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Search Results (7,735)

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Keywords = accessibility measures

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26 pages, 1514 KiB  
Article
Measuring the Digital Economy in Kazakhstan: From Global Indices to a Contextual Composite Index (IDED)
by Oxana Denissova, Zhadyra Konurbayeva, Monika Kulisz, Madina Yussubaliyeva and Saltanat Suieubayeva
Economies 2025, 13(8), 225; https://doi.org/10.3390/economies13080225 (registering DOI) - 2 Aug 2025
Abstract
This study examines the development of the digital economy and society in the Republic of Kazakhstan by combining international benchmarking with a context-specific national framework. It highlights the limitations of existing global indices such as DESI, NRI, and EGDI in capturing the structural [...] Read more.
This study examines the development of the digital economy and society in the Republic of Kazakhstan by combining international benchmarking with a context-specific national framework. It highlights the limitations of existing global indices such as DESI, NRI, and EGDI in capturing the structural and institutional dimensions of digital transformation in emerging economies. To address this gap, the study introduces a novel composite metric, the Index of Digital Economy Development (IDED), which integrates five sub-indices: infrastructure, usage, human capital, economic digitization, and transformation effectiveness. The methodology involves comparative index analysis, the construction of the IDED, and statistical validation through a public opinion survey and regression modeling. Key findings indicate that cybersecurity is a critical yet under-represented component of digital development, showing strong empirical correlations with DESI scores in benchmark countries. The results also highlight Kazakhstan’s strengths in digital public services and internet access, contrasted with weaknesses in business digitization and innovation. The proposed IDED offers a more comprehensive and policy-relevant tool for assessing digital progress in transitional economies. This study contributes to the literature by proposing a replicable index structure and providing empirical evidence for the inclusion of cybersecurity in national digital economy assessments. The aim of the study is to assess Kazakhstan’s digital economy development by addressing limitations in global measurement frameworks. Methodologically, it combines comparative index analysis, the construction of a national composite index (IDED), and statistical validation using a regional survey and regression analysis. The findings reveal both strengths and gaps in Kazakhstan’s digital landscape, particularly in cybersecurity and SME digitalization. The IDED introduces an innovative, context-sensitive framework that enhances the measurement of digital transformation in transitional economies. Full article
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27 pages, 24664 KiB  
Article
Evaluating the Siphon Effect on Airport Cluster Resilience Using Accessibility and a Benchmark System for Sustainable Development
by Xinglong Wang, Weiqi Lin, Hao Yin and Fang Sun
Sustainability 2025, 17(15), 7013; https://doi.org/10.3390/su17157013 (registering DOI) - 1 Aug 2025
Abstract
The siphon effect between airports has amplified the polarization in passenger throughput, undermining the balanced development and sustainability of airport clusters. The airport siphon effect occurs when one airport attracts a disproportionate share of passengers, concentrating traffic at the expense of others, which [...] Read more.
The siphon effect between airports has amplified the polarization in passenger throughput, undermining the balanced development and sustainability of airport clusters. The airport siphon effect occurs when one airport attracts a disproportionate share of passengers, concentrating traffic at the expense of others, which affects the overall resilience of the entire airport cluster. To address this issue, this study proposes a siphon index, expands the range of ground transportation options for passengers, and establishes a zero-siphon model to assess the impact of siphoning on the resiliency of airport clusters. Using this framework, four major airport clusters in China were selected as research subjects, with regional aviation accessibility serving as a measure of resilience. The results showed that among the four airport clusters, the siphon effect is most pronounced in the Guangzhou region. To explore the implications of this effect further, three airport disruption scenarios were simulated to assess the resilience of the Pearl River Delta airport cluster. The results indicated that the intensity and timing of disruptive events significantly affect airport cluster resilience, with hub airports being particularly sensitive. This study analyzes the risks associated with excessive route concentration, providing policymakers with critical insights to enhance the sustainability, equity, and resilience of airport clusters. The proposed strategies facilitate coordinated infrastructure development, optimized air–ground intermodal connectivity, and risk mitigation. These measures contribute to building more sustainable and adaptive aviation networks in rapidly urbanizing regions. Full article
20 pages, 5077 KiB  
Article
Ventilation Modeling of a Hen House with Outdoor Access
by Hojae Yi, Eileen Fabian-Wheeler, Michael Lee Hile, Angela Nguyen and John Michael Cimbala
Animals 2025, 15(15), 2263; https://doi.org/10.3390/ani15152263 (registering DOI) - 1 Aug 2025
Abstract
Outdoor access, often referred to as pop holes, is widely used to improve the production and welfare of hens. Such cage-free environments present an opportunity for precision flock management via best environmental control practices. However, outdoor access disrupts the integrity of the indoor [...] Read more.
