AI chatbots were ChatGPT-5, Gemini 2.5 Flash, and Claude Sonnet 4.5. We created a customized, voice AI chatbot for PAD education grounded on curated and prompt-injected guidance called Vascular Education and Resources using Artificial Intelligence, or “VERA.” De-identified chatbot-generated responses to inputs were assessed for readability (Flesch–Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Simple Measure of Gobbledygook Index, and Average Reading Level Consensus Score), accuracy, comprehensiveness, and patient education quality (Patient Education Materials Assessment Tool; PEMAT) using validated instruments and expert scoring rubrics. Nonparametric statistical testing was used to compare chatbot performance across all evaluation domains. Results: VERA generated the most accessible text compared to the other chatbots and produced responses at a median grade level of 6.6, which was lower than responses from the other chatbots. PAD expert-rated accuracy scores were high across all the chatbots without significant differences between them. Comprehensiveness scores were more varied and demonstrated that VERA was less comprehensive than the other chatbots. PEMAT understandability scores were uniformly high. PEMAT actionability scores were low overall but did not differ significantly across chatbots on post hoc analysis. Conclusions: A generative AI chatbot research tool customized for PAD patient education generates textual information about PAD that is more accessible (mean grade level 6.6) than publicly available AI chatbots without loss of accuracy, albeit with modestly reduced comprehensiveness that reflects intentional simplification for patient-centered communication. Future research will assess the acceptability and feasibility of this research tool to be adopted as part of PAD patient education. Full article

This paper presents a web-based platform designed to support dialogical learning through a Retrieval-Augmented Generation (RAG) architecture. The system integrates retrieval grounding, context-aware dialogue management, and a modular, model-agnostic design to enable controlled and pedagogically aligned learning supported by Artificial Intelligence (AI) and based on instructor-verified educational materials. The proposed approach supports multilingual interaction, including operation in lower-resource languages such as Bulgarian, and models learning as a continuous dialogue rather than a sequence of isolated queries. To ensure reliable knowledge access, the system employs a hybrid retrieval strategy combining semantic embeddings with lexical matching within a two-stage indexing and retrieval framework. The approach is supported by an empirical evaluation based on a manually constructed question set with human-validated relevance assessment. The results demonstrate that the selected configuration achieves 90% retrieval accuracy at TOP-5 and up to 91.4% at TOP-6, providing a reliable contextual basis for response generation. A complementary manual evaluation of generated responses further indicated strong practical usefulness and generally grounded answer quality. The platform is further designed in alignment with European regulatory principles, emphasizing transparency, traceability, and controlled use of AI in educational environments. Overall, the study demonstrates that integrating retrieval precision with pedagogical structure enables the development of AI systems that support structured and contextually grounded learning processes. Full article

Background: Varicella burden is closely linked to national socioeconomic development, yet systematic analyses of its non-linear relationship with the Socio-demographic Index (SDI) are lacking. This study aims to elucidate this relationship and inform equitable, context-specific strategies. Methods: Based on data from the Global Burden of Diseases 2021 study, we analyzed global trends (1990–2021) in the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of varicella. Joinpoint regression was used to identify trend transition points, and an autoregressive integrated moving average (ARIMA) model was applied to forecast the disease burden through 2035. Analyses were conducted, and countries and territories were stratified into five SDI groups: high (SDI > 0.81), high–middle (0.70–0.81), middle (0.61–0.69), low–middle (0.46–0.60), and low (SDI < 0.46). These approaches aimed to systematically elucidate the socioeconomic gradient of the varicella burden and to specifically investigate its potential non-linear relationship with SDI. Results: From 1990 to 2021, global age-standardized mortality and DALYs declined by −45.71% (95% UI: −48.32% to −42.95%) and −36.15% (95% UI: −39.04% to −33.01%), respectively, while incidence and prevalence rates slightly increased. A significant U-shaped relationship emerged between burden and SDI, with rates highest in low- and high-SDI regions. The rise in high-SDI regions was driven by increasing incidence and prevalence from 1996 to 2015. Projections to 2035 indicate continued global decline but persistent disparities. Conclusions: The varicella burden follows a U-shaped socioeconomic gradient. Rising incidence in high-SDI regions highlights that economic development and routine pediatric vaccination alone are insufficient. Precision strategies tailored to SDI levels—closing adult immunity gaps in high-SDI, sustaining gains in middle-SDI, and expanding vaccine access in low-SDI regions—are essential. Full article

