Search Results (379)

Background: Ultrasound (U/S) can be used to evaluate skeletal muscle characteristics in clinical and sports settings. Handheld U/S devices have recently emerged as a cheaper and portable alternative to conventional U/S systems. However, further research is warranted on their reliability. We assessed the reliability and inter-device agreement between a handheld U/S device (Clarius L15 HD₃) and a more conventional U/S system (GE LOGIQ e) for measuring the thickness of the rectus femoris (RF) and vastus intermedius (VI). Methods: Cross-sectional images of the RF and VI muscles were obtained in 20 participants by two assessors, and on two separate occasions by one of those assessors, using the Clarius L15 HD₃ and GE LOGIQ e devices. RF and VI thickness measurements were obtained to determine the intra-rater reliability, inter-rater reliability, and inter-device agreement. Results: All intraclass correlation coefficients (ICCs) were above 0.9 for intra-rater reliability (range: 0.94 to 0.97), inter-rater reliability (ICC: 0.97), and inter-device agreement (ICC: 0.98) when comparing the two devices in assessing RF and VI thickness. For the RF, the Bland–Altman plot revealed a mean difference of 0.06 ± 0.07 cm, with limits of agreement ranging from 0.21 to −0.09, whereas for the VI, the Bland–Altman plot showed a mean difference of 0.07 ± 0.10 cm, with limits of agreement ranging from 0.27 to −0.13. Conclusions: The handheld Clarius L15 HD₃ was reliable and demonstrated high agreement with the more conventional GE LOGIQ e for assessing the thickness of the RF and VI in young, healthy adults. Full article

Childhood obesity increases chronic disease risk, but no comprehensive synthesis has evaluated the impact of school-based combined nutrition education and physical activity interventions on cardiometabolic biomarkers in children aged 3 to 12 years. This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251085194). Five databases were systematically searched through June 2025. Twelve randomized controlled trials involving 18,231 children were included and assessed using the PEDro scale. Ten trials demonstrated significant improvements in at least one cardiometabolic biomarker. Blood pressure (8 studies) outcomes showed systolic reductions of 1.41–6.0 mmHg in six studies. Glucose metabolism (5 studies) improved in two studies with reductions of 0.20–0.22 mmol/L. Lipid profiles (7 studies) improved in three studies, including total cholesterol (−0.32 mmol/L). Insulin levels (5 studies) decreased significantly in two investigations. Anthropometric improvements included BMI and body fat. Physical activity increased by >45 min/week and dietary habits improved significantly. Programs with daily implementation (90-min sessions 4x/week), longer duration (≥12 months), family involvement (parent education), and curriculum integration (classroom lessons) showed superior effectiveness. Interventions targeting children with overweight/obesity demonstrated higher changes compared to the general population. However, methodological limitations included a lack of assessor blinding, absence of subject/therapist blinding, and inadequate retention rates. School-based interventions combining nutrition and physical activity can produce significant improvements in cardiometabolic biomarkers, supporting comprehensive, sustained multicomponent programs for early chronic disease prevention. Full article

Background/Objectives: There is a need for randomized clinical trials with higher quality, especially for older people at high risk of falls, with interventions that consider individual needs, comprehensiveness of care, and connection with primary health care. We designed a randomized controlled trial to examine the effects of a case management intervention combined with a physical exercise protocol on risk factors for falls, falls data, adherence, satisfaction, costs, and implementation in community-dwelling older adults with high risk of falls. Methods: A minimum of 60 community-dwelling older people with high falls risk will participate in the randomized controlled assessor-blinded trial (MAGIC—v. 2). The trial will be conducted in a regional health department of São Paulo state (Brazil), which includes 6 cities. Participants will be randomized to the Intervention Group (case management intervention based on all individual risk factors for falls identified by a multidimensional assessment, over 16 weeks, once a week, by telephone calls). Both groups will perform a physical exercise protocol based on falls prevention for 16 weeks (twice a week) in Health Units. The assessment will be performed at baseline, after 16 weeks of intervention, after 6-month follow-up, and after 12-month follow-up. Primary outcome measures include falls data and potentially modifiable risk factors for falls. Discussion: This study has the potential to facilitate the future implementation of the intervention based on case management with a focus on fall prevention in the health sectors. Trial registration: Brazilian Registry of Clinical Trials (ReBEC). Full article

