Search Results (1,327)

The purpose of this study is to characterize, through an exploratory empirical diagnosis, the degree of development and preliminary association between circular economy capabilities and sustainability-oriented digital transformation capabilities in Chamber-affiliated SMEs in Lambayeque, Peru. Guided by three exploratory working hypotheses, the study expected intermediate levels of development, heterogeneous performance across dimensions, and a positive but non-confirmatory coupling between both capability families. A self-administered questionnaire with thirty Likert-type items measured four circular economy dimensions—circular design and eco-design, resource optimization, circular waste management, and circular business models—and four sustainability-oriented digital transformation dimensions—digital technology infrastructure, dynamic digital capabilities, sustainable digital strategy, and digital innovation culture. The initial database contained 111 complete Chamber-affiliated responses; however, seven large Chamber-affiliated firms were retained only as contextual comparators and were excluded from all statistical processing. Consequently, all descriptive, psychometric, and SEM results were calculated using the final analytical sample of 104 micro-, small-, and medium-sized enterprises. The findings show intermediate development in both constructs, higher perceived performance in digital innovation culture and resource optimization, and lower performance in digital technology infrastructure, reverse logistics, platforms enabling circularity, and monetization of circular models. The latent association between the two higher-order constructs was very high (β = 0.985, p < 0.001); however, because global fit indices were below conventional thresholds, this coefficient is interpreted as preliminary evidence of empirical overlap and capability co-occurrence rather than confirmatory evidence of a validated structural model or causal integration. Full article

This article examines how anti-Zionist sentiment and antisemitism relate among self-identified American Christians, drawing on an original 2024 survey of roughly 2000 respondents. The survey included multiple antisemitic tropes and Israel-related statements measuring severe anti-Israel and anti-Zionist sentiment. Using generalized ordered logistic regression, we find a strong and escalating association between anti-Zionist sentiment and antisemitic trope endorsement across multiple levels of antisemitic intensity. Respondents who express stronger opposition to Israel are significantly more likely to affirm classical antisemitic stereotypes involving Jewish power, dual loyalty, or financial control. Supersessionist beliefs are likewise associated with greater antisemitic sentiment, with the relationship becoming especially pronounced at higher levels of antisemitism. In contrast, the traditional deicide belief does not emerge as a statistically significant correlate once broader theological and political attitudes are taken into account. Younger Christians, urban residents, and Southerners exhibit higher antisemitism, while education, age, and female gender are associated with lower levels. Taken together, the findings show that anti-Zionism and antisemitism are often empirically intertwined within contemporary American Christianity, particularly at more extreme levels. Because the data are cross-sectional, the results should be interpreted as associations rather than causal effects. Full article

Age-associated metabolic dysfunction is commonly defined by abnormalities in adiposity, glucose regulation, lipid metabolism, and blood pressure. Although clinically useful, these criteria do not fully capture the biological heterogeneity that explains why older adults with similar metabolic profiles may follow divergent trajectories toward type 2 diabetes, cardiovascular disease, metabolic dysfunction-associated steatotic liver disease, frailty or multimorbidity. This narrative Review summarizes clinical, translational, and mechanistic evidence on the biological processes that shape metabolic aging, with particular emphasis on inflammaging, immunosenescence, cellular senescence, oxidative stress, mitochondrial dysfunction, adipose tissue dysfunction, endothelial injury, and inflammation-related microRNAs. We first discuss how chronic low-grade inflammation and immune remodeling alter the interpretation of conventional metabolic syndrome components in older adults. We then review redox imbalance and mitochondrial stress as amplifiers of insulin resistance, lipid injury, vascular dysfunction, and tissue remodeling. The review also examines inflammation-related microRNAs, including circulating and extracellular-vesicle-associated miRNAs, as post-transcriptional regulators that may connect inflammatory, metabolic, and redox pathways. Finally, we discuss how conventional metabolic markers may be integrated with inflammatory mediators, oxidative-stress indicators, adipokines, endothelial and senescence-related markers, and miRNA profiles to improve biological interpretation of metabolic risk. Within this context, we present the Inflammaging–Redox–InflammamiR Axis as a conceptual framework for organizing these overlapping mechanisms rather than as an established diagnostic or causal model. The proposed biomarker tiers and candidate risk phenotypes are author-derived, hypothesis-generating constructs intended to guide future longitudinal and interventional research. Clinical translation will require standardized assays, longitudinal validation, external replication, and intervention studies. Full article