Outdoor access, often referred to as pop holes, is widely used to improve the production and welfare of hens. Such cage-free environments present an opportunity for precision flock management via best environmental control practices. However, outdoor access disrupts the integrity of the indoor environment, including properly planned ventilation. Moreover, complaints exist that hens do not use the holes to access the outdoor environment due to the strong incoming airflow through the outdoor access, as they behave as uncontrolled air inlets in a negative pressure ventilation system. As the egg industry transitions to cage-free systems, there is an urgent need for validated computational fluid dynamics (CFD) models to optimize ventilation strategies that balance animal welfare, environmental control, and production efficiency. We developed and validated CFD models of a cage-free hen house with outdoor access by specifying real-world conditions, including two exhaust fans, sidewall ventilation inlets, wire-meshed pens, outdoor access, and plenum inlets. The simulations of four ventilation scenarios predict the measured air flow velocity with an error of less than 50% for three of the scenarios, and the simulations predict temperature with an error of less than 6% for all scenarios. Plenum-based systems outperformed sidewall systems by up to 136.3 air changes per hour, while positive pressure ventilation effectively mitigated disruptions to outdoor access. We expect that knowledge of improved ventilation strategy will help the egg industry improve the welfare of hens cost-effectively. Full article
12 pages, 277 KiB  
Article
Exploring the Implementation of Gamification as a Treatment Modality for Adults with Depression in Malaysia
by Muhammad Akmal bin Zakaria, Koh Ong Hui, Hema Subramaniam, Maziah Binti Mat Rosly, Jesjeet Singh Gill, Lim Yee En, Yong Zhi Sheng, Julian Wong Joon Ip, Hemavathi Shanmugam, Chow Soon Ken and Benedict Francis
Medicina 2025, 61(8), 1404; https://doi.org/10.3390/medicina61081404 (registering DOI) - 1 Aug 2025
Abstract
Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement [...] Read more.
Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement and augment traditional treatments. Our research is the first study designed to explore the implementation of gamification within the Malaysian context. The objective was to explore the feasibility of implementation of gamification as an adjunctive treatment for adults with depression. Materials and Methods: Focus group discussions were held with five mental health professionals and ten patients diagnosed with moderate depression. The qualitative component assessed perceptions of gamified interventions, while quantitative measures evaluated participants’ depressive and anxiety symptomatology. Results: Three key themes were identified: (1) understanding of gamification as a treatment option, (2) factors influencing its acceptance, and (3) characteristics of a practical and feasible intervention. Clinicians saw potential in gamification to boost motivation, support psychoeducation, and encourage self-paced learning, but they expressed concerns about possible addiction, stigma, and the complexity of gameplay for some patients. Patients spoke of gaming as a source of comfort, escapism, and social connection. Acceptance was shaped by engaging storylines, intuitive design, balanced difficulty, therapist guidance, and clear safety measures. Both groups agreed that gamification should be used in conjunction with standard treatments, be culturally sensitive, and be presented as a meaningful therapeutic approach rather than merely as entertainment. Conclusions: Gamification emerges as an acceptable and feasible supplementary approach for managing depression in Malaysia. Its success depends on culturally sensitive design, robust clinical oversight, and seamless integration with existing care pathways. Future studies should investigate long-term outcomes and establish guidelines for the safe and effective implementation of this approach. We recommend targeted investment into culturally adapted gamified tools, including training, policy development, and collaboration with key stakeholders to realistically implement gamification as a mental health intervention in Malaysia. Full article
(This article belongs to the Section Psychiatry)
12 pages, 1167 KiB  
Article
Experimental Studies on Partial Energy Harvesting by Novel Solar Cages, Microworlds, to Explore Sustainability
by Mohammad A. Khan, Brian Maricle, Zachary D. Franzel, Gabe Gransden and Matthew Vannette
Solar 2025, 5(3), 36; https://doi.org/10.3390/solar5030036 (registering DOI) - 1 Aug 2025
Abstract
Sources of renewable energy have attracted considerable attention. Their expanded use will have a substantial impact on both the cost of energy production and climate change. Solar energy is one efficient and safe option; however, solar energy harvesting sites, irrespective of the location, [...] Read more.