The heritagisation of cultural landscapes is often understood as a state-led administrative process. At the same time, the discursive origins and adaptive mechanisms that precede formal designation remain underexplored, especially in relation to cultural sustainability. This study examines the pre-heritagisation of Suzhou’s classical gardens during China’s modern transformation by analysing periodical discourse published between 1870 and 1948. Using a mixed-methods approach that combines quantitative content analysis and Critical Discourse Analysis (CDA), it investigates 699 historical texts from the Index to Chinese Newspapers & Periodicals database. The findings reveal a dual discursive process. On the one hand, reports portrayed the gardens as accessible, multifunctional civic spaces through narratives of public use. On the other hand, literati discourse reinforced their classical value through historical memory and aesthetic preservation. Together, these tendencies show how the gardens were materially refunctioned and symbolically re-anchored under modern conditions. Rather than directly producing later heritage designation, this process helped create the socio-cultural conditions through which the gardens acquired broader public intelligibility, cultural legitimacy, and heritage-like meanings before formal institutional recognition. Full article

Lolium rigidum is among the most prevalent and noxious weeds in cereal and perennial cropping systems worldwide and has developed resistance to several herbicide modes of action. This study employed a sensor-based smart farming method for the early screening of herbicide resistance across three L. rigidum accessions in Greece, followed by dose–response experiments with clodinafop-propargyl, glyphosate, and mesosulfuron-methyl + iodosulfuron-methyl. In the preliminary screening, herbicides were applied at their highest recommended rates, whereas the dose–response experiments included five application rates (0, 1/4X, X, 2X, and 4X). The EM2 accession exhibited confirmed resistance to mesosulfuron-methyl + iodosulfuron-methyl, with a resistance index of 5.31 and a five-fold increase in the herbicide rate required compared to the susceptible EM1 accession. For clodinafop-propargyl, the GR50 value of the resistant EM3 accession (147.97 g a.i. ha⁻¹) was approximately 2.5-fold higher than that of the susceptible EM2 accession (60.28 g a.i. ha⁻¹). Glyphosate application provided only partial biomass reduction in resistant accessions, indicating reduced susceptibility. In parallel, TaqMan assays were developed and validated to detect target-site mutations linked to resistance against EPSPS-, ACCase-, and ALS-inhibiting herbicides, supporting the molecular interpretation of the observed resistance patterns. Overall, the results demonstrate that sensor-based smart farming approaches can provide a rapid and reliable tool for the early screening of herbicide resistance, enabling more informed crop protection strategies and supporting sustainable weed management. Further research across diverse soil types and climatic conditions is warranted to validate and extend the applicability of these approaches. Full article