Mental health during childhood is a major public health concern, and physical activity has been proposed as a modifiable behaviour associated with psychological well-being and emotional health. This study examined the associations between physical activity and mental health indicators, including psychological well-being, anxiety symptoms, and everyday stress, in primary school children. A cross-sectional study was conducted with 207 children from two schools in Jaén (Spain). Physical activity, psychological well-being, anxiety, and stress were assessed using validated questionnaires. Pearson correlations and multiple linear regression analyses adjusted for age, sex, and socioeconomic status were performed. Physical activity was positively associated with all dimensions of psychological well-being and with total psychological well-being (r = 0.182, p = 0.009). Significant inverse correlations were observed between physical activity and all anxiety dimensions, as well as total anxiety (r = −0.145, p = 0.037), although the association with total anxiety was not significant after adjustment (β = −0.149, p = 0.112). Physical activity was also negatively associated with all stress dimensions and remained significantly associated with lower total stress after adjustment (β = −0.253, p = 0.007). These findings indicate that higher levels of physical activity are associated with greater psychological well-being and lower everyday stress in primary school children. However, given the cross-sectional design, these associations should not be interpreted as causal relationships. Longitudinal studies are needed to clarify the directionality of these associations. Full article

Multilevel public finance is a social-administrative system in which authority, fiscal resources, information, and implementation responsibilities circulate across government tiers. China’s Province-Managing-County (PMC) reform provides a case for evaluating how governance redesign affects county-recorded fiscal expenditure. We define the system boundary as the province–prefecture–county fiscal governance chain and decompose the reform into administrative power delegation (D1), which changes decision rights, and fiscal direct reporting (D2), which changes fiscal-flow paths. Using a county-level panel of 2219 counties in 31 provinces from 2000 to 2019, we combine generalized synthetic control, Matrix Completion, panel unconditional quantile regression, and spatial diagnostics. The average effect is positive in the preferred gsynth specification and the Matrix Completion benchmark, but the magnitude is model-dependent: 16.7% under gsynth and 8.1% under Matrix Completion, with further sensitivity to latent-factor choices. Reform-type estimates and a common-model CATE equality test suggest stronger estimated effects for D1 than D2, interpreted as institutional heterogeneity rather than causal dominance. Distributional and spatial diagnostics indicate weaker lower-tail effects and geographically uneven absorption. The findings suggest that changing decision rights and fiscal-flow paths can reshape county fiscal system outputs. Full article

Food festivals have become important instruments of regional tourism development, destination branding, agricultural promotion, and cultural policy. Yet the authenticity of food festivals is often evaluated through visitor perception or promotional discourse, leaving limited room for scalable assessment across large festival systems. This study develops a Location Quotient (LQ)-based framework for measuring agricultural embeddedness as a supply-side structural condition that can support objective material authenticity claims. Using a dataset of 277 South Korean regional food festivals, the study examines how featured food materials are connected to regional agricultural specialization and how this structural connection compares with budget scale, infrastructure, and material-duplication factors in explaining administrative visitor attendance and portfolio-level governance patterns. The results show that agricultural embeddedness is unevenly distributed across the national festival portfolio. Festival budget is the strongest predictor of log-transformed visitor attendance, whereas agricultural embeddedness is not significantly associated with visitor attendance after budget and infrastructure controls are included. Material-level duplication is useful as a portfolio diagnostic for identifying crowded food categories where place-product credibility may become strategically important. Scenario-based portfolio comparisons provide planning benchmarks suggesting that targeted restructuring and reallocation would be associated with higher average agricultural embeddedness under specified portfolio assumptions, although these scenarios should not be interpreted as causal forecasts. The study contributes to food tourism, event governance, and destination branding research by offering a reproducible way to assess the material grounding of food festival authenticity claims and by shifting policy discussion from festival proliferation toward portfolio quality. Full article