Sources of renewable energy have attracted considerable attention. Their expanded use will have a substantial impact on both the cost of energy production and climate change. Solar energy is one efficient and safe option; however, solar energy harvesting sites, irrespective of the location, can impact the ecosystem. This experimental study explores the energy available inside and outside of novel miniature energy harvesting cages by measuring light intensity and power generated. Varying light intensity outside the cage has been utilized to study the remaining energy inside the cage of a flexible design, where the heights of the harvesting panels are parameters. Cages are built from custom photovoltaic panels arranged in a staircase manner to provide access to growing plants. The balance between power generation and biological development is investigated. Two different structures are presented to explore the variation of illumination intensity inside the cages. The experimental results show a substantial reduction in energy inside the cages. The experimental results showed up to 24% reduction in illumination inside the cages in winter. The reduction is even larger in summer, up to 57%. The results from the models provide a framework to study the possible impact on a biological system residing inside the cages, paving the way for practical farming with sustainable energy harvesting. Full article
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26 pages, 7374 KiB  
Article
Copper-Enhanced NiMo/TiO2 Catalysts for Bifunctional Green Hydrogen Production and Pharmaceutical Pollutant Removal
by Nicolás Alejandro Sacco, Fernanda Albana Marchesini, Ilaria Gamba and Gonzalo García
Catalysts 2025, 15(8), 737; https://doi.org/10.3390/catal15080737 (registering DOI) - 1 Aug 2025
Abstract
This study presents the development of Cu-doped NiMo/TiO2 photoelectrocatalysts for simultaneous green hydrogen production and pharmaceutical pollutant removal under simulated solar irradiation. The catalysts were synthesized via wet impregnation (15 wt.% total metal loading with 0.6 wt.% Cu) and thermally treated at [...] Read more.
This study presents the development of Cu-doped NiMo/TiO2 photoelectrocatalysts for simultaneous green hydrogen production and pharmaceutical pollutant removal under simulated solar irradiation. The catalysts were synthesized via wet impregnation (15 wt.% total metal loading with 0.6 wt.% Cu) and thermally treated at 400 °C and 900 °C to investigate structural transformations and catalytic performance. Comprehensive characterization (XRD, BET, SEM, XPS) revealed phase transitions, enhanced crystallinity, and redistribution of redox states upon Cu incorporation, particularly the formation of NiTiO3 and an increase in oxygen vacancies. Crystallite sizes for anatase, rutile, and brookite ranged from 21 to 47 nm at NiMoCu400, while NiMoCu900 exhibited only the rutile phase with 55 nm crystallites. BET analysis showed a surface area of 44.4 m2·g−1 for NiMoCu400, and electrochemical measurements confirmed its higher electrochemically active surface area (ECSA, 2.4 cm2), indicating enhanced surface accessibility. In contrast, NiMoCu900 exhibited a much lower BET surface area (1.4 m2·g−1) and ECSA (1.4 cm2), consistent with its inferior photoelectrocatalytic performance. Compared to previously reported binary NiMo/TiO2 systems, the ternary NiMoCu/TiO2 catalysts demonstrated significantly improved hydrogen production activity and more efficient photoelectrochemical degradation of paracetamol. Specifically, NiMoCu400 showed an anodic peak current of 0.24 mA·cm−2 for paracetamol oxidation, representing a 60% increase over NiMo400 and a cathodic current of –0.46 mA·cm−2 at –0.1 V vs. RHE under illumination, nearly six times higher than the undoped counterpart (–0.08 mA·cm−2). Mott–Schottky analysis further revealed that NiMoCu400 retained n-type behavior, while NiMoCu900 exhibited an unusual inversion to p-type, likely due to Cu migration and rutile-phase-induced realignment of donor states. Despite its higher photosensitivity, NiMoCu900 showed negligible photocurrent, confirming that structural preservation and surface redox activity are critical for photoelectrochemical performance. This work provides mechanistic insight into Cu-mediated photoelectrocatalysis and identifies NiMoCu/TiO2 as a promising bifunctional platform for integrated solar-driven water treatment and sustainable hydrogen production. Full article
(This article belongs to the Section Electrocatalysis)
18 pages, 3360 KiB  
Article
Hydrogen Sulfide Has a Minor Impact on Human Gut Microbiota Across Age Groups
by Linshu Liu, Johanna M. S. Lemons, Jenni Firrman, Karley K. Mahalak, Venkateswari J. Chetty, Adrienne B. Narrowe, Stephanie Higgins, Ahmed M. Moustafa, Aurélien Baudot, Stef Deyaert and Pieter Van den Abbeele
Sci 2025, 7(3), 102; https://doi.org/10.3390/sci7030102 (registering DOI) - 1 Aug 2025
Abstract
Hydrogen sulfide (H2S) can be produced from the metabolism of foods containing sulfur in the gastrointestinal tract (GIT). At low doses, H2S regulates the gut microbial community and supports GIT health, but depending on dose, age, and individual health [...] Read more.