Amid Europe’s demographic decline and the intensifying global “war for talent,” migration is increasingly viewed as a critical source of human capital capable of sustaining economic growth and welfare systems. Nevertheless, the literature on Macro-Talent Management (MTM) has primarily focused on the attraction of highly skilled expatriates, paying limited attention to how national integration systems shape the broader capacity of countries to attract and retain migrant talent. Addressing this gap, the present study conceptualizes migrant integration as a strategic component of macro-level talent management and evaluates the “talent attractiveness” of different European welfare and migration regimes. Methodologically, the study develops a multi-criteria evaluation framework based on the PROMETHEE II (Preference Ranking Organization Method for Enrichment of Evaluations) outranking method, enabling the simultaneous assessment of institutional, socio-economic, and administrative dimensions of migration governance. The model integrates nine indicators combining policy inclusiveness (e.g., Migrant Integration Policy Index—MIPEX (Migrant Integration Policy Index), citizenship accessibility), labor market outcomes (employment and gender gaps), and systemic pressures on migration management (asylum applications). By integrating policy indicators with real-world labor market performance and administrative capacity, the proposed framework offers a novel analytical tool for comparative migration policy evaluation and decision support. The empirical application covers six European countries representing distinct migration regimes: Portugal, Sweden, France, Poland, Greece, and Germany. The results challenge the conventional assumption that economic strength alone determines migrant attractiveness. Portugal emerges as the most attractive destination, demonstrating that inclusive rights-based integration policies can offset lower GDP levels. In contrast, Germany ranks last in the sample, revealing signs of systemic overextension due to extreme administrative pressure, while Greece occupies the fifth position characterized by structural integration deficits. The study contributes to the literature by linking migration governance, integration policy effectiveness, and macro-level talent management and by introducing a multi-criteria decision-analytic approach for evaluating national migration systems in Europe. The study offers a reassessment of the ‘talent attractiveness’ of European welfare models in a post-pandemic context (2023). Full article

COVID-19 was a prolonged public-health shock that disrupted mobility, access to services, and household spending. Although the official U.S. poverty rate declined to 11.1%, the Supplemental Poverty Measure rose to 12.9%, suggesting that material hardship persisted unevenly across places. This study asks whether pre-existing livelihood vulnerability and local epidemic burden translated into geographically concentrated consumption losses during 2020–2022. Because sustained consumption loss can erode households’ health-related spending, tracking where spending declines concentrate helps connect local social and environmental conditions to how communities withstand a health crisis. We analyze consumer expenditure, unlike prior research relying on aggregate retail sales, to capture fine-grained economic strains as a proxy for shock-absorption capacity. A Livelihood Vulnerability Index (LVI) was calculated for each U.S. county using 16 socio-economic variables, and counties were classified as high- or low-risk. A multilevel model then examined how socio-economic and COVID-19 factors at county and census tract levels shaped consumption changes. Higher-risk communities experienced greater consumption reductions. At the census tract level, the non-White ratio, vacancy rate, built year, per capita income, education level, and housing value were significant. At the county level, COVID-19 cases and deaths, crowding, public transportation use, and vehicle availability mattered most. These findings support place-targeted strategies that combine public-health response with socio-environmental interventions to reduce disparities rooted in pre-existing vulnerability. Full article

Background/Objectives: The optimal management of anterior cruciate ligament (ACL) rupture remains debated, especially regarding long-term outcomes after early ACL reconstruction (ACLR) versus rehabilitation-first with optional delayed ACLR. The interpretation of randomized evidence is complicated by frequent treatment crossover. This review synthesized evidence from randomized controlled trial (RCT) cohorts comparing surgical versus rehabilitation-first management strategies across available follow-up durations. Methods: A structured review based on a systematic literature search and narrative synthesis was conducted, with study identification and reporting guided by PRISMA 2020. MEDLINE (via PubMed) and Google Scholar were searched in February 2026 for English-language human RCTs (2000–2026) comparing early ACLR plus rehabilitation with rehabilitation-first management allowing delayed ACLR for persistent instability. A linked-report PubMed search using the KANON trial registration number (ISRCTN84752559) was additionally performed to identify cohort-derived follow-up publications. Reports were grouped by underlying RCT cohort. Data were extracted on crossover, follow-up, and clinical outcomes. Risk of bias for primary RCT reports was assessed with Cochrane RoB 2. Results: Twenty-seven reports representing three RCT cohorts (KANON, COMPARE, ACL SNNAP) were included; six index reports were prioritized for synthesis. In acute ACL rupture (KANON, COMPARE), early ACLR did not show a consistent long-term superiority in patient-reported outcomes versus rehabilitation-first with optional delayed ACLR, although COMPARE reported a statistically significant 2-year subjective functional difference favoring early ACLR; early ACLR more consistently improved mechanical stability and reduced instability episodes. Crossover from rehabilitation to delayed ACLR was common. In non-acute ACL injury with persistent symptomatic instability (ACL SNNAP), surgery-first improved 18-month patient-reported outcomes. Meniscal procedure rates and osteoarthritis-related outcomes did not consistently favor early ACLR. Conclusions: In acute ACL rupture, rehabilitation-first with timely access to delayed ACLR appears to provide long-term patient-reported outcomes comparable to an early ACLR strategy in many patients, while early ACLR more consistently improves knee stability. In non-acute symptomatic ACL deficiency, a surgery-first strategy appears more effective in the mid-term. These randomized trials should be interpreted as comparisons of management strategies rather than of “pure” operative versus nonoperative treatment approaches. Full article