Cardiometabolic residual risk in type 2 diabetes mellitus (T2D) persists despite major advances in glucose-lowering therapy, lipid management, blood pressure control, weight reduction, and organ-protective strategies. This residual burden should not be interpreted solely as the consequence of incomplete achievement of conventional therapeutic targets, but rather as the clinical expression of persistent molecular activity involving multiple interconnected organs and pathways. Insulin resistance, metaflammation, oxidative stress, mitochondrial dysfunction, lipotoxicity, endothelial impairment, hepatic metabolic dysregulation, renal inflammation, fibrotic remodeling, and metabolic memory interact within a dynamic network linking adipose tissue, liver, kidney, immune cells, and vasculature. In this review, we discuss the biochemical and molecular drivers of cardiometabolic residual risk in T2D, with particular emphasis on impaired insulin receptor substrate/PI3K/Akt signaling, stress-kinase activation, NLRP3 inflammasome priming and assembly, MASLD-related lipotoxicity and fibrogenesis, podocyte and tubular injury, endothelial nitric oxide synthase uncoupling, AGE-RAGE signaling, and thrombo-inflammatory vascular injury. These pathways explain why biological vulnerability may persist even when conventional clinical parameters appear adequately controlled. We also examine the role of translational biomarkers and simple clinical indices, including TyG-derived indices, adiposity markers, hepatic steatosis and fibrosis scores, albuminuria, eGFR, and lipid-related markers, as accessible windows into active biological pathways. Finally, we review how contemporary therapeutic strategies may modulate selected components of this residual-risk network. A pathway-centered interpretation of T2D may support more precise residual-risk phenotyping and help move cardiometabolic care beyond isolated target control toward mechanism-based prevention. This review further links these mechanisms to the contemporary cardiovascular–kidney–metabolic (CKM) framework, as defined by the 2026 AHA/ACC/ADA/ASN CKM Guideline, and disaggregates the underlying molecular network into organ-specific pathway cascades that make the causal relationships between metabolic, inflammatory, hepatic, renal, and vascular injury more explicit. Full article

Stacked coalbed methane (CBM) reservoirs can increase the drainage thickness of a single well, but commingled production is influenced by stress-sensitive permeability, gas desorption, water drainage, and interlayer heterogeneity. This study presents a three-segment reservoir model for well GP-2 in the Tucheng block. Pore-fracture compressibility was estimated from overburden low-field nuclear magnetic resonance measurements and compared with stress-dependent permeability obtained by the pulse-decay method. The resulting coefficient was used in the dynamic permeability relationship and held fixed during history matching. The model was calibrated against gas- and water-production data from the first 240 d. One-factor simulations were then run over a common 3000 d calculation window to compare the relative responses to geological, adsorption, and stimulation parameters. In the GP-2 base model, average gas rate increased with equivalent coal thickness, gas content, Langmuir pressure, stimulated area, and stimulated-region permeability; inverse responses were obtained for cleat-fracture porosity, proportional three-layer initial permeability, initial reservoir pressure, and Langmuir volume. Adsorption time and interlayer spacing had comparatively small effects. These trends are specific to the selected model and parameter ranges and should not be interpreted as validated long-term forecasts or established causal relationships. This study demonstrates a practical way to carry a laboratory-derived stress-sensitivity parameter into a multilayer field model. Full article

Cardiac tamponade in pregnancy is an exceptional maternal–fetal emergency in which physiological tachycardia, hypervolaemia and dependent oedema mask the classical signs of tamponade. Corynebacterium amycolatum is a non-diphtherial, Gram-positive coryneform commensal of human skin and mucosa that is increasingly recognised as a true invasive pathogen, although pericardial infection has rarely, if ever, been reported. We aimed to describe the diagnostic and decompression strategy in such a case. We report a 29-year-old woman at 30 + 4 weeks of gestation with class III obesity (pre-pregnancy body mass index 36 kg/m²), pregnancy-induced hypertension and diet-controlled type 2 diabetes referred after a routine echocardiogram suggested tamponade despite preserved haemodynamic compensation. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion with diastolic right-atrial and right-ventricular collapse, a plethoric inferior vena cava and respiratory mitral-inflow variation. Severe maternal obesity superimposed on advanced gestation degraded the acoustic windows, elevated the diaphragm, displaced the heart anteriorly and brought the gravid uterus into the subxiphoid corridor, rendering percutaneous pericardiocentesis prohibitively hazardous. After multidisciplinary heart-team review, a left anterior mini-thoracotomy with pleuro-pericardial window evacuated approximately 1000 mL of fluid. Aerobic culture yielded C. amycolatum (MALDI-TOF), with histological pericarditis and a consistent antibiogram; autoimmune, viral and neoplastic causes were excluded, although blood cultures and extended viral testing were not performed. Targeted intravenous cefazolin was given, and the patient delivered a healthy term neonate at 39 weeks, with a normal 7-month echocardiogram. To the best of our knowledge, this is among the first reported cases of C. amycolatum pericardial tamponade in pregnancy. Because blood cultures and molecular confirmation of pericardial involvement were not obtained, a contaminant or incidental role for the organism cannot be entirely excluded, and the causal attribution should be regarded as probable rather than definitive. The case highlights heart-team-based individualised decompression and the cautious microbiological interpretation of organisms traditionally regarded as commensals. Full article