Hydrogen sulfide (H2S) can be produced from the metabolism of foods containing sulfur in the gastrointestinal tract (GIT). At low doses, H2S regulates the gut microbial community and supports GIT health, but depending on dose, age, and individual health conditions, it may also contribute to inflammatory responses and gut barrier dysfunction. Controlling H2S production in the GIT is important for maintaining a healthy gut microbiome. However, research on this subject is limited due to the gaseous nature of the chemical and the difficulty of accessing the GIT in situ. In the present ex vivo experiment, we used a single-dose sodium sulfide preparation (SSP) as a H2S precursor to test the effect of H2S on the human gut microbiome across different age groups, including breastfed infants, toddlers, adults, and older adults. Metagenomic sequencing and metabolite measurements revealed that the development of the gut microbial community and the production of short-chain fatty-acids (SCFAs) were age-dependent; that the infant and the older adult groups were more sensitive to SSP exposure; that exogeneous SSP suppressed SCFA production across all age groups, except for butyrate in the older adult group, suggesting that H2S selectively favors specific gut microbial processes. Full article
(This article belongs to the Section Biology Research and Life Sciences)
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12 pages, 441 KiB  
Article
Diagnostic Value of Point-of-Care Ultrasound for Sarcopenia in Geriatric Patients Hospitalized for Hip Fracture
by Laure Mondo, Chloé Louis, Hinda Saboul, Laetitia Beernaert and Sandra De Breucker
J. Clin. Med. 2025, 14(15), 5424; https://doi.org/10.3390/jcm14155424 (registering DOI) - 1 Aug 2025
Abstract
Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the [...] Read more.
Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the gold standard method, and explores its prognostic value in old patients undergoing surgery for hip fractures. Patients and Methods: In this prospective, single-center study, 126 patients aged ≥ 70 years and hospitalized with hip fractures were included. Sarcopenia was defined according to the revised 2018 EWGSOP2 criteria. Muscle mass was assessed by the Appendicular Skeletal Muscle Mass Index (ASMI) using DXA and by the thickness of the rectus femoris (RF) muscle using POCUS. Results: Of the 126 included patients, 52 had both DXA and POCUS assessments, and 43% of them met the diagnostic criteria for sarcopenia or severe sarcopenia. RF muscle thickness measured by POCUS was significantly associated with ASMI (R2 = 0.30; p < 0.001). POCUS showed a fair diagnostic accuracy in women (AUC 0.652) and an excellent accuracy in men (AUC 0.905). Optimal diagnostic thresholds according to Youden’s index were 5.7 mm for women and 9.3 mm for men. Neither RF thickness, ASMI, nor sarcopenia status predicted mortality or major postoperative complications. Conclusions: POCUS is a promising, accessible tool for diagnosing sarcopenia in old adults with hip fractures. Nonetheless, its prognostic utility remains uncertain and should be further evaluated in long-term studies. Full article
(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)
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20 pages, 3582 KiB  
Article
Design and Development of a Real-Time Pressure-Driven Monitoring System for In Vitro Microvasculature Formation
by Gayathri Suresh, Bradley E. Pearson, Ryan Schreiner, Yang Lin, Shahin Rafii and Sina Y. Rabbany
Biomimetics 2025, 10(8), 501; https://doi.org/10.3390/biomimetics10080501 (registering DOI) - 1 Aug 2025
Abstract
Microfluidic platforms offer a powerful approach for ultimately replicating vascularization in vitro, enabling precise microscale control and manipulation of physical parameters. Despite these advances, the real-time ability to monitor and quantify mechanical forces—particularly pressure—within microfluidic environments remains constrained by limitations in cost [...] Read more.