The European Health Technology Assessment (HTA) regulation (HTAR) came into effect in January 2025 and impacts the HTA process in all European Member States. Member States must give due consideration to the joint clinical assessment (JCA) report. This may require adaptations at the national level. This paper describes the anticipated changes to the Dutch national HTA process and how the Dutch National Health Care Institute (Zorginstituut Nederland, ZIN) prepared for this, because sharing experience between Member States can be of general interest for future expansion of the EU HTAR. ZIN’s implementation activities were facilitated by a project-governance structure and by a continuous gap analysis of the current national assessment and appraisal process of medicinal products, resulting in a concrete action plan. The implementation of the HTAR has two major implications for ZIN’s HTA process, namely that the scoping phase starts much earlier and that the JCA report is the starting point for the national assessment. Gaps, challenges and issues were identified in the categories: information and knowledge, IT and template, communication and stakeholder engagement, capacity and resources, and financial aspects. Based on a thorough and well-defined implementation plan, ZIN is ready to implement the HTAR in national HTA processes and to take on (co-)assessor roles for JCA of medicinal products in 2025. Full article

Current research predominantly involves human subjects to evaluate AI creativity. In this explorative study, we questioned the validity of this practice and examined how creator–assessor (dis)similarity—namely to what extent the creator and the assessor were alike—along two dimensions of culture (Western and English-speaking vs. Eastern and Chinese-speaking) and agency (human vs. AI) influences the assessment of creativity. We first asked four types of subjects to create stories, including Eastern participants (university students from China), Eastern AI (Kimi from China), Western participants (university students from The Netherlands), and Western AI (ChatGPT 3.5 from the US). Both Eastern participants and AI created stories in Chinese, which were then translated into English, while both Western participants and AI created stories in English, which were then translated into Chinese. A subset of these stories (2 creative and 2 uncreative per creator type, in total 16 stories) was then randomly selected as assessment materials. Adopting a within-subject design, we then asked new subjects from the same four types (n = 120, 30 per type) to assess these stories on creativity, originality, and appropriateness. The results confirmed that similarities in both dimensions of culture and agency influence the assessment of originality and appropriateness. As for the agency dimension, human assessors preferred human-created stories for originality, while AI assessors showed no preference. Conversely, AI assessors rated AI-generated stories higher in appropriateness, whereas human assessors showed no preference. Culturally, both Eastern and Western assessors favored Eastern-created stories in originality. And as for appropriateness, the assessors always preferred stories from the creators with the same cultural backgrounds. The present study is significant in attempting to ask an often-overlooked question and provides the first empirical evidence to underscore the need for more discussion on using humans to judge AI agents’ creativity or the other way around. Full article

Grape marc spirits represent a significant category within the alcoholic beverage sector, particularly across Mediterranean Europe. This study aimed to construct a sensory flavor wheel—covering aroma, taste, and mouthfeel modalities—specifically for non-flavored and non-wood-aged grape marc distillates. To achieve this, we explored the feasibility of a novel methodological approach combining three rapid sensory techniques: Ultra Flash Profiling (UFP), Check-All-That-Apply (CATA), and Rate-All-That-Apply (RATA). Forty-five (45) samples from Greece, Cyprus, and Italy were evaluated by a trained panel of 12 assessors. UFP generated 205 initial descriptors, which were refined to 59 for CATA. Despite the long attribute list, CATA data helped identify the most relevant terms for the final RATA experiment. The sequential application of these methods, along with intermediate data filtering, led to the selection of 45 key descriptors with occurrence frequencies ranging from 33.3% to 97.7%. These were organized into a comprehensive flavor wheel grouped into 12 general categories. This approach offers a flexible framework for future flavor wheel construction in other under-characterized product categories. Full article