Background/Objectives: Asthma-coded hospital admissions in very young children represent a clinically relevant but diagnostically complex marker of severe wheezing/asthma-like morbidity. Methods: We conducted a nationwide ecological municipality-year study of children aged 0–3 years in Spain during 2020–2022 using hospital discharge records from the Spanish Minimum Basic Data Set (MBDS/RAE-CMBD). Exposure and outcome were analyzed at the municipality-year level: the exposure metric was the contemporaneous annual mean municipality-level concentration of PM_2.5, PM₁₀, NO₂, SO₂, O₃, and CO, and the outcome was the annual number of asthma-coded admissions, with the population aged 0–3 years as offset. Results: The regression panel comprised 20,746 municipality-year observations, 7251 municipalities, and 3231 admissions; 93.7% of municipality-years had zero admissions. In unipollutant Poisson models adjusted for calendar year, rural–urban status, temperature, and relative humidity, incidence rate ratios per interquartile-range increase were 1.54 (95% CI 1.28–1.85) for PM_2.5 and 1.89 (95% CI 1.59–2.26) for PM₁₀. Negative-binomial and province-fixed-effect sensitivity models attenuated but did not remove the particulate-matter signal. The multipollutant model was unstable because of strong collinearity between particulate fractions and was interpreted only as an exploratory sensitivity analysis. Conclusions: These findings should be interpreted as ecological, population-level associations between annual ambient particulate pollution and pediatric respiratory hospital burden, not as individual-level causal risk estimates. Full article

Background: Knee osteoarthritis (KOA) is often framed as degenerative knee pain, yet behaves as a decades-long care pathway in which medication, injections, comorbidity, productivity loss, and surgery accumulate into a major economic footprint. This critical narrative review synthesizes pharmacoeconomic and pharmacoepidemiologic evidence across that pathway. Methods: Structured source identification was conducted in PubMed, Web of Science, Scopus, and Google Scholar for publications from 2000 to 2026, with citation tracking. Sources were appraised against predefined critical-interpretation domains and mapped narratively rather than pooled; no meta-analysis was performed. Results: Global Burden of Disease 2019 estimates approximately 364.6 million prevalent KOA cases worldwide. Reported evidence indicates that KOA spending is highly concentrated: in a large U.S. claims analysis, knee arthroplasty was performed in approximately 8.8% of patients yet accounted for 61.5% of KOA-related costs, whereas hyaluronic acid represented 3.0% of overall costs; the remaining pathway burden was distributed across years of outpatient care, analgesics, injections, and other nonsurgical utilization. Medication and injection findings were stage- and phenotype-dependent, and observational studies associated opioid exposure with higher fall risk, healthcare utilization, and cost. Intra-articular hyaluronic acid was repeatedly associated with longer time to arthroplasty, interpreted here as an association limited by confounding and immortal-time bias, not a causal effect; platelet-rich plasma value remained price- and durability-sensitive. Conclusions: KOA economics resembles an iceberg—arthroplasty is the visible peak, while the submerged mass is years of pathway-level care. Value-based policy should measure the full pathway, not the surgical episode, using linked claims, registries, patient-reported outcomes, and productivity data. Full article

Background/Objectives: Triple-negative breast cancer (TNBC) is one of the most aggressive breast cancer subtypes and remains associated with limited therapeutic options and high systemic toxicity from conventional chemotherapy. Ipomoea pes-caprae is a coastal medicinal plant traditionally consumed in Mexico for inflammatory and renal disorders and contains bioactive metabolites with reported antioxidant and pharmacological properties. However, its antitumoral activity and systemic safety profile remain poorly understood. This study aimed to characterize the phytochemical composition, antioxidant capacity, antitumoral activity, and toxicity of a traditionally prepared aqueous infusion of I. pes-caprae leaves (IPCAE). Methods: IPCAE was characterized using phytochemical screening and complementary instrumental analyses. Antioxidant activity was evaluated using the DPPH assay. A randomized preclinical study was performed in mice bearing MDA-MB-231 xenografts treated with IPCAE, cisplatin, or saline control. Results: The infusion showed measurable antioxidant activity (72.25 ± 1.25% DPPH inhibition at 1 mg/mL) and a total polyphenol content of 7.29 µg/mg gallic acid equivalents. Phytochemical screening revealed abundant flavonoids and reducing sugars, with moderate saponin content. In vivo, IPCAE produced only a transient and non-significant trend toward slower tumor progression compared with control (p = 0.214) and cisplatin (p = 0.377). However, marked systemic toxicity was observed, including severe thoracic dermal lesions in 40% of animals and 70% mortality by day 15. Survival was significantly reduced compared with control and cisplatin groups (p < 0.001). Conclusions: Although IPCAE exhibited antioxidant activity, no statistically significant antitumoral effect was observed under the evaluated conditions. Furthermore, repeated oral administration resulted in marked systemic toxicity, characterized by visible dermal lesions, clinical deterioration, and increased mortality. Therefore, the present findings do not support the use of the evaluated crude preparation as an anticancer intervention. Future studies should focus on detailed toxicological characterization, bioassay-guided fractionation, dose optimization, and identification of the individual metabolites responsible for the observed biological effects. The antioxidant activity demonstrated in this study should be interpreted independently from antitumoral activity, as no causal relationship between these findings was established. Full article