Microfluidic platforms offer a powerful approach for ultimately replicating vascularization in vitro, enabling precise microscale control and manipulation of physical parameters. Despite these advances, the real-time ability to monitor and quantify mechanical forces—particularly pressure—within microfluidic environments remains constrained by limitations in cost and compatibility across diverse device architectures. Our work presents an advanced experimental module for quantifying pressure within a vascularizing microfluidic platform. Equipped with an integrated Arduino microcontroller and image monitoring, the system facilitates real-time remote monitoring to access temporal pressure and flow dynamics within the device. This setup provides actionable insights into the hemodynamic parameters driving vascularization in vitro. In-line pressure sensors, interfaced through I2C communication, are employed to precisely record inlet and outlet pressures during critical stages of microvasculature tubulogenesis. Flow measurements are obtained by analyzing changes in reservoir volume over time (dV/dt), correlated with the change in pressure over time (dP/dt). This quantitative assessment of various pressure conditions in a microfluidic platform offers insights into their impact on microvasculature perfusion kinetics. Data acquisition can help inform and finetune functional vessel network formation and potentially enhance the durability, stability, and reproducibility of engineered in vitro platforms for organoid vascularization in regenerative medicine. Full article
(This article belongs to the Section Biomimetic Design, Constructions and Devices)
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11 pages, 1936 KiB  
Communication
Diffusion of C-O-H Fluids in a Sub-Nanometer Pore Network: Role of Pore Surface Area and Its Ratio with Pore Volume
by Siddharth Gautam and David Cole
C 2025, 11(3), 57; https://doi.org/10.3390/c11030057 (registering DOI) - 1 Aug 2025
Abstract
Porous materials are characterized by the pore surface area (S) and volume (V) accessible to a confined fluid. For mesoporous materials NMR measurements of diffusion are used to assess the S/V ratio, because at short times, only [...] Read more.
Porous materials are characterized by the pore surface area (S) and volume (V) accessible to a confined fluid. For mesoporous materials NMR measurements of diffusion are used to assess the S/V ratio, because at short times, only the diffusivity of molecules in the adsorbed layer is affected by confinement and the fractional population of these molecules is proportional to the S/V ratio. For materials with sub-nanometer pores, this might not be true, as the adsorbed layer can encompass the entire pore volume. Here, using molecular simulations, we explore the role played by S and S/V in determining the dynamical behavior of two carbon-bearing fluids—CO2 and ethane—confined in sub-nanometer pores of silica. S and V in a silicalite model representing a sub-nanometer porous material are varied by selectively blocking a part of the pore network by immobile methane molecules. Three classes of adsorbents were thus obtained with either all of the straight (labeled ‘S-major’) or zigzag channels (‘Z-major’) remaining open or a mix of a fraction of both types of channel blocked, resulting in half of the total pore volume being blocked (‘Half’). While the adsorption layers from opposite surfaces overlap, encompassing the entire pore volume for all pores except the intersections, the diffusion coefficient is still found to be reduced at high S/V, especially for CO2, albeit not so strongly as would be expected in the case of wider pores. This is because of the presence of channel intersections that provide a wider pore space with non-overlapping adsorption layers. Full article
(This article belongs to the Section Carbon Cycle, Capture and Storage)
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23 pages, 1706 KiB  
Article
Community-Based Halal Tourism and Information Digitalization: Sustainable Tourism Analysis
by Immas Nurhayati, Syarifah Gustiawati, Rofiáh Rofiáh, Sri Pujiastuti, Isbandriyati Mutmainah, Bambang Hengky Rainanto, Sri Harini and Endri Endri
Tour. Hosp. 2025, 6(3), 148; https://doi.org/10.3390/tourhosp6030148 (registering DOI) - 1 Aug 2025
Abstract
This study employs a mixed method. In-depth interviews and observational studies are among the data collection approaches used in qualitative research. The quantitative method measures the weight of respondents’ answers to the distributed questionnaire. The questionnaire, containing 82 items, was distributed to 202 [...] Read more.