Black soybean is known for its antioxidant and anti-inflammatory properties that help prevent several degenerative diseases, but in the Western diet, it is poorly used, despite the interest in foods rich in bioactive compounds. This study aimed to formulate a black soybean yogurt (BSY) fermented by a probiotic culture of L. acidophilus and evaluate the nutritional and bioactive profiles, the total antioxidant capacity, and complementary parameters during fermentation and storage for one month. We also evaluated the potential for acceptance by Rio de Janeiro consumers (n = 103). The final BSY water content was 92.8%. The dry matter contained 50.2% protein, 20.1% lipid, 5.9% ashes, 23.8% carbohydrates, and other constituents, including 1% sucrose, 5.9% α-galactosides, 26.9 mg/100 g anthocyanins (mainly cyanidin-3-glucoside), 140.5mg/100 g isoflavones (mainly genistin and daidzin). Titratable acidity was 0.44% and pH 4.5. In the sensory test, 12% sucrose and fruit extracts (strawberry, prune, and grape) were added individually to the product to evaluate the acceptability. The sweetened strawberry extract offered the highest acceptability, with a 7.6 score in a nine-point hedonic scale, against a 5.6 of the sweetened control with no fruit extract. Furthermore, all products scored well in the clusters with assessors who consumed soy products often and daily (total n = 26), with the strawberry-flavored one scoring, on average, 8 or 9. One month storage at 8 ± 2 °C caused a 22% decrease in the anthocyanins content and no significant change in isoflavones, titratable acidity, and pH. Fermentation and the addition of a sweetened fruit extract proved to be promising tools to increase the consumption of black soy milk in the West. Full article

Background: Frailty is common in colorectal cancer (CRC) patients and is associated with poor prognosis and increased mortality. Anti-inflammatory dietary education is a promising and cost-effective strategy for frailty improvement. Methods: A prospective, assessor-blinded, two-arm randomized controlled trial was conducted to assess the effects of a 12-week dietary inflammatory index (DII)-based anti-inflammatory dietary education program on frailty in frail CRC patients. Participants in the intervention group received a DII-based anti-inflammatory dietary education, while the control group received a routine health education. Outcome measurements included the Fried frailty phenotype (FP), DII, plasma inflammatory biomarkers, body mass index (BMI), nutritional status, and quality of life (QoL), which were all assessed at baseline and post-intervention. Results: A total of 86.4% (57/66) of participants completed the follow-up. No statistically significant baseline differences were observed between groups. After the intervention, the intervention group showed significant improvements in DII (p = 0.029), BMI (p = 0.012), mini nutritional assessment (MNA) scores (p = 0.027), and QoL (p = 0.014) compared with the control group. Within-group comparisons revealed significant decreases in frailty status (p = 0.031), DII (p = 0.008), and interleukin (IL)-6 (p = 0.003), and significant increases in IL-10 (p = 0.021), MNA scores (p = 0.010), and QoL (p < 0.001) in the intervention group, with no significant changes in the control group. Conclusions: DII-based anti-inflammatory dietary education can improve the frailty, nutritional status, and QoL of frail CRC patients by modulating systemic inflammation. Given its acceptability and utility, this strategy may be incorporated into routine cancer health education. Full article

Jurors and other legal decision-makers are often required to make judgments about the likely memory accuracy of another person. Legal systems tend to presume that decision-makers are well-placed to make such judgments (at least in the majority of cases) as a result of their own experiences with memory. However, existing research highlights weaknesses in our abilities to assess the memories of others and suggests that these weaknesses are not easily ameliorated through the provision of information. In this work we examine the accuracy of layperson assessments of “real” eyewitness identifications following observation of a mock crime. We examine whether novel instructions, characteristics and beliefs of assessors, and underlying reasoning strategies are associated with improved or impaired judgment accuracy. The results support prior research in demonstrating a tendency towards over-belief in the accuracy of identifications. They suggest that reliance on what witnesses have said rather than attempts to make inferences from their statements (e.g., in relation to the level of detail provided or non-verbal cues in testimony) is associated with greater accuracy in assessments and that some individual differences and beliefs about memory are also associated with greater accuracy. However, there was no evidence that the instructions tested were effective. We discuss the implications of results for procedure surrounding the evaluation of memory in the legal context. Full article