Population aging requires residential environments that go beyond basic accessibility. This study theorizes and validates the Accessibility Gap (the divergence between regulatory compliance and the functional lived experience of older adults) using a Multi-Criteria Decision Analysis (MCDA) tool. The research uses a weighted linear aggregation model based on user-centered design and the International Classification of Functioning, Disability, and Health (ICF). Thirty dwellings—apartments, single-story, and two-story houses—were evaluated in Chile’s Metropolitan Region. The model applies 40 indicators, normalized on a 0–100% scale across six dimensions, and weighted by older adults and caregivers. Results reveal fragmented accessibility gap: basic features often meet standards; yet important deficits remain in highly prioritized areas—autonomy, safety, and communication. The Global Performance Index (GPI) identifies “accessibility gaps” that traditional assessments miss. By combining objective metrics with subjective experiences, this study delivers a replicable, evidence-based framework. It shows that specific design choices, rather than architectural configuration, better support functional independence. The MCDA approach provides a robust tool for guiding housing rehabilitation and public policies that support aging in place and ensure homes meet the needs of an aging population. Full article

Multi-link terrestrial backhauls create a shared transport environment in which heterogeneous multipath protocols compete for the same forwarding resources while reacting to congestion with different control logics. In this paper, we investigate this problem in a 5G Integrated Access and Backhaul (IAB) scenario where an IAB node aggregates traffic from multiple User Equipments (UEs) and forwards it toward the core network over two terrestrial backhaul paths. We focus on the coexistence of Multipath TCP (MPTCP) and Multipath QUIC (MPQUIC), evaluating how cross-protocol Congestion Control (CC) pairings affect performance. Specifically, all feasible BBR, CUBIC, and Reno cross-pairings are assessed under symmetric and asymmetric dual-backhaul conditions, considering Enhanced Mobile Broadband (eMBB) and dense low-rate traffic regimes representative of mMTC-like operation. The analysis considers throughput, Jain’s fairness index, jitter , and packet loss to identify the trade-offs of each CC pairing. Results show that CC selection is a first-order design factor in MPTCP/MPQUIC coexistence over shared backhauls. No single pairing is uniformly optimal across all metrics: some configurations provide more balanced throughput sharing, others improve fairness, while the most favorable solutions for jitter do not necessarily maximize transport efficiency. These findings identify CC pairing as a tuning dimension for multi-link backhaul systems based on heterogeneous multipath transports. Full article

Post-cooking storage may modify the glycemic response of starchy foods; however, this effect is usually assessed only through the glycemic index (GI), without capturing the temporal dimension of the metabolic response. In this study, the effect of post-cooking storage on boiled rice was investigated using an integrated approach based on GI, resistant starch (RS) content, and the post-technological stability coefficient (PTSC). Storage significantly reduced GI, from 83.03 ± 15.02 (SD) in the freshly prepared sample to 43.55 ± 6.99 (SD) after prolonged freezing, while concurrently increasing RS from approximately 1.8% to nearly 4.0%. A strong inverse linear relationship was identified between RS and GI (r = −0.935, p < 0.001; R² = 0.8735). These changes are consistent with storage-induced starch retrogradation and reduced enzymatic accessibility of the starch matrix. PTSC analysis further suggested that GI reduction was not automatically equivalent to lower temporal variability in the glycemic response: refrigeration was associated with more negative and more dispersed PTSC values, whereas prolonged freezing was associated with lower GI, higher RS, and smaller temporal variations in the incremental area under the curve (iAUC). Overall, the results suggest that the isolated analysis of GI may not fully describe the effect of post-cooking storage on boiled rice. The combined interpretation of GI, RS, and PTSC may provide a more informative framework for evaluating the metabolic effect of storage and may help differentiate between regimes predominantly associated with a reduction in the amplitude of the glycemic response and those additionally characterized by lower temporal variability of that response. Full article