The increasing amount of detailed learning data in higher education has shifted assessment methods from traditional scores to continuous assessment of student learning performance. This paper presents an applied closed-loop AI system that supports early performance prediction, informed risk decision-making, and personalized intervention planning. The system utilizes aggregated weekly data from learning management systems, including self-regulated learning metrics and participation indicators. A supervised regression model predicts near-future learning performance while employing chronological training strategies to prevent information leakage. Emphasizing decision-driven assessment, the system translates predictive outputs into a resource-sensitive decision framework to identify students requiring early support. Explainable artificial intelligence (XAI) techniques enhance the model’s transparency, providing insights into key learning factors and individual student-level explanations. The system generates actionable recommendations based on these insights. Its closed-loop architecture integrates data collection, prediction, interpretation, recommendation generation, and feedback logging, allowing instructors to monitor learning pathways and examine subsequent learning outcomes. Rather than claiming causal intervention effects, the proposed system illustrates how established AI, explainable learning analytics, and decision-support techniques can be operationally integrated to support ongoing student assessment in higher education. Full article

Drawing on the personal-resource logic of the Job Demands–Resources (JD–R) model, this study examines emotional intelligence (EI) not as a single global trait but as a differentiated set of self-regulatory resources associated with distinct burnout dimensions. Using cross-sectional, self-report data from higher-education instructors (N = 292; complete-cases N = 161–185 for the multivariable models), EI was assessed with the Bar-On Emotional Quotient Inventory and burnout with the BO-SE Burnout Screening Scales (mental, emotional, physical, and social exhaustion, plus an aggregated index); hierarchical regression, relative-importance analysis, and bootstrapped indirect-effect models were estimated. Overall EI was negatively associated with all burnout dimensions. At the component level, intrapersonal skills and stress management (stress tolerance and impulse control) were the two most consistent correlates, with complementary coverage—stress management most consistent for mental, emotional, and physical exhaustion, and intrapersonal skills strongest for mental and emotional exhaustion—while general mood was specific to physical exhaustion; associations survived false discovery rate correction. General mood and stress-management capacity statistically accounted for part of these associations in exploratory indirect-effect models. Because the design is cross-sectional and based on a single self-report method, findings are interpreted as associations and statistical indirect effects rather than causal mechanisms. The findings are consistent with a differentiated resource interpretation of EI in emotionally demanding work, but they do not establish causal mechanisms or temporal ordering. Full article

The low-carbon transition depends not only on technologies and regulation, but also on how employees interpret and enact organizational environmental commitments. This study examines whether carbon anxiety—employees’ perception of organization-focused uncertainty and insufficient preparedness regarding carbon accounting, emissions reduction, reporting, and operational adaptation—and perceived regulatory pressure are associated with employee green behavior (EGB) through psychological contract fulfillment for the environment (PCFE), and whether pro-environmental consciousness strengthens the PCFE–EGB association. Using a cross-sectional computer-assisted web interview survey of 857 employees in Poland’s energy sector, the proposed second-stage moderated mediation model was tested with structural equation modeling and bootstrap analysis. Carbon anxiety and regulatory pressure were positively associated with psychological contract fulfillment for the environment, which was positively associated with employee green behavior. Pro-environmental consciousness strengthened the psychological contract fulfillment for the environment–behavior relationship, and both conditional indirect associations increased at higher pro-environmental consciousness levels. The model explained 33.2% of the variance in psychological contract fulfillment for the environment and 37.1% in employee green behavior; the main pattern remained stable across robustness and subsector analyses. The observed associations support psychological contract fulfillment for the environment as a theoretically specified relational mechanism linking transition pressures with the employee-level implementation of decarbonization. Given the cross-sectional design, the results indicate associations rather than causal effects. Organizations should translate transition pressures into credible environmental commitments, workforce capabilities, transparent communication, and meaningful employee participation. Full article