This study evaluates design effectiveness in Digital Game-Based Learning (DGBL) for primary health education through systematic teacher assessment of the iLearn4Health platform. Rather than measuring educational transformation, the research investigates how DGBL design principles influence user engagement patterns and platform usability as evaluated by education professionals. The study contributes to design optimization frameworks for primary school digital health education applications by examining the distinction between DGBL and superficial gamification approaches in creating engaging educational interfaces. The iLearn4Health platform underwent comprehensive design evaluation by 337 teachers across 24 schools in five European countries (Greece, Cyprus, Romania, Poland, and Spain). Teachers served as design evaluators rather than end-users, assessing platform engagement mechanisms through systematic interaction analysis. The study employed multiple statistical approaches—descriptive analysis, correlation analysis, ANOVA, regression modeling, and cluster analysis—to identify design engagement patterns and their predictors, tracking completion rates, progress trajectories, and interaction time as indicators of design effectiveness. Design evaluation revealed a distinctive bimodal engagement distribution, with 52.8% of teacher–evaluators showing limited platform exploration (progress ratio 0.0–0.2) and 35.3% demonstrating comprehensive design assessment (progress ratio 0.8–1.0). A strong positive correlation (r = 0.95, p < 0.001) between time spent and steps completed indicated that design elements successfully sustained evaluator engagement. Multiple regression analysis identified initial design experience as the strongest predictor of continued engagement (β = 0.479, p < 0.001), followed by country-specific implementation factors (Romania vs. Cyprus, β = 0.183, p = 0.001) and evaluator age (β = 0.108, p = 0.049). Cluster analysis revealed three distinct evaluator profiles: comprehensive design assessors (35.3%), early design explorers (52.8%), and selective feature evaluators (11.9%). Cross-national analysis showed significant variations in design engagement, with Romania demonstrating 53% higher average progress ratios than Cyprus (0.460 vs. 0.301, p < 0.01). Teacher evaluation validates effective design implementation in the iLearn4Health platform for creating engaging primary health education experiences. The platform successfully demonstrates DGBL design principles that integrate health concepts into age-appropriate interactive environments, distinct from gamification approaches that merely overlay game elements onto existing content. Identifying initial engagement as the strongest predictor of sustained interaction highlights the critical importance of onboarding design in determining user experience outcomes. While this study establishes design engagement effectiveness through educator assessment, actual educational transformation and student learning outcomes require future implementation studies with primary school populations. The design validation approach provides essential groundwork for subsequent educational effectiveness research while contributing evidence-based design principles for engagement optimization in digital health education contexts. Full article

MPS I (Mucopolysaccharidosis type I) is a rare lysosomal storage disease originating from the deficiency of the enzyme alpha-L-iduronidase, encoded by the IDUA gene, which impairs the degradation of glycosaminoglycans (GAGs) and diminishes biological functioning across several organs. Background: Out of the eleven MPS disorders, MPS I includes three syndromes, of which the first, named Hurler syndrome, affects the most. Methods: Several in silico tools were used, such as ConSurf (73 variants), Mutation Assessor (69 variants), PredictSNP, MAPP, PhDSNP, Polyphen-1, Polyphen-2, SIFT, SNAP, PANTHER, MetaSNP (24 variants); Missense 3D-DB (11 variants) and AlignGVGD (eight variants) for physicochemical properties; and I-Mutant, Mupro, CUPSAT, and INPS for stability predictions (four variants). Results: A molecular docking study was performed for the two variants: L238Q and P385R scored −7.22 and −7.05 kcal/mol, respectively, and the native scored −7.14 kcal/mol with IDR as the ligand. Molecular dynamics anticipated how these molecules fluctuate over a period of 100 nanoseconds. Conclusions: Alpha-L-iduronidase enzyme has a critical role in the lysosomal degradation of glycosaminoglycans. According to the comparative analysis of the three structures by MDS, P385R had the least stability in all aspects of the plots. Our study demonstrates that the mutation significantly alters protein stability and binding efficiency with the ligands. Full article

Background: The COVID-19 pandemic necessitated immediate regulatory vaccine approvals to facilitate timely global access. The prevailing differences in economies and resources and the varying maturity of the regulatory systems worldwide resulted in different levels of capacity to ensure vaccine quality, safety, and efficacy. In addition to the Emergency Use Authorization or equivalent by some advanced regulatory agencies, the WHO issued Emergency Use Listings (EULs), among other tools, to streamline and expedite regulatory approvals globally. This study aimed to assess the regulatory strategies and best practices adopted during the COVID-19 vaccine approvals and gather lessons for future emergency preparedness. Methods: A mixed-method approach employing qualitative desk reviews and a cross-sectional study collected data from 194 national regulatory authorities (NRAs) across all WHO regions. Results: Three main approval processes were identified: procurement-driven, reliance-based, and independent evaluations. Wealthier countries with more mature regulatory systems were found to spend a longer time issuing approvals, primarily due to being the initial assessors of the vaccines’ quality, safety, and efficacy. Furthermore, various regulatory flexibilities and best practices centered around regulatory reliance, rolling reviews, fast-tracking reviews, and employing digital tools were identified. Notably, the WHO’s EULs were essential in facilitating the timely approval of vaccines globally, including in low- and middle-income countries. Conclusions: The findings suggest a significant turn in vaccine regulation theories and practice, emphasizing balancing speed with scientific validity. This necessitates the creation of thorough provisions for emergency preparedness, regulatory reliance, and administrative flexibility in regulatory practices worldwide. Full article

