Search Results (5,952)

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

The kinetics of insulin aggregation and fibril formation were studied in vitro using Scanning Electron Microscopy (SEM) and Fourier Transform Infrared (FTIR) spectroscopy. Our investigation centered on the protein’s morphological and structural changes to better understand the transient molecular configurations that occur during the lag phase. SEM images showed that, already at early incubation stages, a network of disordered pseudo-filaments, ranging in length between 200 and 500 nanometers, develops on the surface of large aggregates. At later stages, fibrils catalyzed by protein aggregates were observed. Principal Component Analysis (PCA) of the FTIR data identified signatures of intramolecular β-sheet secondary structures forming during the lag phase and at the onset of the exponential growth phase. These absorption bands are linked to secondary nucleation mechanisms due to their transient nature. This interpretation is further supported by a chemical equilibrium model, which yielded a reliable secondary nucleation rate constant, K₂, on the order of 10⁴ M⁻² s⁻¹. Full article

The integration of artificial intelligence (AI) in education offers novel opportunities to enhance critical thinking while also posing challenges to independent cognitive development. In particular, Human-Centered Artificial Intelligence (HCAI) in education aims to enhance human experience by providing a supportive and collaborative learning environment. Rather than replacing the educator, HCAI serves as a tool that empowers both students and teachers, fostering critical thinking and autonomy in learning. This study investigates the potential for AI to become a collaborative partner that assists learning and enriches academic engagement. The research was conducted during the 2024–2025 winter semester within the Pedagogical and Teaching Sufficiency Program offered by the Audio and Visual Arts Department, Ionian University, Corfu, Greece. The research employs a hybrid ethnographic methodology that blends digital interactions—where students use AI tools to create artistic representations—with physical classroom engagement. Data was collected through student projects, reflective journals, and questionnaires, revealing that structured dialog with AI not only facilitates deeper critical inquiry and analytical reasoning but also induces a state of flow, characterized by intense focus and heightened creativity. The findings highlight a dialectic between individual agency and collaborative co-agency, demonstrating that while automated AI responses may diminish active cognitive engagement, meaningful interactions can transform AI into an intellectual partner that enriches the learning experience. These insights suggest promising directions for future pedagogical strategies that balance digital innovation with traditional teaching methods, ultimately enhancing the overall quality of education. Furthermore, the study underscores the importance of integrating reflective practices and adaptive frameworks to support evolving student needs, ensuring a sustainable model. Full article

Background: Since the outbreak of war in Ukraine, countless forcibly displaced individuals facing not only material loss, but also deep psychological distress, have sought refuge across Europe. For those traumatized by war, the absence of a shared language in therapy can hinder healing and exacerbate suffering. While cultural diversity in psychotherapy has gained recognition, the role of native-language communication—especially from a person-centered perspective—remains underexplored. Methods: This narrative review with a thematic analysis examines whether and how psychotherapy in the mother tongue facilitates access to therapy and enhances therapeutic efficacy. Four inter-related clusters emerged: (1) the psychosocial context of trauma and displacement; (2) language as a structural gatekeeper to care (RQ1); (3) native-language therapy as a mechanism of change (RQ2); (4) potential risks such as over-identification or therapeutic mismatch (RQ2). Results: The findings suggest that native-language therapy can support the symbolic integration of trauma and foster the core conditions for healing. The implications for multilingual therapy formats, training in interpreter-mediated settings, and future research designs—including longitudinal, transnational studies—are discussed. Conclusions: In light of the current crises, language is not just a tool for access to therapy, but a pathway to psychological healing. Full article