Background: Osteocalcin is a bone-derived protein traditionally regarded as a marker of bone formation, but experimental and clinical studies have suggested potential endocrine effects on energy and glucose metabolism. In pediatric populations, particularly in the context of obesity, the relationships between circulating osteocalcin, adiposity, and metabolic health remain inconsistent and poorly defined. Objective: To investigate associations between serum total osteocalcin and anthropometric, metabolic, biochemical, and body composition parameters in children and adolescents with obesity, with particular emphasis on adiposity and mineral metabolism. Methods: This retrospective cross-sectional study included 155 children and adolescents aged 4–18 years with obesity. Anthropometric measurements, laboratory parameters, and body composition assessed by dual-energy X-ray absorptiometry were extracted from medical records. Associations between osteocalcin z-scores and clinical variables were evaluated using linear regression models. Multivariable and extended regression models were applied to assess independent associations. Results: Osteocalcin was positively associated with markers of mineral metabolism, including serum 25-hydroxyvitamin D₃ (β = 0.19, p = 0.012), serum calcium (β = 0.19, p = 0.015), and free triiodothyronine (β = 0.32, p < 0.001) in multivariable analyses. No independent associations were observed between osteocalcin and measures of adiposity, including body mass index, visceral adipose tissue index, leptin, or markers of glucose and lipid metabolism. Conclusions: In children and adolescents with obesity, circulating osteocalcin is primarily associated with mineral metabolism rather than adiposity or metabolic health. These findings support the interpretation of total osteocalcin as a clinically accessible marker of bone turnover and mineral homeostasis rather than a robust surrogate of metabolic dysfunction in pediatric obesity. Full article

Qinghai Province shoulders the heavy responsibility of serving as China’s ecological security barrier. In the process of implementing the “ecological priority” strategy, the green development of grassland animal husbandry in Qinghai Province plays an especially important driving role. To systematically reveal the temporal and spatial evolution characteristics and core driving mechanism of Green Total Factor Productivity (GTFP) and provide a decision-making basis for the green transformation and high-quality development of regional animal husbandry, this paper, based on relevant data from 2010 to 2024 in Qinghai Province, constructs a measurement and influencing factor index system for the GTFP of grassland animal husbandry. Then, it conducts a systematic analysis of the temporal evolution and spatial differentiation characteristics of the GTFP of grassland animal husbandry in Qinghai Province using methods such as trend surface analysis and standard deviation ellipse. Subsequently, the influencing factors are discussed through the geographic detector model. The research findings are as follows: (1) During the study period, the GTFP of grassland animal husbandry in Qinghai Province shows an overall upward trend. Spatially, it presents a regional pattern of “strong in the north and stable in the south,” with the migration center moving towards the northeast and the distribution becoming more concentrated. (2) The level of fiscal support for agriculture, accessibility of transportation, the degree of environmental governance and the degree of digitalization play core driving roles in the process of GTFP climbing in grassland animal husbandry. (3) Interaction analysis shows that the explanatory power of any two influencing factors in the study area is higher than that of a single factor, and the interaction between the level of fiscal support for agriculture and the degree of environmental governance is the most significant. Therefore, the key to improving the GTFP of grassland animal husbandry in Qinghai Province lies in the coordinated allocation and linkage of financial support for agriculture and environmental governance. At the same time, this study can provide reference value for the green transformation and high-quality development of plateau grassland animal husbandry. Full article