Achieving carbon neutrality in the building sector is essential for addressing the global climate crisis. However, the production stage—which contributes to over 29% of a building’s life cycle carbon emissions (CE)—poses significant challenges for consistent carbon performance assessment due to the diversity of building materials and the uniqueness of individual building projects. These factors often lead to inconsistent evaluation results across assessors and the fragmented management of carbon data at the project level. This study proposes the Zero Carbon Building Index (ZCBI), a quantitative assessment method that incorporates embodied carbon from raw material extraction, transportation, and manufacturing. ZCBI enables the evaluation of carbon neutrality performance at the material level and supports the identification of reduction potentials in the production stage. A classification system was developed to evaluate CE during production, creating reference buildings for residential and non-residential purposes. Additionally, a Korean Environmental Product Declaration (EPD) database was established by incorporating CE data from 797 EPD-certified materials. Carbon reduction (CR) and ZCBI values were analyzed by categorizing CE variations across manufacturers into the lowest, average, and highest values. The results showed that CR for apartment complexes ranged from 42.1 to 311 kgCO₂e/m², with ZCBI values between 8.84% and 65.30%, and those for business facilities ranged from 40.9 to 264 kgCO₂e/m², with ZCBI values from 8.59% and 55.43. The proposed ZCBI framework provides a basis for optimizing material selection to reduce emissions and may evolve into a comprehensive carbon neutrality assessment covering the entire construction process. Full article

Donkey milk is well known for its beneficial properties for human health, making it a valuable ingredient in the production of value-added cheese. Rolled cheese, a type of pasta filata cheese, is traditionally produced in the northern part of Serbia. In this study, we produced rolled cheese by adding a certain amount of donkey’s milk from the Balkan and Banat breeds to cow’s milk. The rolled cheese samples were analyzed for their microbiological quality, chemical composition, content of essential and trace elements, as well as sensory characteristics. Adding 10% and 20% donkey’s milk had no effect on the microbiological quality or hedonic scale of rolled cheeses compared with rolled cheese made from raw cow’s milk. However, the addition of donkey’s milk partially affected the chemical composition and mineral profile of the cheeses. The fat, fat in dry matter, calcium contents, and the ratio of calcium and phosphorus significantly (p < 0.05) decreased with the addition of donkey’s milk, while the ash, salt, sodium, and potassium contents significantly (p < 0.05) increased. The assessors successfully distinguished the rolled cheeses containing donkey’s milk from those made with cow’s milk, encouraging the future production of value-added cheese. Full article

This study investigates the impact of emulsifier substitution and booster concentration on sunscreen characteristics, including physical properties, the sun protection factor (SPF), and sensory attributes. The impact of substituting Polysorbate^® 80 with Beautyderm^® K10 as an emulsifier in sunscreen formulations, along with the effect of increasing concentrations of the Sunhancer™ Eco SPF Booster, was thoroughly evaluated. Spectrophotometric methods were used to determine SPF, while texture analysis and rheological measurements assessed physical characteristics. Stability was evaluated using a centrifuge stress test, and sensory analysis was conducted on the top-performing formulation. The results indicated that the choice of emulsifier and booster concentration significantly influenced SPF values and stability. The influence of booster concentration on textural properties was most significant in formulations containing Beautyderm^®. Centrifuge testing revealed phase separation in certain formulations. Notably, the formulations that exhibited the greatest stability were those in which Beautyderm^® was combined with either Polysorbate^® or Span^®. Following the stability test results, the cream formulation containing Beautyderm^® and Polysorbate^® as emulsifiers was further evaluated through sensory analysis. Independent assessors determined that the sensory attributes of the cream did not undergo significant changes even when zinc oxide was added at a concentration of 1% (w/w) to the formulation. These findings underscore the importance of carefully selecting emulsifiers and boosters to achieve high sun protection efficacy, stability, and desirable sensory properties in sunscreen formulations. Full article