Carbon flow tracking and spatial pattern optimization at the scale of urban functional zones are key scientific challenges in achieving carbon neutrality. However, due to the complexity of carbon metabolism processes within urban functional zones, related studies remain limited. To address these scientific challenges, this study, based on the “source–sink–flow” ecosystem services framework, develops an integrated analytical approach at the scale of urban functional zones. The carbon balance is quantified using the CASA model in combination with multi-source data. A network model is employed to trace carbon flow pathways, identify critical nodes and interruption points, and optimize the urban spatial pattern through a low-carbon land use structure model. The research results indicate that the overall carbon balance in Hangzhou exhibits a spatial pattern of “deficit in the center and surplus in the periphery.” The main urban area shows a significant carbon deficit and relatively poor connectivity in the carbon flow network. Carbon sequestration services primarily flow from peripheral areas (such as Fuyang and Yuhang) with green spaces and agricultural functional zones toward high-emission residential–commercial and commercial–public functional zones in the central area. However, due to the interruption of multiple carbon flow paths, the overall carbon flow transmission capacity is significantly constrained. Through spatial optimization, some carbon deficit nodes were successfully converted into carbon surplus nodes, and disrupted carbon flow edges were repaired, particularly in the main urban area, where 369 carbon flow edges were restored, resulting in a significant improvement in the overall transmission efficiency of the carbon flow network. The carbon flow visualization and spatial optimization methods proposed in this paper provide a new perspective for urban carbon metabolism analysis and offer theoretical support for low-carbon city planning practices. Full article

Background/Objectives: Frailty is a prevalent geriatric syndrome associated with impaired postural control and elevated fall risk. Although conventional exercise is a core strategy for frailty management, adherence remains limited. Virtual reality (VR)-based interventions have emerged as potentially engaging alternatives, but their effects on objective postural control and task-specific confidence in frail populations remain understudied. This study aimed to evaluate the effectiveness of a supervised VR training program using the Nintendo Ring Fit Plus™ on postural control, functional mobility, and balance confidence among frail community-dwelling older adults. Methods: Fifty-one adults aged ≥65 years classified as frail or prefrail were enrolled in a four-week trial. Participants were assigned to either a VR intervention group (n = 28) or control group (n = 23). Participants were non-randomly assigned based on availability and preference. Outcome measures were collected at baseline and post-intervention. Primary outcomes included center of pressure (CoP) metrics—sway area, mean velocity, and sway path. Secondary outcomes were the Timed Up and Go (TUG), Berg Balance Scale (BBS), Activities-specific Balance Confidence (ABC), and Falls Efficacy Scale–International (FES-I). Results: After adjusting for baseline values, age, and BMI, the intervention group showed significantly greater improvements than the control group across all postural control outcomes. Notably, reductions in sway area, mean velocity, and sway path were observed under both eyes-open and eyes-closed conditions, with effect sizes ranging from moderate to very large (Cohen’s d = 0.57 to 1.61). For secondary outcomes, significant between-group differences were found in functional mobility (TUG), balance performance (BBS), and balance confidence (ABC), with moderate-to-large effect sizes (Cohen’s d = 0.53 to 0.73). However, no significant improvement was observed in fear of falling (FES-I), despite a small-to-moderate effect size. Conclusions: A supervised VR program significantly enhanced postural control, mobility, and task-specific balance confidence in frail older adults. These findings support the feasibility and efficacy of VR-based training as a scalable strategy for mitigating frailty-related mobility impairments. Full article

As medical technology develops and digital demands grow, personal health records (PHRs) are becoming more patient-centered than before based on cloud-based health information exchanges. While enhancing data accessibility and sharing, these systems present privacy and security issues, including data breaches and unauthorized access. We developed a post-quantum, group-oriented encryption scheme using the Crystal-Kyber Key encapsulation mechanism (KEM). Leveraging lattice-based post-quantum cryptography, this scheme ensures quantum resilience and chosen ciphertext attack security for layered cloud PHR environments. It supports four encryption modes: individual, group, subgroup-specific, and authorized subgroup decryption, meeting diverse data access needs. With efficient key management requiring only one private key per user, the developed scheme strengthens the privacy and security of PHRs in a future-proof, flexible, and scalable manner. Full article