This study employs a mixed method. In-depth interviews and observational studies are among the data collection approaches used in qualitative research. The quantitative method measures the weight of respondents’ answers to the distributed questionnaire. The questionnaire, containing 82 items, was distributed to 202 tourists to collect their perceptions based on the 4A tourist components. The results indicate that tourists’ perceptions of attractions, accessibility, and ancillary services are generally positive. In contrast, perceptions of amenity services are less favorable. Using the scores from IFAS, EFAS, and the I-E matrix, the total weighted scores for IFAS and EFAS are 2.68 and 2.83, respectively. The appropriate strategy for BTV is one of aggressive growth in a position of strengths and opportunities. The study highlights key techniques, including the application of information technology in service and promotion, the strengthening of community and government roles, the development of infrastructure and facilities, the utilization of external resources, sustainable innovation, and the encouragement of local governments to issue regulations for halal tourism villages. By identifying drivers and barriers from an economic, environmental, social, and cultural perspective, the SWOT analysis results help design strategies that can make positive contributions to the development of sustainable, community-based halal tourism and digital information in the future. Full article
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24 pages, 6020 KiB  
Article
Seasonal Patterns of Preterm Birth During the COVID-19 Pandemic: A Retrospective Cohort Study in Romania
by Paula Trif, Cristian Sava, Diana Mudura, Boris W. Kramer, Radu Galiș, Maria Livia Ognean, Alin Iuhas and Claudia Maria Jurca
Medicina 2025, 61(8), 1398; https://doi.org/10.3390/medicina61081398 - 1 Aug 2025
Abstract
Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with [...] Read more.
Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (<37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes. Full article
(This article belongs to the Special Issue Advances in Obstetrics and Maternal-Fetal Medicine)
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11 pages, 547 KiB  
Article
Gluten-Free Diet, Symptom Burden, and Autoimmune Comorbidities: Insights from the Hellenic Celiac Disease Population
by Emmanuel Psylinakis, Nikolaos Thalassinos, Alexios Manidis, Maria Togia, Vasileia Kounelaki, Anastasia G. Markaki and Aspasia Spyridaki
Dietetics 2025, 4(3), 31; https://doi.org/10.3390/dietetics4030031 (registering DOI) - 1 Aug 2025
Abstract
Introduction: Living with coeliac disease (CD) requires lifelong adherence to a strict gluten-free diet (GFD). This study assessed GFD adherence, symptom burden, autoimmune comorbidities, and dietetic support among Hellenic CD patients. Methods: A cross-sectional survey was completed by 272 adults with CD. Adherence [...] Read more.
Introduction: Living with coeliac disease (CD) requires lifelong adherence to a strict gluten-free diet (GFD). This study assessed GFD adherence, symptom burden, autoimmune comorbidities, and dietetic support among Hellenic CD patients. Methods: A cross-sectional survey was completed by 272 adults with CD. Adherence was measured using the Hellenic version of the Celiac Dietary Adherence Test (H-CDAT). Results: The mean H-CDAT score was 13.5 ± 3.5. Good adherence was observed in 44.9% of participants, while 14.3% showed poor adherence. Symptom burden was high: 39.3% reported partial symptom resolution and 3.7% had ongoing symptoms. Among patients, 25.0% had multiple autoimmune conditions, ranging from two to four. Dietetic support was limited: 61.5% were not referred to a dietitian at diagnosis, and 75.4% had no regular follow-up. Higher H-CDAT scores, indicating poorer adherence, were significantly associated with younger age (p = 0.014), earlier diagnosis (p = 0.01), and ongoing symptoms (p < 0.01). Age at diagnosis was also positively associated with autoimmune comorbidity count. Conclusions: These findings highlight the need for earlier diagnosis, improved access to structured dietetic support, and individualized care to optimize GFD adherence and improve outcomes in patients with CD. Full article
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15 pages, 619 KiB  
Article
Tell Me What You’ve Done, and I’ll Predict What You’ll Do: The Role of Motivation and Past Behavior in Exercise Adherence
by Luís Cid, Diogo Monteiro, Teresa Bento, Miguel Jacinto, Anabela Vitorino, Diogo S. Teixeira, Pedro Duarte-Mendes, Vasco Bastos and Nuno Couto
Healthcare 2025, 13(15), 1879; https://doi.org/10.3390/healthcare13151879 - 1 Aug 2025
Abstract
Introduction: The main purpose of this study was to test a hierarchical model of motivation that integrates Achievement Goal Theory and Self-Determination Theory to explain and predict exercise adherence. Method: In total, 2180 exercisers (1020 female, 1160 male) aged between 18 and 60 [...] Read more.