Stroke is a significant global health concern characterized by the abrupt disruption of cerebral blood flow, leading to neurological impairment. Accurate and timely diagnosis—enabled by imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI)—is essential for differentiating stroke types and initiating interventions like thrombolysis, thrombectomy, or surgical management. In parallel, recent advancements in wearable technology, particularly smart clothing, offer new opportunities for stroke prevention, real-time monitoring, and rehabilitation. These garments integrate various sensors, including electrocardiogram (ECG) electrodes, electroencephalography (EEG) caps, electromyography (EMG) sensors, and motion or pressure sensors, to continuously track physiological and functional parameters. For example, ECG shirts monitor cardiac rhythm to detect atrial fibrillation, smart socks assess gait asymmetry for early mobility decline, and EEG caps provide data on neurocognitive recovery during rehabilitation. These technologies support personalized care across the stroke continuum, from early risk detection and acute event monitoring to long-term recovery. Integration with AI-driven analytics further enhances diagnostic accuracy and therapy optimization. This narrative review explores the application of smart clothing in conjunction with traditional imaging to improve stroke management and patient outcomes through a more proactive, connected, and patient-centered approach. Full article

In the context of increasing Artificial Intelligence integration in higher education, understanding the factors influencing university teachers’ adoption of AI tools is critical for effective implementation. This study adopts a perception–intention–behavior framework to explores the roles of perceived usefulness, perceived ease of use, perceived trust, perceived substitution crisis, and perceived risk in shaping teachers’ behavioral intention and actual usage of AI tools. It also investigates the moderating effects of peer influence and organizational support on these relationships. Using a comprehensive survey instrument, data was collected from 487 university teachers across four major regions in China. The results reveal that perceived usefulness and perceived ease of use are strong predictors of behavioral intention, with perceived ease of use also significantly influencing perceived usefulness. Perceived trust serves as a key mediator, enhancing the relationship between perceived usefulness, perceived ease of use, and behavioral intention. While perceived substitution crisis negatively influenced perceived trust, it showed no significant direct effect on behavioral intention, suggesting a complex relationship between job displacement concerns and AI adoption. In contrast, perceived risk was found to negatively impact behavioral intention, though it was mitigated by perceived ease of use. Peer influence significantly moderated the relationship between perceived trust and behavioral intention, highlighting the importance of peer influence in AI adoption, while organizational support amplified the effect of perceived ease of use on behavioral intention. These findings inform practical strategies such as co-developing user-centered AI tools, enhancing institutional trust through transparent governance, leveraging peer support, providing structured training and technical assistance, and advancing policy-level initiatives to guide digital transformation in universities. Full article

This study investigates the effectiveness of contact and online biology teaching by assessing student performance and gathering perceptions from students, teachers, and parents. Conducted in autumn 2021 with 3035 students, 124 biology teachers, and 719 parents, this study combined post-instruction assessments of student performance in knowledge reproduction and conceptual understanding with questionnaires examining perceptions of contact and online biology teaching effectiveness across students, teachers, and parents. To investigate how various teaching-related factors influence perceived understanding of biological content, we applied a CHAID-based decision tree model to questionnaire responses from students, teachers, and parents. Results indicated that students value engaging, flexible instruction, sufficient time to complete tasks and support for independent thinking. Teachers emphasized their satisfaction with teaching and efforts to support student understanding. In contact lessons, students preferred problem-solving, teacher guidance, and a stimulating environment. In online learning, they preferred low-stress, interesting lessons with room for independent work. Parents emphasized satisfaction with their child’s learning and the importance of a focused, stimulating environment. This comparative analysis highlights the need for student-centered, research-based biology teaching in both formats, supported by teachers and delivered in a motivating environment. The results offer practical insights for improving biology instruction in different teaching modalities. Full article

Background: Access to safe and reliable water and sanitation remains a critical public health and development challenge, with rural and low-income communities being disproportionately affected by inadequate services and heightened exposure to waterborne diseases. Despite global efforts and infrastructure-based progress indicators, significant disparities persist, and these often overlook users’ perceptions of water quality, reliability, and safety. This study explores the determinants of household satisfaction with drinking water in rural areas, comparing subjective user feedback with official access data to reveal gaps in current monitoring approaches and support more equitable, user-centered water governance. Methods: This study was conducted in Kazakhstan’s Atyrau Region, where 1361 residents from 86 rural villages participated in a structured survey assessing household access to drinking water and perceptions of its quality. Data were analyzed using descriptive statistics and multinomial logistic regression to identify key predictors of user satisfaction, with results compared against official records to evaluate discrepancies between reported experiences and administrative data. Results: The field survey results revealed substantial discrepancies between official statistics and residents’ reports, with only 58.1% of respondents having in-house tap water access despite claims of universal coverage. Multinomial logistic regression analysis identified key predictors of user satisfaction, showing that uninterrupted supply and the absence of complaints about turbidity, odor, or taste significantly increased the likelihood of higher satisfaction levels with drinking water quality. Conclusions: This study underscores the critical need to align official water access statistics with household-level experiences, revealing that user satisfaction—strongly influenced by supply reliability and sensory water quality—is essential for achieving equitable and effective rural water governance. Full article

The Fernald Feed Materials Production Center (FMPC), located in Fernald, Ohio, USA, released radon (Rn) as a byproduct of the processing of uranium materials during the years from 1951 to 1989. Rn is a colorless, odorless gas that emits charged alpha radiation that interacts with cells in the lung and trachea-bronchial tree, leading to DNA damage, mutations, and tumor initiation. The purpose of this project was to use evidence collected by the Fernald Dosimetry Reconstruction Project and other sources to estimate the outdoor Rn exposure to individuals in the community immediately surrounding the FMPC during the years of plant operation. Using previously tabulated source terms, diffusion and meteorological data, and self-reported detailed residential histories, we estimated radon exposure for approximately 9300 persons who lived at more than 14,000 addresses. The results indicated that a portion of the population cohort experiences mean annual Rn exposure exceeding the U.S. Environmental Protection Agency (EPA) action limit of 4 pCiL⁻¹. These exposure estimates support the analysis of the incidence of lung cancer in the Fernald Community Cohort (FCC). Full article

This review outlines a comprehensive methodology for the research and development of heterogeneous catalytic technologies (R&D_HeCaTe). Emphasis is placed on the fundamental interactions between reactants, solvents, and heterogeneous catalysts—specifically the roles of catalytic centers and support materials (e.g., functional groups) in modulating activation energies and stabilizing catalytic functionality. Particular attention is given to catalyst deactivation mechanisms and potential regeneration strategies. The application of molecular modeling and chemical engineering analyses, including reaction kinetics, thermal effects, and mass and heat transport phenomena, is identified as essential for R&D_HeCaTe. Reactor configuration is discussed in relation to key physicochemical parameters such as molecular diffusivity, reaction exothermicity, operating temperature and pressure, and the phase and “aggressiveness” of the reaction system. Suitable reactor types—such as suspension reactors, fixed-bed reactors, and flow microreactors—are evaluated accordingly. Economic and environmental considerations are also addressed, with a focus on the complexity of reactions, selectivity versus conversion trade-offs, catalyst disposal, and separation challenges. To illustrate the breadth and applicability of the proposed framework, representative industrial processes are discussed, including ammonia synthesis, fluid catalytic cracking, methanol production, alkyl tert-butyl ethers, and aniline. Full article

The rapid growth of electric vehicles (EVs) and new energy systems has put lithium-ion batteries at the center of the clean energy change. Nevertheless, to achieve the best battery performance, safety, and sustainability in many changing circumstances, major innovations are needed in Battery Management Systems (BMS). This review paper explores how artificial intelligence (AI) and digital twin (DT) technologies can be integrated to enable the intelligent BMS of the future. It investigates how powerful data approaches such as deep learning, ensembles, and models that rely on physics improve the accuracy of predicting state of charge (SOC), state of health (SOH), and remaining useful life (RUL). Additionally, the paper reviews progress in AI features for cooling, fast charging, fault detection, and intelligible AI models. Working together, cloud and edge computing technology with DTs means better diagnostics, predictive support, and improved management for any use of EVs, stored energy, and recycling. The review underlines recent successes in AI-driven material research, renewable battery production, and plans for used systems, along with new problems in cybersecurity, combining data and mass rollout. We spotlight important research themes, existing problems, and future drawbacks following careful analysis of different up-to-date approaches and systems. Uniting physical modeling with AI-based analytics on cloud-edge-DT platforms supports the development of tough, intelligent, and ecologically responsible batteries that line up with future mobility and wider use of renewable energy. Full article