Introduction: The main purpose of this study was to test a hierarchical model of motivation that integrates Achievement Goal Theory and Self-Determination Theory to explain and predict exercise adherence. Method: In total, 2180 exercisers (1020 female, 1160 male) aged between 18 and 60 years, from different gyms and health clubs, completed several scales validated in exercise settings, regarding perceived motivational climate, basic psychological need satisfaction, behavioral regulation, and exercise adherence. For the last measure, weekly computer access to a control system over a 6-month period before and after data collection was consulted. Results: Through structural equation models (SEM), it was verified that (1) task-involving climate positively predicted basic psychological needs. In turn, the satisfaction of these needs predicted autonomous motivation, which led to a positive prediction of adherence; (2) a small variation in exercise adherence was explained by the motivational model under analysis. Nevertheless, models significantly improved their analytical power when past adherence was inserted in the model increasing the explained variance in future behavior from 9.2% to 64%. Conclusions: In conclusion, autonomous motivation can predict people’s exercise adherence, and past behavior increases that predictive effect. The present study brings scientific evidence to the popular saying “tell me what you’ve done and, and I’ll predict what you’ll do”. Full article
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19 pages, 440 KiB  
Article
Contextual Study of Technostress in Higher Education: Psychometric Evidence for the TS4US Scale from Lima, Peru
by Guillermo Araya-Ugarte, Miguel Armesto-Céspedes, Nicolás Contreras-Barraza, Alejandro Vega-Muñoz, Guido Salazar-Sepúlveda and Nelson Lay
Sustainability 2025, 17(15), 6974; https://doi.org/10.3390/su17156974 (registering DOI) - 31 Jul 2025
Abstract
Sustainable education requires addressing the challenges posed by digital transformation, including technostress among university students. This study evaluates technostress levels in higher education through the validation of the TS4US scale and its implications for sustainable learning environments. A cross-sectional study was conducted with [...] Read more.
Sustainable education requires addressing the challenges posed by digital transformation, including technostress among university students. This study evaluates technostress levels in higher education through the validation of the TS4US scale and its implications for sustainable learning environments. A cross-sectional study was conducted with 328 university students from four districts in Lima, Peru, using an online survey to measure technostress. Confirmatory factor analysis (CFA) was performed to assess the psychometric properties of the TS4US scale, resulting in a refined model with two latent factors and thirteen validated items. Findings indicate that 28% of students experience high technostress levels, while 5% report very high levels, though no significant associations were found between technostress and sociodemographic variables such as campus location, employment status, gender, and academic level. The TS4US instrument had been previously validated in Chile; this study confirms its structure in a new sociocultural context, reinforcing its cross-cultural applicability. These results highlight the need for sustainable strategies to mitigate technostress in higher education, including institutional support, digital literacy programs, and policies fostering a balanced technological environment. Addressing technostress is essential for promoting sustainable education (SDG4) and enhancing student well-being (SDG3). This study directly contributes to the achievement of Sustainable Development Goals 3 (Good Health and Well-being) and 4 (Quality Education) by providing validated tools and evidence-based recommendations to promote mental health and equitable access to digital education in Latin America. Future research should explore cross-country comparisons and targeted interventions, including digital well-being initiatives and adaptive learning strategies, to ensure a resilient and sustainable academic ecosystem. Full article
(This article belongs to the Section Sustainable Education and Approaches)
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